By Kirby Edwards

Internal pelvic release work and education can be helpful for women with chronic pelvic pain including nerve pain, urinary incontinence and womb related issues. Osteopathy can also be helpful for women pre, during and post pregnancy. Internal release/Intra-vaginal is a great way to ‘prepare the passage’ and optimize the tissues. 

One of the principles of Osteopathy is that structure governs function. To me, this means that when we optimize the structure of something it will function optimally and vice versa. By working intra-vaginally, we can have a different approach to the pelvis and trust the body's innate wisdom and ability to heal and achieve balance as best as it can.

I was lucky enough to train in Internal Pelvic Release work with Jenny Blyth and Andrea Lopez. Their internal pelvic release work mentorship was designed with Fiona Halligan. Their collective knowledge and experience working with the pelvis and women (both internally and externally) is phenomenal. By combining my osteopathic background and the knowledge and skills acquired with Jenny and Andrea, it has allowed me to build a solid foundation from which to help you to get to know your pelvis and explore this sacred work with you.

​ Educate and Empower!

• Through education, empowerment and exploration together you can

connect with your pelvis and womb and get to know yourself. 

•  It really doesn’t matter what kind of pelvis you have, it’s yours, it’s

important that you understand it. We want you to know your own body,
but especially pelvis, inside and out so well that you know when to go
and seek assistance. 

•  Self-care will often be taught - how much you invest in yourself is up to you,

but we will often remind you that you are worth it.

Pregnancy Preparation - Prepare the Passage 
Working together to prepare the passage for birth. The intention is to prepare and soften the tissues of the pelvis through the vagina, so that the pushing phase (second stage) of labour can proceed with as much ease as possible. This work can help to minimize trauma for mum and bub and help optimize the birth canal for a safe passage. 

• You will be taught self-care, and your partner will be taught - it’s a bit easier for them to access things at this stage! 
• After 36 weeks is when we can do the “preparing the passage” work together. The tissue is assessed, and confident light touch is used to release the tissues to prepare the passage for bub and mum. The cervix is avoided.
• If bub arrived earthside via the sunroof (c-section) then we may still do some internal work (depending on the situation i.e.. still labored etc.). Any of our osteopaths can help you out with some scar work to help decrease the chance of adhesions to keep that fascia sliding and gliding.

​
Postpartum 
Treading gently after the birth we can check the pelvis and ensure she is healing up as well as she can. Situation pending but your body is often doing a kick arse job recalibrating and healing, so we generally won’t do anything internal until after 6 weeks.

Education for partners 
We can do education for partners in the consultation. Some things to help internally, externally or just a time to ask questions. I use a lot of information from Jenny Blyth’s book - The down to earth birth book - in that book there is some info for the partners.
https://birthwork.com/product/the-down-to-earth-birth-book/  

If you are new to our clinic, we recommend booking an initial osteopathic consultation with Kirby to explore the suitability of this treatment for your unique circumstances. If you are curious to know more about the modality and how it came to be, check out the resources listed below. 

Resources
 
Jenny Blyths “Down to Earth Birth Book”
https://birthwork.com/product/the-down-to-earth-birth-book/ 
 
Andrea Lopez - Secrets of the honey tree and Mama Medicina
https://secretsfromthehoneytree.com/
https://mamamedicina.com.au/
 
Information on pelvic prolapse and self-care. 
https://www.wholewoman.com/
 
Spinning Babies
https://www.spinningbabies.com/

​What are the symptoms of PCOS?

Like many conditions that women further from symptoms can be wide spread and in many cases can vary from woman to woman.
Some of the most common symptoms include:
 Irregular or absent menstrual cycles
 Excess hair growth
 Acne
 Weight gain, especially around the abdomen
 Difficulty getting pregnant
 Infertility
 Thinning hair
 Ovarian cysts
 Metabolic problems, such as insulin resistance, diabetes, and high cholesterol

By Kirby Edwards
​
I recently re-read the book Atomic Habits by James Clear. I have read this book before and find myself re reading it when I need a little motivation. It was such a great reminder that we can make small sustainable changes to help improve our lives, namely our health.

In an attempt to try to keep hip and up with the times, I enlisted my new AI friend bard to help me write a blog about it.
​
The book focuses on the power of small, incremental changes and how to get 1% better each day. James Clear argues that we can achieve significant results by making small changes on a consistent basis. This approach is particularly well-suited for improving our health, as it allows us to make changes that are sustainable and that we can stick with over time.

Here are some of the key principles of Atomic Habits that can be applied to improving our health:
​

• Make it obvious. The first step to changing a habit is to make it obvious what you want to do. This means creating a clear and specific plan for how you will achieve your goal. For example, if you want to start exercising more, you might make a plan to go for a walk every day after work.
• Make it attractive. Once you know what you want to do, you need to make it attractive to do it. This means finding ways to make your new habit enjoyable and rewarding. For example, you might listen to your favorite music while you walk, or you might set a goal to walk to a specific destination that you enjoy.
• Make it easy. The easier it is to do something, the more likely you are to do it. This means making sure that your new habit is as easy as possible to start and maintain. For example, you might keep your walking shoes by the door so that you can easily slip them on and go for a walk.
• Make it satisfying. When you take action towards your goal, it is important to celebrate your successes. This will help you to stay motivated and on track. For example, you might give yourself a small reward after you go for a walk, such as reading a chapter of your favorite book.

