In this episode of PodMD, Specialist Menopause and Menstruation Wellness Coach, Dr Baljit Rana will be discussing the topic of Menstrual and Reproductive Challenges.
- Transcript
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*As always, all in this PodMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMD studio Dr Baljit Kaur Rana.
Baljit has a background in Psychology, teaching and working as a Psychologist. She currently teaches at Monash College. Baljit is a passionate professional dedicated to providing specialist holistic coaching support for young girls going through challenging and sensitive hormonal issues during menstruation, such as Endometriosis, PCOS, and for women transitioning through the menopause stage of peri menopause, menopause and post-menopause in their lives. She is the founder of MenoBloom based at the Clynden Avenue Specialist Centre in Malvern East Melbourne.
Today, we’ll be discussing the topic of hormone-related conditions, such as endometriosis, PMS, PMDD, and PCOS.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expresssed in this podcast are those of the doctor, not PodMD. If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Baljit, thanks for talking with us on PodMD today.
Baljit: Thank you so much for having me here to discuss this very important topic.
The topic of today’s discussion is hormone-related conditions such as endometriosis, PMS and PDP MD Theologic. Can you describe for our listeners what hormone-related conditions are?
Baljit: Yes, I can. So I’ll just run through the different ones here. So the first one is Premenstrual syndrome in no particular order, there’s just there’s range that comes under this category, PMS, abbreviated to. So this is where girls and women may experience days or weeks leading up to their menstrual period, physical and psychological symptoms such as anxiety, depression, disturbed sleep, mood swings, anger and aggression. So the exact cause of PMS is not really known, but there is evidence to suggest that there could be a genetic susceptibility for some women. Approximately 90 percent of girls and women experience PMS.
PMDD, premenstrual dysphoric disorder, is a very severe form of PMS, affecting approximately 5% of girls and women. Symptoms are more intense than PMS and they do have a more of a negative impact on young girls and women. So these symptoms include severe mood swings, marked anxiety, lethargy and a decrease in their usual activities, usually occurring about two weeks before the menstrual period, and then they get better about a couple of days before the start of the period. Then they’re reduced minimally a week after the period.Polycystic ovary syndrome (PCOS is a complex hormonal condition that affects millions of women worldwide. This is where there is a disruption of the normal functioning of the ovaries that often can lead to irregular periods, excessive hair growth, acne, weight fluctuation and fertility challenges. Although it is a common condition, PCOS can often be misunderstood, leaving many young girls and women feeling frustrated and unsure of how to manage their symptoms effectively.
Endometriosis, can be referred to as Endo, is a menstrual health condition affecting approximately 1 in 7 women. This is in Australia of reproductive age, so that’s about 14% of the population, and it takes on average 6 1/2 to 7 years to receive a proper diagnosis. And unfortunately there isn’t any cure for this debilitating chronic disease, so it is very important to raise awareness of this menstrual condition so that young girls and women, you know that have that do experiences throughout the life can recognise the signs, don’t stay quiet and can get the help they need sooner rather than later. So endometriosis can happen when there’s tissue around the uterine lining grows outside the uterus. This can result in intense pain, heavy or regular periods, digestive issues, and even fertility challenges. Endo is more than just having painful periods. It’s a lot more than that. It can affect multiple organs such as the ovaries, fallopian tubes, bladder, intestines, where there can be inflammation, scarring and adhesions that will have an impact on the daily life. So there’s a lot that obviously can come with this condition. So it is chronic and but they’re not being a cure very important to get early diagnosis and management of strategies on how to deal with those. These can include pain relief or minor treatments, and in some cases, surgery can improve the quality of life.
Question 1
How would a patient with endometriosis typically present?Baljit: So, I will focus our chat today on endometriosis. Although I have pointed out that the other different hormonal conditions are all very important, PMS, PMDD and PCOS. But we will focus on Endo today. So in Australia, the average time to get a diagnosis for endometriosis is about 7 years. The reasons for that, and it sounds like a long time, and it is a long time for the patients to go through that over those years, not knowing what they’ve got and obviously suffering without any treatment.
