The Truth About Natural Killer Cells & Miscarriage

Posted on November 8, 2017August 25, 2019 by Andrew Orr

On a daily basis we get people, who are having failed IVF cycles, calling my clinic looking for some miracle pill, to supposedly eradicate the body of natural killers cell and wipe them off the face of the planet in some war like rage, all because they have been told this will bring an end to their fertility woes.

I wish it was that easy and when my staff go on to explain that treating natural killers cells (uterine killer cells), and especially looking at the cause of natural killer cells (uterine killer cells), is complex, there is no one miracle cure, nor some magic pill, people get annoyed and hang up the phone in a huff ,without listening to the reasons why.

One of the things I always say, when people ask me about regulating natural killer cells for fertility purposes, is “How long is a piece of string?”

This is because this subject is very complex and there are many reasons why natural killer cells may be impacting implantation. So, hence the response is always going to be “How long is a piece of string?”

While Natural killer (NK) cells have an important role in the early responses to viral infections, they have also been linked with failure of pregnancy.

Increasingly, clinics are offering blood tests, at an increased cost to the patient, to measure the number and activity of circulating NK cells. As a result of these investigations, many women are offered treatments such as steroids, intravenous immunoglobulins, and tumour necrosis factor blocking agents. The scientific rationale for these tests and treatments, however, is not always supported by our current knowledge of the function of uterine NK cells.

So, I thought it was about time I set the records straight on the BS information, that seems to being handed around as gospel, by money hungry fertility clinics run by big health conglomerates, and by the rotten Dr Google, about natural killer cells (uterine killer cells) and these supposed miracle pills, that will miraculously fix someone’s fertility issues.

Let’s Look at the Facts about Natural Killer Cells Relating to Miscarriage

There is no miracle pill, or one supposed miracle treatment, or a one pill solution to treat, or get rid of natural killer cells. You do not want to get rid of NK Cells.
Natural Killer Cells are a natural part of the immune system designed to target inflammation, kill of cancer cells, kill off bacteria and protect the body from harmful invasion of foreign organism
There is huge difference between natural killer cells that are circulating in the blood stream, compared to uterine killer cells
Uterine Killer Cells are in large numbers during a pregnancy to protect the embryo
Natural Killer Cells are only in large number and are only being sent out by the immune system because there is some inflammatory process going on in the pelvis, or the rest of the body
You cannot regulate Natural Killer Cells numbers unless you first address the inflammatory process that is causing them to be in high numbers in the first place (Eg- Inflammatory gynaecological conditions such as PID, Endometriosis, PCOS, Adenomyosis, Adhesions, STI’s, CIN, HPV, Herpes etc)
Many people have not had the proper initial fertility investigations and testing needed to actually fall pregnant in the first place and looking at Natural Killer Cells, before all that proper testing etc is done, is actually not assessing the patient properly.
If you do not treat the cause of the Natural Killer Cells being in high numbers, you will not be able to reduce the numbers of Natural Killer Cells that are actually doing the job they are meant to do, which is …. Protect the Body.
Many of the so called treatments for Natural Killer Cells, regarding fertility, have never been approved for such treatment and research on it is still inconclusive.
Some of the treatments being proclaimed as miracle cures (Intralipids etc) are purely money making exercises that are preying on the vulnerability of people who have been told wrong information and have this perception of some killer being inside their body attacking their embryos.
Intralipids have never been proven to treat Natural Killer Cells and are derived from highly inflammatory soy based compounds, which then in turn can cause more inflammation.
The drugs used in the treatment of Natural Killer Cells are steroidal based and carry many side effects and are for more harmful to the body that any natural killer cell will ever be. The steroids are also a category C drug that has been shown to have an effect on the neonate
Steroids, such as Prednisone, do work on regulating NK cells, but they do so by suppressing the immune system, thus compromising a person’s immunity. There are also risk to peoples minerals by using these long term and there are also other side effects to the body.
Natural Killer Cells are there to protect the body, not hurt it.
Natural Killer Cells may only be attacking embryos because they are seen as foreign body as well and when they are there trying to kill of the diseases and issues causing inflammation in the body, they just happen to kill of any other foreign organism and inflammatory processes at the same time
Again, to address natural Killer Cells, you need to address the inflammatory process as to why they are in high numbers in the first place
The perception around Natural Killer Cells being this “thing” killing off embryos in the body is misguided and is actually not a true representation of what Natural Killer Cells actually do. It is purely often used to tug on the heartstrings of unsuspecting patients, who are highly emotive and clinics use these emotions to get them to pay for treatments that have never been fully proven to work.
The name “Killer Cell” is too often exploited in the wrong context by many in the fertility world
Blood tests cannot measure the number of Natural Killer Cells in the Uterus, Only a biopsy can do this.
A Natural Killer Cell (uterine killer cells) Biopsy has to be done between the 24^th and 28^th day of your menstrual cycle to give the best results.
Blood tests can only measure the circulating NK cells in the body and not the uterine killer cell activity, which can be the cause of recurrent miscarriage. So, if you have had a blood test, it is not measuring what is needed. Everyone will have circulating NK cells in their blood stream.
The percentage of CD56+ NK cells in peripheral blood in normal healthy individuals varies from 5% to 29% (2)Despite this, more than 12% NK cells in women with infertility or miscarriage has been arbitrarily defined as abnormally raised and used as an indication for treatment (4)
The percentage of NK cells in blood can be affected by many factors including sex, ethnicity, stress, and age too.
There is now new evidence that shows that natural killer cells help with implantation and a healthy uterine environment, which now supersedes old outdated research.

Natural Killer cells (Uterine killer cells and other NK cells) are the main immune cell-type found in the uterus. Their numbers increase through the menstrual cycle to peak at the time of implantation. If an embryo does implant, NK cell numbers increase further to 70% of all cells.

Uterine NK numbers start to decrease at around the 20 week mark of pregnancy and are all but absent at the end of pregnancy.

Natural killer cells acquired their name as a result of the initial test used to identify them in vitro. Unlike T lymphocytes, NK cells are able to spontaneously kill cells in a non-MHC restricted manner.

Regrettably, this is a misleading name in reproduction, and the powerful image of maternal cells attacking the fetus is emotive and easily exploited. None the less, these NK cells can kill off the embryo at early stages of pregnancy, but there is nearly always a reason why. That reason is inflammation in the pelvic cavity and uterus. This needs to be addressed to regulate the number of NK cells, not some notion of killing off the “Killer Cells”.

Types of Inflammation causing high Natural Killer Cells (Uterine Killer Cells)

Endometriosis & Adenomyosis
PCOS/PCO
Fibroids, Myomas
Vaginal Infections & Bacteria
STI’s
Cancer, Trauma, Localised Lesions & Others
Stress

Yes, stress can lead to a compromised immune system, which then leads to high TNF (Tumor Necrosing Factor) and increase Natural Killer Cells, which then leads to prolonged increase activated T Cells, and this then causes reduced implantation of embryos.

This is also a reason why any inflammation in the uterus or pelvic cavity needs to be addressed to help fix this issue and one of the reasons why any woman having fertility issues needs to be investigated and treated properly.

This needs to involve proper differential diagnosis, proper pathology testing, genetic testing and surgical investigations such as laparoscopy prior to any further fertility treatment. A laparoscopy is the gold standard for addressing and treatment of issues in the uterine and pelvic cavity.

Natural Killer Cells (Uterine Killer Cells) may be a part of recurrent miscarriage, but we need to stop the misinformation and perception of them being some killer organism that isn’t meant to be in the body. They are meant to be in the body and the name is all too often exploited by many to offer unproven treatments and medications by clinics trying to increase profits.

