You're listening to a Mom and mea podcast.

Australian women.

Welcome to your full body Health Check.

I'm Claire Murphy.

I am a forty six year old woman who didn't get the chance to really understand what menopause was from my mom because she had a hysterectomy when she was like in her thirties and claims she didn't really know when she was in menopause, so I have no idea and what to compare it to.

I am definitely perimenopausal right now.

That has been confirmed, and I'm on the HRT journey, which has been interesting to deal with all of that.

Go you and I am doctor Mariam, and I remember when my mum got mean the first time.

She would have been in her late forties, early fifties, and then suddenly she became this short, snappy person, not her usual self, and I did take it personally, to be honest.

You know, menopause.

Menopause can do some stuff to you.

If you are in perimenopause right now.

Welcome to the we do not care club.

We do not care about people.

Please me, either you like me or you don't like me.

We don't care.

If it's five pm.

We drinking coffee?

Are we drinking wine?

One or the other.

We do not care if somebody knocked on the door.

If we are not expecting you, we're not coming to that door.

We do not care about arguing with anybody because nine times out of ten we forget what we're talking about mid sentence of the argument.

We do not care about small talk.

Just shut up and don't say anything to me.

We don't care if you want to eat dinner together, please do not make that sound with your mouth when you chew.

That was Melanie Sanders.

She's a US influencer who started that We do not care club has I could not even tell you how many members around the world.

There is an Australian chapter of this as well, and it's literally just members sharing what women who are in peri metapause no longer care about.

It is so funny, like literally like we don't care what men think of us anymore.

If we're going to go clubbing, we're clubbing at four pm and we are at home and in bed by nine, like love it.

We don't care about what we're wearing.

We just don't care anymore.

I love this club.

We are going to be talking about all things menopause over the next few weeks.

Today, we're going to start at the beginning, and that is with the symptoms.

And boy is there an extensive list of those, from dry vaginas to weird itchiness, UTI's hot flashes, night sweats.

We are gonna attempt to tackle as many of them as possible.

We'll also do a quick consult for Ruth today.

She keeps falling into the same sweet trap every single night, the poor thing.

But first, Mariam, did you know that your boob is not the only place you can lactate from?

Tell me more well, another super fun fact about whim's bodies coming your way.

Next, it's time to head off to med school.

Let's go Welcome to med school.

Can you lactate out of your armpits?

Yes, you can.

Not only can I get milk from my armpit, but it sprays so weird.

Some people can luctat from their armpits.

And it's not another nipple.

As you can see, there's like nothing there.

It's just the milk coming out of the glands within the milk line.

That's ethnapar.

And I'm so sorry if I've mispronounced that gorgeous name.

She shows in this video that she's actually lactating from her armpit.

But of course, breast tissue doesn't just exist in your breast because when you're actually growing in utero, breast tissue is like basically from your armpits all the way down to your groin and then it retracts back up to be generally in that breast area when you are mature, but that's not always the case.

Sometimes those milk ducts can still extend all the way up into your arm pit and they can lack take crazy, but really it.

Comes out through your skin.

Isn't that incredible?

Rare but completely harmless.

Breast tissue, like you said, doesn't just stop at the bra line.

It can actually extend into your armpits.

It's called the auxiliary tail, and during breasts feeding that tissue can get activated too.

That said, if there's a lump or bump or swelling that doesn't settle, always worth having a chat to your GP, just to be safe.

But fascinating nonetheless, because women's bodies are incredible.

Okay, that is med school for today.

Are you ready to tackle the epic list of symptoms that is perimenopause?

And menopause.

How long do we have I mean, do we have a four hour showerhead?

Possibly, let's do it.

It's time for the checkup.

So perimenopause is having quite the moment in social media.

It has been described as puberty's feral older sister, which I feel like I aligned with.

I've heard it also described as cougar puberty, which is gorgeous and I love that.

So when it came to symptoms, mine started off with a run of UTIs okay.

So it was then followed pretty quickly by night sweats.