The reasons are that, you know, having period pain and pain around your periods and menstruation is typically seen as being normal and to be expected. However, obviously symptoms can vary between girls and women, and they can change over time, so initially a GP will assess the symptoms that the patient is presenting with, and these could be like saying they’re having painful periods pelvic pain, pain during or after sex, heavy periods, feeling sick, constipated, having diarrhoea or experiencing difficulty getting pregnant.
The GP will then ask them about their family and medical history, and then an internal examination can also be carried out. The GP could recommend an ultrasound or a laparoscopy, which is keyhole surgery, usually performed by a gynaecologist or a laparoscopy specialist, or there could be magnetic resonance imaging, so an MRI. Some girls and women have asymptomatic endometriosis, where they don’t experience any common symptoms of pelvic pain or infertility. So, the big thing here that we really need to talk about and not ignore is that it’s not just physical symptoms that young girls and women will be presenting with. There are huge mental and emotional health issues associated with endometriosis, and these are frequently disregarded: stress, worry, lower self-esteem, low moods and despair can result from managing the chronic pain, difficulties conceiving and the unpredictable nature of their symptoms.
So, coping with this condition, this chronic debilitating condition and trying to enhance the general well being does require regulating the emotions. So, these are obviously up and down and prioritising mental health. Endometriosis is a disease with more than physical symptoms and and as people, you know, young girls and women are negotiating life, going through their day-to-day with this chronic illness, a lot of them do go through an emotional rollercoaster, so they’re feeling frustrated, depressed and perhaps, anxious as well, which is very, very common. As well as feeling helpless because of the uncertainty of flare-ups – “When is this gonna happen?” “Is it gonna happen when I’ve got a really important deadline or work commitment, or social event?”They could also have difficulties locating and knowing what a suitable medication is that would suit them and is is helping them with their symptoms.
Another really, really common thing that we can’t ignore is that young girls and women who deal with this condition could also feel very misunderstood. There have been research also referring to as medical gaslighting, where they are ignored and told “it’s common it’s normal you’re having you know period pain, and it’s heavy periods”, but you know they need to be able to talk openly amd mpt feel scared to tell people the fact that they’re not able to engage in some of the activities around social work, family, of studies because of the pain that they’re suffering. Unfortunately, this could also result in them feeling socially isolated because of that, because every time there’s an “I can’t do this, can’t do that”. So, you know, that’s really, really important to recognise, too and that that’s a real big factor in addition to the pain that they’re experiencing.
So also endometriosis, the symptoms can be intensified by having chronic stress. And there can be a vicious cycle where there’s emotional suffering with aggravated physical pain and vice versa. You do have also stress hormones like cortisol, which can increase inflammation, obviously because you’re going to be feeling stressed and anxious at this time and you go through all of that, and this can result in an increase in inflammation and pain sensitivity, which can then obviously complicate the control of the symptoms. So, it is really important to address the emotional well-being for mental health, but also because this has a, you know, connection with physical symptoms, to try and reduce those and the intensity of those physical symptoms.
Question 2
That’s really interesting, Baljit. So in terms of the risks or efficacy, can you explain a little bit more about the condition?Baljit: So, just to summarise for this discussion here, these are typically the most common ones are infertility or getting pregnant, difficulty getting pregnant. So, this can affect about 30 to 50% of women. Long-term bladder or bowel problems, that’s also common as well. Chronic pain that is also very debilitating, that can be affected with this condition which comes with it, depression, stress and anxiety- there’s a psychological and emotional outcomes as well that can affect them. Overall, quality of life being impacted.
