Tag Archives: Cancers in Women

Frequently asked questions about ovarian cancer screening 2

Frequently asked questions about screening for ovarian cancer

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I have recently put up a post about ovarian cancer and as usual lots of people had question about the symptoms and also about proper screening. Just like many other serious health issues, there are lots of myths out there and why it is important to talk about the facts only.

Before I go into the frequently asked questions about screening for ovarian cancer, I do need to say this. If you do have bloating, or some of the other common symptoms of ovarian cancer, please don’t get all anxious and run off thinking you have ovarian cancer.

Many of these symptoms can be indicative of endometriosis and adenomyosis too. This is why it is important to talk to your healthcare practitioner, or specialist about any concerns you have around any of the symptoms you may be getting. Early intervention and detection is the key to any disease, and ovarian cancer is exactly the same. Either way it is worth seeing someone a specialist in this field.

If you do have any of the symptoms from my post on ovarian cancer, please talk to your healthcare practitioner about a referral to an expert, or specialist in this field and get assessed properly.

Frequently asked questions about ovarian cancer screening

This information covers screening for ovarian cancer i.e. the testing of women at population risk who have no symptoms that might be ovarian cancer. This information has been developed to support discussion with a woman about screening for ovarian cancer. Most of this can be found at the Australian Cancer Council (www.cancer.org.au)and the National Breast and Ovarian Cancer Centre (www.nbocc.org.au)

Is there a screening test for ovarian cancer?

No. There is currently no evidence to support the use of any test, including pelvic examination, CA125 or other biomarkers, ultrasound (including transvaginal ultrasound), or a combination of tests, to screen for ovarian cancer.

A Pap test does not detect ovarian cancer; it is only used to screen for cervical cancer.

What about the CA125 blood test?

CA125 is a protein found in the blood. It is known as a tumour or cancer marker. Increased levels of CA125 may indicate ovarian cancer. However, there are many other conditions that can affect CA125 levels such as ovulation, menstruation, endometriosis, benign ovarian cysts, liver or kidney disease, and other cancers such as breast or lung cancer.

If CA125 levels are not raised, this does not completely rule out ovarian cancer, as about 50% of women with early-stage ovarian cancer have normal CA125 levels.

For these reasons, the CA125 test alone should not be used as a screening test for ovarian cancer. It can be used in the assessment of symptoms that may be ovarian cancer.

Can an ultrasound be used as a screening test?

A transvaginal ultrasound (TVUS) gives the best picture of the ovaries but while able to detect the presence of ovarian disease, a TVUS cannot distinguish between benign and malignant disease.

For this reason, transvaginal ultrasound should not be used as a screening test for ovarian cancer.

What if a woman decides she still wishes to have a CA125 blood test or ultrasound?

She should be informed that if either a CA125 or an ultrasound test is abnormal, it may be necessary to repeat the test, or to undertake further tests, which may include surgery to investigate the abnormal result.

The discovery and investigation of abnormal findings can result in unnecessary anxiety and the investigations can carry significant risks.

Final word

I hope this explains a few of the fact around screening for ovarian cancer and helps people understand why some perceived screening methods are not reliable. For more information, you should always talk to your healthcare practitioner, or specialist, and never ever diagnose yourself based on some stupid google search. Always see a qualified healthcare professional for all your healthcare advice. Your life could depend on it.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-Master of Reproductive Medicine

-The Women’s Health Experts

The link between endometriosis and cancer

The Link Between Endometriosis & Cancer

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One of the most common questions that I get asked from women with endometriosis is “Is there a link between endometriosis and cancer?”

There has been many research papers on this and there is some evidence to suggest that women with endometriosis may have a higher risk of certain cancers such as endometrial cancer and also ovarian cancer.

We all know that Endometriosis is a debilitating disease, but many people don’t realise the possible future implications of this disease, mixed with our highly inflammatory diets and lifestyle. Unfortunately it is a recipe for any inflammatory disease, and for expression of cancer cells.

There have been many reputable studies to date showing the link between inflammation and cancer and endometriosis is definitely an inflammatory disease that needs proper management otherwise some studies are now suggesting it could be a precursor to certain cancers.

This isn’t meant to scare anyone either. It is just to help people realise the possible implications of this disease and to be more proactive around getting yourself and your body healthier and also being properly managed by a qualified health professional. When it come to cancerous states, prevention is key and early intervention is also.

Better education is needed

Given that, we need to really take this disease more seriously than many people with the disease and many in the medical community probably realise. Prevention is always the key to any disease and even though endometriosis cannot be prevented, early intervention and ongoing management of the disease is crucial. This is why I think all young girls should be educated about what a proper menstrual cycle should be like and that period pain is not normal. There also needs to be proper education about diet and lifestyle interventions with inflammatory diseases, such as endometriosis, and how it also needs a multimodality approach to be managed properly.

Endometriosis is like cancer in many ways

Endometriosis, like cancer, is characterised by cell invasion and unrestrained growth. Furthermore, endometriosis and cancer are similar in other aspects, such as the development of new blood vessels and a decrease in the number of cells undergoing apoptosis. In spite of these similarities, endometriosis is not considered a malignant disorder.

The possibility that endometriosis could, however, transform and become cancer has been debated in the literature since 1925. Mutations in the certain genes have been implicated in the cause of endometriosis and in the progression to cancer of the ovary (Swiersz 2006). There is also data to support that ovarian endometriosis could have the potential for malignant transformation. Epidemiologic and genetic studies support this notion. It seems that endometriosis is associated with specific types of ovarian cancer (endometrioid and clear cell) (Vlahos et al, 2010). The relationship between endometriosis and ovarian cancer is an intriguing and still poorly investigated issue. Specifically, histological findings indicate a definitive association between endometriosis and endometrioid/clear cell carcinoma of the ovary (Parihar & Mirge 2009).

Women with endometriosis may be more prone to certain cancers

There are recent studies which have shown that mutations in the certain genes found were identified in 20% of endometrial carcinomas and 20.6% of solitary endometrial cysts, played a part in the development of ovarian cancers. In addition to cancerous transformation at the site of endometriosis, there is recent evidence to indicate that having endometriosis itself may increase a woman’s risk of developing non-Hodgkin’s lymphoma, malignant melanoma, and breast cancer (Swiersz 2014).