If you want to regulate and treat natural killer cells (relating to recurrent miscarriage) properly, you need to find out what is causing them to be there in the first place. There is no magic pill to get rid of Natural Killer Cells.

You cannot rid the body of Natural Killer Cells anyway. They are meant to be there. You can only regulate the amount of killer cells doing their job and you need to find out why they are in higher numbers in the first place. This is usually because there is some sort of inflammation, infection, bacteria, or malignancy going on in the body that has not been investigated properly in the first place. Let’s not forget that stress, yes stress, increases the amount of Natural Killer Cells in the body too.

As part of my fertility program, I talk to couples about the facts about Natural Killer cells, and makes sure that proper investigations, testing and treatments are administered and managed properly. This can also be done alongside current medical protocols such as the Bondi protocol, or California protocol.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

References

Moffett-King A. Natural killer cells and pregnancy. Nat Rev Immuol 2002;2: 656-63.[CrossRef][Web of Science][Medline]
Pijnenborg R, Vercruysse L, Hanssens M, Van Assche A. Incomplete trophoblast invasion: the evidence. In: Critchley H, MacLean A, Poston L, Walker J, eds. Pre-eclampsia. London: RCOG Press, 2003: 15-2615. Parham P. NK cells and trophoblasts: partners in pregnancy. J Exp Med 2004;200: 951-5.[Abstract/Free Full Text]
Hiby SE, Walker JJ, O’Shaughnessy KM, Redman CWG, Carrington M, Trowsdale J, et al. Combinations of maternal and paternal innate immune genes influence the risk of pre-eclampsia. J Exp Med 2004;200: 957-65.[Abstract/Free Full Text]
Aoki K, Kajiura S, Matsumoto Y, Ogasawara M, Okada S, Yagami Y, et al. Preconceptional natural-killer-cell activity as a predictor of miscarriage. Lancet 1995;345: 1340-2.[CrossRef][Web of Science][Medline]
Ntrivalas EI, Kwak-Kim JY, Gilman-Sacchs A, Chung-Bang H, Ng SC, Beaman KD, et al. Status of peripheral blood natural killer cells in women with recurrent spontaneous abortions and infertility of unknown aetiology. Hum Reprod 2001;16: 855-61.[Abstract/Free Full Text]
Bisset LR, Lung TL, Kaelin M, Ludwig E, Dubs RW. Reference values for peripheral blood lymphocyte phenotypes applicable to the healthy adult population in Switzerland. Eur J Haematol 2004;72: 203-12.[CrossRef][Web of Science][Medline]
Kwak JY, Kwak FM, Gilman-Sachs A, Beaman KD, Cho DD, Beer AE, et al. Immunoglobulin G infusion treatment for women with recurrent spontaneous abortions and elevated CD56⁺ natural killer cells. Early Preg 2000;4: 154-64.
RCOG Scientific Advisory Committee. Immunological testing and interventions for reproductive failure. London: RCOG, 2003. (Opinion paper 5.)
Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database Syst Rev 2003;(1): CD000112.
Daya S, Gunby J, Clark DA. Intravenous immunoglobulin therapy for recurrent spontaneous abortion: a meta-analysis. Am J Reprod Immunol 1998;39: 69-76.

What You “Can” Eat During Pregnancy

Posted on November 2, 2017August 25, 2019 by Andrew Orr

A while back, I put up a post to see what people thought that you (can) and (can’t) eat during… pregnancy, or if you were trying to fall pregnant. It was really interesting to see what foods people thought you could not eat during pregnancy.

It is really interesting that most people want to tell you want you can’t eat, but hardly anyone tells you what you can eat during pregnancy and while trying to fall pregnant.

What prompted this post was that a while back I overheard one of my staff and lovely mother to be, talking to another mother to be about what she has been cutting from her diet while she was pregnant and how her food choices were so limited.

I heard all kind of wonderful things from not eating any seafood; not eating any cold meat, not eating soft cheeses, not eating eggs, not eating nuts and nearly the whole food pyramid was being added.

What many people don’t know is that I actually have a background in food science and that I used to teach about bacteria and food hygiene and the nasty consequences of what bacteria can do to the body.

Most pregnant women have the number one fear of foods containing Listeria. It is a rare form of bacteria but it can be fatal (very rare) to a lady if she is pregnant and cause issues such as miscarriage. So not discounting it at all and some countries around the world do not have the food hygiene standards we have here in Australia.

We only see about 5 cases per million people in Australia. Basically there is about 0.3-0.4% chance of getting it and we all make such a big deal about it. Again, this is not to discount it either. Listeria can be found in unpasteurised products such as diary and cheese and can be found in some forms of deli meats mainly. To be honest, it is usually the home made/backyard deli meats and cheeses you really have to watch, with regards to hygiene and bacteria.

But if a health issues such as Listeria poisoning is so rare, why do we make such a fuss about it and not warn women of other potentially worse factors that cause more cases per year, and can be potentially fatal too. The problem is if women only hear about the foods they can’t eat, many of them are going to be nutrient deficient all for the fear of a tiny chance of listeria causing an issue with a pregnancy.

The truth is, other bacteria such as Salmonella, Shigella and Camphyobacter have a higher rate of infection per year than listeria ever will and nobody ever talks about them. There are over 25,000 cases of these combined and most of the spread is through person to person contact, not just foods themselves.

Basically many food poisoning cases are actually from bacteria being on your own hands, which then at some stage end up in, or near your mouth. This is why smokers are at higher risk of food poisoning. To be honest, shopping trolley handles are probably one of the most unhygienic places you can put your hands on and probably cause more bacterial health issues than anything. Money can be the same.

Then we have a far wider implication of gestational diabetes, which account for about 15,000 plus, pregnant women per year, with an annual increase of 5% per year. When someone eats sugary foods, highly processed foods, grains etc during pregnancy, that are a major cause of diabetes, nobody says a thing. Yet mention the word Brie cheese, cold meats etc and everyone goes nuts. Oh yes, we now mention ‘nuts’ and people go nuts too. Again this is not to discount that some people have true allergies to nuts.

So what do pregnant women really need to know and what can you eat?

Basically the same food hygiene that is needed when you aren’t pregnant is to be observed when you are. There only needs to be a little bit more caution, not an ‘OMG’ stay clear of everything, that unreliable Dr Google, or ‘Someone’, has told you. I would love to know who ‘Someone’ is because he, or she, causes a lot of problems. Remember temperatures between 5 and 60 degrees C are you danger zone area. This is why foods need to be stored below 5 degrees and heated over 60 degrees C.

So what can you eat?

So basically you can eat any deli meats as long as they are cryo-vacced and in date. Cryovacced means the air has been taken out and not even bacteria can live in an non-oxygenated environment.
You can eat all seafoods as long as they are cooked and fresh.
You can eat all cheeses but need to be more careful around the soft cheeses. New research actually shows that small amounts can be beneficial for you. If you cook soft cheeses there is definitely no issue. Just don’t eat cheeses from unpasteurised sources.
You can have any form of pasteurised milk or UHT milk.
You can have soft serve ice-cream as long as the place you are getting it from looks hygienically clean. Maybe not a good idea to get them from the old ice-cream trucks that aren’t checked regularly by food standards.
You can eat nuts and now there is evidence to show that mums not eating nuts during pregnancy may now be the cause of nut allergies.
You can definitely eat eggs and you just have to make sure they aren’t raw. Boiled eggs, poached eggs and fried eggs are all fine. Egg custard is fine because it is cooked
You can eat all meats if they are cooked and you don’t have to char it until it resembles an old leather shoe. Medium is fine. You just need to cook all chicken right through because all chicken contains salmonella and cooking it kills it.
You can have coffee and tea and you just need to limit all caffeine to no more than two cups per day (remember tea has as much caffeine as coffee)

Basically the healthy food pyramid I teach at my clinic needs to be applied.

