Meet Dr. Jessica Theron, an Obstetrics and Gynaecology Register, on a mission to revolutionize women's health by shedding light on endometriosis and chronic pelvic pain.
Name: Dr Jessica Theron
Day job: Obstetrics & Gynaecology Registrar with NSW Health
Location: Sydney, NSW
Why the focus on endometriosis and pelvic pain?
My special interest in endometriosis and chronic pelvic pain comes from my experience with my (amazing!) sister, who has stage IV endometriosis. We’ve sat in many hospital beds together over the years. We’ve listened to many specialists and doctors, some helpful and some less helpful. We quickly realised that the health system wasn’t designed very well for people with chronic health conditions like endometriosis. We realised that things needed to change, not just for her, but for the one in five women around the world who live with chronic pelvic pain every day.
What is Ella Health?
Ella is an online platform and community making care for people with chronic pelvic pain more affordable and accessible. In the app you have access to things like daily mindfulness, meditation, relaxation and CBT audio sessions, as well as guided breath-work.
We know from research that a whole person approach to chronic pelvic pain is best; using a team of providers to address every aspect of the pain experience. This includes addressing things such as diet, pelvic floor dysfunction, anxiety, pain system hypersensitivity, and nervous system dysregulation.
We’ve partnered with some amazing clinicians to put all this good stuff in one place. Our first product is a 6-week pain program delivered via our Ella app. It’s the first of its kind in Australasia and we’re pretty proud of it!
Can you describe the difference between a ‘normal’ and ‘abnormal’ period?
Cycle length varies a lot between individuals, but most are between 21 and 34 days. In terms of flow, bleeding tends to last for between 2-7 days, and should not be so heavy that it interferes with your quality of life.
These are some important things to look for that may indicate your bleeding is heavier than normal:
- Bleeding that lasts more than 7 days
- Bleeding that soaks through one or more tampons or pads every hour for several hours in a row
- Needing to wear more than one pad at a time
- Needing to change pads or tampons during the night
- Menstrual flow with large blood clots
What we don’t talk about much is the fact that having a monthly period is an incredibly inflammatory physiological process. It’s a big deal for our body. We release all kinds of inflammatory chemicals to help shed our menstrual lining; the same kind that we get when our body is fighting an infection. When we’re sick, we feel a little grumpy, tired, and generally unwell - it’s the same for many women when they get their period. You can also get a bit of diarrhoea and mild cramps as the uterus contracts.
If any these symptoms are impacting your quality of life, then this is not normal and you should chat with your doctor.
What about period pain? Any red flags something isn’t right?
In general, some red flags would be: the pain is so severe you’re taking time off work or school, you also experience pain during sex, bowel motions or peeing, you experience e severe fatigue, the pain is starting to be there most days (not just on your period)… pretty much anything that indicates to me that your life is impacted by the severity of your period pain
What exactly is endometriosis?
A term used to describe cells growing outside the uterus that are similar to those found in the endometrial lining of the uterus. It’s thought that dysregulation of the immune system is key in allowing these cells to grow and proliferate outside the uterus.
Endometriosis is most found on the surface of the pelvis, in and around the ovaries, on the underside of the uterus, sometimes on the bowel or bladder, and can even be found under the diaphragm, in abdominal scars (like caesarean section scars), or in the lungs.
The main symptoms are period and pelvic pain, bladder or bowel pain, painful sex, infertility, belly bloating, and fatigue. Some people won’t experience any pain, and others may only experience infertility and have endometriosis diagnosed during investigation of their infertility.
What are the top three endometriosis MYTHS?
- Disease stage or severity does not correlate with symptoms! Someone with the most severe endo (stage IV) may have no symptoms, whereas someone with stage I endo could have debilitating symptoms.
- Pregnancy doesn’t cure endometriosis. Symptoms may improve because you don’t get your monthly period; some women find their symptoms improve or go away after giving birth… but for many their symptoms do come back after they stop breastfeeding and their period returns.
- Endometriosis isn’t cured with a hysterectomy.
What are some of the main lifestyle triggers for a flare?
Dietary triggers are really variable but common ones would be alcohol and fatty foods. Saturated fats stimulate the production of pro-inflammatory cytokines and increase inflammation. Alcohol is an irritant to the gut and affects how food moves through the gut. These can both trigger endometriosis symptoms in some people, but may not do so in others. Working with a dietitian can be super helpful in identifying your unique dietary triggers.
Certain exercises like sit-ups, crunches and planks can trigger symptoms if you suffer from things like pelvic floor dysfunction. Chronic pelvic pain can cause the muscles in and around the pelvis to tighten and contract, like the pelvic floor, which can lead to pelvic floor dysfunction. This can feel like an aching pain in the pelvis, which often radiates to the back and/or thighs. Seeing a physiotherapist can help with this.
Can stress and anxiety exacerbate pain?
Yes! This is where I strongly encourage people to see a psychologist if you haven’t already. Living in pain everyday can be very stressful and women with chronic pelvic pain may be more likely to experience anxiety and depression because of their symptoms and how this impacts their life. It’s important to get the help you need to navigate the emotional aspects of the condition as things like stress, anxiety and low mood can exacerbate chronic pain.
What lifestyle mods would you recommend?
- Make sure you’re drinking enough water - about 2 litres per day. Dehydration is a major cause of constipation which commonly contributes to pelvic pain. Drinking enough fluid, alongside an adequate fibre intake will help prevent constipation, which can compound pelvic pain.
- Try to get at least 7-8 hours of sleep every night. We know that up to 80% of chronic pelvic pain sufferers have poor sleep quality which can increase pain sensitivity. Aim to go to bed and wake at the same time every day. Seeing sunlight for a few minutes shortly after waking can help reset your body clock if you struggle with this.
- Manage stress levels with things like mindfulness, meditation, relaxation. We know that regular mindfulness practice can help to reduce pain levels in people with chronic pain of any kind.
- Move your body every day in a way that feels good for you. This might be yoga, Pilates, or physiotherapy stretches/exercise. This can help release tight muscles and increase the release of our body’s natural painkillers called endorphins.
How do you suggest someone prepare for their first appointment with an endo specialist?
Firstly, this is a big deal and I just want to say that you’ve got this. By this point you’ve probably been in pain for a long time and are desperate for answers. You’ve also probably already seen a lot of different specialists - which may or may not have been a good experience for you. My top tips would be:
- Bring a support person. Especially if you’ve previously had unpleasant interactions with health professionals and you’re feeling anxious about the appointment.
- Be as prepared as you can for things like an internal exam or internal ultrasound - you might like to call the practice and ask if this will be a part of your appointment. It can be really distressing when this happens, and you weren’t mentally prepared (or didn’t have a support person!).
- Make a list of all your questions and bring this to your appointment.
- Bring any specialist, surgical, or imaging reports that you have. The more information, the better.
- Lastly – and probably most importantly - don’t be afraid to ask your specialist questions about what the plan is ongoing. If you’re being offered medication, when are you being re-reviewed and what happens if you’re still in pain? Same goes for surgery.
Written by Dr. Jessica Theron. Jess is an Obstetrics & Gynaecology registrar with NSW Health, and founder of Ella Health, the first-ever holistic digital platform designed specifically to address chronic pelvic pain. Head over to ellahealth.co to join the waitlist 💛