Women with endometriosis appear to be more likely to develop certain types of cancer. Brinton, PhD, Chief of the Hormonal and Reproductive Epidemiology branch at the National Cancer Institute has studied the long-term effects of endometriosis, which led her to Sweden about 20 years ago. Using the country’s national inpatient register, she identified more than 20,000 women who had been hospitalised for endometriosis.

After an average follow-up of more than 11 years, the risk for cancer among these women was elevated by 90% for ovarian cancer, 40% for hematopoietic cancer (primarily non-Hodgkin’s lymphoma), and 30% for breast cancer. Having a longer history of endometriosis and being diagnosed at a young age were both associated with increased ovarian cancer risk (Brinton et al, 1997).

Farr Nezhat, MD, Chief of Gynecologic Minimally Invasive Surgery and Robotics at St. Luke’s and Roosevelt Hospitals in New York City and Professor of Obstetrics and Gynecology at Columbia University, spoke on the pathogenesis of endometriosis and ovarian cancer. According to a 2000 study of women with ovarian cancer by Hiroyuki Yoshikawa and colleagues, endometriosis was present in 39% of the women with clear cell tumours and 21% of those with endometrial tumours. The studies clearly suggest that Endometriosis may be the precursor of clear cell, or endometrial ovarian cancer (Yoshikawa et al, 2000).

Inflammation and Estrogens are a big factor in many cancers

If you combine inflammation with oestrogen as with both endometriosis and ovarian or uterine cancers, it’s going to be a vicious circle, as the 2 diseases share numerous other characteristics. For example, both are related to early menstrual cycles and late menopause, infertility, and inability to fall pregnant. Any factors that relieve or offer protection against both conditions need to be explored, including dietary and lifestyle changes etc.

Some authors also suggest that there is an also increased risks of colon cancer, ovarian cancer, thyroid cancer non-Hodgkin’s lymphoma and malignant melanoma in women with endometriosis when compared with the general population (Brinton et al, 2005).

Proper management and early intervention is crucial

If you do have patients with endometriosis you do need to take into consideration the future implications of this disease, not only the pain and turmoil it causes on the way, but also the future possibility that endometriosis could also lead to cervical cancer, ovarian cancer, or many of the other cancers that can be found in the body.

There are certain medications, both natural based and medical that can great assist in the treatments and management of endometriosis and microscopic endometriosis implants. These do need to be explored and we now have the Royal College of Obstetricians and Gynaecologists recommending diet and lifestyle changes and to use complementary medicine such and Chinese Herbal Medicine and Acupuncture for the the management and treatment of endometriosis. This is recommended alongside medical interventions and it does get back to a multimodality approach is the key factor in proper management of this disease.

Diet and lifestyle changes are crucial in cancer prevention

There have been numerous studies showing the benefits of a low inflammatory based diet and reduction in lifestyle factors such as stress. These things are also crucial in any inflammatory disease and certainly in cancer prevention.

Anyone with endometriosis does need to be following anti-inflammatory diet, with reduced refined foods and increased whole foods. This is something I promote whole-heartedly and see great results with on a daily basis. It is also part of my PACE- Diet and Lifestyle program. PACE meaning (Paleo/Primal Ancestral Clean Eating) .

This style of diet is very much like the mediterranean diet which is now shown to be one of the best diets in the world to help with cancer prevention and reduction of cardiovascular disease. It is something that has been shown to assist with inflammatory diseases such as endometriosis. This can be done alongside supplements such as omega 3 oils and antioxidants that also offer protection and prevention against inflammatory diseases too. You should also talk to a qualified healthcare professional about diet and lifestyle interventions and supplementation.

See an Endometriosis Expert

Hope that helps everyone to understand why it is so important to really make some proactive changes if you do have endometriosis. You really need to explore as many options as you can when trying to manage this disease and halt its progression. It is also important to see an endometriosis expert and not try and manage this disease yourself. You just should not be doing this and it is not effective management. Always see an appropriately trained healthcare professional who is trained in endometriosis and other disease states in women. We don’t want to see it end up as cancer later on and this is why it is so important to make sure you are being appropriately managed now.

Final Word

If you do need help with endometriosis, and the associated symptoms of endometriosis, give my friendly staff a call and find out how I can help you. Always remember that early intervention is the key and being managed properly is also crucial.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-Master of Women’s Health Medicine

-The Endometriosis Experts

Cervical Cancer stages

Cervical Cancer Awareness

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Cervical cancer awareness is something all women need to know about and why proper screening for women is so important. It is so important that we bring awareness to cervical cancer, just as we do to many other cancers such as breast cancer and ovarian cancer.

Cervical cancer remains a significant cause of death, from cancer in women worldwide. In clinic I see so many women with the early, intermediate and sometimes advanced stages of cervical cancer. It isn’t good and many women with early detection on cancer cells aren’t being proactive in follow up consults, or have little idea just how significant these results are to their future health and possible length of their life.

Our increasing understanding of the relationship between HPV infection, pre-invasive and invasive disease of the cervix, the introduction of population screening programs using Pap smear testing, the availability of HPV vaccines, and the introduction of testing for high-risk HPV DNA types have changed the burden of disease in developed countries but even so, cervical cancer remains a significant problem in developing countries.

The Statistics of Cervical Cancer

World wide, cervical cancer is the fourth most common cancer in women, and the 7th most common overall.

In 2012, there were approximately 528 000 new cases of cervical cancer, and there were 266 000 deaths as a result of cervical cancer. In 2015, there were 857 new cases of cervical cancer diagnosed in Australia. In 2019, it is estimated that 951 new cases of cervical cancer will be diagnosed in Australia. In 2019, it is estimated that the risk of a female being diagnosed with cervical cancer by her 85th birthday will be 1 in 494.

The majority of cases (approximately 85%) and deaths (87%) occur in less developed regions.

In Australia a report by the AIHW “Gynecological Cancers in Australia: an overview” showed the following statistics regarding cervical cancer.
-there were 951 cases of cervical cancer, accounting for 1.4% of all gynaecological cancers

– cervical cancer was the 14th most commonly diagnosed cancer in females

– the estimated number of deaths from cervical cancer was 256

– approximately 70% of cervical cancers were diagnosed in women under the age of 60 years

– the risk of being diagnosed with cervical cancer by the age of 85 years was 1 in 494.