By following these principles, you can start to make small, sustainable changes that will improve your health. Remember, it is not about making huge changes all at once. It is about making small changes that you can stick with over time.

Another helpful habit hint is “Habit stacking.” It is a technique that can help you to build new habits by linking them to existing habits. For example, if you want to start drinking more water, you could stack it with your morning coffee routine. This means that you would make a point of drinking a glass of water every time you made a cup of coffee.

Habit stacking is a great way to make new habits more sustainable. By linking them to existing habits, you make them easier to remember and more likely to become automatic.

Here are some tips for using habit stacking to improve your health:

• Choose a strong anchor habit. The anchor habit should be something that you already do consistently. This will make it easier to remember to do your new habit.
• Start small. Don't try to stack too many habits at once. Start with one small habit and then gradually add more.
• Be flexible. If you miss a day, don't beat yourself up. Just pick up where you left off the next day.

Habit stacking is a powerful tool that can help you to improve your health. By following these tips, you can start making small changes that will have a big impact on your well-being.

Here are some examples of habit stacking for health:

• After I brush my teeth, I will drink a glass of water.
• After I eat lunch, I will go for a walk.
• After I get home from work, I will do 10 minutes of stretching.

By stacking these habits together, you can make them easier to remember and more likely to become automatic. This will help you to improve your health in a sustainable way.
 
With a little effort, you can use these helpful habit hints to improve your health and reach your goals. So, what are you waiting for? Start making small changes today!

I would like to add that some of us are very all or nothing, ie. We didn’t go for a walk Monday; therefore I might as well not do it all week and start again next week. No! every little bit counts. Small amounts often.
 
Here is a link to his page. He has some great insights into
https://jamesclear.com/atomic-habits-summary

​What can an osteopath do?

Osteopathy is based on many principles. Some of them are that the body is a unit, the body has self regulatory healing capacity and that structure governs function. With this in mind, we can work with you to help improve the function of the neck and entire body. 

Early stages advice may be as simple as hands on treatment and lifestyle modifications. Chronic neck issues may be coupled with further rehabilitation and it may take a little longer to recover. 

As every person and their circumstances is different, your osteopath will assess and treat you individually. You will then discuss a treatment plan together that works for you. We will likely discuss some practical stretches, how to implement them into your daily life. As well as suggest some exercises and strengthening for you and maybe some tweaks to your ergonomics to help decrease it occurring. 

If you have been suffering from text neck or any other neck pain, the team at the Health Management Centre are familiar. The team are equipped with knowledge and experience to treat any and all complaints. 

References
​https://www.physio-pedia.com/Text_Neck

By Liam Neyland
​
What is Dry needling?
​
Dry needling is a form of treatment modality that many health professionals implement. It involves the use of a sterile “dry” single use needle being inserted into the skin and muscle. This particular technique is aimed toward myofascial trigger points that are found in muscles. These trigger points are normally found as hypersensitive and or palpable nodules. The overall goal of dry needling is to help reduce muscle pain and or spams, increase surrounding tissue range of motion and improve nerve conductivity. 

How does it work?
​
​The way that this treatment works can be quite complex in nature. In the most simple explanation when these trigger points are stimulated through the use of the needle, a ‘twitch’ like response is produced in the muscle fibres. This stimulation creates a local influx of blood products such as red blood cells to the affected area. This influx is part of the natural inflammation process which in turn helps stabilise and strengthen surrounding connective tissue. During this process the nerve that innervates the target muscle is also stimulated resulting in nerve fibers releasing specific chemicals that interrupt pain signals which in turn causes muscle depolarisation and relaxation from previously tightened states. 

What can it be used to treat?
​
​Dry needling can be used to treat a multitude of conditions. Ranging from but not limited to tendinitis, headaches, general muscle aches/pains and acute soft tissue injuries. Dry needling will only be a small portion of the treatment consultation as your osteopath will utilise a number of other treatment techniques to best maximise the healing time frame. During treatment of certain conditions having dry needling can be sore during or post but this is normally a case to case basis with most patient’s not feeling any pain or discomfort due to how thin the needle is

Is it the same as acupuncture?
​
​Dry needling and acupuncture have lot’s of similarities between the two. With both inserting needles into specific parts of the body. However, dry needling is used in a more localised fashion where the muscle or region is being treated not the entire body. 

What Would I expect During treatment?
​
During a usual treatment session you will be placed in a comfortable position dependent on what area is being targeted whether it be seated or lying down on either your stomach or back. Once settled a needle will be gently inserted into the trigger point, once in depending on the expected outcome the needle will either be dynamically utilised (moving needle) or statically utilised (stays still). The needles will only be inserted for 30 seconds to 7 minutes depending on a variety of factors.

If you believe that dry needling may be beneficial for you or if you have any questions regarding the procedure, the staff at HMC Osteopath’s are more then happy to answer any questions you may have.

Reference
Dry needling: a literature review with implications for clinical practice guidelines - PMC (nih.gov) Dry needling - Physiopedia (physio-pedia.com) The effectiveness of superficial versus deep dry needling or acupuncture for reducing pain and disability in individuals with spine-related painful conditions: a systematic review with meta-analysis - PMC (nih.gov)

By Ramona Packham
 
Who better to learn about menopause and the impact it has on one’s life than from those going through it themselves? Read on to discover insights into three women’s experiences through menopause. One of my personal take home messages is how different one person’s experience can be from another!

