00:00:08
Speaker 1: You're listening to a Mamma Mia podcast.
00:00:18
Speaker 2: Hello and welcome to Well The Podcast for your health and body explained podcast. I'm Dr. Ginny Mansberg. I am a GP and I am really into women's health.
00:00:27
Speaker 1: And I'm Cass Mahoney and I'm also into women's health. So I'm in the right place. So here's what we're discussing today. The surprising link between sleep apnea and glaucoma, cervical cancer screening tests and why the days of the speculum for most women are over. And in asking for a friend, your anonymous awkward health questions. We're talking about whether adding protein powder to everything from coffee to popcorn, actually helps build muscle. And matching your workouts and diet to each weekly hormone phase actually works.
00:01:00
Speaker 2: But first, it's time for What the Health? Your quick dose of women's health headlines. What the health? I don't understand. What the health?
00:01:12
Speaker 1: What have you got for us, Ginny?
00:01:13
Speaker 2: Okay, I'm feeling like maybe this could be you, Kath. Have you ever heard of orthosomnia?
00:01:19
Speaker 3: No.
00:01:20
Speaker 2: What's that?
00:01:21
Speaker 3: Okay.
00:01:21
Speaker 2: So it's basically anxiety about sleep.
00:01:24
Speaker 1: Oh, I forgot that.
00:01:25
Speaker 2: Yes. So this is often people who are wearing various sleep trackers, the ring, the watch, the whatever, and people are getting so obsessed with the data that they're getting, absolutely believing that their sleep is horrible, terrible, need to go to a sleep specialist stat. And in fact, it's totally fine, but they're spending so much time obsessing about their sleep that it's actually causing them anxiety more than the sleep issue in the first place?
00:01:51
Speaker 1: You see, for me, I didn't have an issue with my sleep till Perry. And then you don't need a sleep tracker because, hey, when you're waking up and the birds are still asleep, you kind of know you're having a disturbed sleep. Do you want me to get a ring and a tracker?
00:02:04
Speaker 2: I do not.
00:02:05
Speaker 1: Or should we just know that I'm not having great sleep?
00:02:07
Speaker 2: Look, I think for some people who've got like really serious sleep issues, like sleep apnea, which is really easy to pick in men. They have this crescendo snoring and then they stop breathing and then it's like this... kind of thing. And then they start breathing. It starts all over again. Your brain's oxygen levels actually drop quite significantly. And that is bad. And we want to know about that. And because women don't snore so much, we don't. Plus, if we have a male partner that don't listen to us while they're asleep, because who does that? We often are not being diagnosed with sleep apnea. But at the same time, you're going to have some symptoms with that. You're going to wake up feeling really tired, sometimes headachy. So if you have that, you go and see your GP. For everyone else, There are certain things that we can expect from normal sleep. Like, you know, you get more than six and a half hours a night. You get more than that. Don't worry about it too much. You wake up in the middle of the night. That's normal. If you get back to sleep within half an hour, that's okay. If you wake up in the morning and you don't feel like you're going to run a marathon, you need half an hour to kind of wake your brain up, that's okay. There are a whole lot of things that we worry about are signs of really bad sleep when they're not. But I would say continuously having like six hours or less of sleep, not good. And the other thing that I'd worry about is if you're waking up really tired with a headache or sore throat and possibly you've been snoring, go and see a doctor.
00:03:27
Speaker 3: Okay.
00:03:27
Speaker 1: But you're not going to be buying us all sleep rings for Christmas?
00:03:30
Speaker 2: Not right now.
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Speaker 3: Okay.
00:03:31
Speaker 2: Kath, everybody is really, really into their luteal phase at the moment. Are you?
00:03:37
Speaker 1: What is a luteal phase? Because I feel like I'm starting to hear that word a lot and I should know, but I don't know.
00:03:44
Speaker 3: Okay.
00:03:44
Speaker 2: So don't want to re-traumatize you with year nine science, but here goes.
00:03:48
Speaker 3: Okay.
00:03:49
Speaker 2: In what is an amazing experiment every single month, egg of the month in your ovaries? is selected to grow into a potential baby because that is your sole biological purpose. It grows up inside this little bubble and it grows and grows and grows. The egg is nurtured in the bubble and then the bubble bursts. Egg goes off to meet the sperm of her dreams and what was left of the bubble becomes the corpus luteum, which is an ex-bubble now turned into progesterone factory. So During the time that the egg is developing, the little cells that lie in that bubble actually develop the ability to turn testosterone into progesterone in the second half of the cycle. Now, normally it takes about 14 days from ovulation to that corpus luteum to completely disintegrate. And that's why you have a period. But sometimes if that luteal phase, the phase when you have a corpus luteum is not as healthy as it could be. Sometimes the luteal phase is shortened, which means that you get a period maybe a week after you've ovulated, or even you start to get not a proper period, but just some brown sludge coming out for a week before your period. And that's when we say that there's a problem with your luteal phase, and it's being blamed for absolutely everything. My friends and I have all been getting inundated with women who are consuming mountains of TikTok content and coming in asking for progesterone supplements to actually help them prolong their luteal phase. That's what is going on in the world of medicine right now. How do you feel?
00:05:18
Speaker 1: So this is all on TikTok?
00:05:19
Speaker 2: All on TikTok and then in our surgeries. It's actually happening in real life because TikTok is now making our patients come to us and say, I need some extra progesterone to get me through my shortened luteal phase.
00:05:30
Speaker 1: Would you recommend that to women? Is this a thing for anyone?