HPV and cervical cancer

HPV (Human Papilloma Virus) is a major cause of cervical cancer and why we need to get the safe sex message out there. In a study of almost of 1000 cases of cervical cancer worldwide, the prevalence of HPV infection was 99.7%.

Screening and regular checkup are also needed in the overall prevention and early intervention of this disease. Large population based studies have shown that screening via gynaecological examinations and Cytologic (Pap smear),may decrease cancer incidence and mortality by more than 80%.

The current screening recommendations are:

Routine screening with Pap smears use to be carried out every two years for women who have no symptoms or history suggestive of cervical pathology. Since 2017, the pap test has been done away with and that has now changed to the new cervical screening test.

All women who have ever been sexually active should start having Pap smears between the ages of 18 and 20 years, or one or two years after first having sexual intercourse, whichever is later. In some cases, it may be appropriate to start screening before 18 years of age.

Pap smears may cease at the age of 70 years for women who have had two normal Pap smears within the last five years. Women over 70 years who have never had a Pap smear, or who request a Pap smear, should be screened.

This policy applies to women with no symptoms and normal Pap smear results who should be screened. To find out more about the cervical screening test, you should talk you your healthcare practitioner, or specialist. You can also find out more information about cervical cancer screening at  Cancer Australia

National screening and education about regular screening, has had a significant impact on the reduction of cervical cancer and deaths caused by this disease

HPV Vaccination

Please note that HPV vaccinated women would still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer. Until any changes are implemented women should continue to have two yearly Pap tests.

Symptoms of Cervical Cancer

Abnormal vaginal bleeding is the most common symptom of invasive cancer of the cervix. This may include bleeding after sex, bleeding in-between periods, or post-menopausal bleeding.

Cervical cancer is often asymptomatic until quite advanced in women who are not sexually active.

Other symptoms may include:

  • Pelvic pain
  • Bowel or bladder symptoms due to pelvic pressure
  • Symptoms from a fistula (leaking urine or faeces vaginally)

Cervical cancer is preventable

Cervical cancer remains an important preventable cause of cancer in women both in Australia and worldwide. Even with the advent of vaccines, it is very important to remember that participation in regular screening is still necessary and a key part of reducing the incidence and deaths from cervical cancer.

Avoiding risk factors and increasing protective factors will help prevent many forms of cancer

The following risk factors increase the risk of cervical cancer:
1. HPV infection
2. Smoking (even social smoking, or 1-2 per day)
3. DES (diethylstilbestrol) Exposure – A man made estrogen
4. Poor diet
5. Being Overweight
6. Lack of exercise
7. High number of full-term pregnancies
8. Long term use of oral contraceptives

The following protective factors decrease the risk of cervical cancer:
1. Preventing HPV infection
2. Cervical Cancer Screening (pap smears & new HPV screen)
3. Diet (decreasing highly refined foods)
4. Exercise
5. Weight Loss
6. Quitting smoking

Avoiding risk factors and increasing protective factors does help prevent cancers and we all need to look at avoiding the risk factors and increasing more of the protective factors. If you are worried about your risks, you should talk to your healthcare professional about how you might lower your risk of cervical cancer.

Final Word

In practice I see so many women presenting with various stages of this disease and end up not being pro-active around the treatment of the disease. So many take this disease and precancerous cells too lightly. It can kill if not treated properly and therefore it is important to follow up with proper screening, treatments and interventions of cervical cancer.

Let’s bring more awareness to cervical cancer and let’s bring more awareness to prevention and hopefully a cure.

Regards
Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Women’s Health Experts

Untitled design 10

Breast Cancer Awareness

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Breast cancer awareness is something that everyone should know about. Mankind has known breast cancer since ancient times. In 460 B.C. Hippocrates explained breast cancer as a disease caused by an excess of black bile, or “Melancholia”. He named the condition ‘Karkinos’- (Cancer)- the Greek word for crab and the astrological constellation. This was because the tumor seemed to have tentacles which reached out into the surrounding breast tissue, resembling the legs of a crab.

The history of Breast Cancer

This theory of Hippocrates held for many centuries until 1680, when the French physician Francois de la Boe Sylvius suggested that Breast Cancer developed from an increase in the disruptions of the acidity of local lymphatic fluids.

There were many theories that followed including celibacy causing breast cancer, too much rigorous sex causing disruption to the local lymph drainage and thus causing breast cancer and others linking breast cancer to mental disorder-the melancholia references again.

In 1757 Dr Henri Le Dran was the first person to suggest that the surgical removal of the tumor was the most effective treatment, provided all the lymph nodes in the armpits were removed. This must have been a horrific prospect prior to anaesthetic and proper sterilised surgical procedures. The survival rates were appalling, due to immediate death post surgery from the high infection rates. It wasn’t until 1976 that advancement in radiation and chemotherapy actually took place. This really isn’t that long ago and the first mammogram trails showing reduction of breast cancer due to early screening, where only initiated in 1989. To think that in such a short spam of time, we now have this as a routine screening tool that can save lives.

It wasn’t until 1994 that scientist have isolated the first of the genetic mutations associated with breast cancer and these genetic screening for the gene mutations and being predisposed to breast cancer. This screen has led to Angelina Jolie having a double mastectomy when testing revealed she had the BRCA1 gene mutation which predisposed her to both ovarian and breast cancer. It was estimated that Jolie had an 87% risk of breast cancer and a 50% risk of ovarian cancer. Jolie’s mother died at 59 from the disease in 2007.

Since Angelina Jolies decision, there was a surge in enquiries around genetic testing and medical evaluation as to breast cancer risks across all parts of the world.

Breast cancer remains the most common malignancy in women, comprising 18% of all female cancers and there is 1 million cases of breast cancer diagnosed worldwide. Most women will know someone who has had the diagnosis, based on these figures.

Despite all the testing and screening it is estimated that about 40% of women have never discussed their risk factors with there doctor, or health care practitioner.

So what can you do to reduce your risks?

The first thing anyone can do is check yourself for any noticeable signs of changes to the breast. You can also have a routine breast examination at your doctor.

