#223 Premenstrual Dysphoric Disorder (PMDD) with Professor Jayashri Kulkarni

Twenty-five years ago, having a baby daughter struggling with severe hives turned GP Dr. Alison Muller into an accidental allergy guru - and general practice has been better for it since. She unpacks IgE vs non-IgE reactions, why 10% of one-year-olds now have a genuine food allergy, why smearing avocado oil on eczema is asking for trouble, and why anaphylaxis rates are up 900% in twenty years. Plus she gives us the practical tips we need such as weight-based antihistamine dosing, the three-ingredient "magic cream" for infected eczema, and why putting your clothes in the dryer for ten minutes might be the cheapest allergy hack around. If you have ever ordered a RAST and had a result telling you that someone is "allergic to grass" and not really known what to do next, or you've wondered whether desensitisation is worth the needles (and what exactly is involved?!), then this podcast is for you. Alison covers exercise-induced food anaphylaxis, FPIES, and even Neffy - the new nasal adrenaline spray that might finally get more people to use their emergency treatment when it counts. A great one not to miss! ... If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Dr Chris Davis is a GP, Co-Founder and CMO of the Clean Slate Clinic, Australia's leading virtual detox and recovery service, and an Addiction Specialist at St Vincent's Hospital, Sydney. He established the Clean Slate Clinic in Sydney for primary care alcohol withdrawal and recovery services, after successfully implementing the model in the UK. His teams inspiring work demonstrates highly effective, more accessible and supportive care in recovery and continues to scale nationally. https://cleanslateclinic.com/ Cracking Addiction Podcast - https://podcasts.apple.com/au/podcast/cracking-addiction/id1579789505  Episode #139 of The GP Show where we first met Dr Chris - https://thegpshow.libsyn.com/139-alcohol-recovery-and-the-clean-slate-clinic-with-dr-chris-davis-and-flip-prior ... If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Professor Jayashri Kulkarni is one of Australia's leading psychiatrists and researchers specialising in women's mental health. She is the Director of the HER Centre Australia (Health, Education and Research for Women's Mental Health) and Professor of Psychiatry at Monash University. Professor Kulkarni's work focuses on mood disorders across the female lifespan, with particular attention to the neurochemical effects of reproductive hormones on brain function, including perimenopausal depression and premenstrual dysphoric disorder. She is the developer of the Meno-D rating scale and has been a leading voice for over four decades in the recognition and treatment of hormone-related mental illness in women. This is a supplementary episode to the GP Show's earlier conversation with Professor Kulkarni on perimenopausal mental health, recorded in the same sitting. In it, Dr. Ashlea Broomfield and Professor Kulkarni discuss what distinguishes PMDD from common premenstrual symptoms; the emerging evidence on trauma and gene expression as a mechanism for PMDD onset; why current guidelines default to SSRIs rather than hormonal treatment and the limitations of that approach; practical hormonal treatment options for women with and without contraceptive needs; and the role of trauma therapy alongside hormonal management. Professor Kulkarni argues that PMDD is a brain condition, not an end-organ condition, and that treatment should reflect that. RESOURCES "How to Treat PMDD" — Professor Jayashri Kulkarni, Australian Doctor. Read here UK Guidelines: The Green-top Guideline 48 — Management of Premenstrual Syndrome Green LJ, O'Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians andGynaecologists. Management of premenstrual syndrome. BJOG 2017 ; 124:e73–e105 HER Centre Australia — monash.edu/medicine/her-centre Perimenopausal Mental Health episode — The GP Show with Professor Jayashri Kulkarni Fast Facts in Sexual and Reproductive Health with Dr. Sara Whitburn — The GP Show  ... If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Professor Jayashri Kulkarni is one of Australia's leading psychiatrists and researchers specialising in women's mental health. She is the Director of the HER Centre Australia (Health, Education and Research for Women's Mental Health) and Professor of Psychiatry at Monash University. Professor Kulkarni's work focuses on mood disorders across the female lifespan, with particular attention to the neurochemical effects of reproductive hormones on brain function, including perimenopausal depression and premenstrual dysphoric