Yeah, I got thunderclap headaches, and then I got vertigo.

It was just there was lots of different things happening, and so my doctor was trying to tackle them one at a time.

So I was being treated individually for all of those separate things.

And well, Mama Mere did the very pery summit and I was like, oh God, I think this is peri menopause.

And I took that to my GP again.

I'm so so I need to apologize him.

I said to him, could this be perimenopause?

And he said, You're not in menopause because I still got my period and it was, you know, regular and I said to him, look, no offense, but what's your understanding of perimenopause And he said, it's the few months before you hit menopause.

It isn't And I was like, mate, let's have a conversation because it's actually beef up to a decad beforehand.

So I'd love to know from you, as you know, in your capacity as a GP, when do you start treating those symptoms as individual things and start looking at it as a whole experience.

So I think too often people kind of experience what you experienced, where they're like, oh, here's something for your hot flushes, or let's fix the sleep issues, and let's do a mental health care plan and send you to a psychologist because you're quite irritable.

Everybody likes you.

And you hate everybody.

But menopause isn't just a list of isolated problems.

It's a whole life transition that affects every part of a woman's wellbeing.

And that's why from the very first consult, especially as a woman's health GP, I kind of zoom out and I look at the full picture, the hormonal shifts, the mental health, the sleep, bone and heart health, lifestyle relationships, sex, all of it everything, And I always consider perimenopause and menopause early on, even while I'm ruling out other disease processes.

So when I suspect they might be in that peri menopause or menopause transition, it's understanding the full story.

There's a really great resource on the Australasian Menopause Society website and it's called a symptom score sheet, and I often do this with my patients and then they're like, oh, holy shit, and then just going through their guiny history, medical family, social history, their mood and sexual health.

That's one that gets missed fairly often.

You know, sex is a big part of the perimenopause transition as well.

And perimenopause it's not just about the hot flushes.

It's a time.

When long term health risks start to shift.

So we see accelerated bone loss, we see that increased cardiovascular risk, like that central weight gain that females might experience.

They've got changes in cholesterol and blood sugar, and a higher chance of mood related disorders, especially in a history of females who have hormone related mood symptoms.

Yeah, so that consult I ensure that all their screening is up to date, do a physical examination.

I also do blood tests and investigation because you also do want to exclude underlying processes like firewood dysfunction and all sorts of other things.

And yeah, by the second visit, we've usually got test results and we can build a personalized plan whether that's hormonal or not, and have a clear path forward with the Medicare rebates for menopause consults.

It's a big step forward allowing more time in general practice, but they don't match the complexity of care many women need.

It's like twenty minutes.

I can't do a menopause consult in twenty minutes.

I usually see a patient two to three times before I prescribe.

So don't expect to go in for one appointment of care.

We know, no, definitely not.

The new menopause hubs are also welcome addition for complex cases, and we see a lot of females who really struggle to kind of get on top of their symptoms or we can't start MHT or HRT as you might know it.

So it's really great that there's a service that I can refer them to where there are some great specialists that can give individualized care.

Can you give us a little idea on what is actually happening internally to me when I hit perimenopause, because like it's often compared to puberty, but like, how there's similarity, is there?

Okay, so that's the million dollar question?

So what is going inside our bodies when pery menopause begins, Because let's be honest, it can feel like chaos.

That's why we do call it the period of chaos.

It is the window of case.

But there's a method to it and understanding it can help us feel a lot more grounded.

So from puberty until your late thirties or early forties, your brain and ovaries are doing this like little nice synchronized hormonal tango.

So think of it like a long term couple with this solid rhythm.

Every month, your brain sends out these little too cute chemical messages so FSH and LH for theicle stimulating hormone and lutinizing hormone to your ovaries, and they tell them when to grow and release an egg and to produce the hormones estrogen and progesterone.

But in perimenopause, which can start several years before your last menstrual period, that choreography starts to get a bit clumsy, right, the ovaries start going, yeah, nah, I'm a little tired.

It's not happening today, and they don't respond as predictably and they don't produce the hormones consistently anymore.

