Find your rhythm F o r - Jean Hailes
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F o r W o m e n ’ s H e a l t h
Find your
rhythm
How to boost your
energy cycles
PELVIC PAIN BOOZE BUST
What to know, Rethinking your
what to do drinking
Contents VOLUME 1 2019
03 12 22
Jean Hailes Last drinks Ask Dr Jean
welcome Time to say Your health
A message ‘adiós’ to questions
from our Chief alcohol? answered by
Executive our experts
Officer 15
Finding 23
04 your energy Recipe
Jean Hailes How to harness Our easy-as 15
news your ‘power’ Breakfast in Rhythm of life
Latest news, times to work a jar
book review for you
“It’s all about
06 19 finding your
Small Spotlight on own pattern.”
wonders Jean Hailes
The trillions Endocrinologist,
hard at work Dr Yvonne
in your gut Chow
08 20
Pelvic pain Research
Chronic pain Key insights
and how to from our 2018 12
treat it Women’s Last drinks
Health Survey
“A lot of women
report how wonderful
they feel once they
Cover illustration
by Luci Everett
reduce their intake.”
Our Commitment Acknowledgement Connect with Jean Hailes
Jean Hailes is Jean Hailes for Women’s Subscribe to our email update and receive
committed to bringing Health gratefully acknowledges the latest women’s health news at
you the most recent the support of the Australian jeanhailes.org.au/subscribe
evidence-based Government.
information. twitter.com/JeanHailes
All articles go through Every donation counts facebook.com/JeanHailesforWomensHealth
rigorous review with Secure donations can be made youtube.com/JeanHailesFoundation
experts. References are online at jeanhailes.org.au
or call toll free on instagram.com/JeanHailes
available upon request.
1800 JEANHAILES (532 642) jeanhailes.org.au
2 VOLUME 1 2019
Welcome!
Former CEO Janet Michelmore AO and
new CEO David Lloyd chat about the
future of Jean Hailes.
“My vision JM: It’s great to have you on board, David. I’m proud and honoured
is to keep to have been appointed to my new role as Patron, spreading the Jean
Hailes word across the country. How are you settling in?
building on DL: You’ve built this house on very firm foundations, so it makes my goal
what’s already of growing the organisation relatively easy. My vision is to keep building
here ...” on what’s already here – providing women with a first-class clinical
service, ensuring all women are as well informed as possible and that all
our work is backed by the most recent and relevant research.
JM: What led you to become CEO of Jean Hailes?
DL: A long and winding road, through the public service in New Zealand,
higher education management, and a long stint in medical research.
All these experiences are in use now in this job. My wife and I have three
adult daughters, so I have seen first-hand the truth of what Dr Jean
Hailes said – ‘if a woman is in good health, her family, community and
the society around her also benefit’. That really resonated with me.
JM: What are your plans for growth?
DL: Responding to the diverse needs of women across the country
demands a nationwide network of clinics based on our two Melbourne
models. We’re also developing a research network that I hope one
day will link into every university and medical research institute that
is conducting relevant research. And of course our public health
information program will continue to be the most sought-after source
of information for patients and health practitioners in all aspects of
women’s health. This underpins everything that we do.
JM: Thanks David, we all have so much to contribute here at Jean
Hailes to help women live healthy and happy lives.
Janet Michelmore AO David Lloyd
Patron Chief Executive Officer
JEANHAILES.ORG.AU 3
Jean Hailes
news
Women’s Health Week
This year’s Women’s Health Week is shaping
up to be another fun-filled and informative
week for women all around Australia. From
2-6 September, 2019, Women’s Health Week
encourages all women to put themselves
– and their own good health – first.
Persistent Pelvic Pain Service An annual Australia-wide event since 2013,
now open it has grown hugely in six years. In 2018, not
Jean Hailes for Women’s Health has opened a only did more than 100,000 women take part
dedicated persistent pelvic pain management in the week, but 92% of these women said they
service at our East Melbourne clinic. were making positive health changes because
Persistent pelvic pain (also known as chronic of the information they
pelvic pain) is defined as pain felt on most days received during the
for six months or more, in the area below the week. “Than
the botto k you from
belly button and above the legs. Though it affects In 2018, investing m of my
in wome heart for
around 15% of all women, the condition remains more than annual e n
vent is m ’s health. This
poorly understood and underdiagnosed. 2100 events d if fe renc a k ing a ge
women li e in the lives of nuine
Director of the new service, Jean Hailes – including ke me. B countles
changes y encou s
in daily rag
gynaecologist Dr Janine Manwaring (above), morning to signif activitie ing small
icant im s, it has le
said women with persistent pelvic pain had often teas, health life and p d
the lives rovements in my
faced long waiting periods and disjointed care. checks network of my fa
within th mily and
e comm our
“We want to change that,” she said. and group unity.”
Dr Manwaring said research showed a training Cheree
D
(aged 35
multidisciplinary approach was the best way sessions – were -44)
NSW
to treat persistent pelvic pain. held around the
“This means that women suffering from pelvic country. Around
pain can reduce their symptoms and improve 25,000 women also signed
their quality of life if surrounded by a supportive up to receive free daily health-related emails
medical team,” she said. during Women’s Health Week.
The new team includes women’s health GPs, This year, Women’s Health Week will reflect
physiotherapists, clinic nurses, a psychologist, our commitment to caring about women and
a naturopath, an acupuncturist, a gynaecologist the communities they live in. We will reduce
and a pain physician. For more information our carbon footprint by removing single-use
about the service, call 03 9562 7555 or email promotional material. We look forward to
clinic@jeanhailes.org.au your support.