Question 3
What are the treatment options available to patients?Baljit: There is no set cure for endometriosis, and like I mentioned, I’m not a medical practitioner. I practice as a menopause coaching specialist and a menstruation coach. As I mentioned earlier, I work at Clydnen Avenue specialist centre with Doctor Shami, who’s a very experienced cardiologist and expert laparoscopic surgeon. So I am aware through the training that I’ve done and the work that she does, that we worked together, that there is obviously, there can be hormonal and medical treatments for endometriosis such as the pill, progesterones and gonadotrophin-releasing hormone analogues (GnRHa). This could reduce the pain and severity of the condition by reducing the growth of the endometrial cells and stop the bleeding. However, symptoms could return if the treatment is stopped. Laparoscopy surgery involves the removal of the endometrial tissues and reducing the development of adhesions. If there is endometriosis that’s found in the bowel or bladder, a urologist or a colorectal surgeon could also be involved in the procedure, so there has been shown this research has shown that laparoscopy surgery improves the symptoms of endometriosis and the overall quality of life for young girls and women.
Pelvic floor physiotherapists can also support with the reduction of pelvic pain symptoms and painful sex by assessing the pain and teaching dental stretches and exercises. You can also have alternative treatments and therapies, including psychology, that side of it, so it could be cognitive behavioural therapy, diet and physical activity, natural therapies, including supplements like vitamins, minerals and fish oils, herbal medicine, tea tablets, liquids and nutrition. There is limited research that has evaluated the actual benefits and effectiveness of these, but these are all individual for different women and girls, too, obviously, to use and to try out. See if that helps them with their symptoms.
Ryeqo was introduced in Australia last year as a treatment for endometriosis, their medicinal treatments. Specifically, to help with moderate to severe pain. So, these are obviously different treatment options and in terms of how you know, the symptoms can be helped, physical ones and psychological and as I mentioned in the work that I do, I provide a holistic approach to supporting young girls and women with their diet, nutrition, fitness and psychological side of you know, helping them to their mindset and coping with these symptoms as well.
Question 5
Have there been any developments in treatment in the last years or are there any in trials or in development at the moment?Baljit: I’m aware of just doing some research myself, obviously I’m not a medical practitioner, but I’m aware of medical clinical trials that are ongoing globally. The University of Oxford are testing a specific imaging technique before surgery to detect whether there are endometriosis lesions. There is also scientific research that’s looking at how the potential immune disease dysregulations could contribute to the disease, and also the studies exploring how dysregulation of the gut microbiome could be linked to the pathology of the disease. There is also ongoing research about the link between gastrointestinal disorders and endometriosis, they also continue to be investigated.
Aside from any developments in treatment and trial clinical trials, there are also a lot of advocacy groups and support groups across Australia who do provide excellent help and resources and tools and evidence-based information to young girls and women suffering with endometriosis, these include Endometriosis Australia, Endozone, Endohelp, pelvicpain.org.au and EndoFoundation Australia, so these also provide apps as well for helping women to manage and track their symptoms as well. So they’re really good too.
Question 6
Are there any warning signs that the GP should look out for?Baljit: Yes. So some of the main problematic symptoms that patients and GP should look out for are chronic pain, so with their period or pelvic pain areas, so pain due to their periods of the pelvic regions, part of their body. The pain during or after sex, heavy periods and the psychological impact on their overall well being and daily functioning. This is an area that does require a lot of attention and support, particularly as I mentioned earlier, they could be living with these symptoms without a diagnosis, 7 years is typical. So that really could have a huge impact on them not knowing what’s happening, why, what’s going on, what’s wrong with them likely to have a huge impact on the mental health, self-esteem, negative body image and overall well-being. Obviously, a psychological impact of living with such a chronic, debilitating condition and you know, it’s important for them to feel that they have some sort of control and balance to manage this condition as well, which there is no cure for. So this is where obviously at Menobloom, I’m focusing on hormonal wellness. Through the clinic work that I do to provide coaching support to young girls and women to navigate through their symptoms, because it’s not just about managing physical symptoms and pain, obviously they can see the the specialists for GP’s and other specialists get the medical interventions. They also need to learn tools to be emotionally resilient, manage their stress and practise self compassion- very important components of well-being and and obviously individuals who are living with endometriosis can improve the quality of life by incorporating mindfulness, emotional support, and self-care into their daily routines.