So this is where it gets really interesting.

And this is what most people don't realize.

Even though you're nearing the end of your reproductive years, you still have eggs, right, you can still get pregnant in perimenopause.

I love how like every doctor I've spoken to about menopause is like, you can still get pregnant, because if everyone who's hit perimenopause is just like, oh, it's over, thank god, and they're like, no.

So you still have eggs left, and those are the follicles in your ovaries, but they're slowly running out, and the ones that are left they're kind of shy, they're hiding and they're not exactly lining up to do their job.

So when your.

Brain senses that the hormones levels, especially estrogen, are low, it panics little.

So it's like holy shit, and it starts to ramp up the fsh and the lh sending stronger signals to try to wake those overiaes up, and sometimes it works.

Those quite little follicles respond to the extra push, and then your estrogen level spike up and they're high the next month, then nothing crickets, and then they're low and then then they drop.

So you've got this like estrogen excess, estrogens efficiency, estrogen excess.

So you get these wild hormonal swings down, up again, down, and your body rides that roller coaster along with them.

That's why might feel like a different person from one week to the next.

So you've got hot flushes, mood swings, poor sleep, heavy erratic periods, anxiety, brain fog.

It's not in your head, Gods, the brain fog.

Yeah, actual, And this is something my friends and I hurl around the same age talk about has been probably the worst symptom of them all.

Yeah, it's starting to.

Feel like a crazy person forgetting things like shirts.

Yeah, and it's not in your head, as we mentioned, it's in your hormones, and your whole system is trying to keep up.

And this is why we tell a lot of females are like, oh, I just want to get more hormones tests, but if you're over the age of forty five and you're having symptoms of perimenopause, there's really no need for us to do hormonal testing to diagnose it because, as I mentioned, you will have days where your estrogen is high and you'll have days when your estrogen is low, and so that level is not really going to tell.

Me anything, so we have no idea where you actually are exactly.

So your cycles and your symptoms will tell me more about whether you are in that perimenopause space, and we define that by the straw ten criteria, which is available in Australasian menopause society.

That's being said, a lot of people are on contraception, so it's really hard to tell if your periods are regular or irregular.

So that's where your symptoms will be our telltale sign.

And while estrogen gets a lot more of the focus, let's not forget about progesterone and that tends to decline earlier and more steadily.

It's not quite as chaotic and not as chaotic as estrogen, and that drops can lead to more irritability, poor sleep, and those PMS style symptoms.

Even if your cycles seem normal, perimenopause it's a transition.

It's not a disease.

It's your body slowly powering down its baby making factory.

But because hormones like estrogen and progesterone just don't control your periods, they also support your brain, They support your bones, your heart, mood, sleep, muscles, metabolism, skin, sex drive effects show up everywhere.

I heard someone say that there is an estrogen receptor in almost every syllable.

Crazy, isn't that crazy?

So that's why you feel like a completely different human some days, because internally you are.

It's not all in your head.

It's in your hypothalamus, your pituitary gland, your ovaries, in every cell that's been relying on those hormones for decades.

But the good news is you're not going crazy, You're changing, and there are evidence based treatments hormonal or not, that can actually help.

Amazing.

Okay, we are going to get into this in a little bit more detail next with doctor Sonya Davison.

We are going to be talking about the potential list of symptoms because there are a lot, and we're going to find out whether that all stops when actual menopause arrives.

Now, look, I caught up with doctor Sonya Davison, she's an endochronologist at the gene House Medical Center.

To find out about these symptoms and how we handle them.

I started off asking her what are the most common perimenopause symptoms.

So we've got some estrogen overboard symptoms, and we've got estrogen deficiency or low estrogen symptoms trying to creep in as well.

The low estrogen symptoms are the flushes, the sweats, typically when estrogen is dropping really low before the period, so women will start to notice that even in late thirties, possibly even early forties, feeling low in mode, cranky as feeling anxious, so a heightening of anxiety as well.

Some will not sleep, some will find difficult to initiate sleep as well and wake frequent times.