Turn to page 8 to read our story
Sign up at womenshealthweek.com.au
about pelvic pain
4 VOLUME 1 2019
HEALTH PROFESSIONAL UPDATE
Webinar update
New webinars available on the Jean Hailes
website for professional development:
‘Why ask about vulval health?’
Specialist women’s health GP Dr Felicity Dent
discusses a range of vulval presentations
often seen in clinical practice.
‘Endometriosis: an overview’ Polycystic ovary syndrome (PCOS) update
Jean Hailes gynaecologist Dr Neelam Bhardwaj In line with the new polycystic ovary syndrome
presents an informative overview of endometriosis, (PCOS) treatment guidelines, we have updated
including diagnosis, pathogenesis and impacts on the PCOS active learning module (ALM) and
mental health. PCOS health professional tool. Both are designed
to help health professionals improve care and
‘An introduction to family violence’ management of women with PCOS. New PCOS
Karen Bentley from WESNET presents an consumer booklets are also coming soon.
introduction to addressing family violence
in clinical practice, from how to ask your
patients, safety planning and referral pathways. For more details, visit www.jh.today/hp
Every day, each of us instead make the most demonstrates that the
is getting older. But of our longer lives. To old model of learning
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JEANHAILES.ORG.AU 5
Small wonders
How to nourish your gut bacteria, and why it can benefit your whole health.
T
eeming with life, your fibre (also known as roughage).
digestive system is home This type of fibre – found in
to trillions of bacteria and wheat bran, high-fibre cereals,
other microorganisms. Known brown rice, wholemeal products
as the gut microbiome, this and fruit and vegies – helps to
collection of ‘small wonders’ keep your bowels regular.
is driving a rapidly expanding “This is great news,” says
body of research. Jean Hailes naturopath Sandra
Linked to many areas of Villella, “but what we need more
human health – from obesity of are fermentable fibres such as
and immunity, to inflammation, resistant starch.” eaten, resistant starch is created,
allergies, mental health and explains accredited practising
metabolism – research in the Bonus recipe dietitian Kim Menzies.
past decade has revealed the Get our gut-nourishing “As it avoids digestion, it
gut microbiome’s crucial role in makes its way to the large
Aduki bean salad recipe.
our overall health and happiness. intestine where it can be
With so much still to be It’s rich in resistant starch. fermented [or eaten up] by
explored, now’s the time to learn www.jh.today/recipes20 the good gut bacteria,” says
how to take care of your gut’s Ms Menzies.
greatest allies. Resistant starch is what’s The end products of
known as a prebiotic – a type fermentation, short chain fatty
A menu for your of carbohydrate that can’t be acids, are “excellent for the
microbiome digested by your own body, health of your intestinal cells”,
Science tells us that fibre is but is food for your gut’s fuelling the ‘good’ gut bacteria
your gut’s best friend. But when ‘good’ bacteria. and helping to reduce gut
it comes to nourishing your “Having a healthy balance of inflammation.
gut bacteria, not all fibre is gut bacteria is all about being a
created equal. good host; keep the ‘good guys’ Add and subtract
The CSIRO says that happy by feeding them the food The key to a healthy microbiome
Australians generally do a good that they love,” says Ms Villella. may not only be what you put
job of eating enough insoluble Foods rich in resistant starch on your plate, but what you
include lentils, peas, beans, firm leave off it.
bananas, some wholegrain foods, Researchers are finding that
cooked and cooled potato and certain food additives, common
rice, and cold pasta salad. in packaged and processed
When potato, rice or pasta foods, may harm gut bacteria
are cooked, then cooled and and, in turn, your overall health.
Two common emulsifiers
(chemical agents used to give
processed foods a smooth
texture or extend their shelf life)
were tested on mice and found
to not only reduce levels of
healthy gut bacteria and increase
levels of inflammatory gut
microbes, but also put them at
increased risk of chronic disease.
6 VOLUME 1 2019
Artificial sweeteners may
also be a cause for concern.
Recipe
Often used in ‘diet’ or ‘sugar-
free’ products, animal studies
have shown that these additives
disrupt the balance and
Sauerkraut
diversity of gut bacteria. Serves: 30
However, as Ms Villella Prep: 20 minutes,
then 10 days to ferment
explains, the key to knowing
what’s in your food is to use Vegan, gluten free,
less packaged foods and dairy free, nut free
build your diet around natural
whole foods.
“Keep ‘sometimes’ foods Ingredients by liquid throughout the
to sometimes only, check 1 medium green or red cabbage fermentation process.
food labels for numbers and 1 ½ tbsp sea salt If it is not, mix 1 tbsp salt
additives, and where possible, 1 tbsp mix of fennel, cumin
with 2 tbsp water, add to jar
use simple natural ingredients and coriander seeds and press mixture down firmly.
and make your meals from Repeat as necessary.
and/or 1 small birdseye chilli,
scratch,” she says. Cover jar top with fabric,
finely diced (if you like spicy)
secure with elastic band/string.
The right types Utensils Store in pantry, out of direct
Fermented foods, such as 1 litre glass jar (or 2 or 3 large jars) sunlight, and allow to ferment
sauerkraut, kimchi, kefir and Small piece of fabric to for 10 days. Then, move it to
yoghurt contain good bacteria cover jar top the fridge and enjoy!
as an ingredient. Plus, if you Elastic band or string
learn how to ferment these Nutritional information
Large mixing bowl
foods at home, there’s the Traditionally-made sauerkraut
bonus of one less food label has had a long journey
to read. Method throughout human history and
“We cannot always be sure Clean and rinse jar and bowl can be traced back to 400 BC.
just how many good bacteria thoroughly. Remove and Sauerkraut can be used
are present in home-fermented discard cabbage’s wilted in many ways. Add it to salads,
foods, but provided you outer leaves and core. Thinly sandwiches, wraps and burgers,
prepare them safely and follow slice remaining cabbage, or serve as a side for roasts,
instructions, it certainly does no then combine with salt in vegies, curries, casseroles
harm,” says Ms Villella. mixing bowl. and stir-fries.