1. Take a good practitioner only Multivitamin, Omega 3 Oils, prebiotics and probiotics daily

2. Eat 2 handful of nuts daily or two tablespoons of healthy oils

3. Limit you grains to one serve (only) per day or cut them completely (best)

4. Eat 2 pieces of low GI fruits per day

5. Protein with every meal or snack

6. 3-5 serves of veggies or salads per day (just not from a salad bar)

7. 8 glasses of water

8. 2 serves of electrolytes per day when pregnant

9. 30 -45 minutes exercise 2-3 times per week

# No diet drinks or artificial sweeteners, or alcohol at all

Remember food is to be enjoyed and so is pregnancy. Don’t get too caught up in all the worry of what you can’t eat and look more at what you can eat and stick to those foods.

Take care

Regards

Andrew Orr

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

Alcohol Decreases Fertility & Makes Gynaecological Conditions Worse

Posted on October 31, 2017August 25, 2019 by Andrew Orr

In today’s modern society, alcohol has become the cornerstone for social engagements, business dinners and after work relaxation. It is important to realise however, that alcohol can directly impact the fertility of both males and females.

In males it can decrease sperm quality, reduce testicular size, decrease libido and cause impotence, all of which can impair fertility.

In females it has a more systemic response, affecting the reproductive hormones, leading to abnormalities in the menstrual cycle and an increased risk of miscarriage.

Many men and women these days are actually consuming copious amounts of alcohol and may think that their drinking habits are normal, when compared to others around them.

When people do things on a regular basis, it becomes their normal. But truth be told, many people’s drinking habits, both men and women, are actually in the realms of alcoholism. The impacts of that are far reaching and fertility and gynaecological conditions are definitely impacted by alcohol consumption.

Effect of Alcohol on Conception for Men

Fecundability refers to the probability of conception during a particular menstrual cycle. It is dependent on the reproductive potential of both partners. Alcohol decreases fecundability by its effect on sperm quality and quantity. Men who continue to consume alcohol on a regular basis, can decrease their sperm motility, morphology and their DNA in the sperm. All of which are important factors in achieving fertility.

While outwardly a man’s sperm may look OK, many forget that inwardly, the sperm DNA could be highly fragmented and unless this is tested every ejaculation, you will have no idea how bad the sperm actually is. A one off DNA fragmentation analysis does not mean the sperm each time is OK. It only measures the sperm from the ejaculate that was tested and sperm quality can change by as much as 20% each ejaculation.

Testicular size is also affected by alcohol intake; and can also affect sperm production. Alcohol is a depressant of the central nervous system (CNS), and can disrupt the autonomic system of the CNS. These effects are temporary and short lived. Abnormal sperm production is also temporary and also can resume after abstaining from alcohol.

One study, this one looking at couples going through IVF treatment, found that for every additional drink a man consumed per day, the risk of conception not leading to a live birth increased by 2 to 8 times. This was especially true if the drinking occurred within a month of the IVF treatment.

Effect of Alcohol on Conception for Women

In women, alcohol affects fecundability, by disrupting the delicate balance of the menstrual cycle. Clinical research data published in the “British Medical Journal” suggests that women, who drank socially, 1-5 drinks per week, were at a greater risk of decreased fecundability when compared to women who remained abstinent. These findings underscore the importance of remaining abstinent while attempting to conceive.

Alcohol disrupts the hormonal imbalance of the female reproductive system, leading to menstrual irregularities, and even Anovulatory cycles, (menstrual cycles where ovulation fails to occur). Menstrual pain can directly be linked to the amount of alcohol consumed in the lead up to the menses and consumptions of alcohol, even small amounts, exacerbates most gynaecological conditions. These changes can drastically decrease a woman’s chance of becoming pregnant and thus affect fertility.

Alcohol effects fertility in both partners, and can do so in so many ways. For couples who desire to have a baby, it is best to stay away from drinking completely. Presently there is no safe limit of alcohol intake; even socially acceptable amounts of alcohol can affect fertility potential and outcomes.

Moderate drinking (1-2 drinks in one sitting) is probably okay, especially if you reserve those drinks to a few times a week, instead of daily. However, if you’re going through IVF treatment, or trying to conceive naturally, you might consider cutting out alcohol for the time being.

A woman that is trying to concieve, or trying to improve a gynaecological issues, or menstrual issues, should not be consuming more than 4 standard drinks per week.

A male who is trying to conceive, or have sperm quality issues, should have no more than 2 standard drinks in one sitting and be having at least 2 alcohol free days per week. These are all part of the healthy drinking set out in health department and government safe drinking guidelines.

Trying to conceive is a special time in a couple’s life, it should be filled with love, devotion and safe health practices, which means a healthy diet and lifestyle and having a healthy mind too. It also means having healthy drinking habits as well.

Decreasing alcohol, having bete foods and looking at a healthy detoxification program is also a great idea for those trying to increase their fertility and get their reproductive systems working better. Healthy eggs and health sperm make healthy babies. Healthy reproductive systems also mean better menstrual cycles and better testicular health too.

Safe drinking everyone. This is something I talk about as part of my fertility program and preconception care. If you would like to find out more about my fertility program, please contact my friendly staff to find out more.

Regards

Andrew Orr

-Women’s and Men’s Health Advocate

– No Stone Left Unturned

-The International Fertility Experts

Seminal Fluid Improves Fertility in Women and Improves IVF Pregnancy Rates

Posted on October 26, 2017August 25, 2019 by Andrew Orr

Seminal fluid is often viewed as simply a vehicle to carry sperm to fertilize the female egg, but a more complex function in influencing female reproductive physiology is now evident.

Remarkably, seminal fluid contains special signaling agents that interact with the female reproductive tract to prime the immune response, with consequences for fertility and pregnancy outcome. This research isn’t new and we have spoken about this in previous posts.

But we now know a bit more about how sperm may assist in implantation for, especially for IVF.

See my other post https://drandreworr.com.au/sex-around-the-time-of-embryo-transfer-increases-the-likelihood-of-successful-early-embryo-implantation-and-development/

Recent studies demonstrate a key role for seminal fluid in enabling embryo implantation and optimal placental development. In particular, seminal fluid promotes health immune responses which facilitate embryo implantation by suppressing inflammation, assisting uterine circulation and blood supply and also protecting the embryo.

There is emerging evidence where seminal fluid provokes an adaptive immune response in the cervical tissues after contact at intercourse, and spermatozoa accessing the higher tract potentially affect the endometrium directly. Research has now shown that sperm and seminal fluid actually help with endometrial receptivity, which is needed to create the right environment for a healthy embryo to implant.

These biological responses may have clinical significance, explaining why

[1] intercourse in IVF ET cycles improves the likelihood of pregnancy

[2] inflammatory disorders of gestation are more common in women who conceive after limited exposure to seminal fluid of the prospective father

[3] preeclampsia incidence is elevated after use of donor oocytes or donor sperm where prior contact with conceptusalloantigens has not occurred.

Research like this is important to define the mechanisms through which seminal fluid interacts with female reproductive tissues, to provide knowledge that may assist in preconception planning and infertility treatment.

It also bring attention to the fact that couples still need to be engaging in regular intercourse during IVF cycles to help not only with implantation, but to increase pregnancy rates through optimisation on the endometrial lining through contact with seminal fluid.

Regular intercourse also promotes connection and bonding for the couple as well and this is something that is very much overlooked.