So they're the low estrogen symptoms.

But the high estrogen symptoms, on the other hand, headaches, breast tenderness, floating, fluid retention, and amplification of PMS as well.

So that's a really tricky one.

If you've had that throughout life, it can be a hodgepodge of this, that and the other within the month.

It can be very tricky and it will vary over time.

So women will typically not know if they're Arthur or Martha.

Well, can we talk about some of the less common symptoms, And I'm not sure how many we can actually attribute to perimenopause, because depending on where you look, some say there are thirty symptoms, some say there are thirty five, some say there are more than forty.

Some say they're closer to fifty.

So things like in continents, or needing to wee a lot more often, or getting UTI's is that part of perimenopause?

Well, that could be because estrogen symptoms are starting to bottom out, and also those really wild and wide fluctuations in the estrogen.

A genito urinary tract is riddled with estrogen receptors.

What about the brain fog there seems to be the one that, anecdotally the women I've spoken to is the one that gets them off to the GP.

What's going on there?

Estrogen levels throughout the cycle, when we're reproductive, and we have normal cycles, and we're normal, not polycystic oversinto are not breastfeeding, not on the pill, our estrogen will go from about one fifty up to fifteen hundred mid cycle drop down when the egg is released, and then we'll have another little hump at the side, and progesterone does a very different thing.

There's a big peak just after ovulation, before the period.

So if you think that a woman is used to having those hormones circulating for about thirty years and it all goes astray in perimenopause, brain fog, cognitive disturbance, word finding issues, memory issues.

They have been well reported.

A lot of people experience frozen shoulder when they hit this time in their life, and others experience lots of like hip pain and pains in their hands, like what's happening there?

Again, this is more an estrogen deficiency symptom.

Some women come to menopause or perimenopause with just usually the small joints of the hands and feet, but can be hips, can be elbows, et cetera.

And they just ache and they just feel old.

Can we give this next lot for them?

Under the itchy banner because many women explain having itchy skin, itchy scalp itchy inner ears, like just.

Lots of dry skin.

Sometimes in patches it'll get quite red raw, like what is happening there?

There is an exciting looking word called for my caation.

There's another word that looks quite similar to that.

It's a sensation of ants crawling under the skin, and some women can get this very vigorously at perimenopause and menopause.

This is a drying out time of life for some women, not for everyone.

And yes, they can get dry eyes well, and they can also get dry mouth, so yes, this is not unusual.

I guess we have to add dry vagina into that mix.

Too, absolutely, But again with perimenopause, these things will be coming and going, and they might be more noticeable again when the estrogen really bottoms out and progesterine botoms out before the period.

Except for chin hair growth that seems to arrive and then remain constant forever.

That's because the relative estrogen has gone from being about average four hundred over reproductive life heading towards twenty at menopause, which is the last period no more eggs, but the relative decrease in testosterone and androgens is less than that, so there's relatively more testosterone, even though it's very low still compared to estrogen just late perimenopause and early menopause.

What about bone density at this time is that being impacted by our hormone fluctuation.

There can be about a three percent per year decline in bone density at perimenopause when we're running out of estrogen.

The bones love estrogen.

It keeps them healthy, keeps them strong.

Estrogen actually helps grow bone and stops lose bone.

We reach peak bone mass at around thirty.

It's very sad.

So the cells that grow bones are winning.

But after thirty, the cells that lose bone, the ostiaclass, are chomping away.

And unfortunately, bone density does decline, but a really rapid decline around perimenopause, and you can lose about ten percent over perimenophorse and we all want that ten percent back.

Let's move onto some weirder symptoms.

So a lot of people report smelling things that may not be there, Like a lot of people report smelling cigarette smoke, even though and I'm talking about indoors where we haven't been allowed to smoke for a very long time.

Like, why are women smelling things that aren't there?

Again?

I think that it's heightened sensitivity to very wide and wild fluctuation in hormones.

A lot of women are more aware of their own body odor and particular oh.

My god, the bo yeah gets bad.