Next is regular mammogram, or ultrasound screening, followed by biopsy if anything suspicious is found. Screening for genetic predisposition is another tool that should be used by all women too. About 10% of breast cancer in developed countries is due to genetic predisposition. Certain populations of people have higher genetic risk factors with the Ashkenazi Jewish population having the highest risk factors and well as risk factors for some rare genetic diseases.

The good thing with early screening and detection is that we have now seen in increase in survival rates with the increase between 72-89%.

There are also other risk factors that people need to take into consideration. Women who have their menstrual cycle too early and those who go into menopause later in life are at increase risk of developing breast cancer. Having a baby later in life also increases the risk factor for cancer. Having a baby after 35 years old doubles the risk, while having children earlier reduces the risk. Breast-feeding also reduced the risk of breast cancer too.

Obesity and lifestyle factors increasing breast cancer risks

Obesity and increased alcohol intake also increases a woman’s risk and doubles the chances of having breast cancer. Obesity doubles a woman’s risk factors in postmenopausal women and increased alcohol intake (3-6 standard drinks per day) also doubles the risk factors.

Women on the combined pill also have in increased risk of breast cancer, while progesterone only options do not increase the risk.

Lifestyle modifications

Since there is compelling evidence alcohol and obesity increase the risk of breast cancer, women do need to reduce their alcohol intake and also aim to keep their weight within a healthy range.

This is why we all need to be looking at anti-inflammatory based diets, free from inflammatory wheat grains, excess refined soy products, alcohol, refined foods and refined sugars. These highly inflammatory based foods all lead to excess blood sugars, which in turn spike insulin product. This then causes interference to hormone metabolism (namely estrogens) and also causes the body to store fats and stops the burning of fats, again interfering with estrogen metabolism. This is turns causes inflammation, which is he cause of many of our disease states and leading causes of death.

This is why I always promote a Primal based, low inflammatory, clean eating diet. This is the basis for my PACE-Diet and Lifestyle program (Paleo/Primal Ancestral Clean Eating) that I promote to my patients. This style of diet promotes leans meats, fresh fruits, nuts, seeds, good fats, fresh vegetables and salads, clean water etc. This is very similar to the famous Mediterranean diet, which has to date never been scrutinized and has lot of research behind it. Eating this way will not only make you healthier for it, but will be reducing your risk factors around any inflammatory disease state. Just remember that 90% of breast cancers come from non-hereditary factors related to lifestyle and the way we eat in the modern world.

Early detection and awareness is vital

It is well known that early detection and treatment is vital to survival rates in women with breast cancer. It is so important to regularly check for lumps and bumps and talk to your doctor about regular screening. If you have hereditary risks then talk to your healthcare provider, or specialist about genetic screening for breast cancer.

Let’s all raise awareness for breast cancer and support more research into finding a cure for this disease that affects millions of women world wide each year.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Women’s Health Experts

 

 

Cancers in women 1

Bringing Awareness To Cancers In Women

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Over the next week I am going to focus on a very serious subject – Cancers in women.

Having recently focusses on the awareness of endometriosis and adenemyosis, I thought I should bring some awareness to the topic of cancers in women as a whole. This isn’t to scare people either. It is to bring awareness to a very serious topic and to help people understand the importance of early intervention and changes to diet and lifestyle can greatly reduce the risks of this horrible disease.

With cancer rates increasing I am going to focus on the cancers that affect the female reproductive system and impact of reproductive health. This will also include those cancers that increase after menopause too. Whenever I talk about fertility and reproduction, it is referring to the stage in life when women are fertile and are of reproductive age. Menopause is also including because that still comes under the reproductive system.

Cancer has been around a long time

Humankind has been dealing with the impact of cancer and malignancy for its entire history and the first clear description of any cancer is found in the Ebers Papyrus, dating from nearly 3500 years ago. The cancer was very accurate described by the Egyptian writer and what was described was in fact breast cancer. Chinese Medicine has texts dating back for further than that, describing the different forms of cancers and their treatments. Modern medicine does tend to only reference Greek, Egyptian and Roman text.

When these Greek physicians first cut the surface of a breast cancer, it did in fact resemble a crab, because of it solid central body, with extensions into the surrounding tissue resembling legs.

The ancient Greek word for crab is “Karkinos” which in Latin is translated into ‘cancer’- as in the astrological sign. This term was then extended into all cancers and malignancies, not just breast cancer.

Genetic, hereditary and hormonal links to cancer

It is believed that cancer is predominantly caused by a failure in the regulation of genes which govern cell growth and differentiation. Malignant change is most typically the result of a cascade of changes in a number of genes.

These changes in genes can be bought on by hereditary genetic genetic changes, while others may be the incorporation of foreign viral DNA, or a compound that may act as the primary trigger for malignant change. Some cancers and malignancies are also caused by hormonal stimulation both internally and by injection, or ingestion of hormones from an outside source (Drugs, Hormone Replacement etc).

Diet and lifestyle links to cancer

Other cancers are plain and simply caused by the highly inflammatory foods we eat and the lifestyle we live. Obesity and being overweight increases our cancer risks and there are no many studies proving these links. Having excess fat stores, eating highly processed foods, high GI foods and over 3-4 glasses of alcohol per week can increase your cancer risks exponentially. This why we all need to adopt a clean eating approach to foods and look at eating less refined foods and more whole foods.

The incidence of cancers in women is highest in developing western countries and lowest in countries such as Africa and Asia. The difference has more to do with diet than it does genetics. Since there is compelling evidence that alcohol, highly refined foods and obesity increase the risk of cancers in women (and men) I will be focusing greatly on the need for us all to look at changing our diets to not only help in the prevention of certain cancers, but to also help prevention of other disease states that are leading causes of our lives being cut short.

The most common cancer in women

Since breast cancer remains the most common malignancy in women, comprising of 18% of all female cancers, most women will know someone who has had this diagnosis.

I’ll focus on breast cancer firstly and then go into the other cancers so that we can all be educated about how we can prevent these disease states from increasing. If you have any questions, or topics you want discussed around this topic, please let me know

Take care and remember prevention is better than cure. Always talk to your doctor, or healthcare practitioner about cancer risks and always seek early intervention if you find any lumps and bumps that were not there before.

