Daily Archives: September 10, 2020

Nattydread

Endometriosis: The Great Chameleon

Endometriosis is an inflammatory autoimmune disease that affects 1 in 10 women globally, and impacts women mainly during their reproductive years. Secondary to the ability of these inflamed tissues, or inflammatory mediators possibly spreading to anywhere in the body, endometriosis is woefully underdiagnosed, and misdiagnosed. Unfortunately, it can take an average of up to 15 years, before a woman is diagnosed with endometriosis. Those intervening years of non-treatment, and constantly being exposed to the cognitive bias of psych-out bias, most of the women suffer from excruciating pain, devastating disabilities, as well as, untreated fertility issues.

Alas, endometriosis can cause migraines with subsequent seizures. Many women with lung and heart issues are not asked about the occurrence of these symptoms with their menses, which should be a routine part of the history of reproductive-age women. Additionally, lung lesions are normally only realized when the patient’s lung collapses, and the patient undergoes emergency surgery.

Another issue with the prolonged misdiagnoses of endometriosis, is the lack of understanding that Stage 0 endometriosis has no macroscopic, or critical mass findings. Thus, endometriosis is a clinical diagnosis, and not a pathological diagnosis. Unfortunately, there may not be enough tissue specimens to even send to pathology. A patient who has to go to the emergency room almost every month when having her menses due to excruciating pain, has endometriosis, even if there is no evidence of pathological disease upon diagnostic laparoscopy. However, if an endometrioma is found during laparoscopy, it is now recommended to ultimately perform an oophorectomy emergently for increased risk of ovarian cancer over time. In the face of pulmonary endometriosis/thoracic endometriosis syndrome, removal of the endometrioma normally results in the lung symptoms being resolved.

There is no cure for endometriosis at the moment, even if one removes both ovaries, and uterus during surgery. The adrenal glands and the patient’s adipocytes, especially if overweight, or obese will produce estrogen analogs/imitators, and can cause symptoms, wherever there are endometriosis lesions, or inflammatory mediators in the body.

The severity of the systemic endometriosis symptoms should be decreasing as one approaches menopause. However, there is postmenopausal endometriosis, although it is rare. With the advent of Telemedicine, psych-out bias, and posterior probability bias should be greatly diminished relative to improved continuity of care. Thus, endometriosis with more education, awareness, and academic studies should be easier to diagnose over time. There is a blood test developed in England, but the sensitivity is only 90%, meaning the test can miss 10% of positive cases.

Nattydread

Treatment for Low Sexual Desire in Women

Hyposexual desire disorder (HSDD) or low sexual desire in women, affects about 1 in 10 women globally. The causes of low sexual desire in women are varied, and many. The main causes I have seen in my practice are due to oral contraceptives, intrauterine devices, implantable hormonal devices, occupational/life stress, anxiety/depression, and psychiatric medications.

Unfortunately, obesity also plays a huge role in low sexual desire in women. Obesity is a chronic inflammatory state, and can cause hypertension, heart disease, kidney damage, and diabetes. One of the main side effects of medications used to treat the aforementioned diseases, is low sexual desire. So it is absolutely important, to maintain a body mass index of 25, and a waist circumference of 35 inches in women. Additionally, obesity can be responsible for polycystic ovary disease (PCOS), and infertility.

The most important systems to be optimized are endocrine, such as, thyroid/parathyroid levels, a circulatory system diagnostc laboratory test, such as hemoglobin level, and vitamin B/D levels. Optimization means that levels should be above the 50th percentile, sometimes even closer to the 100th percentile. The level should be titrated to how the patient feels relative to the improvement in symptoms.

The main treatment for low sexual desire is dietary/lifestyle change. The diet that is normally recommended for low sexual desire in women is the green Mediterranean diet. It is important to make sure that this diet has organic/non-GMO/no gluten, components, since regular food has a lot of hormones/steroids, antibiotics, and fertilizers/dioxins.

Medications that are available to treat low sexual desire in women are few. The drug that works really well after any underlying medical conditions are stabilized or resolved, and the aforementioned optimization of systems achieved, is Addyi. Addyi can take up to 8 to 12 weeks to start working, the shortest time frame I have seen in my practice is 2 to 3 weeks, and I advised the patient to discontinue her oral contraceptive prior to starting Addyi. Once underlying medical conditions are stabilized, Addyi can be effective 70 percent to 90 percent of the time, otherwise, it is only 10-20 percent effective.

Telemedicine/Telehealth is a methodology for facilitating the delivery of women’s health, and should be utilized frequently to improve the care of women globally. Low sexual desire in women is easily eradicated with Telehealth/Telemedicine, as a modality for the delivery of women’s healthcare.