They might think that they smell, but they actually are just what they always smelled like, but it's a more heightened sensitivity of their own smell.

What about vertigo, I know a lot of women get dizzy spells or like some extreme vertigo in some cases.

Again, I don't dismiss this.

I've heard it often in my perimenopause ladies.

I think it's because of this wild fluctuation in hormones.

Can we talk about getting tested for perimenopause because we know now that blood tests that check your hormones mostly will come back as totally normal in this period.

So how do you actually know that you're in pery?

Is it all about just checking off that symptoms list?

It's the classic symptoms at the correct time in life.

It does get tricky because the median age of menopause the last period in the last egg is pretty set at fifty one to fifty two years, but it's normal for menopause to happen from forty five to fifty five even fifty seven or so.

Early menopause is before that, and premature is less than forty years of age.

Women do want their hormones measured, but perimenopause is diagnosed based on a typical age, typical symptoms, and it's only really someone was maybe less than forty and had perimenopausal symptoms that I might look at this just thinking is she going to be at higher risk of having a premature menopause?

Why I've been seeing lots of Americans on my social media feed doing this thing called a Dutch test that seems to now claim to be able to tell you if you're actually in perry?

Is that a thing?

And do we have access to that here in Australia.

You can do Dutch testing.

You can do for livery testing.

I've done a PhD in measuring estrogen teststerone and lots of other different hormones.

No one needs a Dutch test unless they're a very unusual person and their blood doesn't react properly with the normal hormonal essays, which we of course don't really need to do in perimenopause and menopause.

And I just encourage women to spend their hard earned money on something else and get to see a good general practitioner or other health practitioner who has knowledge and is a good practitioner and kind and caring and knows about perimenopause and how to manage it.

Sonia, why do you think some women experience symptoms of perimenopause quite extreme and then some women barely feel it.

Twenty percent of women at menopause and perimenopause do not have symptoms.

They sail right through.

Twenty percent have severe symptoms and can drench a beach towel in sweat overnight and have to wring it out several times.

This is just human physiology and wiring possibly experienced too.

So a history of trauma or PMS or being unwell might give you increased sensitivity and you might notice more worse symptoms at this time.

Can you talk to me about histamine, because a lot of the social media landscape when around perimenopause now talks about histamine in its relation to estrogen and how that could be causing symptoms.

There's not any evidence to support that people who do have a histamine sensitivity, by and large, they do have more skin issues.

They might have allergies and all those sort of things, but I don't think it's a really direct relationship.

We are going to be focusing on HIT or MHT in next week's episode, as well as other potential treatments, But what is your suggestion when we do try and handle all of these symptoms.

Sometimes they come on, you know, one at a time, and kind of you reach each one and can handle them as they approach, but sometimes they all dump on you pretty much simultaneously.

Really depend on the symptoms that the woman is presenting with.

So for example, if the mood symptoms anxiety, low mood and the irritability are the worst thing, or if they've got an amplification of PMS, one treatment might be suitable for them and they won't possibly want to embrace it.

But the antidepressant group called the SSRRY group.

Women typically don't like being handed an antidepressant, but it is a brilliant strategy for flushes and sweats.

If mood is better, they'll probably sleep better, it might relieve some of the brain fog.

But another good option is the oral contraceptive pill.

The pill will just stop this cyclical and wild fluctuation of hormones and will just give the very steady levels of hormone in the pill, but it will also be a higher level, so it might cater for the flushes, sweats, sleep disturbance.

And if you use a low dose pill.

This is if women are healthy, not smoking, not obese, and don't have migrain with aura, and a less than fifty years of age.

But it is the closest estrogen to our bodies estrogen, and many women don't bleed on that, and it is the lowest dose.

There is also a progesterone only pill which inhibits ovulation now and that might be a good option.

And of course those both give contraception, which is needed because you may not want to be forty nine and push around another PRAM.

Just finally, one of the questions we got from the World Community made me chuckle a little bit because she was like, seriously, just when does this shit stop?

Just want to Oh, do the symptoms resolve when you're in full menopause?