So eating these foods Squeeze and massage It contains vitamins A, B,
regularly may help to bring the cabbage with your hands C and K, various minerals,
right types of bacteria to your for 10-15 minutes, until you live lactobacilli (beneficial
gut, and, most importantly, have a very wet mixture. Add gut bacteria, also known as
including a wide variety of your chosen seasonings and probiotics) and a large amount
resistant starches and fibres mix through. of lactic acid.
in your diet will keep the Pack the mixture into the It is best eaten uncooked
populations happy. jars as tightly as possible, to preserve this good bacteria.
It’s an exciting time in the pressing down as you go. For Cabbage is also a prebiotic,
world of gut microbiome food safety, the cabbage needs feeding existing healthy gut
exploration, so watch this to be completely covered bacteria.
space for more developments.
In the meantime, give your
gut a head-start with our easy Find this recipe online at www.jh.today/recipes58
Sauerkraut recipe.
JEANHAILES.ORG.AU 7
Pain
and the pelvis
With the opening of our first persistent pelvic pain service,
we talk to Jean Hailes gynaecologist Dr Janine Manwaring
about pelvic pain treatment.
P
ersistent pelvic pain, also known as chronic muscles, bones and nerves, chronic pelvic pain
pelvic pain, is a common condition that is a complicated condition. Its symptoms can
affects around 15% of women worldwide. vary, and it can have many causes. It may even
Chronic pelvic pain has been described as a be a symptom of another disease.
‘silent epidemic’ because it’s poorly understood One of the most common types of pelvic
and underdiagnosed. The condition is also pain is due to a condition called endometriosis,
often overlooked because of the incorrect belief which occurs when cells similar to those that line
that period pain is normal the uterus are found in other parts of the body.
and a natural part of being a woman.
However, the impact of chronic pelvic pain is
large. It is the most common cause of days off Chronic pelvic pain has been
work for women of child-bearing age and costs
described as a ‘silent epidemic’
Australia around $6 billion annually.
The good news is, recent research shows that because it is poorly understood
women suffering from pelvic pain can reduce and underdiagnosed.
their symptoms and improve their quality of
life – particularly if surrounded by a supportive Some women with endometriosis have painful
medical team. periods, while others have symptoms associated
with the bladder, bowel and/or pelvic muscles.
About chronic pelvic pain It can also affect psychological health (eg, low
A chronic condition is when an illness persists mood, anxiety) and can be associated with
for a long time or keeps coming back. Chronic headaches.
pelvic pain occurs in the area below the belly
button and above the legs, and is defined as Science behind pain
pain felt on most days for six months or more. There has been an increasing amount of
As the pelvic area is home to the bowel, research into pain science in the past decade,
bladder and reproductive organs, as well as particularly in Australia. Brain imaging studies
8 VOLUME 1 2019
PAIN EXPLAINED
When something painful
happens, the nerves in the
affected area send pain
signals to the spinal cord
and then up to our brain.
There are two types of pain:
short-term pain, and long-
term (chronic) pain.
Short-term pain
Short-term pain is how our
body tells us something is
wrong and to react to protect
ourselves (eg, pulling our
hand away from the touch of
a hot pan). Short-term pain
goes away after a time.
Chronic pain
Chronic pain is when the
pain doesn’t go away. The
original cause of the pain
may no longer be there, but
the nerves start sending
pain impulses to the brain at
any time, not just when there
is pain.
With chronic pelvic pain,
the pain pathways from the
pelvis to the brain change.
This is called ‘central
sensitisation’ and once this
happens, pain in the pelvis
becomes complex. Things
that weren’t painful can
become painful (eg, wearing
tight jeans), and the pain
can spread to a larger area.
Central sensitisation is also
common after shingles,
sporting injuries or other
conditions with long-term
pain. Phantom limb pain
– the pain that is felt after
a limb amputation – is
another example of central
sensitisation.
JEANHAILES.ORG.AU 9
“For women suffering from
chronic pelvic pain, I would
urge them to seek out, and
be actively involved with,
their treatment team. You’re
not alone, and we’re here to
support you.”
have shown that chronic pain patients respond There can be some trial-and-error, and pain
to pain in a different way to healthy patients. flare-ups along the way. However, management
“Chronic pain patients appear to have becomes part of the process, says Dr Manwaring.
altered brain function and structure,” says “For women suffering from chronic pelvic pain,
Dr Manwaring. “They can become ‘hardwired’ I would urge them to seek out, and be actively
to pain and their body may start to feel pain involved with, their treatment team. You’re not
even without a trigger or cause.” alone, and we’re here to support you.”
Yet promisingly, says Dr Manwaring, there
is evidence to show that such brain changes
can be reversed with the right individualised
3 THINGS TO KNOW:
treatment. 1. Chronic pelvic pain occurs in the area
below the belly button and above the
Chronic pain management legs, and is defined as pain felt on most
Managing chronic pain is about recognising the days for six months or more.
condition, and then creating a treatment plan 2. With chronic pelvic pain, the pain
to manage symptoms. The aim is not for a cure; pathways from the pelvis to the
rather, it is for the patient to be able to live with brain change. This is called ‘central
the condition in a manageable way and have a sensitisation’. Once this happens, the
good quality of life. pelvic pain becomes complex.