Hope you the topics help you all. If I can save just one person with this information, then I am happy. Lets try and save more than one, so please like and share to spread the word.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Women’s Health Experts

Endometriosis complications

The Complications That Can Result From Unmanaged Endometriosis

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A lot of the information about endometriosis, is more about it’s symptoms, time to diagnosis and future fertility outcomes. While it is necessary to educate people about these things, nobody is really talking about the serious complications of unmanaged endometriosis. This is not to scare people, or create fear, but at the same time it does need to be talked about and for all concerned to know how serious this disease state can be at its worst.

We know that many women are missed and dismissed when it comes to endometriosis. It often takes up to 10 years, or even more for some women, before they are definitively diagnosed. Some women are never diagnosed and end up suffering a terrible life because of it. Some women with endometriosis are asymptomatic (meaning no symptoms) and often only get diagnosed as part of fertility evaluation, when they may be having trouble conceiving.

The symptoms of endometriosis are easy to see

The symptoms of endometriosis are very easy to see, if someone knows what they are looking for and knows the right questions to ask. Sure, a definite diagnosis via laparoscopy is still needed, but there are some very clear-cut pointers that a woman may have the disease. But due to lack of education and lack of true experts in this area means that lots of women are missed and dismissed, and that is a fact.

The vicious cycle of mismanagement

But while there are inadequacies in the healthcare profession when it comes to endometriosis, not all mismanagement can be blamed on healthcare professionals. There are people who are not seeking proper help soon enough, and some not at all, and this can lead to long-term complications too. We also have women trying to manage their own disease through advice of friends, social media groups and Dr Google as well. This then creates one hell of a mismanaged cycle that does not help anyone.

I can see the issues from all points of view, especially those who suffer the disease. But as a healthcare professional with a special interest in Endometriosis, I have had my fair share of non-compliant patients too.

While many have been let down through mismanagement, lack of funding and education, being missed and dismissed etc, there are many women who are self sabotaging as well. I have seen many not take on advice, recommendations and proper management of their disease, that could help them, then these same people scream high and low that the system has let them down. There are some who are just happy to live with the disease, as it is their only way of seeking attention. This is a fact also and we need to talk about it.

This is what has prompted me to do this post so that all concerned get to know what the serious side of mismanaged endometriosis is. Sometimes it is only via the serious harsh side of reality, that all concerned may actually get some help and some serious attention be bought to this disease state.

The common symptoms of endometriosis

We know that many women suffer greatly at the hands of this disease. Women with endometriosis can get the follow common symptoms:

  • Period pain
  • Pain with intercourse
  • IBS like symptoms
  • Gastrointestinal issues
  • Chronic constipation
  • Chronic diarrhoea
  • Pain on bowel movement
  • Bleeding from the bowel
  • Chronic abdominal pain
  • Severe bloating (endo belly)
  • Chronic bloating
  • Aversion to foods (even if they are not the trigger)
  • Ovulation Pain
  • Ovary pain
  • UTI like symptoms (with no infection present)
  • Migraines and headaches
  • Chronic pelvic pain
  • Pelvic and rectal pressure feeling
  • Musculoskeletal pain
  • Chronic nerve pain
  • Fluid retention
  • Iron deficiency
  • Mood swings
  • Anxiety
  • Depression
  • Mood disorders
  • Infertility
  • Other symptoms

Early intervention and management is crucial

Women’s lives are greatly impacted by this disease and it is important that not only healthcare professionals understand this but also sufferers of the disease. Early intervention and proper ongoing management is the key to helping this disease and everyone needs to be aware of this. Being missed and dismissed, or waiting too long to help, can really have some serious consequences if this disease is left to grow and spread and cause serious damage in the body

The serious consequences of mismanaged/unmanaged endometriosis

While we have talked about the common daily symptoms that many can put up with, we also need to bring attention to just how serious this disease can get. Let’s face it, it can and does spread like cancer and it can spread to every organ in the body. It has been found in the joints of bones, fingers, in the liver, around the lungs, around the diaphragm, around the heart, on the bowels, on the bladder, on the ovaries, on the pelvic, in the fallopian tubes, one the retina in the eyes and it has even found in the brain.

There is no doubt that this disease can be very devastating for anyone who has it, but what happens in the worst cause scenario, if it is left unmanaged.

The following can be serious complications of unmanaged endometriosis:

  • Haemorrhage from the ovaries
  • Ruptured ovaries
  • Ovarian torsion
  • Obliterated fallopian tubes
  • Ruptured endometrioma
  • Endometrioma infection
  • Pelvic infection
  • Obliteration of the pelvic cavity
  • Peritonitis
  • Sepsis
  • Compacted bowel
  • Obstructed bowel
  • Perforated bowel
  • Bowel haemorrhage
  • Torsion of the bowel and intestines.
  • Ureteral Obstruction (Blocked ureters)
  • Renal infection
  • Bladder obstruction
  • Painful bladder syndrome
  • Severe adhesions
  • Significant scar tissue build up
  • Significant fluid build up in the pelvic cavity.
  • Multiple organs adhered together
  • Diaphragmic adhesions
  • Liver damage
  • Perihepatic adhesions
  • Pericardial endometriosis
  • Cardiovascular events
  • Stroke
  • Chronic nerve pain
  • Pudendal nerve neuralgia.
  • Chronic musculosketal, or spinal pain
  • Arthritic like pain and associated symptoms
  • Chronic Migraine and neurological events.
  • Malignancies and cancers (rare but more research being done)
  • Hysterectomy
  • Recurrent miscarriage
  • Absolute infertility
  • Opioid dependency and addiction
  • Death from opioids medications
  • Complications from medications and hormonal treatments
  • Psychotic disorders
  • Mania
  • Incapacitation
  • Suicidal tendencies and thoughts
  • Suicide
  • Death (rare from endometriosis directly, but can be from associated factors related to endometriosis and also taking ones own life)
  • Other

Women with endometriosis need to see an “Endometriosis Expert”

This is why endometriosis needs to be managed properly and managed by a healthcare professional that specialises in the management of endometriosis and associated symptoms. You need to see and Endometriosis Expert.

People cannot treat, or manage the symptoms of endometriosis on their own. This is why it is so important to have the right care and also have a multimodality/team approach to endometriosis. No amount of google searching is going to help people treat endometriosis on their own. You need to find an endometriosis expert.