My clinic offers a comprehensive Fertility Program where couples are educated on important factors such as this… and more

If you would like to find out how you could improve your chances of having a baby, please give my clinic a call and ask about my fertility program that has assisted over 12,500 babies (and counting) into the world may be able to assist you as well.

For more information on my fertility program, see also https://drandreworr.com.au/fertility/fertility-program/

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Expert

-The International Fertility Experts

Facts About Sperm Health and Their Lifespan

Posted on October 25, 2017August 25, 2019 by Andrew Orr

There is a lot of misinformation with regards to facts about sperm health and their lifespan.

Typically, millions of sperm cells are produced in the testicles every day. During this time, many things can affect their formation and interfere with their quality and maturity.

It takes around 90-120 days for a sperm to become motile

From a tiny sperm cell it can take between 90-120 days before a sperm is fully mature. The sperm eventually develops a head and tail, so that its cells start to resemble the shape of a tadpole.

The head contains all of the DNA, or genetic material, and the sperm uses the tail to help it move. A sperm doesn’t reach full motility until it actually reaches the egg, where when touching the egg it creates a reactions that causes “super motility” to give it the final power to push inside the egg. This is called the acrosome reaction.

There has been lots of debate about the actual time it takes for a sperm to mature and become fully motile, but general consensus is that it will take somewhere between 90-120 days.

This is why it is important that men look after their health long prior to conception, because the sperm they ejaculate today was created around 90-120 days ago and what they did to their bodies at that time, will influence how healthy those sperm are.

A man’s lifestyle affects his sperm quality

So if a man had a poor diet, was drinking, smoking, had heaps of stress and goodness knows what, this can all have an impact of the maturing sperm and this can result in poor sperm quality and damage to the DNA of the sperm, which will then be carried onto his offspring, should the sperm be successful in fertilising an egg. This is why the couple need to be healthy prior to conception, not just the female.

Biology 101 tells us it take a sperm and an egg to make a baby, not just an egg. Sperm quality issues make up a big part of fertility issues and they can also be a big part of miscarriage issues too. I have spoken about this many times in previous posts. Up to 85% of miscarriage issues can be related to chromosomal and DNA factors related to poor quality sperm and this is often very much overlooked.

What factors impact on sperm health?

There are always many factors that can affect the sperm formation process and interfere with sperm quality and the DNA of the sperm.

Health and lifestyle factors

Recreations drugs, medications or alcohol use
job, or occupation
tobacco use, or smoking in general (including recreational drugs)
stress
overheating the testicles (spas, saunas, bike riding)
excess weight gain and excess body fat
Trauma
Bike riding (due to heat and trauma through the seat of the bike)
Poor diet and nutrition
Excess sugars and additives
Preservatives and artificial colours and artificial sweeteners

Environmental causes

exposure to industrial chemicals
heavy metals
radiation or X-rays

Medical reasons

infection of the testicles
cancer of the testicles
swelling of the veins (varicoceles etc) that drain blood from the testicle
hormone imbalances
physical problems in the tubes that carry sperm through the reproductive system
chromosomal or genetic disorders (such as Kleinfelters syndrome)
certain medications
surgery involving the pelvis, abdomen, or reproductive organs

How long do sperm live inside the female body?

There is always a huge misperception about how long sperm can survive outside the man’s body and when they enter into the female reproductive tract. Many women are told all manner of untruths of sperm lasting for weeks at a time. The truth is that sperm cannot survive for long once they are released.

Precisely how long they can survive depends on the environment that they are released into and how quickly the fluid surrounding the sperm cells dries up.

Sperm lifespan inside the female body

After ejaculation, sperm may be able live inside the female body for several days, but that is dependent on many varying factors once they enter a woman’s body. To be honest, most of the 300-500 million sperm are dead with an hour. That is a fact.

The fluid in a woman’s reproductive tract, especially the fallopian tubes, has all of the nutrients that sperm need for their survival during that time. But while the woman’s body can help sperm on their way to meet the egg, it can also hinder it their survival as well.

An egg has 24 hours to be fertilised, otherwise it dies

But even so, sperm really only have about 24 hours to fertilise an egg once it is released. After 24 hours, if the egg isn’t fertilised it will die, so really, it doesn’t matter how long the sperm can survive for if the egg has already died.

Poor sperm have to contend with many things when they enter a woman’s body. A woman’s vagina is coated in acids, to protect her from infections and bacteria, but it is also lethal to sperm. This is why within minutes and hours, most of the 300-500 million sperm that set off in search of the egg will be dead. Only a few million will survive to swim through cervix.

Climax helps with getting sperm into the uterus

A woman’s body can help to get the sperm going up into to the cervix though. Through climax (orgasm) contractions are created that can help pull sperm up and into the uterus. Through these contractions the cervix is dipped time and time again into a pool of waiting sperm and this then helps carry the sperm up into the second stage of their journey through the uterus and then up into the tubes.

Only a small number is sperm survive the journey

Once inside the female reproductive tract, the sperm cells must swim through the cervix and into the uterus to reach the fallopian tubes and then on to find the female egg. It is a very long journey for sperm to make and very few survive. Many get lost inside the uterus and some are attacked by the woman’s immune system along the way. By the time the survivors make it to the fallopian tubes to have a rest, there will only be less than 20 or more left to make the final journey.

After the sperm have a rest in the tubes and actually feed off some of the nutrients in the tubes many more will die, or be lost inside the tubes and by the time the final sperm reach the egg, there will be less than 10 single sperm left. Only one may then go on to fertilise the egg and an embryo is then started to be created.

All men should have there sperm quality tested

This is why all men need to have their sperm quality checked by a proper andrology lab and some men will need further testing of the DNA (DNA fragmentation analysis) and further genetic testing if the semen results are poor.

This should all be done prior to trying to conceive, as 50% of fertility issues are related to men. If a man has any of these risk factors, he should try to change them at least 3-4 months before trying to conceive, since that is how long it takes for sperm to fully mature. Some men may need longer than this, depending on what is causing their sperm to be of poor quality.

I will discuss some more myths and facts around sperm and what the most important parameters are to look at with sperm, in some later posts.

Regards

Dr Andrew Orr

-Women’s and Men’s Health Advocate

-No Stone Left Unturned

-The International Fertility Experts

How to cope with endometriosis and manage it moving forward

Posted on October 17, 2017April 27, 2020 by Andrew Orr

Endometriosis can be a challenging condition to deal with, both physically and emotionally. But with proper interventions and proper management and treatments after diagnosis, you can be shown how to deal with the associated symptoms of endometriosis and improve your quality of life. Please have a read of some of the best ways to cope with endometriosis.

What is Endometriosis?

Endometriosis can be painful disorder that is characterized by tissue that behaves like the lining of the uterus but that grows outside the uterus. Endometriosis is really normal tissue growing in abnormal places. This tissue can be found in various places, such as the ovaries, fallopian tubes, and pelvic lining, and even in or around the bladder and bowel.

Endometriosis affects around 1 in 10 women and girls and those are only the ones diagnosed. This mean these figures are grossly under-diagnosed and downplayed with many women not being diagnosed properly and those that do not even know they have the disease. Endometriosis can cause symptoms during the reproductive years, between the ages of 12 and 60, but it can show up in young girls under 10 years old too. Many people with the condition remain undiagnosed and many more and missed and dismissed with many taking up to ten years or more to be diagnosed.

What are the symptoms of Endometriosis?

The main symptom of the condition is usually pelvic pain typically associated with the menstrual period. While women can experience some discomfort during their menstrual period, some of those with endometriosis describe pain that is worse than usual. For some it is actually unbearable.