Question 7
What’s the likelihood of the recurrence of this condition?Baljit: Because there’s no cure as such to to to get rid of it forever, it can recoccur after treatment. So that could be after laparoscopic surgery or whatever other treatment they’ve gone through or, you know, taking the pill or whatever else. Typically, it’s not something that’s just going to go away on its own, especially if it’s not treated. However, some symptoms may improve naturally, and treatments can help manage the condition and reduce the pain.
After menopause, a condition often subsides as the oestrogen levels drop and there is also just to add to this as well, there’s a lot of people who suffer with this, and research has shown this as well. And you know everyday practise is that by getting pregnant, I could alleviate, for that time being, the symptoms that you have, obviously, of endometriosis. Although it could be something that can affect fertility, but it’s also. A lot of the time people will hear, they’ll say, well, if you get pregnant, you know, that would help you to alleviate some of the symptoms. You won’t get rid of it, obviously, but it could help with the symptoms as well.
Question 8
So Baljit, when should a GP refer?Baljit: Typically, a GP should refer a patient to a gynaecologist or an expert laparoscopy surgeon at the earliest opportunity that they can get that specialist advice and treatment and obviously themselves they can do some screening measures and scans as well.
Question 9
Ok, and what role does the GP play in the treatment of the condition?Baljit: Very, very important role, again being the very first point of contact. They can listen to the patient, their symptoms and and you know, hear them talk about the impact it’s having on their lives. They could suggest to the patient, they keep a track of their symptoms via a diary or an app. This will give them a for themselves and to the GP, a record and summary of the severity and duration of the symptoms because they will all be different for different people. If the symptoms are persistent and chronic, then that’s when the GP should proactively make a referral to a gynaecologist and or pelvic pain physiotherapist.
Obviously I mentioned earlier too, that there is support aside from the GP and we can work, we work very well together. I work very well together with the GP’s and this holistic support that we have with hormone or wellness coaching that can help young girls and women with their emotional well-being, and educate them about how they can make lifestyle changes and how they can build a supportive community. That’s a huge thing in this area where it is a very common condition and a lot of people have suffered for a long time, and having a community-based or support, whether it’s the advocacy groups, but even just through other people who are suffering with the symptoms comparing stories and their journeys, and what treatment options have been done. That’s important too. So that’s that’s something that I definitely need to acknowledge.
Question 10
Thanks for your time here today in the PodMD studio. It was lovely having you again. To sum up for us, could you please identify the three key take-home messages from today’s podcast on hormone-related conditions?Baljit: Thank you so much for inviting me here again to talk about this really very important topic in relation to the various hormonal-related conditions and hormonal wildness that’s important for us to practise and be aware of. So, I guess there are many messages like with all these topics, just to pick out three, I’d say the range of hormonal conditions needs to be acknowledged that there are a few of obviously focused on endometriosis today. There is also a PMS, PMDD and PCOS as well. That can affect a lot of young girls and women across Australia and internationally.
The second message I guess, would be about trying to encourage young girls and women to be proactive and confident to get the medical and other interventions and support that they need and to not suffer in silence. So hopefully over the years to follow we can decrease that seven years of getting a diagnosis, that would be a really, really important, you know, takeaway and a real big win there, big outcome for everybody.
Thirdly, just continuing with scientific and academic research. Raising awareness through education and definitely this is what I’m doing as well, and the work that I do is not just in the clinic, I do a lot of stuff on the ground in the Community Schools and colleges and universities, workplaces, community based organisations to let them know that these conditions exist, what symptoms to look out for and to you know, let them know about the range of holistic and integrative support that is available for them as they navigate through these really complex hormonal conditions that can have a huge impact on their day-to-day life overall well-being, physically and emotionally.
Well, Baljit, thank you so much for your time and the insights you’ve provided.
Baljit: Thank you so much. It’s been a great pleasure and a great opportunity for me to have this platform to do that to raise this awareness and to, you know, encourage young girls and women to get the support that they need and not to stay quiet and to know that there are a lot of specialist practitioners out there to help and support them.