00:05:34
Speaker 2: Very rarely is there a problem and very rarely is there any evidence that taking progesterone at that time is actually going to do anything beneficial for your body anyway. I mean, some people just have a shorter luteal phase. It doesn't necessarily mean that you're less fertile. Definitely, there's no evidence that taking extra progesterone is going to make you more fertile during that time if you are getting a period after 10 days after ovulation instead of after 14 days. I think there's a lot of rubbish that's going around on TikTok and it's actually making women really anxious and over analytical of their periods instead of just kind of chilling out about it.
00:06:08
Speaker 1: When would there be a problem though? If someone is listening and going, oh, I'm not sure if I should check this out.
00:06:13
Speaker 2: So I think for anyone who has suddenly developed irregular cycles where they used to have regular cycles, that would be a change and that would be worth investigating. If all of a sudden you're growing chin hairs or lot of hair around your nipples that you didn't used to have, if you suddenly got an acne breakout that suggests there's something hormonal going on that you've not had before or that you haven't had for 10 years or something. The other thing is if you've been trying to get pregnant for like six months or more and you're not getting pregnant, it's worth checking in with your GP at those times. But if you're just a normal person going about your normal life and you're now starting to notice things that you didn't notice before, it's possible that just your TikTok algorithm has gone off and you're now paying more attention to exactly what day the brown sludge starts, it's probably not going to be a problem.
00:06:59
Speaker 1: All right, Ginny, while I've got you and you're free, my doctor's question this week is, should I be worrying about my skin tags?
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Speaker 2: Where are you getting them?
00:07:08
Speaker 1: I've got one under each arm and I don't know if it's because I regularly walk Centennial Park in Sydney every morning or And I do walk in a Kath and Kel kind of sort of way, very army, you know, for people that haven't watched Kath and Kim. Am I causing friction? Should I worry about them? Can I pick them off?
00:07:29
Speaker 2: What's the go? So you can pick them off. They're likely to regrow. If they're really big, they might hurt a lot if you try to pick them off and they might bleed a lot.
00:07:39
Speaker 1: Just touching them now, just coming into the skin tag zone. Yeah, not very big, but just there, annoying little hanging downers.
00:07:45
Speaker 2: If you get. One or two, like one under each armpit. I wouldn't worry about it too much. But there are people who get skin tags absolutely everywhere, all around their neck, everywhere under their arms, under the boobs, that kind of area.
00:07:56
Speaker 1: Yeah.
00:07:57
Speaker 2: And that can be a sign of insulin resistance, which is where the insulin hormone that I consider like a key that unlocks the door of the cell to allow sugar from the bloodstream into the inside of the cell where it's needed as petrol, where that whole system breaks down a little bit. You've got plenty of keys. You've got plenty of sugar. but the locks are rusty. And so the process of getting your sugar inside the cell is actually disrupted. Your body responds by overproducing insulin. And one of the impacts of that, interestingly enough, is getting skin tags, particularly in areas like your underarms, around your neck, that kind of thing. So if you were to start getting a whole stack of them, I would go to the doctor and just check in. But I think just one under each armpit is probably a bit of a friction thing.
00:08:41
Speaker 1: Up next, it's time for Are You Well? and we'll be unpacking the surprising link between sleep apnea and glaucoma.
00:08:55
Speaker 2: How are you? Well, how are you feeling? Are you well? Are you well? Alrighty, it is time for Are You Well?, where we discuss the most important things that you need to know that are happening in women's health right now. So, Kath, I know you can't say it, but have you even heard of glaucoma before?
00:09:13
Speaker 1: No. Yes, because I think my dad or my grandma had it. So I sort of have to mention it when I get my eyes tested.
00:09:20
Speaker 2: You do. But I say it the wrong way, props. It does run in families. Basically, it's this condition where the pressure inside your eye builds up because your eye is constantly recycling the fluid inside it. I know it's sort of yucky to think about the jelly inside your eyes, but it is constantly being turned over. And if that pressure inside that builds up, it can actually damage your eyes. nerves that actually contribute to your sight. So it's a really major condition. But I found this really fascinating new study, and it was a study of 12 and a half million adults. That's a very big study. Oh, that's a big study. Even I know that's a big study.
00:09:55
Speaker 1: Yeah.
00:09:56
Speaker 2: And it found that people with sleep apnea, you know that where you're snoring and you don't have good oxygen supply to your body and your brain at night, actually were more likely to go on to develop glaucoma. And the researchers who were doing this study were like, hey, what is the possible link there? And they were saying that if the oxygen levels in the brain and the body drop It's possibly dropping inside the eye as well, which is impairing the ability of the eye to turn over that fluid, increasing the pressure. They don't know. They've just found... this association now because they were looking for it. But there's probably heaps of associations with glaucoma that we don't know about. But it kind of made me think about the number of people who possibly have glaucoma. But because they're not going and getting regular eye checks, they don't know about it. So are you getting regular eye checks? Absolutely.
00:10:49
Speaker 1: Because I'm definitely at the age where the eye is in Failing me slightly. So I have my eyes tested every year.
00:10:54
Speaker 2: Yeah, me too. And we don't have really good guidelines on this, but I always say to my patients, I think it's worthwhile going to an optometrist where often the eye checks are bulk build. There's some extra special tests that you can have. The optometrist will tell you whether you need that or not, that are not bulk build. But the great thing about that is it sounds weird, but they squeeze this puff of air into your eye while you've kind of got your chin resting on this kind of chin resting thing. And actually, that's how they measure the pressure inside your eye. And if it is starting to get a bit high, we've got lots of things that we can do for you, including lots of drops. You want to know what the side effects of the drops are for glaucoma?
00:11:33
Speaker 1: Tell me.
00:11:33
Speaker 2: They grow your eyelashes really long. Oh, do they? That's no side effect in my books.
00:11:38
Speaker 1: I know.
00:11:39
Speaker 3: How good.