QUESTION 1#
​Please state your age and stage of menopause (i.e. perimenopausal, menopausal). If menopausal, how long have you been going through this? What age did you become perimenopausal or menopausal?

Person 1.

• 55 yrs
• Postmenopause
• 51 yrs became menopausal.
• Four years going through menopause.  Getting less but still have hot flushes. Was not the typical 12 months that you hear via information.

Person 2.

• 56 years old.
• Age when menopausal started was 50 years old. The menopausal stage lasted about two years.

Person 3.

• I am 55, 56 next month. I think I am going through menopause. It’s been going on for about 4 years. Started at 51

Person 4.

• 55
• Perimenopausal from approx. 54.5yoa

QUESTION 2#
Please state 3 of your main symptoms, and a short summary of how each one has affected your life. You can mention how these symptoms might have contributed to other symptoms.

Person 1.

• Irregular Periods
• Hot flushes: either during the day or at night.  Bought only cotton, bamboo, or merino clothing to help my body breathe better at work. Needed to wear t-shirts and always a jacket so I could take it off. At night sometimes drenched in sweat.  Would need to change and have a quick shower. Sometimes I would wake up with a headache as I was overheated. Took my body a while to cool down. Contributed to broken sleep and tiredness, following irritability.
• Urinary Issues: the need to wee a lot more than usual especially at night. Lighter sleep, sometimes burning when needing to go, pelvic floor muscle a lot weaker. A big reason I started doing Pilates to strengthen which has helped hugely.
• Difficulty losing weight. This may be more hormonal than menopause, but I am not quite sure.  I try to eat healthy and exercise to help with weight. I never had high cholesterol but apparently, I do now so I am being diligent besides ice coffees 1x week.

 
All these tend to affect each other and of course changes to life.  I choose breathable clothing, do Pilates, exercise each day, take caffeine and hydrated sticks in water to give me energy to get through the day as tired from not sleeping well.
 
Person 2.
Only one symptom, which was very slight hot flashes that lasted for a minute or two.

Person 3.
Hot flushes in the legs. Mood swings. Weight gain and slowed metabolism.
​
Person 4.

• Change in periods: timing (up to 10 days late) and flow
• Weight gain: around midriff rather than thighs
• Sleep pattern (??? not sure if perimenopause related): Waking 2-3 hrs earlier 

QUESTION 3#
Do you suffer from headaches or migraines? If so:

• How long have you suffered from these?
• How long do they usually last?
• On a scale from 0-10, 10 being so debilitating that you have to bed-ridden, how intense are they on average?
• What strategies have been helpful to you in coping with these? (this can include medication, home-remedies, or alternative therapies)

Person 1.
I do suffer from headaches. I generally know why I get them which are following:
My vision: I wear glasses and often find if too much glare or sun or night-time where I have to really concentrate can bring on a headache. I can’t read too much or look at screen as I can get a headache.  I have two different eye visions.
Lack of Sleep: tired from not sleeping well due to going to toilet or just waking up for no reason. This can lead to wrong position when I do sleep leading to sore neck muscles.
Dehydration: Particularly when I am at work I may not get to drink enough water.
Driving to my dad to look after him: whether it is tension, anxiousness, or stress or whether it’s a long way driving that I am not sure. My sister also experiences this.
Strategies:

• Prayer
• Dark room: resting my eyes sitting up in bed (can’t lie down due to headache).
• Massage: husband massage my forehead and temples. Sometimes his cold hands bring relief to my face and head.
• Chamomile tea.
• Peppermint and lavender oils in a diffuser or candle.
• Panadine or neurofen tablets.
• Drinking water.

Person 2.
No, extremely rare. If I did get a headache I don’t think it was related to menopause.
Sleep and or relax rest helped with rare headache.

Person 3.
So far, I don’t suffer from migraines so can’t answer any of these questions.

​Person 4.

• Yes
• Since early 20s
• Up to three days
• 5 out of 10
• Massage, osteopathic treatment, paracetamol, peppermint tea

QUESTION 4#
Do you exercise? If so, what exercise do you do and how often? Has this changed since becoming menopausal?

Person 1.
Yes I exercise. I have always enjoyed outdoors walking, hiking, cycling.
Average: 5/7 days a week.
Walk (5km average) 4x
Walk up steps 2.5km then return (You Yangs hike) 1x (sometimes 2 x)
Pilates 2x
Since menopause I started Pilates to help strengthen muscles as well as help with some extra aches and pains (age or menopause not sure).

Person 2.
Yes, some stretching muscle exercisers and occasional walking, at least 2/3 times a week.
It has not really changed but sometimes less or more.

Person 3.
I walk at times, sometimes hike. I have a job that keeps me active. I used to walk more but I get so tired after work now.
​
Person 4.
Minimal
Walking, short HIIT routines 

QUESTION 5# What was your main concern in lead up to perimenopause if you had any. How has this concern been addressed?

Do you still have any fears around the changes associated with menopause?

Person 1.
I did not have many concerns basically as my last 15yrs has been dedicated to caring for my parents as well as bringing up my girls that I simply didn’t think much of myself. This probably helped as I wasn’t concerned.  I have Faith in God which helps me regarding my health.  I know He knows everything about my life which is comforting that I am not alone.