So I think the big relief with the end of perimenopause is that this stops.

But then, remember I talked about an average level through reproductive life of about four hundred of estrogen.

That level at menopause will flatline and sit there at twenty, so they may have flushes, sweats, sleep disturbance, mood disturbance, etc.

Luckily enough, they won't have any bleeding and the other thing is it should be constant.

Menopause at least is constant, so it's much easier to approach treatment.

And of course hormone therapy might be a good option.

Not all can take it, but there are other non hormonal medications and other strategies such as cognitive behavioral therapy which might be useful in perimenopause too.

Hypnotherapy is very useful, not to stop the symptoms, but to help the body with how they respond to it.

Some have acupuncture in a given individual that might be a good option as well.

Gosh, this can be such a confusing time.

Thank you, doctor Davison apparently, and this is something that is now being tracked as we see spikes in divorce rates amongst women who enter perimenopause and menopause or years.

And we're talking about heterosexual couples.

I don't know how it works in that same.

Sex coupling, Like, oh jeez, i'll be interesting.

If you want two women currently going through perimenopause, I would like you to tell me what you're at experience is like like is your house peace and serenity because you're supporting each other and you understand do you understand it?

Or is it like raging chaos and like the depths of hell.

But it's a lot, right.

I am seeing a lot of women in my practice who are not only dealing with the brain fog and the physical symptoms like hot flushes and the night swits, but the strain it is putting on their relationships.

So many females are coming in and just it's like I cannot stand my partner.

And one big piece that doesn't get talked about enough is the impact on intimacy and libido.

Many women experience are dropping their sex drive during this time, which can make things really tough with their partners.

Also drive vagina, Yeah, it's fun, not sexism.

Fun.

No, And sometimes men might not understand why things have changed, and that can lead to frustration or feeling disconnected in the relationship.

But it's not just about intimacy, Like women are also dealing with a massive physical load.

They're managing symptoms that are exhausting.

Depending on where you are too.

If you're Sandwich generation, you're caring for elderly parents exactly, you're going through perimenopause and menopause, and you may have a child going through puberty at the same time, Like holy heck.

So menopause isn't just about a woman's journey.

It impacts the whole relationship, the whole family unit.

Getting support, talking about it openly and learning about this phase together can really help couples and families navigate it in a healthier way.

We can all do with a better support network.

And leave the bloody ac on even if you're a mentor leave it on cold.

I feel like if men partners adolescents can learn more about pery than menopause and really learn to be patient and kind during this time can really make a world of difference.

You know, it's not just about sex.

It's about that emotional closeness, understanding and support, and when people are educated and compassionate, it helps ease the pressure and it can actually strengthen the relationship.

Well, at least be talking about it now where our mums are all like, no metopause what?

Yeah?

So I'm hoping now that it's having its moment in the sun.

It's not just for females recognizing, oh, I'm going to go speak to my doctor about this.

I don't have to live with these symptoms, but also a chance for people around those females to learn about it and see how they can support these females through this transition period.

Next it is.

Quick consult time, Mariam.

I hope you're prepared, because this is something I would really like to know the answer to.

It is about a certain time of night yep, where we all seem to fall into a similar trap, a very sweet, very enticing trap.

We are about to answer Ruth's question about her after dinner addiction.

But if you're not across how you can actually get a question to you, Dr Mariam, Let's share the process because there's a few ways you can do this.

You can send us a year oldie traditional email well at muma mia dot com.

Today you can hit us up in the dms because we're on a whole bunch of social media including Insta and TikTok so cool.

But also we have this thing called the waiting Room, and this is because we know sometimes sharing health information can be a little bit scary, so we have this way that you can remain anonymous.

And there is a link in our show notes that you can click through.

And I am loving that some people are putting so much information in the things that they are sharing here.

Thank you very much for sharing.

It is time.

Please marry em do your thing.

The doctor will see you now.

Just through here to consort Room one.

Thanks for waiting.

How can I help you?

All right?

It is a weekday evening.