00:11:39
Speaker 2: How did we get that? There's this whole thing of people using glaucoma drops and just putting them on their eyelashes to actually grow their eyelashes.
00:11:46
Speaker 1: So if you get diagnosed with it, it's your optometrist that diagnoses it?
00:11:51
Speaker 2: Generally, and often they will send you, your optometrist can send you straight to the eye doctor. So it's a referral that does not need to come from your GP. The optometrist can do that. And they actually, we just need to make sure that we've got the right combination of drops for you and for your needs and for your eyes. It's not always one drop. Sometimes we need two or even three drops. And we need to keep a really close eye on it because if that pressure gets too high, Of course, you're at risk of losing your eyesight and we just definitely don't want that. Nobody wants that.
00:12:17
Speaker 1: Are there any symptoms to it?
00:12:19
Speaker 2: Look, if it happens, there's a thing that we call acute angle closure glaucoma, which is a much more like a sudden onset of high pressure inside the eye. That's a whole different story. And yes, you can have very painful eyes. That's unusual. For most people, it's a chronic condition. And that's why eye checks are so important because you want to pick this problem up years before you ever go near blindness because it is preventable.
00:12:42
Speaker 3: Yes.
00:12:45
Speaker 1: Okay, up next, we need to talk about cervical cancer screening and there's some good news.
00:12:56
Speaker 2: Moving on to our next Are You Well? Kath, I think we need to talk about cancer screening tests for cervical cancer because in my surgery, actually possibly more than 50% of women, they still don't know that these days... A cervical cancer screening test does not need to involve a speculum and you lying on the doctor's couch with your pants around your ankles. Did you know this? Have you had a cervical cancer screening lately?
00:13:25
Speaker 1: Look, I only know this because you are my friend and this is a stat that you talk about a lot when we catch up for coffee. I did what you said and I did the test that you can do without your doctor, but because I had some HPV show up, I then had to have a pap smoo with my doctor and then I've recently seen the gynecologist.
00:13:45
Speaker 2: So just for anyone who has not heard this groundbreaking news, which I think is really good news.
00:13:51
Speaker 1: It's huge because, I mean, I love, love, love my doctor. But, you know, I'd like to see a face-to-face, not that face to my other bits.
00:14:00
Speaker 2: Yeah. Yeah. So what we used to do as a cervical cancer screening test was you lay on your doctor's bed. Some doctors liked you on your back, some on your side, and basically... you put your legs way apart and the doctor sort of uses this duckbill little instruments, used to be metal, these days it's plastic. We crank everything open and then we bring your cervix into view. That is not as easy as it sounds. Sometimes we've got to go and dig in there to actually make it show the right way. And then we use this brush on the inside of your cervix, ouch, and we would do kind of three turns of the cervix brush and put it into some liquid. Very, very good way to do things. And we would capture a lot of the cells that we could look at under the microscope. But given that we're looking for the human papillomavirus, sometimes called the wart virus, which is responsible for 99% of cervical cancers, the Australians, who are the world leaders in this space, this is where we really shine, came up with this idea that we could actually swab the vagina. It does not need to be the cervix. And we can use what effectively looks like a COVID swab. Stick it about, I'm using my fingers, which is always good on a podcast, but about 10 centimetres into the vagina and you literally swirl it around like a COVID test, pop it back in the vial exactly like a COVID test and you send it off. And you can do that yourself in the bathroom of your doctor's surgery or you can do it on their bed if that's what you want to do, if you want some privacy. You don't need to have anybody look there. Everything's fine and the only reason you will need to go and have an actual pap test, the old school one, is if HPV turns up. So we'll keep doing them yearly until you've had two clear ones. Otherwise, everybody can have the newer version of the test. And yet these were the statistics that I found. Only 40% of women are taking up the new pap test. 60% are still going for the old one. And I've been trying to work out, Kath, is this because women don't know about the better option? Is this because women don't want the better option? Is it because doctors aren't telling them what is going on?
00:16:01
Speaker 1: I think it's more that they don't know about it. Yeah. Because it is actually really easy to do. But I didn't know. I didn't know until my GP said, actually, now we can do it like this. And I did exactly that. Took my vaginal COVID test to the toilet and the doctors and, you know, Bob Drunkle.
00:16:16
Speaker 2: So I think for anybody who is due for a pap test, and just a reminder, here in Australia, it's only every five years unless you have active human papillomavirus or you've just recovered from it. Ask about the new test. If you go in and book in, just say, is there a new test? Because... I think that 40% figure is just wild.
00:16:35
Speaker 1: Do we get a reminder from the GP? I'm trying to think what happens.
00:16:39
Speaker 2: Not usually from your GP. You're going to get it earlier than that from the government, actually. They send you a reminder to say you're- For that five years? The government used to wait till you were six months overdue and then send you the reminder. Now they do it early. So anybody who has not had the reminder, also, if you move house, you need to tell medicare that you've actually changed address otherwise they're going to send the reminder to the old address by the way but if you are in the same place and it's been you know if you're not sure when you had your last pap test you can either ask your doctor to look it up or just assume that you're actually okay because you're probably going to get an early reminder not a late one.
00:17:17
Speaker 1: Okay up next asking for a friend we've got one about whether adding protein powder to everything actually helps build muscle and another from a listener who's convinced she's cycle-syncing by matching her workouts and diet to her hormonal phase every week.
00:17:33
Speaker 2: I'm just asking for a friend. So, my friends, they want to know. It's not for me. Hashtag just asking for a friend.