3. Chronic pelvic pain is best managed
Team approach by a team of specialists. This is known
Chronic pelvic pain is best managed by a team as a multidisciplinary approach.
of specialists. This is known as a multidisciplinary
approach. The team may include a
gynaecologist, pain specialist, GP, psychologist, Need help?
pelvic physiotherapist, dietitian and nurses.
Call Jean Hailes to hear more about
Specific treatment may include surgery or
our Persistent Pelvic Pain Service
physiotherapy. Overall physical health will also
Toll free 1800 JEAN HAILES (532 642)
be addressed, for example, through nutrition
and exercise. The team provides a medical The Pelvic Pain Foundation of Australia
pain management plan, in addition to teaching www.pelvicpain.org.au
patients how to manage the pain themselves
(eg, pain science, triggers and management).
“We treat underlying mood issues, as well
as teaching mindfulness – both of which can For more information, visit
significantly improve the woman’s quality of www.jh.today/news108
life,” Dr Manwaring says.
10 VOLUME 1 2019Women’s Health Week “Women’s Health Week has been
fantastic. I’ve loved reading all the
2–6 September 2019 interesting facts and how making
positive changes can help me to
navigate my way through this new
chapter in my life.”
I’m a busy working mum and
don’t get to talk to many friends
about women’s stuff. It’s good
for me to know I’m not alone and
helps me to look after myself.”
“The women in my rural
community are becoming more
aware of the need to make their
health and wellbeing a priority
Women’s Health Week is a week for every and to lead by example for
woman in Australia. How can you join in? their daughters.”
Sign up now:
womenshealthweek.com.au
Jean Hailes is supported by funding from the Australian Government.Last
Yet the recent headlines about alcohol have
been … well … rather sobering.
The largest ever study to assess alcohol and
drinks?
disease has concluded that there is no safe
level of drinking alcohol.
This news is especially worrying for women,
given that alcohol is more toxic to women
than men, and takes longer to process. This
As more research links is due to the smaller percentage of water in a
alcohol with ill-health, is it woman’s body, and because the protein that
breaks down alcohol is produced in smaller
closing time on Australia’s quantities in smaller livers.
love affair with booze? The study, published in the international
medical journal The Lancet, showed that three
million deaths globally were due to alcohol
D
use in 2016. The findings mirror other studies
uring Australia’s penal era, more alcohol which link alcohol with premature death, heart
was consumed per person than at any disease, and cancer, particularly breast cancer.
other time in history. Rum was even In Australia alone, more than 5500 lives are lost
used as currency. every year due to alcohol use.
Today things are different. The Australian Jean Hailes endocrinologist Dr Sonia
Bureau of Statistics says that Australians Davison says there is a lot of debate about
are drinking at the lowest level in 50 years, what is ‘safe’ alcohol use and the study
amounting to around 2.6 standard drinks per reinforces the overall message “that zero
person per day. alcohol intake is safest”.
The 2018 Jean Hailes women’s health survey, which surveyed more than
15,200 women across Australia about their health, revealed that 9.5% of
women drink alcohol every day. Of this, 13.7% of women aged over 50
reported drinking alcohol daily, compared to 2.2% of women aged 18-35.
12 VOLUME 1 2019Attitudes to alcohol Cancer risk
A 2018 poll by the Foundation for Alcohol Alcoholic beverages are a group 1 carcinogen,
Research and Education found 45% of Australian meaning they’re as dangerous as smoking.
drinkers consume alcohol to get drunk, and – Alcohol causes seven different types of cancer
not surprisingly – that 73% of people believe – mouth, throat, oesophageal, liver, stomach,
that excess drinking is a problem in Australia. bowel and female breast.
Cancer Council Victoria’s Alcohol Legal
Guidelines Policy Adviser Sarah Jackson says that
Dr Davison believes that despite the potential most Australians are unaware that alcohol
harm, it’s not realistic to advise women to stop causes cancer.
drinking entirely. Instead, she says “we should “Cancer Council Victoria recommends that
educate about responsible alcohol consumption to minimise the risk, people should avoid
– drinking within the recommended limits.” alcohol altogether,” she says.
Guidelines and standard drinks vary around “But if people do choose to drink, then limit
the world. A standard drink in Australia is to within the guidelines,” she says.
defined as 10g of alcohol. This equates to a
100mL glass of wine. However, many restaurants Breast cancer and alcohol
and pubs will pour at least 150mL in a regular While drinking alcohol doesn’t automatically
serve, making it more difficult to keep track. mean you will get breast cancer, research
In the UK, a standard drink is 8g of alcohol. shows that the more you drink, the greater
The UK’s guidelines are now set at six glasses your risk. Women who drink one standard
per week, while the recommended limits in Italy, glass of alcohol each day have a 7% greater
Portugal, and Spain are about 50% higher. risk of breast cancer when compared to
The 2009 Australian Alcohol Guidelines women who don’t drink.
are currently under review by the Australian Alcohol use is believed to cause 6% of breast
Government’s National Health and Medical cancer cases each year in Australia.
Research Council (NHMRC) and due for Although the exact link is not fully
release in 2020. understood, it is known that:
• alcohol increases the levels of the hormone
The current guidelines advise: oestrogen. High levels of oestrogen can
• drinking no more than two standard cause a cancer cell to multiply out of
drinks on any day control
• drinking no more than four standard • alcohol is broken down by the body into a
drinks on a single occasion substance called acetaldehyde, which can
• no drinking for women who are pregnant, cause changes in our DNA. This can cause
planning a pregnancy, or breastfeeding cancerous cells to grow.
• no drinking for the under 15 age group
How many standard drinks in a regular serve?