Person 2.
No concerns or fears, although my mother had medium to extreme sudden hot flashes of sweat.

Person 3.
No concerns really as it was inevitable. I’m worried when I’m through menopause that I will age faster than I am expecting to.
​
Person 4.
Later than average age has higher incidence of cancers (familial history of cancer) 

QUESTION 6# How long were the periods of amenorrhea in your perimenopausal stage?

Person 1.
Periods were not lasting 4 days like usual.  Periods lasted a day towards fully transitioning to menopause to just spotting. They were not once a month, and I didn’t know when they would come and go.  Basically over 3 to 4 years reduced in duration and time.

Person 2.
Period flows lasted less days and lighter and skipped random months. Sometimes no period flow for three months and there was no consistency. On rare occasions period flows were heavier than usual and sometimes lasted longer days, but this occurred only about three times. At 50 years old menopause started and lasted about two years, then the third year I had no periods for at least 12 months, when suddenly I got a heavy period for about two hours in one day and then nothing, and I haven’t had a period since. I visited the doctor and all tests showed that everything was fine. I also discussed my concern with a friend from work who reassured me it was normal to get a random period after a year, it happened to a few people she knew.

Person 3.
I have continued to have light periods. I had uncontrollable bleeding at 51 and had to seek medical attention.

Person 4.
10 days maximum 

QUESTION 7# Can you provide information to any services, products, or advice that has been personally effective for you in coping with menopausal symptoms? Please list specifics.

Person 1.
Exercising Daily: I feel this has improved many of my symptoms.  My hot flushes are not as frequent, my whole body feels stronger, and I feel better getting out into nature.
Arbonne Energy Fizz Sticks: Flavours are great, boosts energy levels (don’t need caffeine however I enjoy a coffee).
Energy Renew Gundry: Great Energy and overall health. Skin feels better.
Colloidal Silver: helped with any urinary discomfort.  Whether itchiness, dryness or burning sensation.

Person 2.
I noticed my very slight hot flushes occurred when l ate lots of sweets/cakes. The hot flushes never intensified just occurred slight hot flushes. As usual. I reduced my sweets and hot flushes were rare and if occurred were very mild, for a minute or less. 

Person 3.
Have never been given advice on how to cope.
​
Person 4. 

QUESTION 8# Did you feel prepared for menopause?

Person 1.
Not really but then I wasn’t really thinking too much about it.  I had very difficult periods, heavy bleeding and much discomfort so it was more of a welcome in my life.

Person 2.
It seemed to happen naturally, yes, l was expecting it at some point in my fifties.
​
Person 3.
I accept it as inevitable. 

QUESTION 9# Do you discuss your symptoms with other women?

Person 1.
Not hugely but I have a dear friend who shared how she felt.  I would also hear others talking about it.

Person 2.
Yes, with women friends at work and a couple of close friends.

Person 3.
Sometimes with good friends.
​
Person 4.
Yes 

QUESTION 10# In your opinion, is there anything lacking in the healthcare system today to help women through these years?

Person 1.
Yes, lack of education and information from the healthcare system, or school. It seems to come across as a private subject or something and therefore many women do not know about it.
I have not come across much information regarding menopause.  Information on what you could do to prepare would be helpful to many such as exercise, dietary, meditative areas.
Doctors rarely talk about it (mine has not).  I also have been to osteopath (s) for different ailments not once has menopause come up as a possible reason for soreness, aches, pains etc.

Person 2.
Independent research not related or controlled or sponsored by big companies... This ensures accurate science results from independent doctors. More knowledge of natural and healthy options, such as essential oils, herbs, pure foods, exercises to help women rather than drugs or medications that usually have side effects and only treat the symptoms (surface issues) and not the cause.  More awareness and information about the triggers and impact of certain supermarket food ingredients, diets, medications taken for long periods of time, etc.

Person 3.
I don’t think it’s approached by drs very effectively. They should ask more about what’s happening. I had to have an IUD put in to control the bleeding but I’d never heard of it happening to anyone before. The other option is uterine ablation which sounds horrific.

Person 4.
General information including definitions and non-pharmaceutical methods of assistance.

QUESTION 11# Do you have any advice for young women who are getting close to the perimenopausal phase?

Person 1.
It would be good to share with young women common symptoms to expect in the lead up to menopause so that they are aware that their lives will be affected by the change and that it is normal. I know someone that reached menopause at age 38. She had no idea and had delayed having kids. Good for all women to be aware that it will happen at some point.

Person 2.
Do not be concerned if your mother has had a difficult menopause.
Take notice of what you eat. No refined foods, and eat more unrefined.
Be aware of certain chemicals placed in supermarket foods such as preservatives, additives and flavour enhancers. Book to read: The Chemical Maze, guide to food and cosmetic ingredients. Be aware of chemical cosmetic ingredients since it is placed on face near eyes, mouth, nose, brain etc. Choose natural and pure face products.
Rest, sleep at least 8 hours, exercise-walking, drink water and or herbal teas, but no soft drinks and alcohol or only on extreme rare occasions.
Do not smoke.
Regular visits to detox in a sauna, very healthy.
​
Person 3.
Don’t be afraid and try to take care of yourself.

Please use this space to make any further comments. The floor is yours!

Person 1.
Pilates has been very helpful to me. My daughter who is an osteopath recommended it. Getting the message regarding Pilates being the perfect exercise for premenopausal and menopausal women – balance, flexibility, muscle strength, women getting together and chatting about their health etc.
I had a difficult time since a young teenager with my periods.  I experienced a lot of pain, bleeding, not feeling great etc so in away for me to not have to deal with this has given me a break.

Person 2.
I had an easy menopause, so l shared my lifestyle over years of growing. My sister who smoked from a teenager to 48years old had extreme menopause headaches that lasted for at least 3 days but I don’t know if smoking had any impact.
My mother had extreme hot flushes and is over weight.  She eats healthy but enjoys her sweets.
​
Person 3.
I wish I’d know more about the way menopause varies for each woman. My new dr assures me I’m normal – I’m nearly 56, I should be done with this by now but I’m not. It’s very disconcerting!

​ Wrap up

This brings you to the end of this little survey. While the basic physiology of menopause is similar in all women, it is worth noting that everyone’s experience is unique to them. Let’s use this opportunity to encourage women about to go through the menopausal transition, those in it and those beyond it, to look after yourselves. Take this opportunity to reset and make any health-related changes or improvements to set you up for strength in the future. Sharing about your experiences with other women can also be beneficial to both the one sharing, and those who have the pleasure of listening. You never know what someone might relate to. Finally, if anyone reading this has any questions on the topic of menopause, be it personal or generic, please reach out to the HMC Osteopaths team who are here ready to listen and help. 

By Ramona Packham
​
Since all humans housing functional female reproductive organs go through a transitional stage in their reproductive lives called menopause, it’s a subject beckoning to be discussed.
This first blog aims to empower the reader with knowledge by providing a brief introduction to menopause including information on important terms, some basic physiological changes that take place during menopause and common symptoms consequential to these. This blog will be followed by a meaningful post revealing insight into a small sample of women and their experience with menopause.  

Basic physiology of Menopause
Categories explained:

Menopause: The final menstrual period which usually occurs between the ages of 45 and 55, with the average onset at 51 years of age. During menopause the body stops producing cyclical oestrogen and progesterone (reproductive hormones) due to loss of ovarian follicles (little sacs within the ovaries that house unfertilised eggs), follicular development, and ovulation (release of the unfertilised egg).
Perimenopause: Also referred to as the menopausal transition, is the time preceding until one year following the menopause. Typical characteristics accompanying perimenopause include hormonal fluctuation, anovulatory cycles (the ovary does not release an egg, so ovulation does not occur), irregular menstrual cycles, and the onset of menopausal symptoms. This transition usually lasts between 2-6 years.
Post-menopausal: A woman is considered post-menopausal when she has had 12 consecutive months without having her menstrual cycle.
Early menopause: The onset of menopause between the ages of 40 and 45.
Premature menopause: Also referred to as ovarian insufficiency, is considered if the final menstrual period occurs before age 40. Reasons behind premature menopause include natural cessation of ovarian function, surgical removal of the ovaries, or previous chemo / radiotherapy. 

Why the change?
The reproductive cycle is regulated by hormones. The amount of each hormone produced changes throughout each menstrual cycle, and across the reproductive lifespan. Let’s start with the disclaimer that hormones are a rather complicated point of discussion, so let’s be brief and fearless of terms like the ‘hypothalamic-pituitary-ovarian axis’ (HPO axis). The HPO axis is the relationship between the hypothalamus in the brain, the pituitary gland sitting just below it which releases hormones to send to the ovaries, and the ovaries (female reproductive organs) that produce Oestrogen and Progesterone (reproductive hormones). In menopause, the body’s physiology changes which slows and stops the production of oestrogen. Given the various roles oestrogen plays, it is not surprising that many menopausal symptoms arise because of this reduction.
​
Vasomotor changes also occur. WOAH let’s rewind for a second and explain vasomotor symptoms. The term vasomotor refers to the neural control of the constriction and dilation of blood vessels and is regulated by a part of the brain called the vasomotor centre. Symptoms including hot flushes, night sweats and sleep disturbance are examples of vasomotor symptoms.
Sleep deprivation or reduced sleep quality is also a significant underlying reason for many symptoms of menopause. Sleep deprivation is often tied to vasomotor instability. 

All the wonderful symptoms 
Symptoms are greatest in the menopausal transition, compared to the post-menopausal stage which is often easier to manage. This is due to the changes in reproductive hormones as explained in the previous section. 80% of women report experiencing menopausal symptoms including hot flushes, night sweats, body aches, breast tenderness, weight gain, dry skin, vaginal dryness, loss of libido, urinary incontinence, and changes in mood and memory. Other less common symptoms can include itchy skin, thinning of the scalp and pubic hair, and skin changes.

Symptoms can be classified into two parts:

1. High oestrogen symptoms, experienced earlier on in menopause, and low oestrogen symptoms which are experienced later in menopause. High oestrogen symptoms include heavy menstruation, breast tenderness, weight gain, and headaches.
2. Low oestrogen symptoms include all the vasomotor symptoms and vaginal dryness. Three common vasomotor symptoms are hot flushes, sweats, and sleep deprivation.

 

Hot flushes
Hot flushes are a hallmark symptom of menopause and are experienced by 75% of women, with approximately 25% of these being significantly problematic. Hot flushes may last 1 to 2 years, however it is not unusual for these to last 10 years or more. A hot flush, as it sounds, is the episodic experience of extreme heat, followed by cutaneous vasodilation and a consequential drop in core body temperature. Women with oestrogen deficiency in the later stages of menopause have a lower than usual thermoneutral zone, which means that even a small increase in core body temperature causes the sensation of extreme heat. Vasodilation (expanding) of blood vessels in the skin and sweating help the body to release heat.

Changes in mental status
Serotonin is a chemical neurotransmitter that helps to regulate sleep, emotions, and mood, and it decreases by 50% during menopause. Sleep deprivation, depression, anxiety, fatigue, irritability, and loss of libido are all associated symptoms that affect many women as they journey through menopause, especially towards the later stages. While depression does not increase in prevalence among menopausal women compared to other stages of life, it can become apparent in those with a previous history of depression, or because of the presence of other symptoms such as lack of sleep or loss of libido. Some women experience cognitive symptoms like the inability to concentrate and make decisions. Additionally, changes in the menstrual cycle causes unpredictable periods of amenorrhea, or, not having a period, which can be a source of stress and anxiety for many women since it becomes difficult to predict the next period.
 
The vagina
​Let’s address the elephant in the room and talk about the vagina, and all the changes that go on down there. These symptoms when related to menopause are termed genitourinary syndrome of menopause and are often not spoken about due to discomfort in disclosing this kind of information. Let’s talk about them. Vaginal dryness and dyspareunia (painful sexual intercourse) are two of the most common symptoms experienced by 1/3 women in the later stages of perimenopause, so if you thought you were alone in this boat, you are not.

Other symptoms relating to the vagina and structural changes of the vagina that women may observe include burning and irritation of the vagina, decreased lubrication due to changes in vaginal mucous production, thinning of pubic hair, atrophy of the labial fat pad, and resorption of the labia minora. The structural changes of the vagina may be termed as vulvovaginal atrophy.
As these symptoms are a result of hormonal change, it is not surprising that hormone therapy is most often the first treatment modality, and for most women the advantages of using hormone therapy outweigh the possible risks. 

There are always links.
Menopausal symptoms have a reciprocal relationship with each other such that one symptom can add to the severity of another. For example, poor sleep can contribute to depressed mood, which can increase one’s perception of discomfort. There is also a link between depressed women experiencing more hot flushes which leads to poorer sleep, particularly as the hot flushes occur nocturnally. So, these vicious cycles go on, not dissimilar to those that influence pain conditions.
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As this can be very frustrating, it is important to speak about them and seek out management. These profound reproductive and hormonal changes cause 90% of women to seek professional healthcare advice to help them cope with the associated symptoms.

Small suggestions
The menopausal transition is a great time to think about overall health and wellness and be assessed by a healthcare professional, like a GP, an Osteopath or both! This is prime time to get your body feeling healthy and strong, preparing you for the post-menopausal stages of life. Achieving good cardiovascular fitness and optimal bone density are absolute priorities.
Due to cycle irregularity throughout the menopausal transition, continuing contraception is suggested as pregnancy is still possible.
It is also worth considering self-care practices throughout the menopausal transition. Making sure you prioritise your health and wellbeing, being gracious to your body and patient with what it is going through, are factors that can have a very positive influence on both physical and mental health.

More suggestions from REAL women in the next blog.

Stay tuned!
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Stay tuned for my next blog to learn from women and their experience through the menopausal transition. 

References
Australian Menopause Society. (2017). The perimenopause or menopausal transition. North American Menopause Society (NAMS) - Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights
Australian Menopause Society. (2022). What is menopause? North American Menopause Society (NAMS) - Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights
Australian Menopause Society. (2021). Risks and benefits of menopausal hormone therapy. North American Menopause Society (NAMS) - Focused on Providing Physicians, Practitioners & Women Menopause Information, Help & Treatment Insights

By Angus Nicol

As the tiny human reaches the end of the peace and comfort of their nine month incubation period, they start to descend, head down facing backwards until it engages behind the pubic bone, in a process known as “lightening”. At the same time, preparing for a traumatic entry for their solo journey upon our planet. Mums cervix softens and becomes thinner in preparation to dilate during labour. Labour begins when the muscles at the top of the uterus contract, initiating the baby’s traumatic journey through the cervix/vagina and out into the real world. Towards the start of labour, the water breaks and the baby is released from the sac of amniotic fluid it called home. The initiation of labour is strongly influenced by the release of oxytocin. 

​Oxytocin is also known as the “love hormone”, and more recently, the “spirit hormone” because of it’s important role in feeling love and in social interaction. This hormone is also thought to play an integral role in feelings of spirituality by enhancing feelings of interconnectedness. This creates a beautiful juxtaposition - The significance of oxytocin helping to initiate labour, the physical separation of mother from baby, with the love hormone responsible for an eternal emotional bond between parent and child.
 
As labour progresses, the mother’s cervix dilates, creating a tunnel that exits the cavernous womb. Contractions get stronger and stronger, forcing the baby’s head down into the cervix. During this process, the baby’s unfused skull bones are squashed and forced to overlap and take on the shape of an elongated cone with a rounded end. Altogether, labour is a process that can last anywhere from a few hours to a couple of days (average 12-14 hours).

Once the baby’s head passes through the vagina, it usually only takes a few more contractions until the rest of the body is liberated. The newborn may appear blue and mottled. However it should take it’s first breath, creating it’s own life force energy, within the first minute following birth. As the baby continues to breathe, appearance should become pinker as blood and oxygen circulates through the body. The baby will be covered in amniotic fluid which is important for the baby to be able to smell and taste, because it creates a sense of familiarity and security in an otherwise alien environment.
 
Following birth, the placenta will also be delivered, along with the umbilical cord. Often the support person will be invited to cut the cord, signifying the end of the newborns physiological dependence on it’s parent. However, connection via skin-to-skin contact immediately following birth is important as it helps start and sustain breastfeeding, and also aids in the maintenance of baby’s core body temperature (which is basically a measure of energy release via heat). Baby will usually ask for it’s first meal around an hour after birth. The newborn will be exhausted from the traumatic birthing process, so shortly after it has been nourished it will usually fall into a long sleep that may last 6 hours. Usually a baby will spend about half of it’s first day on Earth asleep.
 
Baby has been listening to Mums voice for the last half of pregnancy, and will recognise it when you speak to them after birth - they may also recognise partner/support persons voice if they have also been talking near the womb. This creates a sense of security for the newborn, and they may respond by turning their head towards the voice. Your baby will also be able to hear your heart beating as they did in the womb.
 
A new borns vision is blurred at birth but they will be able to focus on your face from about 30 centimetres away - the ‘cuddle distance’ (roughly distance from Mums breast to face). Your baby will make the connection between what they hear and what they see.

By Angus Nicol

First Trimester
 
At a more macro, less cellular level, there are some significant milestones between weeks 3-8.
 
Weeks 4-5 - The heart usually starts beating between 4th-5th weeks and all the muscles and blood vessels in our body branch outwards from our growing, beating heart. Eye pits form, limb buds become apparent, first signs of pulmonary system are formed (connects heart to lungs).

Week 6 - Uncontrolled foetal limb movements start to occur, paddle-shaped fingers/toes undergo “apoptosis” (programmed cell death) so webbing disintegrates leaving defined fingers/toes.

Week 7 - Facial structure more complex. Includes nostrils, outer ears and lenses. By the end of Week 7, the foetus is distinguishable as a tiny alien-human.

Week 8 - Head as large as rest of embryos body, external genitalia become apparent (can’t distinguish M/F), cartilage begins ossification process into bone.

Week 10 - Organs like kidneys, intestines, brain, and liver are beginning to function, and fingernails and toenails are starting to form.

Week 11 - Red blood cells (carry oxygen vital for energy/life) start forming in liver.  By end of week, external genitalia apparent (penis or labia & clitoris). Bud for teeth appear. Now no longer classified as embryo, now classified as foetus.
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Week 12 - Face has a more developed profile.

Second trimester
 
Week 13-16 - Sensory organ development. The eyes move closer together; blinking motions begin, although eyes sealed shut. Lips exhibit sucking motions. Scalp begins to grow hair. The excretory system developing: the kidneys well-formed; meconium (fetal feces) begins to accumulate in the intestines.
 
Weeks 16-20 - Fetus grows & limb movements become more powerful. Mother may begin to feel “quickening” (foetal movements - space restrictions force foetus into foetal position). Skin coated with waxy substance “vernix caseosa) for protection, moisturisation and lubrication during birth. 

Third trimester
 
Weeks 21–30 -  Rapid weight gain (important for maintaining stable body temp after birth). Bone marrow completely takes red blood cell synthesis, nerves undergo myelination (production of fatty protective sheath that helps electrical conduction - this process continues until adolescence). Fetus grows eyelashes. Eyelids not fused (can open/close). Lungs produce surfactant (substance that reduces tension in lungs, assists proper lung expansion after birth). Males: Testes descend into scrotum(towards the end). Fetus at 30 weeks measures 28 cm from crown to rump, exhibits approx body proportions newborn (but much leaner).
Baby may begin dreaming (28-32wks).

Weeks 31 - Birth -  Fetus lays down fat (fills out layer below skin aka “hypodermis”, skin transitions from red/wrinkled to soft/pink. Nails grow to tips of fingers & toes. At birth, average crown-to-rump length is 35.5–40.5cm, weight 2.5–4kg.

​​By Angus Nicol

Weeks 1-3 - Cellular function & Connection with universe

Even before the moment of conception, our physical form has to fight to survive. The journey for a sperm to meet it’s soul partner ovum/egg is dangerous. Throughout pregnancy, there are so many different challenges that a developing embryo/foetus has to face. To survive these challenges, we rely on cooperation with other living things (mother, bacteria, mitochondria) to help us survive.
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Our bodies, like the Earth, consist of ~70% water. Water is the main component in every cell
in our body, and outside of our cells too, and this is why it is ESSENTIAL for all life. Water is
composed of H2O (two parts hydrogen, one part oxygen). . Hydrogen can sometimes be
known as the “god molecule”. During the Big Bang, it was the high power collision between
two hydrogen atoms in process of “nuclear fusion” that released tremendous amounts of
energy. This caused a cascade of collisions between atoms that got increasingly larger, and
resulted in the formation of all of the natural elements that make up our Earth (and our solar
system) today… including all of the elements which are CRITICAL for life (especially
hydrogen, oxygen, carbon, nitrogen, calcium, phosphorus… alongside all the others). It’s the
combination and connection between these elements in infinite combinations of intricate lattice frameworks that make up EVERY physical thing (the things we can see, and the things we can’t…everything that isn’t ENERGY).

This first “Big Bang” that happened at the beginning of time, and that occurs with the birth of
every star in the solar system, is similar to the process that occurs just immediately following
fertilisation, right at the beginning of our physical life. After it’s treacherous journey, when the
sperm meets it’s destined egg and our physical fate becomes reality, a process of rapid
expansion called “cleveage” occurs through a process of cell division/multiplication known as

mitosis. This process happens at a rapid rate during the first 12-24h after fertilisation, and
slows but continues for the first three weeks of pregnancy.

​DNA holds the “blueprints”/genetic code for every protein in our body. Long, continuous
chains of DNA can be separated into units known as “genes”, and sequences of genes flow
along structures known as chromosomes. We inherit 23 chromosomes from the egg from
Mum, and 23 from Dad’s sperm cell. During fertilisation/fusion, this genetic information is
fused in a complicated process, giving each little human 46 sets of chromosomes spread out along 21,000 genes (~3 billion base pairs of DNA). Within this genetic code lies the information for our “innate/true self” - it dictates how we look, what our personality is predisposed to be (before the influence of “human experience”), what illnesses we may be predisposed to etc. Similar to the natural course of the universe being decided during the first “Big Bang”.

DNA is held within the nucleus of a cell. As a foetus develops and cells begin to rapidly
multiply by process of “mitosis” they also become more specialised, and serve specific
functions in our body. This process happens quickly from Day 4 - Week 3 of embryonic
development, through a process known as “blastulation”. This cell specialisation eventually
gives rise to the development of all the different body systems, organs, structures, muscles,
bones, nerves etc in our body.

​One type of specialised cell organelle that lives within each and every cell in our body is
mitochondria. Mitochondria are the “powerhouses”/batteries of our cells, and create energy
by converting sugar into chemical energy in process of “cellular respiration”. Respiration at a
macro level is the process inhalation and exhalation… also known as breath. In many
cultures, the etymology of the word “breath” is synchronous with “spirit”. For example… In
Hebrew, spirit & breath are known as “ruach”, “hu-akh” in Egyptian and “pneuma” in Greek.
In Sanskrit/yogic philosophy, breathing techniques are referred to as pranayama. This is
derived from two parts - “prana” meaning “vital life force”, and “yama” meaning “to gain
control”. Similarly, in traditional Chinese medicine, “breath” is synonymous with “chi” which
also describes vital energy. The breath, through respiration, drives our life force because it
enables us to harvest oxygen from our external environment. This oxygen is then infused
through specialised cells in the lungs and enters systemic circulation through our arteries,
much like the roots of trees, and is transported in the bloodstream all over the body to where
it is most required. Here, it enters the microscopic environment of the cell. Some of the
oxygen is used in a very special cell organelle known as mitochondria to undergo
“glycolysis”, the process of breaking down glucose (sugar) into usable energy, in a process
known as cellular respiration (respirationwithin individual cells).

​Mitochondria are special because they are non-human - they have a similar size and
structure to bacteria, with their own unique genetic blueprint/DNA code. However, we rely on
this non-human entity for the creation of energy to power EVERY function in our body -
every movement, every thought, every physiological process, that occurs within our physical
being, relies on something outside of ourself. This includes all of the physical and
physiological changes that occur during embryological/foetal development (pregnancy).
Mitochondria has a plant sibling whose function is equal and opposite - chloroplasts,
specialised non-plant organelles with their own DNA, harvest light energy directly from our
sun, our star, and convert it to chemical energy in the form of complex sugars/carbohydrates
via the process of photosynthesis. Plants are then consumed by animals and that chemical
energy this converted back into energy by mitochondria. Ourouboros - circle of life. This
emphasises the inherent connection between ALL life on Earth and our sun. There are so
many different examples of codependency within our body, another important one being
within our gut. The bacteria that live in our gut and aid in their digestion and absorption of
nutrients that we rely on to continue living.

​During weeks 3-8, developing embryo continues process of gastrulation and development of
germ layers - the ectoderm, mesoderm and endoderm. Endoderm (“within”) forms lining of
GIT, stomach, colon, liver, pancreas, bladder, lung. Many structures that Eastern medicines
such as TCM and Ayurvedic approaches focus upon. The mesoderm (“middle”) forms
muscle, bone, connective tissue, notochord, kidneys, gonads, circulatory system. The
ectoderm (“outer”) forms Skin, hair, nails, brain, spinal cord, peripheral nervous system…interesting that even from an embryological perspective our brain and nervous system, who makes up who we are, in perceived as being “outer”, outside of us, connection to outside world. These germ layers then fold in on themselves to form tubes, with our guts on the inside and our skin on the outside.

​These processes all occur whilst we are suspended, floating within the protection of the
placenta, in a pool of amniotic fluid. The placenta itself is composed of tissues that originate
from both the growing embryo, and from the inner lining on Mum’s womb, the endometrium. Here, the umbilical cord, connects from the placenta to bub’s belly button (umbilicus), and sheaths the umbilical artery and umbilical vein. The umbilical vein supplies the growing foetus with nutrients and oxygen vital for it’s growth, whilst the umbilical artery removes waste products for excretion.