00:17:43
Speaker 1: All right, it's time for my favourite, asking for a friend. Awkward, anonymous health questions that we know aren't actually about your friend, but we pretend they are anyway. Okay, Today's question comes from an anonymous listener. I'll read it out. Hi, Ginny and Kath. I'm seeing protein maxing all over my feed. Does adding protein powder to everything from coffee to popcorn actually help build muscle? Or are people just giving themselves extra calories and a stomach ache? All right, Ginny, what are your thoughts on protein maxing?
00:18:15
Speaker 2: It's interesting because I think There is definitely evidence that without adequate protein, you can't build the skeletal muscle that you need to have like a healthy body, particularly as you hit midlife. Having said all of which, the whole more is more with protein with no upper limit on the protein is definitely not correct. So currently in Australia's healthy eating guidelines, the recommendation is that we all have 0.8 grams of protein per kilogram of body weight per day. So, you know, rough rule of thumb, if you weigh 70 kilos, you might need about 65 grams of protein, something like that per day. And ideally distributed over three meals, if you can do that. The thing is, I mean, there have been a few studies, very small studies showing that it might be beneficial to go up to 1.6 grams of protein per kilogram of body weight. But even that, there's very small studies and no one is prepared to change the guidelines based on those studies. What we do know is, After a certain amount, you can neither absorb that protein nor does it help give any additional muscle after that 1.6 level. What you do risk is that you are eating so much protein that you don't have room to have all the fiber that you need. And the thing is we all need, women need 25 grams of fiber, men need 30 grams of fiber a day. This is essential for good gut health. Good gut health is really important to not have a body that's in inflammation. That's also really important to your health. And my concern is by just picking one simple nutrient that we're really focused on, particularly protein powders that tend to be ultra processed foods. Like if you have a look at them, the ingredients on them sound like a science experiment. I don't love the whole idea of protein maxing. It's kind of not feeling great to me. What about you?
00:20:08
Speaker 1: Well, I think for a while then my feed was full of it in that whole kind of perimenopause.
00:20:13
Speaker 2: More protein, more protein.
00:20:14
Speaker 1: And I feel like I was kind of getting out of bed at night to just have more kind of Greek yogurt. To go, I don't think I've had enough protein.
00:20:21
Speaker 3: More.
00:20:21
Speaker 2: Bring the yogurt. More yogurt.
00:20:24
Speaker 1: So I definitely fixated on it for a bit. And then I just was like, I just can't. And then like some of my favorite foods like chicken or steak became.
00:20:33
Speaker 2: Like a job rather.
00:20:34
Speaker 1: Than like a, you know, something I loved eating. So yeah, I pulled back on the maxing. Yeah.
00:20:40
Speaker 2: And I think just a reminder, the fiber is also really, really, really important.
00:20:45
Speaker 1: I need to fiber max because I don't think I'm hitting my 25 grams.
00:20:49
Speaker 2: It's hard.
00:20:49
Speaker 1: Yeah. All right. This next one comes from Antoinette, who's 28. Hey, Kath and Ginny.
00:20:55
Speaker 3: I have a friend who does cycle syncing. So matching her workouts and diet to her hormonal phase every week and every month. Is this backed by actual endocrinology and science or are they just giving themselves an excuse to take a rest day?
00:21:11
Speaker 2: Sounds delightful.
00:21:12
Speaker 1: All right, Ginny, what do you think?
00:21:14
Speaker 2: Look, I mean, there's definitely hormonal changes across the cycle. That is absolutely true. The whole question is, should you be changing your workouts to match your hormonal cycles? And there was this really interesting study based on Apple Watches. So it's called the Apple Women's Health Study, looked at 110,000 women Yeah, 23 million logged workouts. And they looked at the phase of the month, the time of the month versus workouts. And guess what the difference was? So in the follicular phase, the very first half of the cycle, women exercised 21 minutes a day. And in the luteal phase, 20.9, like no difference whatsoever. I think... I would really not be splitting hairs over cycle syncing. I think that there's just no evidence for that there. I don't think it's being used by the Australian Institute of Sport or anything like that. I think doing some exercise every day is the important thing and I don't think you should be worrying about what phase you're in.
00:22:13
Speaker 1: I mean, from my point of view, not a sports person, not a massive exerciser all the time, but I take it from how I feel. You know, like sometimes you do have a really heavy period and I'm like, I wouldn't want to be doing a spin class. Right now, but I will always try and walk and move my body. So maybe we just need to listen to our bodies as opposed to track our cycles.
00:22:34
Speaker 2: Yeah, I think that that sounds really, really fair. And I think, you know, don't forget, you need 150 minutes a week of exercise, two sessions of like some sort of resistance exercise. It's not that much. Like it's not like you need to be doing an hour of marathon running with, you know, 30 kilo weights on your follicular cycle. It's just not like that. I would say just do your basic stuff. And if you feel better doing a little bit of extra, you do you.
00:23:03
Speaker 3: Okay.
00:23:03
Speaker 2: Oh my goodness. That is it from us. Don't forget to follow the show so you never miss an episode. It'll drop straight into your feed automatically. And if you're feeling nice and who wouldn't be after finding out you don't need to Cycle Sync Your Exercise, that's great news. Please leave us an amazing rating and a great review on Apple Podcasts or Spotify.
00:23:21
Speaker 1: And if you want to hear your asking for a friend question, send us an email or voice note to well at mamamia.com.au and Dr Ginny will get to the bottom of it and I'll add probably not much. And please remember information discussed in this podcast is for education purposes only and is not intended to provide professional medical advice. Please seek your own medical advice online specific to your circumstances from your healthcare professional. See you next time.
00:23:47
Speaker 2: Stay well.
00:23:50
Speaker 1: Mamma Mia acknowledges the traditional owners of land and waters that this podcast is recorded on, the Gadigal people of the Eora Nation. We pay our respects to elders past and present.