Red White Full-strength Low-strength High-strength Full strength
wine wine beer beer spirit nip pre-mix spirits
1 0.9 1.1 0.6 1 1.5
100ml 100ml 285ml 285ml 30ml 375ml
13% alcoholic 11.5% alcoholic 4.8% alcoholic 2.7% alcoholic 40% alcoholic 5% alcoholic
volume volume volume volume volume volume
The above shows an approximate number of standard drinks only. Always check the label for the exact number
of standard drinks. For further information and resources about alcohol consumption, visit alcohol.gov.au
JEANHAILES.ORG.AU 13How to reduce home drinking Gillian’s tip
“Drinking is woven into the fabric of society Segment the week. Keep your weekdays
in Australia,” says Jean Hailes psychologist alcohol-free, so that you can enjoy a
Gillian Needleman.
“Home drinking, in particular, is both a
couple of drinks on the weekend.
common occurrence and a challenging habit to
change – especially if it is the ‘circuit breaker’
or daily ritual used to transition from work to
relaxation mode,” she says. “If you would like
to curb your drinking, however, you should feel
confident you can make it happen.”
Getting started
Anyone concerned about their drinking
can talk to their local GP or other health
professional for support. Ms Needleman also
asks her clients to consider the following when
planning for change:
Self-reflection
Assess why you’re drinking in the first
place – this helps to identify the ‘cause’.
Goal setting Feeling good
Make a plan – set an overall goal and then Ms Needleman says those wishing to reduce
segment in to smaller, measurable targets. their drinking may feel a bit fearful. But it doesn’t
need to be that way, she says.
Plan “A lot of women report how wonderful
Substitute drinking with another activity, eg, they feel once they reduce their intake,”
walking, yoga, reading. Identify which days of says Ms Needleman.
the week you find it more difficult to abstain “Many will have been unaware of the
and think of an alternative activity. pervasive effect alcohol has been having on
their mood, weight, motivation, and overall
Set new rituals functioning.”
At home, don’t sit in the same chair that you “It may be hard at first, but if you make it fun
would normally drink in. Add cucumber and and reward yourself in other ways, in time you’ll
lemon to soda water. Make it interesting/tasty. find your new routine and a new lease of life.”
Monitor self-talk
Combat negative self-talk with 3 THINGS TO KNOW
some positive thoughts or affirmations.
1. Largest-ever study confirms no safe level
Respect the process of change of drinking alcohol.
If you don’t meet your targets one week, 2. Alcohol is more harmful for women
acknowledge it, and then put it behind you. than men, and increases the risk of breast
Look ahead to what you can do differently and other cancers, heart disease and
next week. early death.
3. Women can enjoy improved health and
You’re not the only one wellbeing by reducing alcohol intake.
Use websites such as Hello Sunday Morning,
which frame alcohol-free living in a positive
light and help to remind you that many others For more details, visit
are trying to change too. www.jh.today/health8
14 VOLUME 1 2019Finding
your
energ y
rhythm
Is there a hidden
pattern to our energy
levels? If so, how
can we use it to our
advantage?
“The demands can become
overwhelming.”
Dr Davison says that early
F
motherhood, having multiple
rom a bouncing buzz to or challenging dependents,
drop-dead fatigue – the and midlife are common phases
highs and lows of everyday when fatigue can be a real issue.
energy are tricky to navigate. But within and beyond these
And if you feel like you’re life stages, if your fatigue is
always running on empty, you’re greater than would be expected
not alone. Dr Sonia Davison, or you’re worried about it, see
endocrinologist (hormone your doctor, says Dr Davison.
specialist) at Jean Hailes for “Iron deficiency and anaemia
Women’s Health, says fatigue [common causes of fatigue
is common among women, in women] should be ruled
moreso at certain life stages. out,” she says. “Your GP may
“Women often take on many also need to test your thyroid
roles – carer, worker, parent, function, blood glucose and
partner, volunteer,” she says. vitamin B12 levels.”
JEANHAILES.ORG.AU 15It comes in waves A secret map of the “In the same way that these
On top of all the external factors, month hormones are responsible
your hormones can also affect As well as dancing to a daily for reproductive health, they
how much spring you have in rhythm, other hormones have us are also very, very potent in
your step. At different times moving to a monthly one. determining things like mood,
in the day, we can feel more Research in the past five drive, motivation and energy.”
energetic than others; it’s all years has revealed that female
about finding your own pattern, hormones may be writing a Oestrogen & energy
says Dr Davison. secret map of the month ahead, In terms of energy levels,
“Each morning, our body telling you which days you’re oestrogen, put simply, is the
kicks into gear with a peak of more likely to be bursting with “good” hormone, says Prof
hormones, probably because bounce, and which days you’ll be Kulkarni. “It’s protective to
we’re designed to be physically best off taking it easy. the brain and a natural, mild
active then and gather food,” Jayashri Kulkarni, Professor antidepressant.”
she says. of Psychiatry at Monash At day 1 of the menstrual
For many women, these University, says that for women cycle (the first day of your bleed),
peaking hormones align with having periods who aren’t on oestrogen levels are low. They
the time of day they feel most hormonal contraception, the begin to pick up around week
productive. Later in the day our pattern of monthly hormones 2, and peak sharply in the days
hormones dip, making us less can be “absolutely connected” before ovulation (egg release).
energetic and more prone to to the levels of energy they feel. This means that, in a 28-day
fatigue. “I call it the ‘3pm lull’,” “Hormones such as menstrual cycle, it’s common for
says Dr Davison. oestrogens, progesterones women to feel more energetic
However, she says, every and testosterone have an around days 12-14.
impact obviously on the female
For many women … reproductive system, but they
also have a major impact
peaking hormones align
on brain chemistry,”
with the time of day they Prof Kulkarni says.
feel most productive.
woman is different and while
many women operate better in
the first half of the day, other
women find they function
better at night, irrespective of
their hormone levels. The key
is to observe your own natural
rhythms, and find what works
for you.