At the same time more education needs to be given to GP’s and other healthcare professionals about endometriosis. Too many women are being missed and dismissed because of lack of practitioner understanding and education at the front line. Women need to see healthcare professionals that specialise in endometriosis and endometriosis experts for this disease, not just a GP. Women also need access to advanced trained laparoscopic surgeons who specialise in excision surgery, not just a regular gynaecologist who is not advanced trained. I have talked about this often.

Endometriosis is not just about period pain

Lastly, we need to educate ‘all’ that endometriosis is not just about period pain. Endometriosis can present with many different signs and symptoms ranging from gastrointestinal symptoms, extreme bloating, bladder issues, bowel issues, IBS symptoms, migraines, fluid retentions, pain with intercourse, pain on bowel movement and so many other symptoms mentioned before. There is also the long-term impact on fertility for up to 50% of women too.

This is why early intervention and management of teenagers presenting with the disease symptoms is crucial. The longer the disease is left, the more damage it can do and all women deserve to be mothers (if they chose) and deserve a normal happy life. We also need to recognise the psychological impact of the disease and how this can present in someone with the disease as well.

Women are dying because of being mismanaged/unmanaged

Let’s face it, there are women dying because of this disease. Maybe not as direct result, but definitely indirectly. No woman should ever be pushed to the point where she cannot handle her pain and symptoms any longer and be only left with the choice of taking ones own life. This is exactly we need to bring more education to all about this disease. This means both healthcare practitioners and people with the disease itself too.

People need to be managed properly and by professionals. We need to start bring education and attention to this, so that people do not try to manage this disease on their own, and practitioners are held more accountable for dismissing women as well. Because if we don’t the complications of this can be very severe and sometime they can be fatal also.

Endometriosis awareness month is next month and I want to see all women with endometriosis being managed properly and seeking the right help. There are endometriosis experts out there who can help you if you have the disease and the associated symptoms. No woman should be doing this on their own.

Let me help you

If you so need help with managing endometriosis and the associated symptoms of endometriosis, please give my staff a call and find out how I can assist you. I have options for in-person consultations and online consultations. I use a multimodality/team approach and I also work in with some of the best medical healthcare professionals and surgeons in the country. I will always make sure you get the best care, best support and best management possible. I will also hold your hand every step of the way and make sure your every concern is listened to as well.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine

-The Endometriosis Experts

 

 

 

 

 

When a Hysterectomy Should Be Considered

When A Hysterectomy Should Be Considered

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Many times I have talked about “Why a hysterectomy does not cure endometriosis” and so I have decided to talk about “When a hysterectomy should be considered”

Now, before you go any further, I need people to sit back, listen objectively and also take the personal out of this. This is a very personal topic and yes, I am a man and a male healthcare practitioner all in one, with over 20 years experience in helping women with women’s health conditions and being a voice for them also. But regardless, this topic does need to be talked about. Any negative comments, or rudeness will get the delete button immediately. Constructive discussion is always welcome.

The long and short of it is this. There are times when a hysterectomy should be considered (lack of quality of life, cancers etc) and we need to be able to give women the facts so that they can make informed choices, and also not be judged for those choices either. The fact is that for some conditions, women actually get their life back after having a hysterectomy and I talk about all of this and more in this video blog.

 

Kath Mazzella interview

Gynaecological Cancers & Gynaecological Awareness with Kath Mazzella

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I’m sharing a video link up with Kath Mazzella (OAM) about her journey with being a gynaecological cancer survivor and her passion for now helping women with better understanding of gynaecological, sexual and mental health conditions.
 
Kath Mazzella OAM is a Gynaecological cancer survivor. Kath is now so passionate about creating change in relation to the level of awareness of Gynaecological, Sexual and related Mental Health challenges and to break down the barriers and stigmas associated.
After her gynaecological cancer surgery Kath discovered how little women knew and talked about conditions “down there”, and how many women were suffering in silence. This empowered Kath to go on a journey … a journey that her partner Tony had no choice initially but to go on with her. Now he has stepped up to stand beside her and promote this very worthwhile and necessary message, extending it beyond just the women, but also to the men that surround their worlds. After all, when one woman suffers, all those in her world suffer with her.
Kath and Tony together are powerful advocates for women challenged by gynaecological, sexual and related mental health conditions, personally inspiring women (and a few men also), arguing for institutional and social change that delivers better awareness, prevention, treatment and support.
Kath and Tony are inspirational public speakers and Kath is the founder of the International Gynaecological Awareness Day.
Most recently, Kath was awarded the Jeannie Ferris Cancer Australia Gynaecological Cancers Award, which she handed to Tony upon acceptance, stating that he deserved the award for his patience in supporting her through all the years of her campaigning.
 
In 2012, Kath received the prestigious WA Senior of the Year Award and the Beyond Blue category award, finally having the link between Mental Health and Gynaecological and Sexual health recognised.
 
In 2009 Kath was awarded an Order of Australia Medal for her service of the community through raising the profile of Gynaecological health; was inducted into the 100 Women WA Hall of Fame and also was an inductee to the Hall of Fame – Our Bodies Ourselves Women’s Health Heroes, Boston, US. Kath was shortlisted for the Centre for Women in Leadership Award; and Most Inspiring Woman of the Year – Momentum Women’s Forum. Kath was also presented with the Zonta International “Woman of Achievement Award” for Western Australia and received an Executive Women’s Forum Woman of the Year award, both in 2005.
 
Have a listen to our video link up and don’t forget to get behind the gynaecological awareness day on September 10.
Ovarian Cancer Awareness 1

Let’s Talk About Ovarian Cancer

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Ovarian cancer often has no symptoms in the early stages. Later stages are associated with symptoms, but they can be non-specific, such as loss of appetite and weight loss.

Ovarian cancer often goes undetected until it has spread within the pelvis and stomach. At this late stage, ovarian cancer is more difficult to treat and can be fatal. This is why early intervention is something I am very big on and why we all need to not put things off when they present themselves.

Ovarian cancer is the 9th most common cancer diagnosed in Australian women.

Ovarian cancer is the 6th most common cause of cancer death in Australian women.