disorder. She is the developer of the Meno-D rating scale and has been a leading voice for over four decades in the recognition and treatment of hormone-related mental illness in women. In this episode, Dr. Ashlea Broomfield speaks with Professor Jayashri Kulkarni about the mental health impact of perimenopause. They discuss the role of oestrogen and progesterone as neurosteroids influencing mood, cognition, and behaviour; why mood symptoms often precede vasomotor changes by years; which women are most at risk and why; the distinct clinical profile of perimenopausal depression and how to avoid common misdiagnoses; and how to approach hormonal treatment in practice (including contraceptive options, transdermal oestradiol, micronised progesterone, and tibolone) alongside a review of the evidence around MHT safety. RESOURCES "The primary care management of perimenopausal depression" — Kulkarni J et al. Australian Journal of General Practice 2026;55(4). Read here HER Centre Australia — Research, clinical resources, and the Meno-D scale: monash.edu/medicine/her-centre Meno-D rating scale — Available via HER Centre Australia and as an appendix in the AJGP article above Healthy Hormones — GP-led community, resources, and webinars: healthyhormones.au Australasian Menopause Society — Evidence-based guidelines and resources: menopause.org.au Monash University women's mental health short course — Via HER Centre Australia ( PMDD companion episode — The GP Show with Professor Jayashri Kulkarni (link once live) Fast Facts in Sexual and Reproductive Health with Dr. Sara Whitburn — The GP Show    TIMESTAMPS 00:00 — Introduction, Welcome to Country, guest bio 03:40 — Reproductive hormones as brain neurosteroids: neurochemical effects of oestrogen and progesterone across the perimenopausal transition 12:19 — Risk factors for perimenopausal mood sensitivity: early life trauma, the HPA/HPG axis, and recognising hormonal sensitivity in clinical history 24:28 — Diagnostic considerations: the Meno-D scale, distinguishing perimenopausal depression from MDD and bipolar disorder, and current gaps in psychiatric classification 37:29 — MHT safety: reviewing the 2001 WHI study, absolute and relative contraindications, and monitoring in practice 45:33 — Treatment approaches: hormonal contraception, transdermal oestradiol, micronised progesterone, tibolone, and tailoring to the individual 59:16 — Further resources and preview of the PMDD companion episode   ... If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Dr David Fineberg is a General Practitioner and PhD candidate at the University of Melbourne whose research focuses on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Long COVID. He is the founding clinician of the ME Research Clinic (MERC), a translational research hub dedicated to advancing the diagnosis, evaluation, and treatment of complex post-viral syndromes through an evidence-based, patient-centred model.  His PhD is "Precision Medicine techniques In the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome ME/CFS + Long Covid (PRIME)". Episodes resources:  MECFS diagnostic criteria from ME Research UK DePaul Questionnaire FUNCAP (Functional Capacity) Questionnaire Open Medicine Foundation Resources and Clinical Guidelines Visible App - wearable tech for illness, not wellness, designed for MECFS, POTS, EDS and Long Covid RACGP Energy Limiting Disorders SIG and CPD CHECK ... If you find this podcast valuable, please help by rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Many of us have patients with hypermobility and Ehlers-Danlos syndrome who we work hard to help. As our understanding of these complex multisystem conditions grows, understanding that it doesn't just affect joints but potentially autonomic function, cardiovascular health, digestion, and producing widespread, often debilitating pain, so too does the need for a broader range of therapeutic options.  In this episode, musculoskeletal medicine specialist Dr. Rob Illingworth introduces prolotherapy and PRP as practical, evidence-informed options that could make a real difference to your patients' quality of life and function. For anyone managing patients with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorders, this one's essential. Dr. Illingworth unpacks the "perfect storm" of lax connective tissue, sensitized pain pathways, and complex comorbidities and adds a valuable option to your therapeutic toolkit for people presenting with these complex conditions. ... If you find this podcast valuable, please help but rating the podcast 5 stars and leaving a review in your podcast app. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.    