There are also other symptoms such as painful periods, pelvic pain, ovulation pain, pain with sex, chronic fatigue, irritable bowel like symptoms, bladder issues and pain and bleeding on bowel movement. This is why all women need to know that period pain is not normal, because many times, period pain can actually be a sign that a woman has an underlining gynaecological conditions such as endometriosis.

We also need for everyone to know that endometriosis is not just about period pain. There are many other symptoms women face when dealing with endometriosis.

There is no cure, but there ways to manage Endometriosis

There is no cure for endometriosis (not yet anyway), but there are treatment options and lifestyle changes that can ease your symptoms so that the condition does not interfere with your day-to-day life.

The main thing with endometriosis is to manage the disease and try and create a quality of life moving forward. While there is no cure for endometriosis, it is possible for women to become asymptomatic (meaning having no symptoms) and this requires the right treatments and management of the disease and to see the right people from the beginning.

Again, it all gets back to who you are seeing and their experience with knowing about endometriosis. This is one the biggest issues women face when trying to get treatment. Many just do not know much about the disease at all and why women are left to deal with the horrible symptoms. But with the right treatment and management, women can have a better life and be able to cope with this horrible disease.

Before we look at proper management for women with endometriosis, it is important that all understand the facts because there is so much misinformation out there and this is part of the bigger issue for women with this disease.

Surgical intervention and medications alone are not enough

While surgical interventions are hormones/medications are needed for women with endometriosis, alone, or in combination are not enough. We know that despite the best surgical and medical intervention that women are still in pain and still having the associated symptoms of endometriosis. This is why women do need a multimodality/team approach, and a combination of different modalities to effectively manage endometriosis.

The problem for many is that once they have the surgery, they believe their endometriosis is gone, or that they don’t have to do anything else. This is where many go wrong and why they end up having to have multiples surgeries. Women need proper ongoing management after surgery, which includes medications, hormones, other therapies, counselling, physiotherapy, mindfulness, exercise, diet and lifestyle interventions and so much more. Without this, endometriosis cannot be effectively managed.

The Facts About Endometriosis

Period Pain IS NOT Normal
A significant portion of women with Endometriosis are asymptomatic
Symptoms DO NOT correlate to the extent of the disease
The only way to diagnose Endometriosis definitely is via surgical intervention
There is NO cure for Endometriosis
Having a baby will not cure endometriosis
Endometriosis does not always cause infertility
Endometriosis is Estrogen Driven and is not caused by Estrogen dominance
The Pill, or Contraceptives DO NOT fix endometriosis
You can have Endometriosis at a Young, or Older Age
Hysterectomy does not cure endometriosis
Endometriosis requires a multi-modality approach to be managed properly. You need a team for proper management
Endometriosis IS NOT an autoimmune disease
There Are Hereditary and Genetic links
Endometriosis can cause many other issues in the body
The first line approach for hormone therapy should be the use of progesterone only options
Endometriosis needs to be excised (cut out) by an advanced laparoscopic surgeon, who has had extra years of specialised surgical training, and who specialised in the excision of the disease and specialised in the disease itself. Surgery should be performed by anyone other than an advanced laparoscopic surgeon and not by just a regular gynaecologist
Not all women with endometriosis have suffered sexual abuse

What Women Can Do To Help Manage Endometriosis

1.Seeing the Right Specialist & Surgeon

First and foremost make sure you have seen someone who specialises in endometriosis and the management and treatments moving forward. You also need to make sure that your first surgery is your best surgery and that you have seen an advanced laparoscopic surgeon to ensure you have had the proper surgical intervention. This is many women’s biggest issue as they have not seen the proper surgeon initially and they aren’t seeing someone who specialises in the management of the disease moving forward.

2.Watch your diet

Eating the right foods may provide some protection from the symptoms of endometriosis. The role of diet in endometriosis has been investigated in recent years due to the influence of diet on some of the processes linked to the disease, such as inflammation, prostaglandin metabolism, and estrogen activity. Many of the so called endometriosis diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all. Women need to adopt an anti-inflammatory diet (grain free, non-refined food ) to help with settling any inflammation in the body and also helping the immune system. This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.

Certain environmental estrogens such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating endometriosis too.

Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. We know that estrogen drive endometriosis and that any estrogens (dietary, body fats, environmental etc) needs to be regulated and controlled.

3.Boost intake of omega-3 fatty acids

Researchers have also found that the type of fat included in your diet makes a difference in your risk of endometriosis. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of endometriosis by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of endometriosis by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for endometriosis. Women should also be supplementing with Omega 3 oils too. Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training can help to reduce the symptoms of endometriosis.

Exercise may help those with endometriosis in many ways, including:

encouraging the circulation of blood to your organs
maintaining nutrients and oxygen flow to all your body systems
decreasing estrogen production
reducing stress
releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Women who regularly exercise may be likely to have the symptoms associated with endometriosis. Research has shown that those who engage in frequent high-intensity physical activity have fewer symptoms of endometriosis than women who do not participate in regular exercise. High-intensity physical activity, such as running, swimming, weight training etc, may be beneficial for reducing your symptoms.

Low-intensity exercise, including Yoga and Pilates may provide some relief in endometriosis, too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.

5.Managing Stress Levels

Stress is a big factor in any disease and can make any disease worse. Not only can stress be exacerbated by endometriosis, but so can endometriosis symptoms be exacerbated by stress, in a never-ending cycle. Endometriosis could contribute to making your stress levels worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques can help to reduce stress that exacerbates endometriosis-related symptoms and pain.

Women with endometriosis need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.Try complementary medicine and therapies

Many women with Endometriosis find symptom relief from using a range of different complementary and alternative medicines. The Royal College of Obstetricians and Gynaecologists also recommends that women try natural medicines to help with the management of endometriosis and the associated symptoms. There is now some good research to support many natural medicines treatments such as acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, yoga, pilates and more, alongside medical interventions.

Acupuncture and Chinese medicines has some good research around period pain and pelvic pain and may be beneficial to those suffering this disease and its associated symptoms, alongside medical interventions.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of endometriosis. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in endometriosis. Just like in the medical model, this can also be hard to find.

7.Medications

Your endometriosis specialist can provide you with a list of treatment options for endometriosis and outline the risks and benefits of each. They will take into account your age, your symptoms, whether you want to become pregnant, and any treatments that you have had previously. It is important to manage pain and inflammation so that you can have a life and to be able to function daily.

You may need to use different forms of pain medications on script, as well as those that can be purchased over the counter. Please ensure you speak to your healthcare provider about setting up a pain management plan when using medications

You will also need to look at hormone therapy to help slow down the growth and expression of the disease and microscopic implants and also help with the associated symptoms of the disease. Hormones will usually be in the form of progesterone only medications and gonadotropin-releasing hormone antagonists and agonists. You may be prescribed other hormones depending on your individual case and symptoms.

Although all of these hormone therapies are effective at treating endometriosis, but, they all have different side effects. You need to talk to your doctor and pharmacists about the side effects and risk factors of any medications and hormones that you are taking.

In Summary

It is important to know that women with endometriosis will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms.

Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who are experts in the disease too. Again, the approach that you and your healthcare profession choose to take will vary depending on your signs and symptoms, and whether or not you would like to become pregnant in the future.

Before starting any treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are and expert in endometriosis and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are experts in this area of medicine.

Regards

Andrew Orr

-No Stone Left Unturned

-Period Pain IS NOT Normal

-The Endometriosis Experts

Period Pain “Is Not” Normal and Doctors in Australia and The Rest of The World Need to Start Listening

Posted on September 9, 2017August 22, 2019 by Andrew Orr

Millions of women around the world are told that period pain is normal and then go on to endure years of suffering and even infertility because it. Some women have endured so much pain and been “missed” and “dismissed” by so many healthcare professionals so many times that they have taken their own life because of it. It just should not happen and it needs to stop.