Speaker 1: You're listening to a Mamma Mia podcast.
00:00:18
Speaker 2: Hello and welcome to Well The Podcast for your health and body explained podcast. I'm Dr. Ginny Mansberg. I am a GP and I am really into women's health.
00:00:27
Speaker 1: And I'm Cass Mahoney and I'm also into women's health. So I'm in the right place. So here's what we're discussing today. The surprising link between sleep apnea and glaucoma, cervical cancer screening tests and why the days of the speculum for most women are over. And in asking for a friend, your anonymous awkward health questions. We're talking about whether adding protein powder to everything from coffee to popcorn, actually helps build muscle. And matching your workouts and diet to each weekly hormone phase actually works.
00:01:00
Speaker 2: But first, it's time for What the Health? Your quick dose of women's health headlines. What the health? I don't understand. What the health?
00:01:12
Speaker 1: What have you got for us, Ginny?
00:01:13
Speaker 2: Okay, I'm feeling like maybe this could be you, Kath. Have you ever heard of orthosomnia?
00:01:19
Speaker 3: No.
00:01:20
Speaker 2: What's that?
00:01:21
Speaker 3: Okay.
00:01:21
Speaker 2: So it's basically anxiety about sleep.
00:01:24
Speaker 1: Oh, I forgot that.
00:01:25
Speaker 2: Yes. So this is often people who are wearing various sleep trackers, the ring, the watch, the whatever, and people are getting so obsessed with the data that they're getting, absolutely believing that their sleep is horrible, terrible, need to go to a sleep specialist stat. And in fact, it's totally fine, but they're spending so much time obsessing about their sleep that it's actually causing them anxiety more than the sleep issue in the first place?
00:01:51
Speaker 1: You see, for me, I didn't have an issue with my sleep till Perry. And then you don't need a sleep tracker because, hey, when you're waking up and the birds are still asleep, you kind of know you're having a disturbed sleep. Do you want me to get a ring and a tracker?
00:02:04
Speaker 2: I do not.
00:02:05
Speaker 1: Or should we just know that I'm not having great sleep?
00:02:07
Speaker 2: Look, I think for some people who've got like really serious sleep issues, like sleep apnea, which is really easy to pick in men. They have this crescendo snoring and then they stop breathing and then it's like this... kind of thing. And then they start breathing. It starts all over again. Your brain's oxygen levels actually drop quite significantly. And that is bad. And we want to know about that. And because women don't snore so much, we don't. Plus, if we have a male partner that don't listen to us while they're asleep, because who does that? We often are not being diagnosed with sleep apnea. But at the same time, you're going to have some symptoms with that. You're going to wake up feeling really tired, sometimes headachy. So if you have that, you go and see your GP. For everyone else, There are certain things that we can expect from normal sleep. Like, you know, you get more than six and a half hours a night. You get more than that. Don't worry about it too much. You wake up in the middle of the night. That's normal. If you get back to sleep within half an hour, that's okay. If you wake up in the morning and you don't feel like you're going to run a marathon, you need half an hour to kind of wake your brain up, that's okay. There are a whole lot of things that we worry about are signs of really bad sleep when they're not. But I would say continuously having like six hours or less of sleep, not good. And the other thing that I'd worry about is if you're waking up really tired with a headache or sore throat and possibly you've been snoring, go and see a doctor.
00:03:27
Speaker 3: Okay.
00:03:27
Speaker 1: But you're not going to be buying us all sleep rings for Christmas?
00:03:30
Speaker 2: Not right now.
00:03:30
Speaker 3: Okay.
00:03:31
Speaker 2: Kath, everybody is really, really into their luteal phase at the moment. Are you?
00:03:37
Speaker 1: What is a luteal phase? Because I feel like I'm starting to hear that word a lot and I should know, but I don't know.
00:03:44
Speaker 3: Okay.
00:03:44
Speaker 2: So don't want to re-traumatize you with year nine science, but here goes.
00:03:48
Speaker 3: Okay.
00:03:49
Speaker 2: In what is an amazing experiment every single month, egg of the month in your ovaries? is selected to grow into a potential baby because that is your sole biological purpose. It grows up inside this little bubble and it grows and grows and grows. The egg is nurtured in the bubble and then the bubble bursts. Egg goes off to meet the sperm of her dreams and what was left of the bubble becomes the corpus luteum, which is an ex-bubble now turned into progesterone factory. So During the time that the egg is developing, the little cells that lie in that bubble actually develop the ability to turn testosterone into progesterone in the second half of the cycle. Now, normally it takes about 14 days from ovulation to that corpus luteum to completely disintegrate. And that's why you have a period. But sometimes if that luteal phase, the phase when you have a corpus luteum is not as healthy as it could be. Sometimes the luteal phase is shortened, which means that you get a period maybe a week after you've ovulated, or even you start to get not a proper period, but just some brown sludge coming out for a week before your period. And that's when we say that there's a problem with your luteal phase, and it's being blamed for absolutely everything. My friends and I have all been getting inundated with women who are consuming mountains of TikTok content and coming in asking for progesterone supplements to actually help them prolong their luteal phase. That's what is going on in the world of medicine right now. How do you feel?
00:05:18
Speaker 1: So this is all on TikTok?
00:05:19
Speaker 2: All on TikTok and then in our surgeries. It's actually happening in real life because TikTok is now making our patients come to us and say, I need some extra progesterone to get me through my shortened luteal phase.
00:05:30
Speaker 1: Would you recommend that to women? Is this a thing for anyone?