16 VOLUME 1 2019natural energy levels around
week 3 of your cycle.
Tiredness is a hallmark of both
PMS (premenstrual syndrome)
and PMDD (premenstrual
dysphoric disorder, a severe form
of PMS), says Prof Kulkarni.
“The tiredness comes on all
of a sudden,” she says. “Some
women say ‘it’s like someone
pulled the power socket out of
the wall’; a sudden change tends
to suggest a hormone issue.”
What about ‘the Pill’?
The effect that the Pill, or
What goes up must other forms of hormonal
come down contraception, have on fatigue
If pregnancy hasn’t occurred, can vary, says Prof Kulkarni.
after ovulation oestrogen levels She says women need to
In this way, being more in tune drop, the other major female find the right Pill for them,
with your cycle can take forward- hormone, progesterone, as different types can affect
planning to the next level. Big begins to rise. women differently.
presentation at work? Training Progesterone, according to “Some types of progesterone
for a half-marathon? When Prof Kulkarni, can be a draining in different Pills can be energy-
possible, it may pay to schedule and depressive hormone in sapping for some women,”
those big life events mid-cycle, some women. So these changing she says. “But for women who
when oestrogen is up. hormones can start to affect your experience huge surges and
DOING TOO MUCH? HOW TO GET INTO YOUR GROOVE
With fatigue being a common Energy
and constant experience for Energy is a balancing act;
many women, it begs the some things give you energy,
question: are we taking too some things take it away, says She also recommends that
much on? Ms Needleman. women see themselves as
Jean Hailes psychologist “Exercise is a giver of the ‘gatekeepers’ of their
Gillian Needleman says energy, as is eating nutritious own time and routines.
overcommitment is common food,” she says. “Spending “Cast your mind over
among women she sees. time with family and friends, the whole week and ask
“From Monday through to generally, gives you energy.” yourself, ‘how much time
Sunday night, they know what am I dedicating to work,
they’ll be doing for every Time times 2 errands, family, friends and
minute,” she says. “While Ms Needleman recommends self?’. Then break it down to
that’s a good feature of being ‘doubling-up’ tasks for time- what can be changed and
organised, it’s important to slot poor women. “Going for a walk what can’t be,” she says.
in times which are blank and with a friend ticks two boxes “This can help you to free
dedicate these to down-time. – blending your social needs up some spare time,or work
If you don’t block out time for with getting some exercise out how you can do things
yourself, it just won’t come.” for yourself.” differently.”
JEANHAILES.ORG.AU 17lows in energy across the month, (MHT, also known as hormone
3 THINGS TO
the Pill can help to stabilise this.” replacement therapy, HRT) can
KNOW
hold real benefit.
Ch-ch-ch changes “A lot of these changes are 1. Fatigue is common,
In midlife the natural rhythms due to the decreasing levels but if it’s greater than you
of the monthly hormones, and of oestrogen in the brain – would normally expect, or
all the follow-on effects, begin the same principle we see in if it worries you, see your
to shift as women approach the premenstrual depression.” doctor.
menopause. 2. Female hormones can
Prof Kulkarni says menopause Keeping track influence brain chemistry
in the brain starts about four to If you’re keen to work out your and fatigue levels.
five years before menopause in own monthly rhythms, Prof 3. Observe and track/write
the body, but because there are Kulkarni suggests keeping track down your own energy
no physical signs, a woman may by writing it down, or using a rhythms, to find what
not know what is going on. period tracking app. works for you.
“Preceding the hot flushes “But what’s really important is
and so on, there can be mood to validate,” she says. “If severe
swings and, particularly, there symptoms are happening to For more information
about sleep and fatigue,
can be a sudden loss of energy,” you on a regular basis then it is
visit www.jh.today/health7
she says. “Many women say ‘it’s happening, it’s valid, it’s real and
taking me all day to do half of deserves attention.”
what I normally would do’. Because life doesn’t just stop,
“If a woman has no new there will be times when you
stressors in her life, particularly have to push through low energy
if she is around 45 years old, we days. But if we can hear the beat
need to think that maybe this is of our own internal rhythms, then
the first sign of perimenopausal we can ride the waves of high
changes.” energy and plan for calmer
The good news is that, over seas ahead.
time, the energy returns, says
Prof Kulkarni. In the meantime,
if the fatigue is affecting a
woman’s quality of life, she says
menopause hormone therapies
18 VOLUME 1 2019Spotlight on...
Jean Hailes for Women’s Health Endocrinologist
Dr Yvonne Chow
We talk to Jean Hailes endocrinologist Dr Yvonne Chow
about her fascination for hormones, passion for public
health, and love for her baby daughter.
What does an What are some of the For example, I can see around
endocrinologist do? common conditions you 20 patients per day and help
An endocrinologist is a doctor see in your patients? the health of those 20 people.
who is trained to diagnose and The most common conditions I A good public health policy can
manage diseases that affect the see are diabetes, thyroid disease, change the health of thousands
glands and hormones within osteoporosis, polycystic ovary or millions of people. We need
the body. Our aim is to help syndrome, menopause, adrenal good policy for good health.
the patient to restore hormone disorders, and neuroendocrine I also learnt a lot about
balance. conditions. different healthcare systems,
which has helped me to
What drew you into the How do you treat hormone appreciate the Australian
field of endocrinology? issues? healthcare system.