One of the major causes of period pain is Endometriosis, or its sister disease Adenomyosis. This crippling disease can cause period pain, pelvic pain, joint pain, pain with bowel movement, irritable bowel syndrome, pain with ovulation, swollen painful belly (known as endo belly), chronic fatigue, anaemia, heavy painful menstrual flow and can lead to infertility. Some women will quite literally not even be able to work due to debilitating symptoms of this disease.

It is estimated to affect 176 million worldwide and affect one in ten women, but that is only the ones diagnosed, so those figures are grossly understated. The facts around the disease are also grossly understated and poorly understood by many and why so many women are “missed” and “dismissed” by all the so called healthcare professionals they have seen.

The other issue for a significant portion of women with the disease, is that they are asymptomatic (meaning no symptoms) and do not even know that have it. Many of them may never be diagnosed unless they are having problems falling pregnant, and even then many of them are not investigated properly to see if endometriosis is the cause of their long-term struggle to have a baby. It really is disgusting on so many levels. There is no other way to put it.

Of those one in ten women actually diagnosed many of them have taken up to ten years, or more, to be diagnosed and have their disease “missed” and been “dismissed” by multiple healthcare professional during their debilitating journey to find an answer for their sufferings. It is a nightmare of epic proportion for women world wide and the nightmare needs to end and healthcare professionals and everyone else needs to become educated and start listening to women and getting the message out there that “Period Pain IS NOT normal”.

So many women worldwide are suffering from period pain, pelvic pain, pain during sex, or infertility and endometriosis is the first thing that needs to be ruled out.

Young women in particular have trouble convincing people they are having more than just bad period pain. So many young women (and older ones) are told just to “Suck it Up”, or “Deal with it”. Many mothers will even tell their daughters “This is just normal”, or “This is just what happens”, or “I have to put up with this, so you need to as well”, when in fact nothing could be further from the truth. Teenagers are not too young to have the disease and have it diagnosed and investigated either.

Early intervention, diagnosis and management is crucial when it comes to endometriosis. The longer the disease is left, the harder it is to treat and manage, and left untreated can cause a woman years of debilitation and misery in every aspect of her life, years of surgery, years of pain killers and opiates, even after the best medical treatment.

Healthcare providers and women around the world need to know that the longer it takes to diagnose, the longer the disease is there and the more damage it can do inside the body. Some women will have their lives crippled by not having early intervention. Some women have got to the point that they can no longer put up with the disease and being dismissed and have either attempted taking their own life, or have succeeded in doing so. It is just so wrong that women get to this point.

The other issue that women face, once they are diagnosed, is that many of them end up seeing the wrong specialist to do their surgery. While most gynaecologists can do investigative surgery, many of them are ill-equipped to surgically remove the disease and actually do not specialise in the disease, or the excision of the disease properly. Many women are under managed surgically, which then leads to further complications and the need for multiple surgeries later on.

So many women have not seen the right specialist, who has not investigated and managed the disease properly and then left women to deal with the consequences of this inadequacy in their scope of practice.

Women and healthcare providers need to be educated that women who potentially have endometriosis, or have a high likelihood of the disease, need to see an Advanced Trained Laparoscopic Surgeon, who has had extra specialised training in the excision of the disease and who has had extra specialised training in the management and treatment of the disease as well.

Just because someone is a gynaecologist, or specialist, does not mean they are a specialist in the disease. This is also a huge misunderstanding when women require diagnosis and management of the disease and why so many are still left with crippling pain and symptoms, even after medical intervention. Quite simply, they have just seen the wrong person for the job and this also needs to be addressed in education and training around this disease.

The National Institute for Health and Care Excellence (NICE) in England has released the first ever guidance on managing this horrible disease that affects millions of women worldwide. They are hoping it will not only help GP’s and healthcare providers in the UK, but also GP’s and healthcare providers here and around the rest of the world too.

NICE is calling for GP’s in Australia and the rest of the world to stop overlooking symptoms of this disease, such as bad period pain, so that women are not “missed” and “dismissed” for up to a decade or more. NICE are asking for endometriosis to be taken more seriously than it presently is and while that is starting happen here in Australia and the rest of the world, the changes have still been too slow. It really is just not good enough given that so many women are suffering from this debilitating disease worldwide. The Australian government is listening, and much has been achieved, but the action plan has been slow to implement and there needs to be more done. Other countries need to follow suit too.

One of my motto’s is that “Period Pain IS NOT Normal” and I will continue to say this forever and a day and it is great to see national health care bodies like NICE actually backing that up and trying to get healthcare providers to do the same. While others are slow on the uptake, I will never stop in my quest to get women the help they need for this disease and will do my best to stop women being “missed” and “dismissed” and get them the help, care and attention they need and hopefully be a part of one day bringing an end to this debilitating disease.

Let’s hope governments and all healthcare providers finally start listening to the facts about endometriosis too. Let’s end the silence and get this information out there to everyone.

If you do want to find out more about the facts about period pain and this disease, you can visit my webpage, or you can also visit Endometriosis Australia at www.endometriosisaustralia.org.

I have a special interest in the treatment and management of this disease and spend countless hours researching and presenting education to both practitioners and public alike. I also see the consequences of this disease in my practice daily and have been assisting women with endometriosis for many years. I want every woman on the planet to know that Period IS NOT Normal and that there is help out there too.

Take care

Regards

Andrew Orr

-“No Stone Left Unturned”

-“Period Pain IS NOT Normal”

-The Endometriosis Experts

What Is Lichen Sclerosis?

Posted on September 5, 2017September 5, 2021 by Andrew Orr

Lichen sclerosis is a long-term problem of the skin. It mostly affects the genital and anal areas. Sometimes, lichen sclerosis appears on the upper body, breasts, and upper arms.

For this article I am just going to talk about Lichen Sclerosis of the genital region (Vulva) and more around how this affects women and how it can be treated and managed.

Lichen sclerosis can cause itching, pain and scarring of the affected areas, but there are treatments available that can relieve symptoms and prevent and treat scarring.

Much of the information out there is also outdated and it all seems to be doom and gloom, so I wanted to do a post and put some positive options up for sufferers. With the right treatment and management, women with Lichen Sclerosis can get their lives back.

Who Does Lichen Sclerosis Affect?

Nobody knows exactly how many women are affected, but it is thought that as high as 1 in 30 women could suffer from Lichen Sclerosis. While anyone can get lichen sclerosis at any age, women after the menopause have the highest risk. In fact, it is about 10 times more common in women than in men. It is possible, but rare, for children to be affected.

What Are the Symptoms?

Early in the disease, small white spots appear on the skin. The spots are usually shiny and smooth. Later, the spots grow into bigger patches. The skin on the patches becomes thin and crinkled. The skin may also be inflamed and red or ulcerated from scratching.

Skin affected by lichen sclerosis can tear easily, and there may be tiny fissures (cracks in the skin). When severe, there may be bleeding and blistering.Sometimes, the skin becomes scarred. If the disease is a mild case, there may be no symptoms.  Other symptoms are:

Itching (very common)
Discomfort or pain
Bleeding

Many women with lichen sclerosis are often misdiagnosed as having thrush because it too can also causes itchiness around the vulva.

Many women I see also have vaginal atrophy, which can be missed due to the focus on the lichen sclerosis. Women who have vaginal atrophy can also have pain with intercourse, and atrophic vaginitis can also exacerbate the symptoms of lichen sclerosis. It can be a vicious cycle if it isn’t properly diagnosed.