00:05:34
Speaker 2: Very rarely is there a problem and very rarely is there any evidence that taking progesterone at that time is actually going to do anything beneficial for your body anyway. I mean, some people just have a shorter luteal phase. It doesn't necessarily mean that you're less fertile. Definitely, there's no evidence that taking extra progesterone is going to make you more fertile during that time if you are getting a period after 10 days after ovulation instead of after 14 days. I think there's a lot of rubbish that's going around on TikTok and it's actually making women really anxious and over analytical of their periods instead of just kind of chilling out about it.
00:06:08
Speaker 1: When would there be a problem though? If someone is listening and going, oh, I'm not sure if I should check this out.
00:06:13
Speaker 2: So I think for anyone who has suddenly developed irregular cycles where they used to have regular cycles, that would be a change and that would be worth investigating. If all of a sudden you're growing chin hairs or lot of hair around your nipples that you didn't used to have, if you suddenly got an acne breakout that suggests there's something hormonal going on that you've not had before or that you haven't had for 10 years or something. The other thing is if you've been trying to get pregnant for like six months or more and you're not getting pregnant, it's worth checking in with your GP at those times. But if you're just a normal person going about your normal life and you're now starting to notice things that you didn't notice before, it's possible that just your TikTok algorithm has gone off and you're now paying more attention to exactly what day the brown sludge starts, it's probably not going to be a problem.
00:06:59
Speaker 1: All right, Ginny, while I've got you and you're free, my doctor's question this week is, should I be worrying about my skin tags?
00:07:07
Speaker 2: Where are you getting them?
00:07:08
Speaker 1: I've got one under each arm and I don't know if it's because I regularly walk Centennial Park in Sydney every morning or And I do walk in a Kath and Kel kind of sort of way, very army, you know, for people that haven't watched Kath and Kim. Am I causing friction? Should I worry about them? Can I pick them off?
00:07:29
Speaker 2: What's the go? So you can pick them off. They're likely to regrow. If they're really big, they might hurt a lot if you try to pick them off and they might bleed a lot.
00:07:39
Speaker 1: Just touching them now, just coming into the skin tag zone. Yeah, not very big, but just there, annoying little hanging downers.
00:07:45
Speaker 2: If you get. One or two, like one under each armpit. I wouldn't worry about it too much. But there are people who get skin tags absolutely everywhere, all around their neck, everywhere under their arms, under the boobs, that kind of area.
00:07:56
Speaker 1: Yeah.
00:07:57
Speaker 2: And that can be a sign of insulin resistance, which is where the insulin hormone that I consider like a key that unlocks the door of the cell to allow sugar from the bloodstream into the inside of the cell where it's needed as petrol, where that whole system breaks down a little bit. You've got plenty of keys. You've got plenty of sugar. but the locks are rusty. And so the process of getting your sugar inside the cell is actually disrupted. Your body responds by overproducing insulin. And one of the impacts of that, interestingly enough, is getting skin tags, particularly in areas like your underarms, around your neck, that kind of thing. So if you were to start getting a whole stack of them, I would go to the doctor and just check in. But I think just one under each armpit is probably a bit of a friction thing.
00:08:41
Speaker 1: Up next, it's time for Are You Well? and we'll be unpacking the surprising link between sleep apnea and glaucoma.
00:08:55
Speaker 2: How are you? Well, how are you feeling? Are you well? Are you well? Alrighty, it is time for Are You Well?, where we discuss the most important things that you need to know that are happening in women's health right now. So, Kath, I know you can't say it, but have you even heard of glaucoma before?
00:09:13
Speaker 1: No. Yes, because I think my dad or my grandma had it. So I sort of have to mention it when I get my eyes tested.
00:09:20
Speaker 2: You do. But I say it the wrong way, props. It does run in families. Basically, it's this condition where the pressure inside your eye builds up because your eye is constantly recycling the fluid inside it. I know it's sort of yucky to think about the jelly inside your eyes, but it is constantly being turned over. And if that pressure inside that builds up, it can actually damage your eyes. nerves that actually contribute to your sight. So it's a really major condition. But I found this really fascinating new study, and it was a study of 12 and a half million adults. That's a very big study. Oh, that's a big study. Even I know that's a big study.
00:09:55
Speaker 1: Yeah.
00:09:56
Speaker 2: And it found that people with sleep apnea, you know that where you're snoring and you don't have good oxygen supply to your body and your brain at night, actually were more likely to go on to develop glaucoma. And the researchers who were doing this study were like, hey, what is the possible link there? And they were saying that if the oxygen levels in the brain and the body drop It's possibly dropping inside the eye as well, which is impairing the ability of the eye to turn over that fluid, increasing the pressure. They don't know. They've just found... this association now because they were looking for it. But there's probably heaps of associations with glaucoma that we don't know about. But it kind of made me think about the number of people who possibly have glaucoma. But because they're not going and getting regular eye checks, they don't know about it. So are you getting regular eye checks? Absolutely.
00:10:49
Speaker 1: Because I'm definitely at the age where the eye is in Failing me slightly. So I have my eyes tested every year.
00:10:54
Speaker 2: Yeah, me too. And we don't have really good guidelines on this, but I always say to my patients, I think it's worthwhile going to an optometrist where often the eye checks are bulk build. There's some extra special tests that you can have. The optometrist will tell you whether you need that or not, that are not bulk build. But the great thing about that is it sounds weird, but they squeeze this puff of air into your eye while you've kind of got your chin resting on this kind of chin resting thing. And actually, that's how they measure the pressure inside your eye. And if it is starting to get a bit high, we've got lots of things that we can do for you, including lots of drops. You want to know what the side effects of the drops are for glaucoma?
00:11:33
Speaker 1: Tell me.
00:11:33
Speaker 2: They grow your eyelashes really long. Oh, do they? That's no side effect in my books.
00:11:38
Speaker 1: I know.
00:11:39
Speaker 3: How good.