I find hormones fascinating. Most hormone problems are very
Hormones are how the body manageable. For example, if your What advice would you give
communicates. The endocrine thyroid does not produce enough to women today in relation
system’s glands and organs hormone, we can supplement to their health?
secrete hormones, which are with thyroid hormone. In a very busy, modern lifestyle,
the chemical messengers that women often do not prioritise
help various parts of the body How has being bilingual their own physical and emotional
to function. I love the fact that (English, Cantonese) helped wellbeing. My advice for women
we can measure the quantity of you with patient care? is to ensure they make time to
hormones in the body as this can Being able to reach people in eat well, do regular physical
really help us treat the hormone a language other than English activity and of course, spend
imbalance of various conditions means that I can immediately time doing things they enjoy.
in a very targeted way. improve the rapport with Maintaining a healthy body
Cantonese-speaking patients. weight is particularly important
What are some signs My background also helps me for hormonal conditions such as
that your hormones are to relate to women from migrant type 2 diabetes and polycystic
out of sync? backgrounds generally. ovary syndrome.
Fluctuations in weight and
irregular periods may point You recently completed What do you like doing
to a hormone imbalance. a Master of Public Health when you are not at work?
Other signs may include from Tufts University School If I’m not at work, I’m with my
persistent problems with of Medicine in Boston, nine-month-old daughter, Emily.
acne as an adult, excessive US. What were some key Seeing the world through her
hair growth on the face, jawline, learnings from this course? eyes is amazing.
upper back, chest, as well as At a broad level, I see the value Find more information about
unexplained irritability, and in having good public health hormones here:
mood fluctuations. policy and systems in place. www.jh.today/news92
JEANHAILES.ORG.AU 19Research
Women’s Health
Survey Exploring women’s
health issues and
concerns.
Our fourth annual Women’s Health Survey reveals the health needs and
behaviours of women across the country. More than 15,200 women aged
18 or older and living in Australia responded to our 2018 survey.
Physical health
50.4%
Staying active, eating nutritious food, limiting
alcohol and not smoking are four key ways
to maintain good physical health. To stay
of women described their overall more active, increase your daily incidental
health as very good or excellent exercise (eg, take the stairs instead of the lift)
and exercise with friends to keep it fun. Try a
90.5% 9.5% weekly meal plan, buying only the ingredients
you need. This will not only make it easier to
had not smoked reported daily eat healthily, but will reduce waste.
in the past year drinking
Health needs
one in five
While more than 50% of women were totally
confident asking their doctor questions,
and discussing health issues that concerned
women (21.5%)
reported that there were issues/questions that
them, one in five had questions they avoided they avoided discussing with their doctor
discussing. To improve your confidence when
seeing your doctor, read up on a topic from a More than
trusted health website (eg, jeanhailes.org.au,
betterhealth.vic.gov.au). Write questions down one in four
before you visit your doctor to get the answers
you need. And don’t be afraid to ask a question
women (25.5%)
more than once to make sure you understand. have discussed or need to discuss
with their doctor a lack of interest
in sex in the past 12 months
20 VOLUME 1 2019Mental and
emotional health
Almost
half of Health information
women (46.1%)
who responded to the survey had been
Top 5 health topics women
want to know about
diagnosed with depression or anxiety
by a doctor or psychologist 1. Weight
management (34.9%)
More than
2. Healthy eating
a third of /nutrition (31.7%)
women (34.3%)
reported not getting time to
3. Mental and
themselves on a weekly basis emotional health (29.3%)
4. Anxiety (28.3%)
66.9%
reported feeling nervous, 5. Menopause (24.9%)
anxious or on edge nearly
every day or on more than
seven days in the past It’s important to discuss any concerns with your
four weeks doctor. Regular health checks and screenings
are also an important part of maintaining good
health. Talk to your doctor about health checks
Life is busy! That’s why it’s important for you appropriate for your age and family history of
to notice how you’re feeling and seek help if illness. For more information, go to
required. Looking after your physical health www.bit.ly/checksJH
will help to look after your emotional health,
as physical activity has been shown to reduce
anxiety and depression. More research is also
linking what we eat to how we feel, so balanced
eating is important too. Meditation and
mindfulness can help to calm the mind,
but see what works for you
Want to know more?
For more information on topics covered here:
Physical health: www.bit.ly/movemoreJH Looking after yourself: www.jh.today/tool5
Confidence: www.jh.today/mind6 Weight management: www.jh.today/health5
JEANHAILES.ORG.AU 21Ask
Dr Jean Your women’s health questions
answered by our experts.
When it comes to women’s health, there is no such thing as a silly question.
Answering your questions for this edition of ‘Ask Dr Jean’ is Jean Hailes
endocrinologist (hormone specialist) Dr Sonia Davison.
undergo. In particular, the progestogens in
these products do not guarantee womb lining
protection and the Medical Journal of Australia
previously had a report of some Australian
women who had womb lining cancer after
having bioidentical hormone treatment.
It’s possible, however, to have ‘body-
identical’ hormone therapy, which has been
rigorously tested and is identical to the
hormones previously produced by your ovaries.