You've come home from work, You've done all the things required of you.

You've had dinner, you've put away the dishes, you've.

Wipe down the benches.

God, I'm happy.

Everything is free and clear.

Your house is tidy.

You don't have to think about anything.

You think.

I've got a bit of time.

I can do a bit of couch time before I go to bed, and that is when it happens.

This is what Rue is asking for a help with today, Marriam.

She wrote this, why can't I resist eating junk food at night despite eating healthily all day?

It's like I can't control the urge and it sabotages my efforts to lose weight.

Ah, Yes, the night time snack attack.

You eat well all day and the nine pm comes and your elbow deep in the biscuit tin.

It's like you can hear the sugar from the banda going Claire Claire, I'm here for you, Come get me.

So there are real reasons behind it.

So number one, your brain is tired, so this is when your decision making power drops off.

So it gets us when we're at al low, that's right.

This is when you're more likely to go shopping online or do things that you're going to instantly regret.

Right, So it's harder to resist cravings at night, especially for high sugar, high fat comfort foods.

Number two, you might not be eating enough earlier.

So if you're unintentionally restricting food during the day, your body's naturally going to try to catch up at night.

It's not a lack of wheel power.

Number three hormones.

Hormones are always involved.

Every single conversation we have comes back to hormones eventually, So things like.

Cortisol, insulin, and even those estrogen fluctuations, especially in perimenophors, they can intensify those evening cravings.

And then there's the emotional side.

So like nighttime is often the first moment we stop, we breathe.

We even just have a moment to ourselves exactly, and food.

Becomes this quick way to like comfort, smooth or manage stress.

So what can help Ruth?

Okay, so we've got to make sure that you're eating enough across the day, especially protein, fiber, and healthy fats.

We want to keep your energy and blood sugar level stables.

Include treats in your regular diet so you don't need to cut out all the foods that you love.

Restriction can make those cravings stronger and lead to that all or nothing mindset.

We don't want that, so we also want you to build healthy eating patterns where your meals are balanced, they're satisfying and not about punishment or control.

That relationship is with food is so important, and if you feel like it's starting to control your life that relationship with your food, or if you're constantly stressed, we're feeling guilty about eating, it's really worth checking in with your GP.

You may benefit from speaking with a dietitian or mental health professional to make sure your relationship with food is really supporting your overall wealth.

This is something I had no idea about until I went to see a dietitian.

Yep, and she said to me, you're existing in a punishment reward cycle exactly.

She's like, that's not a healthy relationship.

To include those treats throughout the day in a healthy Amountah.

She's like, just melt a bit of chocolate on top of your yoga and I was like, shut up, I can do that, and she's like, yeah, you can.

Some very good advice.

Thank you, doctor Merriam.

Now we just have to put it into practice.

So it is the fun pot never easy.

Thank you so much for hanging out with us again today here on.

Well, we need to let you know though, when we are speaking to you about things, were speak in general terms, and that is because neither I nor marriage are your actual doctors.

We actually cannot diagnose you with a single thing.

So what you really need to do is head off to your own gp, have the conversations, ask all the questions, and use the info that we've given you as like a baseline.

So we've armed you.

Yeah, now it is up to you to go and do something with that.

Next week, we are talking about HRT or MHT as you refer to it as it's a topic that divides a lot of people.

Ye, homone replacement.

It has a lot of history.

There is a study that we will be discussing which comes up in conversation all the time.

Whether you're aware of it or not, it might be coloring the way you think about HRT or MHT.

So we are going to be getting to.

The bottom of that, so so excited.

We will catch you for your appointment next week.

Bye Bye Well is produced by me Claire Murphy, senior producers Sasha Tannic and Sally Best, with audio production by Scott Stronik, video production by Jillian Rosario, and social production by Elliemore.

Mamma Mia acknowledges the traditional owners of the land.

We have recorded this podcast on the Gadigul people of the Eora Nation.

We pay our respects to their elders past and present, and extend that respect to all Aboriginal and torrest Rate Islander cultures.