00:11:39
Speaker 2: How did we get that? There's this whole thing of people using glaucoma drops and just putting them on their eyelashes to actually grow their eyelashes.
00:11:46
Speaker 1: So if you get diagnosed with it, it's your optometrist that diagnoses it?
00:11:51
Speaker 2: Generally, and often they will send you, your optometrist can send you straight to the eye doctor. So it's a referral that does not need to come from your GP. The optometrist can do that. And they actually, we just need to make sure that we've got the right combination of drops for you and for your needs and for your eyes. It's not always one drop. Sometimes we need two or even three drops. And we need to keep a really close eye on it because if that pressure gets too high, Of course, you're at risk of losing your eyesight and we just definitely don't want that. Nobody wants that.
00:12:17
Speaker 1: Are there any symptoms to it?
00:12:19
Speaker 2: Look, if it happens, there's a thing that we call acute angle closure glaucoma, which is a much more like a sudden onset of high pressure inside the eye. That's a whole different story. And yes, you can have very painful eyes. That's unusual. For most people, it's a chronic condition. And that's why eye checks are so important because you want to pick this problem up years before you ever go near blindness because it is preventable.
00:12:42
Speaker 3: Yes.
00:12:45
Speaker 1: Okay, up next, we need to talk about cervical cancer screening and there's some good news.
00:12:56
Speaker 2: Moving on to our next Are You Well? Kath, I think we need to talk about cancer screening tests for cervical cancer because in my surgery, actually possibly more than 50% of women, they still don't know that these days... A cervical cancer screening test does not need to involve a speculum and you lying on the doctor's couch with your pants around your ankles. Did you know this? Have you had a cervical cancer screening lately?
00:13:25
Speaker 1: Look, I only know this because you are my friend and this is a stat that you talk about a lot when we catch up for coffee. I did what you said and I did the test that you can do without your doctor, but because I had some HPV show up, I then had to have a pap smoo with my doctor and then I've recently seen the gynecologist.
00:13:45
Speaker 2: So just for anyone who has not heard this groundbreaking news, which I think is really good news.
00:13:51
Speaker 1: It's huge because, I mean, I love, love, love my doctor. But, you know, I'd like to see a face-to-face, not that face to my other bits.
00:14:00
Speaker 2: Yeah. Yeah. So what we used to do as a cervical cancer screening test was you lay on your doctor's bed. Some doctors liked you on your back, some on your side, and basically... you put your legs way apart and the doctor sort of uses this duckbill little instruments, used to be metal, these days it's plastic. We crank everything open and then we bring your cervix into view. That is not as easy as it sounds. Sometimes we've got to go and dig in there to actually make it show the right way. And then we use this brush on the inside of your cervix, ouch, and we would do kind of three turns of the cervix brush and put it into some liquid. Very, very good way to do things. And we would capture a lot of the cells that we could look at under the microscope. But given that we're looking for the human papillomavirus, sometimes called the wart virus, which is responsible for 99% of cervical cancers, the Australians, who are the world leaders in this space, this is where we really shine, came up with this idea that we could actually swab the vagina. It does not need to be the cervix. And we can use what effectively looks like a COVID swab. Stick it about, I'm using my fingers, which is always good on a podcast, but about 10 centimetres into the vagina and you literally swirl it around like a COVID test, pop it back in the vial exactly like a COVID test and you send it off. And you can do that yourself in the bathroom of your doctor's surgery or you can do it on their bed if that's what you want to do, if you want some privacy. You don't need to have anybody look there. Everything's fine and the only reason you will need to go and have an actual pap test, the old school one, is if HPV turns up. So we'll keep doing them yearly until you've had two clear ones. Otherwise, everybody can have the newer version of the test. And yet these were the statistics that I found. Only 40% of women are taking up the new pap test. 60% are still going for the old one. And I've been trying to work out, Kath, is this because women don't know about the better option? Is this because women don't want the better option? Is it because doctors aren't telling them what is going on?
00:16:01
Speaker 1: I think it's more that they don't know about it. Yeah. Because it is actually really easy to do. But I didn't know. I didn't know until my GP said, actually, now we can do it like this. And I did exactly that. Took my vaginal COVID test to the toilet and the doctors and, you know, Bob Drunkle.
00:16:16
Speaker 2: So I think for anybody who is due for a pap test, and just a reminder, here in Australia, it's only every five years unless you have active human papillomavirus or you've just recovered from it. Ask about the new test. If you go in and book in, just say, is there a new test? Because... I think that 40% figure is just wild.
00:16:35
Speaker 1: Do we get a reminder from the GP? I'm trying to think what happens.
00:16:39
Speaker 2: Not usually from your GP. You're going to get it earlier than that from the government, actually. They send you a reminder to say you're- For that five years? The government used to wait till you were six months overdue and then send you the reminder. Now they do it early. So anybody who has not had the reminder, also, if you move house, you need to tell medicare that you've actually changed address otherwise they're going to send the reminder to the old address by the way but if you are in the same place and it's been you know if you're not sure when you had your last pap test you can either ask your doctor to look it up or just assume that you're actually okay because you're probably going to get an early reminder not a late one.
00:17:17
Speaker 1: Okay up next asking for a friend we've got one about whether adding protein powder to everything actually helps build muscle and another from a listener who's convinced she's cycle-syncing by matching her workouts and diet to her hormonal phase every week.
00:17:33
Speaker 2: I'm just asking for a friend. So, my friends, they want to know. It's not for me. Hashtag just asking for a friend.
