This is the area where I make the most referrals, and I think that is a feature rather than a failure. A great deal of women\u{2019}s health has effective medical and allied health treatment that people simply have not been offered.
What I check: iron studies with ferritin in anyone with heavy bleeding, because anaemia is common, quiet and completely explains the exhaustion. Thyroid function, because it mimics both perimenopause and depression. Whether cervical screening is current. What the cycle records actually show over three months rather than what someone remembers.
What I refer, and to whom. Pain pattern suggesting endometriosis — to a GP, asking for a gynaecologist with an interest in it, and Australian guidance now supports earlier referral. Leaking, prolapse symptoms, pain with sex or a pelvic floor that has been guarding for years — to a pelvic health physiotherapist, which is one of the most underused effective referrals there is. Perimenopausal symptoms — to a GP for a hormone therapy conversation. And any bleeding after menopause, between periods or after sex — to a doctor, that week.
What I treat is what is left: pain between cycles, sleep, digestion that shifts with the month, and the held tension that comes with living around a symptom for years. In pregnancy or a fertility cycle, positioning and technique change and herbs need specialist clearance.
The clinic is in Lane Cove, opposite the library, and I write to your GP.