The present life expectancy of Australian women is 84 years. One in 77 women will be diagnosed with ovarian cancer before the age of 85.The risk of ovarian cancer increases with age. About 83% of all new cases of ovarian cancer diagnosed in 2005 were in women 50 years or older. The median age of first diagnosis is 64 years.

The five year survival rate for ovarian cancer is 45%.

Symptoms
Most women with ovarian cancer experience at least one symptom of the disease in the year prior to their diagnosis. The following can all be signs of ovarian cancer:

  • Abdominal bloating
  • Abdominal or back pain
  • Appetite loss or feeling full quickly
  • Changes in bowel habit
  • Urinary frequency or incontinence
  • Pain during intercourse
  • Menstrual irregularities
  • Unexplained weight loss or gain
  • Indigestion or heartburn

Why is bloating a sign of ovarian cancer?

Ascites (a build-up of fluid in the abdomen and a sign of advanced ovarian cancer) is probably the major cause of bloating in women with ovarian cancer. Therefore, waiting for bloating as a key ‘sign’ is too late and we want to encourage all women to ‘know your normal’ and if this changes, to seek medical help. This is why any changes in the body need to be looked into. Many may think that they are reacting to foods, or they have a gut issue etc, but it may actually be the signs of ovarian cancer. This is why proper investigations and proper differential diagnosis by a trained professional is so important.

Family history
While having a family history of ovarian cancer increases a woman’s risk of developing ovarian cancer, 90-95 per cent of all ovarian cancers occur in women who do not have a family history.

Key factors associated with increased risk include:

  • Multiple relatives on the same side of the family affected by breast cancer (male or female) or ovarian cancer
  • Younger age at cancer diagnosis in relatives
  • Relatives affected by both breast and ovarian cancer
  • Relatives affected with bilateral breast cancer
  • An increase in age
  • Inheriting a faulty gene (called a gene mutation) that increases the risk of ovarian cancer
  • Being Caucasian (white) and living in a Western country with a high standard of living having few or no full-term pregnancies
  • Starting your menstrual cycle early (before the age of 12) and beginning menopause after the age of 50
  • Taking hormone therapy (HT) after menopause. Some studies suggest this may increase your risk of developing ovarian cancer, but others don’t make this connection
  • Never having taken the contraceptive pill – the pill has been found to reduce the risk of cancer of the ovaries and uterus
  • Only five to 10 per cent of all ovarian cancers are associated with a family history. The risk of developing ovarian cancer increases with the number of affected first degree relatives (parents, siblings, children)
  • Ashkenazi Jewish ancestry.

Diagnosis for Ovarian Cancer

There is currently no evidence to support the use of any test, including pelvic examination, CA125 or other biomarkers, ultrasound (including transvaginal ultrasound), or a combination of tests, to screen for ovarian cancer. The only way to properly screen for it is through histology done at the time of laparoscopy.

While CA126 can be a diagnostic, it really has limited value and I have to let people know that it isn’t the best diagnostic at all. 50% of ovarian cancers will actually have a normal CA125 reading.

The cancer council’s guidelines are quite clear about this after numerous research studies show that CA125 has limited diagnostic value for Ovarian cancer. If markers and symptoms are suggestive of Ovarian Cancer, the only true diagnostic is Laparoscopy with histology to really get an accurate diagnosis.

Treatment for Ovarian Cancer

At such an advanced stage, the cancer is more difficult to cure. As ovarian cancer advances, cells from the original tumor can spread (metastasize) throughout the pelvic and abdominal regions and travel to other parts of the body. Cancer cells are carried through the body through lymph vessels and the bloodstream.

If a woman is suspected of having ovarian cancer, she should be referred to a gynaecological oncologist. Research shows survival for women with ovarian cancer is improved when their surgical care is directed by a gynaecological oncologist.

Treatment for ovarian cancer usually involves surgery and chemotherapy. It may also include radiotherapy.

Usually your healthcare practitioner, or GP, will generally arrange for initial tests and looks after your general health as well as coordinating with your specialists. Depending on your treatment you will be seen by several specialists, such as: medical oncologist, radiation oncologist, radiologist, gynaecological pathologist, cancer nurses and other health professionals such as a dietitian, physiotherapist, social worker and a counsellor.

With any condition that affects the body, we often get early warning signs and this is why early intervention and making sure you are investigated and management properly is so important.

Regards

Andrew Orr

-Women’s and Men’s Health crusader

-No Stone Left Unturned

-The Women’s Health Experts

01 Dr Andrew Orr

Cancer Pregnancy Endometriosis

Why am I getting bleeding between my periods?

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Vaginal bleeding between periods can be common and is not generally a cause for concern. Most of the time women will get just very light pink coloured watery flow, or just some spotting.

There can be many reasons why a woman would be getting bleeding between periods, which includes hormonal changes, injury, or an underlying gynaecological, or health condition.

While bleeding between your periods may not be cause for concern, on one level, the ideal situation is to not have any form of bleeding at all and if you do get bleeding between your cycle, it is a good idea to have this investigated, just to be on the safe side.

What a proper menstrual cycle should be like

I have done quite a few posts on what a proper menstrual cycle should be like, but I will go over this again just briefly

A proper menstrual cycle should be between 26-32 days in length and really only have about 3-5 days flow. Any longer than this can be too long and put a woman at risk of being low in iron, especially if this happens all the time.

The blood flow should be a nice red consistency, no clots, with no stopping and starting, and women shouldn’t have too many digestive disruptions, and really, a woman should not be getting pain with her cycle.

A little bit of distention and knowing the period is coming is fine, but there should not be pain at all. If you have to reach for the pain killers and the heat pack, or are doubled up in pain, this is not normal and you need to get this checked out.

What are the causes of bleeding between periods?

As mentioned before, there can be a variety of reasons for breakthrough bleeding, some of which are no cause for concern at all. Some however do need to be investigated.

Below are some of reasons for bleeding between periods:

Ovulation

When an egg is released from the ovary, it does create a tiny wound, through which the egg will then travel through the tubes and prepare to make its way to be fertilised, or then shed with the menstrual flow. At ovulation, this tiny wound can also create a tiny amount of bleeding, which can be seen as spotting during the ovulatory phase of a woman’s cycle.