Some women may have lichen sclerosis, atrophic vaginitis and thrush combined and this is why differential diagnosis is so important and women need to see someone who knows about how to diagnose these issues correctly.

Women need to see someone who specialises in this area and treats these conditions often. With correct treatment and management, women can live very normal lives.

Genital lichen sclerosis

Lichen sclerosis that affects the vulva usually feels intensely itchy. There may also be pain, stinging, burning or discomfort, especially during sex or when urinating.

Lichen sclerosis is a chronic, or ongoing, condition, and over time it can lead to scarring. If this affects the vulva, it may narrow the entrance to the vagina, interfering with sexual intercourse.

Women with severe lichen sclerosis in the genitals may not be able to have sex. The disease can cause scars that narrow the vagina. Also, sex can hurt and cause the patches to bleed.

However, treatment with creams or ointments can help. Women with severe scarring in the vagina may need surgery, but only after lichen sclerosis is controlled with medication. When the skin around the anus is affected, pain when emptying the bowels can lead to constipation.

Four out of 100 women will go onto develop cancer of the vulva and this is why early intervention and management is so important.

What Causes Lichen Sclerosis?

Doctors don’t know the exact cause of lichen sclerosis. Some doctors think a too active immune system and hormone problems may play a role. In women, lichen sclerosis also seems to be associated with autoimmune diseases (conditions where the immune system attacks the body), such as lupus , alopecia and thyroid disease.

It is also thought that people inherit the likelihood of getting the disease.

There may also be a hormonal involvement as It is also more common after menopause, when there is less oestrogen in the body. This is why careful differential diagnosis is so important, so that other conditions are not overlooked as well. This is something that I see happen to women often.

Lichen sclerosis is more likely to appear on skin that has been damaged or scarred from some other previous injury. Importantly, lichen sclerosis is not infectious and your partner cannot catch it during sex.

How Is It Diagnosed?

Lichen sclerosis can often be diagnosed from the appearance of the affected skin. It is important that your GP refer you to a pelvic floor/urodynamic specialist, or women’s health specialist that specialises in conditions affecting the female reproductive organs. Sometimes a referral to a dermatologist may also be needed also.

Besides visual diagnosis, a biopsy may be recommended to confirm the diagnosis. This involves taking a small sample of affected tissue for a pathologist to examine under a microscope. This allows specialists to make sure that it is not a different disease.

Treatment of lichen sclerosis

Treatment of lichen sclerosis is aimed at:

Relieving symptoms of itch and discomfort;
Healing the lesions (returning the affected skin to its normal colour and texture);
Preventing the development of scar tissue; and
Treating any scar tissue that has developed.

Medical Treatments for Lichen Sclerosis

Lichen sclerosis is usually treated by applying a strong steriod cream, or ointment to the affected area. This is usually applied daily for several weeks, or months, and then less frequently (once or twice per week) long-term to prevent a recurrence.

Corticosteroid ointment or cream should be applied only to the white patches and gently rubbed in. Try to avoid applying steroid to the normal surrounding skin to help prevent side effects.

Symptoms such as itch may improve within a couple of days of starting corticosteroid treatment. Healing of lesions generally takes longer.

Women with Lichen Sclerosis will need regular follow up consultations and management with their specialist while using these creams and ointments for a long time because they can cause the following

Thinning and redness of the skin
Stretch marks where the cream is applied
Genital yeast infections.

Sometimes, women just do not get better using this medication and there could be other things that could be stopping symptoms from clearing up. This could be from the following:

Low estrogen levels
Infection
Allergy to the medication.

Other treatments

If topical steroid treatment is not effective, your specialist may recommend other medications and treatments that target the immune system and help control inflammation.

Sometimes other medications such as Retinoids, or vitamin A-like drugs are used and your specialist may also recommend laser treatment.
If scarring has occurred, this does not usually improve with steroid treatment. Scarring in females that is affecting sexual intercourse or urination may be helped by surgery
There are also some new medical treatments that are presently being researched and providing some amazing results options and I will discuss at a later date. They are actually natural medicines that are being used as a medical treatments. All I can say is that I have seen the results of this new treatment option and I think it is going to help many people. At present on of my colleagues is using this treatment to help women as part of a research project. I will update people when I am allowed to say more about this new treatment.

Natural Medicine Treatments

There are natural medicine treatments that may assist in the management of Lichen Sclerosis, alongside medical interventions.

Self-care measures for genital lichen sclerosis

The following self-care measures may help in the treatment of lichen sclerosis that affects the genital area.

Gently wash the area daily with warm water and pH neutral soap cleanser.
Try not to rub or scratch the area. This can sometimes be really hard when it is itchy and inflamed
Avoid tight clothing and any activities that may aggravate itching and discomfort, such as bike riding.
Your specialist may recommend you apply cream to gently moisturise and protect the area.
Women should use a mirror to become familiar with the location and appearance of their genital lesions, and to apply cream or ointment to the affected area of the vulva.

Complications and follow-up

If you have been diagnosed with lichen sclerosis then it is advisable to have regular follow-up appointments with your specialist every 6 to 12 months.

In addition, genital lichen sclerosis is associated with a small, but important, increase in the risk of cancer developing at the affected site. As mentioned before 4 out of 100 will go on to develop cancer of the vulva.

This is why frequent check-ups are important to detect any cancers early on, when they can be more easily treated. This is why I always say that early intervention and proper treatment and management of any disease and the same goes for lichen sclerosis.

I have helped and assisted many women with Lichen Sclerosis in my years in practice and I do find that a multimodality approach is the best way to assist and manage this disease effectively.

Sometimes you need to have a team to help treat this, just like many other diseases women endure.So many women are are at their wits end with this disease and all sorts of treatments that have not worked. The problem is that they have just seen the wrong people and haven’t been properly looked after.

Women with Lichen sclerosis can be helped if they see the right people and get the right help and proper clinical health care and management. You just need to find the right people who know about this disease and how to treat it properly.

I can say this, if this disease is treated and manage properly, it can give women their quality of life back. Instead of all the doom and gloom and negatives things, let’s get some positivity back and give women with this disease some hope. There always hope and you just need to know where to find it.

Take care

Regards

Andrew Orr

Women’s & Men’s Health Advocate

-“No Stone Left Unturned”

-The Women’s Health Experts

Women with PCOS Have Four Times Higher Risk of Developing Type 2 Diabetes

Posted on August 31, 2017August 22, 2019 by Andrew Orr

One of the hardest things I find that is hard to get through to women with PCOS, is their risk factors for type 2 diabetes, gestational diabetes and their increased risk of cardiovascular disease. They just aren’t being educated about it either.

It has long been known that the major driving factor behind PCOS is insulin resistance and this also increases the risk factor of developing diabetes for those with this endocrine/reproductive disorder.

Polycystic ovary syndrome is an endocrine/reproductive disorder that affects millions of women of reproductive age worldwide, and a new study has shown that it also put these women at a significant risk of developing type 2 diabetes.

PCOS is also the leading cause of female infertility and many women with this condition are often misdiagnosed, or do not know that they have it. PCOS is also a risk factor for miscarriage too. Please see my other posts about signs and symptoms of PCOS. (Click Here)

All women with PCOS will have insulin resistance, either hereditary insulin resistance, or purely caused by diet and lifestyle choices. Insulin resistance is a condition wherein the muscles, fat, and liver do not respond properly to the hormone, so the body keeps producing more of it.

Excessive insulin production is a risk factor for type 2 diabetes and gestational diabetes. This is why it is so important for women with PCOS to follow a modified low GI/low inflammatory/ style diet and that the number one treatment for assisting PCOS (as recommended by the World Health Organisation) will always be diet and lifestyle changes.