00:17:43
Speaker 1: All right, it's time for my favourite, asking for a friend. Awkward, anonymous health questions that we know aren't actually about your friend, but we pretend they are anyway. Okay, Today's question comes from an anonymous listener. I'll read it out. Hi, Ginny and Kath. I'm seeing protein maxing all over my feed. Does adding protein powder to everything from coffee to popcorn actually help build muscle? Or are people just giving themselves extra calories and a stomach ache? All right, Ginny, what are your thoughts on protein maxing?
00:18:15
Speaker 2: It's interesting because I think There is definitely evidence that without adequate protein, you can't build the skeletal muscle that you need to have like a healthy body, particularly as you hit midlife. Having said all of which, the whole more is more with protein with no upper limit on the protein is definitely not correct. So currently in Australia's healthy eating guidelines, the recommendation is that we all have 0.8 grams of protein per kilogram of body weight per day. So, you know, rough rule of thumb, if you weigh 70 kilos, you might need about 65 grams of protein, something like that per day. And ideally distributed over three meals, if you can do that. The thing is, I mean, there have been a few studies, very small studies showing that it might be beneficial to go up to 1.6 grams of protein per kilogram of body weight. But even that, there's very small studies and no one is prepared to change the guidelines based on those studies. What we do know is, After a certain amount, you can neither absorb that protein nor does it help give any additional muscle after that 1.6 level. What you do risk is that you are eating so much protein that you don't have room to have all the fiber that you need. And the thing is we all need, women need 25 grams of fiber, men need 30 grams of fiber a day. This is essential for good gut health. Good gut health is really important to not have a body that's in inflammation. That's also really important to your health. And my concern is by just picking one simple nutrient that we're really focused on, particularly protein powders that tend to be ultra processed foods. Like if you have a look at them, the ingredients on them sound like a science experiment. I don't love the whole idea of protein maxing. It's kind of not feeling great to me. What about you?
00:20:08
Speaker 1: Well, I think for a while then my feed was full of it in that whole kind of perimenopause.
00:20:13
Speaker 2: More protein, more protein.
00:20:14
Speaker 1: And I feel like I was kind of getting out of bed at night to just have more kind of Greek yogurt. To go, I don't think I've had enough protein.
00:20:21
Speaker 3: More.
00:20:21
Speaker 2: Bring the yogurt. More yogurt.
00:20:24
Speaker 1: So I definitely fixated on it for a bit. And then I just was like, I just can't. And then like some of my favorite foods like chicken or steak became.
00:20:33
Speaker 2: Like a job rather.
00:20:34
Speaker 1: Than like a, you know, something I loved eating. So yeah, I pulled back on the maxing. Yeah.
00:20:40
Speaker 2: And I think just a reminder, the fiber is also really, really, really important.
00:20:45
Speaker 1: I need to fiber max because I don't think I'm hitting my 25 grams.
00:20:49
Speaker 2: It's hard.
00:20:49
Speaker 1: Yeah. All right. This next one comes from Antoinette, who's 28. Hey, Kath and Ginny.
00:20:55
Speaker 3: I have a friend who does cycle syncing. So matching her workouts and diet to her hormonal phase every week and every month. Is this backed by actual endocrinology and science or are they just giving themselves an excuse to take a rest day?
00:21:11
Speaker 2: Sounds delightful.
00:21:12
Speaker 1: All right, Ginny, what do you think?
00:21:14
Speaker 2: Look, I mean, there's definitely hormonal changes across the cycle. That is absolutely true. The whole question is, should you be changing your workouts to match your hormonal cycles? And there was this really interesting study based on Apple Watches. So it's called the Apple Women's Health Study, looked at 110,000 women Yeah, 23 million logged workouts. And they looked at the phase of the month, the time of the month versus workouts. And guess what the difference was? So in the follicular phase, the very first half of the cycle, women exercised 21 minutes a day. And in the luteal phase, 20.9, like no difference whatsoever. I think... I would really not be splitting hairs over cycle syncing. I think that there's just no evidence for that there. I don't think it's being used by the Australian Institute of Sport or anything like that. I think doing some exercise every day is the important thing and I don't think you should be worrying about what phase you're in.
00:22:13
Speaker 1: I mean, from my point of view, not a sports person, not a massive exerciser all the time, but I take it from how I feel. You know, like sometimes you do have a really heavy period and I'm like, I wouldn't want to be doing a spin class. Right now, but I will always try and walk and move my body. So maybe we just need to listen to our bodies as opposed to track our cycles.
00:22:34
Speaker 2: Yeah, I think that that sounds really, really fair. And I think, you know, don't forget, you need 150 minutes a week of exercise, two sessions of like some sort of resistance exercise. It's not that much. Like it's not like you need to be doing an hour of marathon running with, you know, 30 kilo weights on your follicular cycle. It's just not like that. I would say just do your basic stuff. And if you feel better doing a little bit of extra, you do you.
00:23:03
Speaker 3: Okay.
00:23:03
Speaker 2: Oh my goodness. That is it from us. Don't forget to follow the show so you never miss an episode. It'll drop straight into your feed automatically. And if you're feeling nice and who wouldn't be after finding out you don't need to Cycle Sync Your Exercise, that's great news. Please leave us an amazing rating and a great review on Apple Podcasts or Spotify.
00:23:21
Speaker 1: And if you want to hear your asking for a friend question, send us an email or voice note to well at mamamia.com.au and Dr Ginny will get to the bottom of it and I'll add probably not much. And please remember information discussed in this podcast is for education purposes only and is not intended to provide professional medical advice. Please seek your own medical advice online specific to your circumstances from your healthcare professional. See you next time.
00:23:47
Speaker 2: Stay well.
00:23:50
Speaker 1: Mamma Mia acknowledges the traditional owners of land and waters that this podcast is recorded on, the Gadigal people of the Eora Nation. We pay our respects to elders past and present.