Implantation bleeding

When an embryo implants into the uterine lining and begins to grow, many women experience spotting around this time. This is called implantation bleeding. They may also experience some slight cramping at the same time and all of this is quite normal. Some women may then experience some lighter bleeding as the embryo grows further. They usually get some light spotting, which can be a light pink, or a brown colour. Sometimes it can be more like fresh blood. While this is normal, it is a good idea to get this checked out just to be on the safe side and to also put the pregnant mothers mind as ease too.

Miscarriage

Bleeding between menstrual periods can be an early sign of a miscarriage. Many women may not even know they are pregnant and may be completely unaware they are having a miscarriage.  While it is generally thought that once a woman reaches twelve weeks gestation everything is generally going to be ok, miscarriages can occur at any time during pregnancy.

Termination

After having a termination women can bleed for some time after the procedure, or taking the medication to start the abortion process. If bleeding continues and is very heavy, women need to seek medical advice.

Polyps 

Polyps are small growths that can develop in the uterus or on the cervix. They are often a cause for unexplained bleeding between the cycles. Polyps do need to be removed as they can prevent implantation happening and they can also turn cancerous if left behind. Polyps are a very common cause of bleeding between periods.

Fibroids

Fibroids, or myomas (also known as leiomyomas, or fibromyomas) are growths, or benign (non-cancerous) tumours that form in the muscle of the uterus. Up to 40% of women over the age of 40 years have fibroids and as many as 3 out of 4 women develop fibroids in their lifetime.

Fibroids can cause heavy bleeding, extended bleed and painful periods. They can also cause infertility, miscarriage and premature labour. In many women, they will not cause any problems at all. Fibroids are a very common cause of bleeding between the cycles.

Polycystic Ovarian syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a very common condition that can cause irregular periods, absent periods, and can also cause bleeding between periods. PCOS can also cause other issues such as acne, weight gain, infertility and hormonal and emotional disturbances.

Endometriosis or Adenomyosis

One in ten women are diagnosed with endometriosis and many more do not even know that they have it. Endometriosis and Adenomyosis are very closely related, with endometriosis usually being more superficial disease and not confined to the uterus,  and adenomyosis being deep within the uterine tissue. Chronic conditions such as endometriosis and adenomyosis, can cause bleeding or spotting between periods.  These conditions may also cause heavy or painful menstrual periods and cramps between periods. Adenomyosis will usually cause more bleeding symptoms along with pain etc.

Sexually transmitted infections (STIs)

Some sexually transmitted infections (STIs) can cause pain, vaginal bleeding and spotting. If you do suspect you may have a STI, you need to see your doctor for investigation and treatment.

Injury to the vaginal wall

During sexual intercourse the tissue of the vagina can be damaged and this can then cause bleeding. If the vagina is too dry, lack of arousal, and not lubricated enough this is more likely to happen. It can also happen if there is atrophy in the vaginal tissue as well. This is called atrophic vaginitis.  This is more likely to be seen when a woman is going into menopause, or undergoing cancer treatments, or has diabetes.

Menopause or perimenopause

The menopausal stage of life and especially the perimenopause stage, can be a cause of irregular menses and irregular bleeding. It can also cause spotting, or heavy bleeding too. Perimenopause is the period leading up to menopause. This stage of a woman’s life can last for up to 10 years as hormone levels in the body change and can be unstable.

Hormonal contraceptives

Hormonal contraceptives are a common cause of bleeding between periods. They can also cause irregular bleeding and this can be quite usual in the first 3 months of using the contraceptive. If a woman misses takin her oral contraceptive, it can also cause irregular bleeding, or a withdrawal bleed.  Intrauterine Devices (IUD’s) like the Mirena, will often cause irregular periods and irregular bleeding in the first 3 months after it have been inserted. If bleeding lasts for longer than 3 months on any contraceptive, it is a good idea to seek medical advice and get investigated and managed properly.

Emergency contraception

The morning after pill, or emergency contraceptives, may also cause bleeding. If bleeding persists, you should seek medical advice.

Certain cancers

Vaginal bleeding between periods can also be a sign of gynaecological cancers in women. Most bleeding that women get is not serious, but it still needs to be checked.  Cervical cancer can affect women of any age. Bleeding between the cycle, or after intercourse, and pain after intercourse, or unpleasant smelling discharge can be symptoms of cervical cancer and these all need to be checked by your doctor, or gynaecologist.

Uterine cancer tends to occur in women over 50 year of age. One of the early symptoms of uterine cancer can be vaginal bleeding. Uterine cancer mostly affects women are in the menopause and no longer have periods, so this is why any bleeding after menopause needs to be investigate and seen as not being normal.

Stress

Yes, stress can cause abnormal bleeding and also interfere with a woman’s cycle. Increased levels of stress can interfere with hormones and this can lead to bleeding, irregular cycles, or pain with cycles too.

When to see a doctor

If vaginal bleeding between periods is heavy, persistent, or unusual then a woman should go and see a specialist, or a gynaecologist, who is a specialist in this area of medicine. As mentioned previously, while some causes of bleeding are not serious, some are and need to be properly investigated and properly managed medically.

Treatment and prevention

All women should keep a record of their menstrual cycle and when the period starts and how long it lasts for. Any abnormal bleeding should be recorded so that you can show your healthcare specialist if need be. Any abnormal bleeding should be investigated and the treatment will depend on what the underlying cause is.

Women should try and see their healthcare specialist for regular pap smears and regular check-ups for gynaecological health.

If women are getting small tears and bleeding caused from dryness in the vagina, then there are water based lubricants that can be used to help with lubrication and to moisturise the surrounding tissue.

There is no cure for gynaecological and reproductive issues such Endometriosis, but these disease states can be treated and managed to give women a normal life.

Proper treatment of these issues needs a “Team”, or multimodality approach using medical options, surgical interventions, pelvic floor specialists, complementary therapies, hormone therapies, and diet and lifestyle changes. It is about using what works for the individual and not a blanket one treatment fits all approach.

Last but not least, all women should know that period pain is not normal and that irregular bleeding really isn’t normal either. While most causes of bleeding are not life threatening, they still need to be investigated and checked out properly. Never ever put off seeing a medical specialist if you have abnormal bleeding.

If you would like to book in a consultation with me and find out how I can assist you with women’s health conditions, please give my friendly staff a call and they will be able to assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate