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The Pause Clinic, Castle Hill Medical Centre, Murrumba Downs (2025)

05/08/2025

Migraines often worsen in perimenopause—especially premenstrually or around erratic bleeds. This is often driven by falling and fluctuating estrogen, which lowers the brain’s migraine threshold by affecting serotonin, CGRP, and glutamate regulation.

Progesterone also plays a role. It stabilises GABA (the brain’s calming neurotransmitter), supports sleep, and reduces neuroinflammation. As progesterone declines in anovulatory cycles, some women lose this protective effect—triggering more frequent or severe migraines.

Many women find that migraines improve post-menopause once hormone levels stabilise. Others may continue to struggle without tailored treatment.

Transdermal estrogen and micronised progesterone can help when prescribed appropriately, and patches may be the preferred delivery as they give a steady state of estrogen compared to gels. Transdermal estrogen IS SAFE for women with migraine + aura.

To explore your symptoms and treatment options, visit the Pause Clinic. We can’t wait to meet you!

02/08/2025

If you’re suddenly reacting to wine, cheese, or leftovers with headaches, flushing, or gut issues, you’re not imagining it. Histamine intolerance is an under-recognised issue in perimenopause. Histamine is a naturally occurring compound involved in immune responses, stomach acid secretion, and brain signalling. It also plays a key role in regulating inflammation and allergic responses—stored in mast cells and released when triggered by food, hormones, or stress.

Histamine is influenced by our s*x hormones. Estrogen promotes histamine release—and histamine, in turn, stimulates more estrogen. During perimenopause, fluctuating or high estrogen can tip this loop into overdrive. At the same time, declining progesterone reduces diamine oxidase (DAO), the enzyme that helps break histamine down. The result? More histamine circulating, with more symptoms—especially around ovulation or premenstrually.

Symptoms can include: • Flushing, hives, rashes, itch • Nasal congestion • Headaches or migraines • Gut symptoms: bloating, diarrhoea • Palpitations or dizziness

Managing estrogen, supporting progesterone, and using a low-histamine diet short-term may help—alongside stabilising the nervous system and gut.

To explore your symptoms and treatment options, visit the Pause Clinic. We can’t wait to meet you!

18/07/2025

Ovarian resistance refers to the reduced responsiveness of the ovarian follicles to stimulation by pituitary hormones—primarily FSH (follicle-stimulating hormone) and LH (luteinising hormone). It’s a hallmark of the perimenopausal transition and is sometimes (but not always) visible on blood tests.

As ovarian reserve declines with age, follicles become less sensitive to FSH and LH. In response, the brain increases production of these hormones in an attempt to force ovulation. Sometimes this works—resulting in a strong, high-oestrogen cycle. Other times it doesn’t—leading to a cycle with minimal or no ovulation, causing lower estrogen and progesterone cycles.

This variability in follicular response explains why perimenopause symptoms fluctuate so widely day to day, week to week and month to month.

Common symptoms driven by these hormonal fluctuations include: • Night sweats and hot flushes • Anxiety, low mood or irritability • Sleep disruption • Breast pain • Heavy or irregular periods

Ovarian resistance seems highly individual as well, explaining why some women experience greater variety and severity of perimenopause symptoms than others. Understanding ovarian resistance helps explain why symptoms can begin years before menopause—even when periods are still regular—and why blood tests don’t always provide a clear picture in perimenopause.

If you’re experiencing any of these symptoms, no matter your age or menstrual pattern, visit us at the Pause Clinic. We can’t wait to meet you!

15/07/2025

Many women notice sleep disruption in perimenopause—and fluctuating progesterone may be part of the reason.

Progesterone has sedative, calming effects on the brain. It enhances GABA activity, a neurotransmitter that promotes relaxation, reduces anxiety, and supports deeper, more stable sleep. It also helps regulate body temperature, which can reduce night sweats and support sleep onset.

In perimenopause, falling progesterone—particularly in the second half of the cycle—can lead to restless sleep, frequent waking, and early morning anxiety.

For some, micronised progesterone (body-identical progesterone) taken at night can improve sleep quality by restoring some of these effects..

If you’re waking up at 3am or struggling to stay asleep, it may be more than stress—it could be hormonal.

If sleep is becoming an issue for you, visit us at the Pause Clinic. We can’t wait to meet you!

07/07/2025

During perimenopause, fluctuating and declining estrogen levels reduce the brain’s ability to use glucose for energy, particularly in memory and decision-making regions. Neuroimaging shows decreased grey matter volume and altered brain activity, along with early signs of Alzheimer’s pathology in at-risk women. This hormonal transition also increases mitochondrial stress and low-grade brain inflammation, contributing to symptoms like brain fog, forgetfulness, and mood changes. Some of this may help explain why two-thirds of Alzheimer’s cases occur in women.

But cognitive decline isn’t inevitable.
The pauses are a powerful window for prevention. Addressing hormonal shifts, vascular health, and metabolic risk can help protect the brain.

While HRT is being studied further for its benefits in brain health, existing evidence highlights the importance of targeted lifestyle changes:
• Prioritising regular exercise (especially strength + aerobic) • Following a Mediterranean-style diet rich in omega-3s and polyphenols • Ensuring adequate sleep quality and duration • Managing chronic stress and building daily cognitive stimulation • Maintaining stable blood glucose and healthy blood pressure

At Pause, we take a whole-brain, whole-body approach to perimenopause and menopause—because your cognitive health is too important to ignore. Visit us to discuss brain health - we can’t wait to meet you!

04/07/2025

Emerging evidence suggests that hormone therapy may have protective effects on the bowel—particularly for postmenopausal women.
HRT may improve bowel health by activating estrogen receptors in the gut, reducing inflammation, enhancing mucosal integrity, and supporting a more balanced gut microbiome.
These effects are thought to lower the risk of several conditions by improving immune regulation, gut motility, and epithelial cell stability:

• Inflammatory Bowel Disease (IBD): Observational studies have shown a possible link between estrogen use and reduced risk of developing Crohn’s disease and ulcerative colitis. Estrogen receptors are present in the gut, and HRT may influence mucosal immunity, permeability, and inflammatory pathways.

• Bowel Cancer (Colorectal Cancer): Multiple large studies, including the Women’s Health Initiative, have found that estrogen with progestogen is associated with a modest reduction in colorectal cancer risk of 20-40%. This protective effect has not been seen with estrogen-only therapy.

• Bowel Function: Declining estrogen can affect gut motility and microbiome composition. Many women notice bloating, constipation, or digestive shifts in perimenopause. For some, HRT seems to help regulate gut function and reduce abdominal discomfort.

If you’d like to discuss bowel health in the Pauses, visit the Pause Clinic. We can’t wait to meet you!

21/06/2025

Estrogen is a key regulatory hormone — not just for our ovaries, but for ALL systems across the body.

* Brain & Mood: Estrogen modulates serotonin, dopamine, and norepinephrine — neurotransmitters involved in mood, motivation, and focus. Fluctuations contribute to anxiety, low mood, and cognitive fog.
* Sleep: It influences the sleep-wake cycle and helps maintain deep, restorative sleep. As estrogen falls, women may experience lighter sleep, frequent waking, and insomnia.
* Joints & Soft Tissue: Estrogen supports collagen production and connective tissue integrity. It is an anti-inflammatory in the joints. Its decline is linked to joint pain, stiffness, and increased injury risk, particularly in tendons and ligaments.
* Bones: Estrogen slows bone resorption. Low levels after menopause accelerate bone loss, increasing the risk of osteopenia and osteoporosis.
* Cardiovascular System: It has vasodilatory, lipid-modulating, and anti-inflammatory effects. Its loss is associated with rising cardiovascular risk in midlife.
* Urinary & Vaginal Health: Estrogen maintains the thickness and elasticity of the va**nal and urethral tissues, as well as supporting the pelvic floor and bladder. Decline leads to genitourinary syndrome of menopause — with symptoms like dryness, urgency, and discomfort.
* Immune system: estrogen supports your immune system by enhancing responses to pathogens, supporting mucosal barriers (like in the bowel), and promotes anti-inflammatory molecules.

So … what does estrogen not do?!! Estrogen isn’t optional. It’s a foundational hormone that influences how women feel, function, and age.
Understanding its role helps shift the conversation — from “this is just part of getting older” to “this is something we can treat.”

If you’re keen to ensure your body & brain continue to receive the benefits of estrogen, visit the Pause Clinic. We can’t wait to meet you!

18/06/2025

BRCA1 and BRCA2 are tumour suppressor genes that help repair damaged DNA. Inherited mutations in these genes significantly increase the risk of breast and ovarian cancers - BRCA 1 lifetime risk 72% / 44% & BRCA 2 69% & 17% respectively.

Risk-reducing salpingo-oophorectomy (RRSO) is recommended between ages 35–45 to lower ovarian cancer risk, but induces early menopause. HRT is almost always appropriate to manage symptoms and protect long-term bone, cardiovascular, and cognitive health.

BRCA1 & HRT has been studied to a greater degree than BRCA2, and for both, most studies have focussed on “short-term” which is usually

12/06/2025

Perimenopause symptoms can be vague, disruptive, and are often dismissed - especially if your periods are regular or you’re under 45! However, they also overlap with other medical conditions — and it’s important not to assume every mood shift or hot flush is hormonal.

Here are some of the most common mimics of perimenopause:

1. Thyroid Dysfunction (Hypo or Hyperthyroidism) Symptoms: Fatigue, brain fog, weight changes, mood shifts, irregular cycles, hair thinning, bowel disturbance, anxiety, tremor, skin change Testing: TSH & if needed Free T4, Free T3, Thyroid antibodies 
2. Nutritional Deficiency - iron/B12/folate Symptoms: Fatigue, low mood, brain fog, palpitations, hair loss, weird cravings Testing: Ferritin, iron studies, full blood count, B12, folate 
3. ADHD (Unmasked or Worsening in Perimenopause) Symptoms: Poor focus, memory issues, impulsivity, emotional reactivity Testing: Clinical history, validated screening tools 
4. Depression or Anxiety Disorders Symptoms: Insomnia, low mood, irritability, low libido, loss of enjoyment, anxiety Testing: Clinical screen 
5. Polycystic O***y Syndrome Symptoms: Irregular periods, acne, weight gain, unusual hair growth Testing: LH, FSH, Testosterone, SHBG, DHEA, fasting insulin 
6. Hypothalamic Amenorrhoea Symptoms: Irregular periods, sometimes no cycle, fatigue, immune system dysfunction  Testing: LH, FSH, Estrogen, progesterone, prolactin, sometimes AMH 
At the Pause Clinic, we assess every patient holistically and never assume it’s just perimenopause. If you’re unsure what’s going on with your body, that’s exactly what we’re here for. We can’t wait to meet you!

10/06/2025

The genitourinary syndrome of menopause (GSM) has a broad array of symptoms and will affect at least 80% of women, worsening with age. It has a direct relationship with mortality, as it significantly increases risks off urinary tract infections.
Though systemic HRT seems to improve GSM for 60-80% of women, many women will still need localised treatment.

We now have both estrogen, and DHEA treatments available.

DHEA is the hormone that estrogen and testosterone are made from. Tissues that contain the enzyme to convert DHEA to estrogen and testosterone, will therefore have an increased concentration of these hormones if DHEA is given locally.

Sadly, there have not yet been any direct head-to-head comparisons of DHEA vs estrogen. Happily, we know that they both improve pain during s*x, va**nal dryness, or**sm, urinary tract infection frequency, urinary frequency/urgency symptoms and va**nal tissue health!

The main differences:
- Vaginal estrogen is available as both a cream & a pessary, while DHEA is only available as a pessary
- DHEA is applied every night, va**nal estrogen is given nightly for 14 nights then reduced to 1-2x weekly
- DHEA allows for stimulation of the many testosterone receptors in the va**na, bladder & pelvic floor, theoretically supporting a greater amount of tissue than va**nal estrogen alone
- Vaginal estrogen is on the PBS, DHEA isn’t
- Vaginal estrogen has been studied extensively in women with breast cancer that is estrogen responsive, and has been shown to be safe! DHEA hasn’t been studied as extensively yet, so a conclusion on the science can’t be drawn. However, estrogen levels when using va**nal DHEA remain in the post-menopausal range, so it’s very likely it is safe for breast cancer survivors.

GSM affects quality of life & s*xual function, and it can kill you! It will get worse with age, and there are such amazing treatments available to help. We just aren’t talking about it enough!

If you’re experiencing any symptoms of GSM, visit us at The Pause Clinic to discuss your options. We can’t wait to see you.

03/06/2025

Ozempic/Wegovy and Mounjaro are the most effective pharmacological weight-loss agents in our history. These medications are GLP-1 agonists (Mounjaro has a second action too), which means they hyper-stimulate the release of GLP-1 in the body far above what the body can do on it’s own. GLP-1 is a hormone produced by the gut in response to food with a number of functions, and medications targeting it have a number of effects:
1. Signally pancreatic insulin release & blood sugar lowering
2. Slowing stomach emptying
3. Appetite reduction
4. Possibly protective benefits to heart and brain independent of these effects

I utilise these tools very carefully, as misuse can set women up for much worse health outcomes long-term.

As with any effective weight-loss strategy, all people should be considering that if they use GLP-1s - how do they ensure that the weight they lose is mostly fat, and not an equal mixture of fat, muscle and bone? How do they avoid weight regain?

1. Resistance training while losing weight -> the only real way to retain muscle.
2. High protein & high fibre diets -> helps with muscle retention, and preserving gut health … and your pelvic floor if you tend towards constipation!
3. Eating ENOUGH calories -> this is where I see GLP-1s being misused (IMO) -> doses are cranked up quickly, appetites are suppressed significantly and women are losing weight rapidly. This is a recipe for bone/muscle loss and nutrient deficiencies.

Losing weight more slowly ALSO keeps your metabolism higher at the end of your fat loss journey (up to 100 calories worth a day!!), reducing the likelihood of weight regain as you can eat more calories without gaining weight.

GLP-1s are a tool, but they’re a tool that should never be used without resistance training & a high protein/fibre diet. They should also (IMO) be used at the MINIMUM effective dose for a weight loss that sets women up for a successful future with good muscle and bone mass, and at a lower risk of weight regain.

At the Pause Clinic, we’ll teach you how to use these tools safely and sustainably, and hopefully only temporarily!

01/06/2025

One of my favourite components of longevity is muscle mass, and the conversation around how best to lift weights is rampant online. To build muscle, you need to tax them enough that they need to heal - through this healing, with adequate rest and more calories than you need to maintain your weight, you can build muscle.

First step however, and the most crucial, is resistance training. We know now that you can build muscle at ANY rep range, as long as you are approaching “failure”. The terminology I use is “reps in reserve” (RIR). What this means, is that with any exercise you do, as you’re approaching the end of your set, the exercise should be becoming progressively harder so that as you do your final rep, you could probably only have done 1-2 more reps with good form. This would be a RIR of 1-2. Every session should also focus on “progressive overload”, which means you try to do just a little bit more than you did the last session.

An example:
Monday of week 1, I do 3x6 squats at 30kg. My 6th rep felt quite challenging, and I could probably have done 1-2 more with good form but after that would either have not been able to lift the weight, or my form would have broken down significantly.
The next week, Monday of week 2 could be: 3x7 squats at 30kg, or 3x6 squats at 32.5kg etc.

Heavy weight-lifting is a really empowering activity and provides a strong stimulus to muscle and bone. However, it is not the only way to build or maintain muscle. It can feel isolating for women who have injuries that make learning compound movements like squats and deadlifts hard, or for women whose pelvic floors struggle to function when under strain. Any resistance training is fantastic, and you can improve your muscle mass at any rep range, as long as you train with enough intensity (RIR 1-2), employ progressive overload, and STAY CONSISTENT.

The Pause Clinic sets women up for better quality of life both now, and in the future, and muscle is absolutely vital. We have several referral partners in places like , and , who can help you no matter what your starting point is

The Pause Clinic

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