This is prescribed treatment manufactured
by pharmaceutical companies under strict
Dr Sonia Davison conditions, and the safety profile (and risks) have
been well established. I recommend looking
Q. Hi. Bioidentical hormones have been at the Australasian Menopause Society (AMS)
recommended for me to treat hot flushes, website, under the Find an AMS Doctor page,
anxiety and depression. Is there a blood to seek a menopause expert GP in your area
test that I can do that could show what I who can guide you. Our website (and the AMS
am lacking in and what I am needing? website) have more excellent information about
A. Without knowing any further details I’m bioidentical and other hormone therapy and
assuming you’re either perimenopausal menopause/perimenopause management in
or postmenopausal and have bothersome general.
symptoms. Blood tests aren’t useful in this For more information on managing menopausal
situation if you’re of typical age (40s to 50s) symptoms, go to www.jh.today/meno4 or visit the
and have typical symptoms that women have Australian Menopause Society at menopause.org.au
around menopause, mainly because the For more information on bioidentical hormones,
read our article here: www.jh.today/news89
hormone levels fluctuate considerably during
perimenopause, and the oestrogen levels just
remain low after menopause. Q. Hello. Periodically I experience icy flushes,
What will be useful is for you to see a health similar to hot flushes in menopause. When it
practitioner who has expertise in managing passes, I need to urinate. I am 72 and this has
perimenopause and menopause. They can only been happening in the last 12 months or
guide you as to the best evidence-based so. My GP doesn’t have an answer.
treatment for your symptoms and also consider A. These aren’t typical symptoms and I would
other factors like your general health, your recommend referral to an endocrinologist
bone health and your cardiovascular risks. who specialises in women’s health and can
Bioidentical hormone therapy is often a investigate for causes of these flushes.
custom-compounded treatment that hasn’t For more information on menopausal symptoms,
been tested for safety. There are concerns that go to: www.jh.today/meno3
women may be at risk due to this lack of safety
and effectiveness testing that other types of Have a question for Dr Jean?
prescribed hormone therapy products must Visit www.jh.today/news78
22 VOLUME 1 2019This easy-to-
prepare breakfast
can be a delicious
friend in the fight
Recipe against pelvic pain.
Breakfast jar
By Sandra Villella
Jean Hailes naturopath
Serves: 1
Prep: 5-10 mins, then overnight
to set
Dairy free, gluten free, vegan
Ingredients is that a diet higher in the ‘good’ Aromatic spices, including
2 dessertspoons linseeds, fats and lower in the ‘bad’ fats cinnamon and cardamom (also in
freshly ground may help to lower a woman’s risk this recipe), contain oils that not
of developing endometriosis, or, only provide the sweet-smelling
2 dessertspoons hemp seeds
for a woman with ‘endo’, help flavour and scent, but are also
2 dessertspoons chia seeds ease the abdominal pain. traditionally used in herbal
½ teaspoon each of cardamom medicine to calm potentially
and cinnamon Avoiding trans fatty acids – often painful gut spasms.
3 fresh walnuts, broken into pieces found in commercial baked
goods like cakes and pastries – For those who struggle to have
½ cup coconut-almond milk
also has been shown to reduce breakfast before leaving the
1 tablespoon maple syrup the risk of endometriosis. house, this easy five minutes
3-4 strawberries to serve of preparation the night
Omega-3 polyunsaturated fatty before makes this breakfast jar
acids (PUFAs) are known as convenient to take to work, and
Method ‘good’ fats. Of the three main is perfect for those who exercise
Prepare the night before. omega-3s, two are found in fish, before work. If coconut-almond
Combine seeds, spices and while one – alpha-Linolenic acid milk isn’t to your taste, you can
walnuts in the jar. Add coconut- (ALA) – is found in plants. swap it for another milk. Just note
almond milk, then maple that the recipe may no longer be
syrup and stir well to combine, Hemp seeds, linseeds, chia dairy or gluten free.
ensuring any seeds at the base seeds and walnuts are the best
of the jar are not left dry. The sources of ALA and are all in this I like this combination for the
mixture should be quite runny, breakfast jar for a great serve of warmer months. In the cooler
as the high-fibre seeds will then omega-3 PUFAs. These omega-3 months, the ground seeds
absorb the liquid. Refrigerate fats can also help to fight and spices can be used to top
overnight. In the morning, serve substances in the body that cause porridge.
with chopped strawberries. Yes, inflammation, working much like
it’s that easy! how drugs such as aspirin and This recipe is an example of
naprogesics do to reduce pain. choosing healthy fats over
Nutritional information unhealthy fats, to help reduce
While there may be many causes The seeds are also high in inflammation and pain one
of persistent pelvic pain (PPP), fibre, which is important for spoonful at a time.
endometriosis and irritable bowel managing symptoms of IBS such
syndrome (IBS) are common as constipation and diarrhoea,
causes and/or contributors. There and may ease painful bloating. To watch the video and
is little research so far on the Fibre also provides fuel for the download the recipe visit
connection between diet and gut microbiome, encouraging a www.jh.today/recipes59
endometriosis, but what is known healthier gut.
JEANHAILES.ORG.AU 23Once you have finished with this
We want magazine, please share it with someone
to hear who may also enjoy it.
from you!
We’d love to hear from you. Please email
us at education@jeanhailes.org.au
For further information, please contact About Jean Hailes
Jean Hailes for Women’s Health Head Office Founded in 1992 in honour of an extraordinary medical
Toll free: 1800 JEAN HAILES (532 642) practitioner, Dr Jean Hailes, Jean Hailes for Women’s
Email: education@jeanhailes.org.au Health reflects the enduring legacy that Jean made
to women’s health. She had a far-sighted vision to
The Jean Hailes Medical Centres for Women improve the quality of women’s lives and give them
Phone: 03 9562 7555 practical information based on the best available
Email: clinic@jeanhailes.org.au evidence. She is credited with being the pioneer
of menopause management in Australia.
Magazine inquiries Today, Jean Hailes is Australia’s leading and most
Jo Roberts trusted women’s health organisation, combining
Phone: 03 9453 8999 clinical care, evidence-based research and practical
Email: jo.roberts@jeanhailes.org.au education for women and health professionals. We aim
to translate the latest scientific and medical evidence
in order to inspire positive change in women by
jeanhailes.org.au improving their physical health and wellbeing.
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