Dr. Sara Whitburn is the Medical Director of Sexual Health Victoria, Chair of the RACGP Sexual and Reproductive Health Special Interest Group, and a Senior Lecturer in Sexual Health at the University of Melbourne.  Her clinical and advocacy interests span STIs, unplanned pregnancy, genital health, menopause care, and long-acting reversible contraception (LARC) training. She is passionate about supporting health professionals to deliver great sexual and reproductive healthcare and enabling equitable access to care for patients. Connect with the RACGP Sexual and Reproductive Health Special Interest Group:  Join the community (open to all RACGP members) by emailing [email protected]. The group offers peer case discussion, newsletters, and webinars covering topics including PrEP, sexual pain, heavy menstrual bleeding, and more. Resources •          MAGIC App — National Cervical Screening Program guidelines (searchable): search "National Cervical Screening Program MAGIC App" •          Australian STI Management Guidelines — sti.guidelines.org.au  •          ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine) — PrEP and DoxyPEP decision aids: ashm.org.au  •          FSRH Medical Eligibility Criteria (UK Faculty of Sexual and Reproductive Healthcare, updated December 2025): fsrh.org  •          RANZCOG Contraception Guidelines: ranzcog.edu.au  •          Australasian Menopause Society — clinical resources and find-a-practitioner: menopause.org.au  •          Sexual and Reproductive Health Australia (SRHA) / AusLARC scholarship: srha.org.au    Timestamps 00:00 — Introduction & acknowledgement of country 01:00 — Guest introduction: Dr. Sara Whitburn 02:56 — Contraception: Pill Choice, Medical Eligibility Criteria Considerations, PBS Updates 12:18 — The menopausal transition: contraception vs. MHT, managing bleeding on MHT 23:10 — IUD pain management and post operative considerations 30:40 — Progesterone sensitivity and MHT options 33:00 — Monitoring patients on MHT 39:20 — Genitourinary syndrome of menopause and genital skincare 44:57 — Vaginal treatments vs. lubricants — clarifying the difference 45:42 — Libido: a biopsychosocial approach 49:00 — STIs: asymptomatic screening and approaching vaginal discharge 54:39 — Symptomatic STIs and trauma-informed examination 57:18 — Bacterial vaginosis and partner treatment 59:12 — STI prevention: PrEP and DoxyPEP 1:03:21 — Cervical screening: 2025 guideline updates and the MAGIC App 1:06:56 — Trauma-informed care in practice 1:10:51 — Medicare changes: LARC rebates and bulk billing incentives 1:12:58 — Why join the RACGP-SRH special interest group .. If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Ever found yourself staring at a workers' compensation or insurance form, pen in hand, quietly wondering what on earth you're supposed to write in half these boxes? You're in good company. Most of us learned this stuff the same way, watching someone else do it, nodding along, and then absolutely winging it the moment we were left alone with a patient and a certificate to fill in. Yes, we know, workers' compensation and insurance sounds about as thrilling as a mandatory compliance training video. But stick with us.  Dr Rob Park sits down with Greg Spinda, specialist personal injury lawyer and, as it turns out, not nearly as terrifying as his credentials suggest, to work through real GP scenarios, tackle those form boxes that have been quietly haunting us, and explore how getting the details right from day one can make an enormous difference to your patients' outcomes. You might just walk away feeling like you finally know what you're doing. ... If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.  

Dr Sama Balasubramanian is a General Practitioner and Sexual Health Physician, Fellow of the Australasian Chapter of Sexual Health Medicine and Fellow of the European Committee of Sexual Medicine.  He holds an Advanced Masters in Psychosexual Health and is Chair of the Training Committee in Sexual Health Medicine for the Royal Australasian College of Physicians. He is also a Senior Lecturer and Rural Academic Coordinator at the Rural Clinical School, Australian National University School of Medicine and Psychology. In this episode we discuss men's sexual health and dysfunction – erectile dysfunction, low libido, and premature orgasm.   Resources: Healthy Male website: https://healthymale.org.au/  The Penis Project podcast Deprescribing psychotropics podcast with Dr Mark Horowitz ... If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.    

In this episode of The GP Show, Dr Ashlea Broomfield and Dr Kate Wylie explore why climate change is a pressing human health issue and what it means for general practice. Throughout the discussion, Dr Wylie explains how changing environments affect our patients and the way we practice medicine, as well as how clinics can operate more sustainably. Dr Kate Wylie is an Adelaide based GP and the executive director of Doctors for the Environment Australia (DEA), a not-for-profit advocacy organisation that recognises that human health depends upon a healthy environment.  Dr Wylie is the immediate past chair of the RACGP's Climate and Environmental Medicine Specific Interest Group, elevating the need for climate action with GPs across Australia. She is a previous chair of DEA and is the founder of Climate Medicine, an advocacy project whereby she presents to community groups on the health effects of climate change. This episode offers insights and strategies for GPs and healthcare teams seeking to navigate the growing intersection of climate and health in their daily practice. Resources & Links: Doctors for the Environment Australia RACGP Special Interest Group – Environmental Medicine MJA Insight Plus: Let's get practical: how we can heal the planet and our patients ... If you would like to request a topic, please contact us via [email protected]  Thank you for listening and your support. ...  Study and learn lifestyle medicine:  Interested in whole of person clinical practice, research and careers that address the lifestyle and social determinants of illness and wellbeing, using lifestyle approaches, behaviour change, health coaching and implementation science?  Check out the JCU College of Medicine postgraduate degrees: Graduate Certificate, Graduate Diploma, and Master in lifestyle medicine. Dr Sam Manger on YouTube: Using lifestyle as medicine: A new era in chronic disease remission and YouTube: Careers in lifestyle medicine The 3 week online microcredential in Lifestyle Medicine and Mental Health: Life and Mind available here.