Young women with PCOS at risk

This new study investigated 54,680 women in total and found that younger women with PCOS are now more at risk of developing diabetes than older women with the disease. The study found that the risk factor for developing diabetes is four times greater for younger women. This is probably due to poor diet and lifestyle choices that many young women are choosing these days.

The increased risk of developing type 2 diabetes is an important finding and this is something that women with this disease should know, especially those who are obese and have PCOS as well. But it is important for women that are of normal weight, or even underweight to know that they are also at an increased risk as well. Just because you are underweight, or of normal weight, doesn’t mean you cannot have PCOS, or be at risk of diabetes.

This new research was carried out by Denmark-based scientists and the findings were published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

If you do need help with managing PCOS and dietary and lifestyle changes, then please call my friendly staff and book in for a consultation with me.

Regards

Andrew Orr

-Women’s and Men’s Health Crusader

-“No Stone Left Unturned”

-The Women’s Health Experts

Atrophic Vaginitis

Posted on August 25, 2017August 22, 2019 by Andrew Orr

Atrophic vaginitis is a vaginal disorder that usually happens after menopause, but it can happen long before this time as well. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed. This then causes the surrounding tissue to lose its elasticity and become atrophied.

This can be uncomfortable and it can make sex uncomfortable, or extremely painful. Gynaecological conditions such as endometriosis, adenomyosis and fibroids can make someone more prone to atrophic vaginitis as well.Many women that have atrophic vaginitis may not even know that they have it.

As many as 40% of postmenopausal women experience symptoms of atrophic vaginitis after menopause, but only 20 to 25 percent will seek medical help.

Many women will not seek treatment because they feel embarrassed due to the sensitive nature of the condition. Some women just put up with it believing it is normal.

Untreated, it can affect a woman’s quality of life and even lead to increased risk of prolapse and other gynaecological and urological conditions. Many of the treatments are non-invasive and are very effective in a short amount of time.

Symptoms of Atrophic Vaginitis

vaginal dryness
pain during sexual intercourse, or dyspareunia
thin, watery, yellow or gray discharge
paleness and thinning of the labia and vagina
irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
more frequent urinary tract infections (UTIs), or urinary tract like infections(which is from inflammation, with no infection present)
Vaginal Prolapse

Symptoms can also present in issues with the bladder and urination

painful urination
blood in the urine
increased frequency of urination
incontinence
increased likelihood and occurrence of infections, or irritation to the bladder that may feel like an infection

There may also be a reduction in pubic hair, and the vagina may become narrower and less elastic, which may cause a condition called vaginismus.

Causes

During perimenopause, menopause and post-menopause, a woman can have decreased levels of estrogen. When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions are reduced. Similar changes can happen to women after childbirth, but these changes are temporary and less severe.

These same changes can happen for women with endometriosis and adenomyosis and often why there can be changes to the wall of the vagina. Some of the medications used to help these conditions can also cause thinning of the vaginal wall and surrounding area. Many women with endometriosis, adenomyosis, fibroids etc, will have increased risk of atrophic vaginitis during the perimenopause, menopause and post-menopausal period.

Medications, or hormones, can be used as part of the treatment for breast cancer, endometriosis, adenomyosis, fibroids, or infertility to reduce estrogen levels. This decrease in estrogen can lead to atrophic vaginitis.

Other causes of atrophic vaginitis include:

severe stress
depression
Surgery, or treatment to the pelvic area
uncontrolled diabetes
rigorous exercise
chemotherapy

Other substances that can cause further irritation to the vagina are:

smoking
soaps
laundry detergents
lotions
perfumes
douches
tampons
yeast infections
condoms (due to latex allergy)

Diagnosis

The best person to see for this condition is a pelvic floor/urodynamic specialist, or a women’s health specialist. While you GP can help with diagnosis of this condition, it is preferable to see a specialist who has more training in this condition and can help manage this moving forward. A specialist will carry out proper examinations, be able to diagnose this correctly and ask about medical history. They may ask about the use of agents that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.

Your specialist will also do tests to rule out STI’s and other possible causes of infections such candidiasis, bacterial vaginosis etc. Atrophic vaginitis can make the area more susceptible to becoming infected. It can occur alongside an infection. A diabetes test may be performed to rule out diabetes. A biopsy may be taken to rule out cancer.

Treatment

The first line treatment is usually conservative treatments with topical estrogen creams inserted into the vagina and focuses treatment on the affected area. A low-dose estrogen cream can be used to stimulate rapid reproduction and repair of the vaginal wall, tissue and cells. Women should be shown how to insert the creams with an applicator and then use their finger to help disperse the cream properly to get good coverage of the vaginal wall.

Creams are much better than pessaries, because pessaries often do not disperse well and may only give coverage to a small area. These creams are also safe to use for those at risk of certain cancers, or who have had hormone dependent tumors.

Some women may also need to take Hormone Replacement Therapy (HRT), in the form of a tablet, gel, patch, or implant to supply estrogen to the whole body. These estrogens are effective, but there may be side effects. Patients should discuss the risks of long-term HRT (especially breast cancer risk) with their healthcare practitioner.

Some women may also need to use a water-soluble vaginal lubricant may help to provide relief during intercourse, for mild cases.

Regular exercise is important, as it keeps blood flow and genital circulation high. Pilates and yoga may be beneficial for the pelvic floor and core stability and should be part of a woman’s overall lifestyle management. Women in the perimenopause and menopausal periods of their life should be doing some form of weight baring and strengthening exercise regularly.

There are also natural medicines that may assist in the treatment of atrophic vaginitis. Acupuncture and Chinese herbal medicine may help and assist with the symptoms of atrophic vaginitis (such as pain), alongside medical treatments.

Prevention

Regular sexual activity and stimulation of circulation to the vagina can help prevent atrophic vaginitis. It is more around climax helping, rather than just sexual activity, or intercourse. Some women have pain during intercourse, or experience dryness, so foreplay and being well lubricated can help this. Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse. Masturbation and stimulation without intercourse to produce climax may help those women who have pain with intercourse, or who may not have a partner.

Regular climax and sexual activity can also show benefits for both the elasticity and flexibility of the region. Women who have regular climax and are sexually active report fewer symptoms of atrophic vaginitis when compared to women who do not regularly climax, or have regular sexual intercourse.

Regular exercise, such as Pilates and Yoga may assist in helping with the pelvic floor, vaginal tone, bladder and reproductive organs. Kegels exercises, and vaginal eggs/stones may also assist with atrophic vaginitis, alongside medical interventions.

There are natural medicine which may assist with the prevention of atrophic vaginitis and assist with circulation and hormone regulation. To find out more, please consult your healthcare provider.

Fast facts on atrophic vaginitis

Atrophic vaginitis refers to dryness of the vagina.
Symptoms include painful intercourse and an increase in urinary tract infections (UTIs), or urinary tract like infections (due to inflammation of the bladder, not from infection).
It is caused by a reduction in estrogen, normally following menopause or treatment with anti-estrogen drugs. It can also be caused from gynaecological conditions such as endometriosis, adenomyosis and fibroids.
Topical treatments and hormone replacement therapy (HRT) may help relieve symptoms
Around 40 percent of postmenopausal women experience symptoms of atrophic vaginitis, but many do not seek treatment.

If you do need help with suspected atrophic vaginitis,please see your healthcare provider, or see a specialist in this area.

Take care

Regards

Andrew Orr

– Women’s and Men’s Health Advocate

-“No Stone Left Unturned”

-The Women’s Health Experts