Everyday Medicine with Dr Luke

Gastroesophageal reflux (GORD) is common reported by 5 %-10% of our population as a daily occurrence,15-20% as a weekly event and experienced by 25-40% monthly. It occurs when gastric content flows up into the oesophagus across the lower oesophageal sphincter initiating a burning sensation that is felt rising behind the breastbone and at times is associated with an acidic taste in the mouth. Symptoms of GORD are best investigated by upper gastrointestinal endoscopy.  These more classic symptoms referred to as heartburn may be associated with mucosal inflammation, scarring and the development of Barretts intestinal metaplasia over time. Symptoms may also be reported by patients who are found to have very minor or no inflammation at endoscopy and this is referred to as non-erosive reflux disease (NERD). Indeed 60-70% of patients with reflux symptoms have NERD whilst only 30-40% have erosive changes found at endoscopy. It is Interesting that the relationship between symptoms and endoscopic findings is often poor.  The description of typical reflux dyspepsia outlined above contrasts with silent reflux where regurgitation may be occurring, as demonstrated by oesophageal pH monitoring, but without classic heartburn symptoms. As many as 20-30% of patients with actual reflux may be in this category. Some of these patients are said to have laryngopharyngeal reflux and may report a number of extra-oesophageal symptoms including chronic cough, nocturnal exacerbation of asthma, repeated micro aspiration, hoarseness, globus sensation, halitosis, dental enamel erosion and non-cardiac chest pain. Whilst medical management is generally very effective and includes acid suppression using pharmacologic treatments combined with lifestyle modification focussed on weight loss toward a healthy BMI as well as reduction in exposure to caffeine containing drinks and alcohol. Other advice includes the recommendation to eat 3 hours before retiring and to avoid smoking. Despite these relatively simple conservative strategies there are still some patients who fail to respond, have breakthrough symptoms or would like to consider surgical options. Eventually about 1-3% of patients with chronic reflux or complicated reflux will progress to corrective surgery by fundoplication. This technique has high success rates in selected patients quoted as 85-90% at five years although 5-10% may require revision and 15-30% resume acid suppression treatment at some point post operatively. To review the surgical approach to GORD management in more detail we are joined by upper gastrointestinal surgeon Dr Hamish Shilton.  Hamish performs upper gastrointestinal surgery through predominantly laparoscopic and robotic techniques including management of oesophageal neoplasia by minimally invasive esophagectomy but also hiatal hernia repair, cholecystectomy and bariatric surgery. He completed subspecialty training in both Auckland and Norwich in the UK - both high volume bariatric and oesophageal cancer units. He works at Cabrini Hospital Malvern and has an appointment at Monash Health in Melbourne.  Please welcome Hamish to the podcast. References Dr Hamish Shiltonwww.mayoclinic.org GORD

Constipation is a very common clinical problem in our community, characterised by infrequent bowel motions or difficulty passing stool. It affects an estimated 24% of adults, with up to 18% of adults regularly using laxatives. Constipation may be secondary to slow colonic transit, pelvic dyssynergia, pelvic floor disorders associated with organ prolapse, or all of the above. Slow transit constipation or colonic inertia reflects an abnormally long length of time for waste material to pass through the colon. This contrasts with pelvic dyssynergia, also referred to as anismus or obstructed defaecation, which is a functional defaecation disorder in which the muscles involved in defaecation fail to coordinate properly. In pelvic dyssynergia, the anal sphincter and puborectalis muscle paradoxically contract or fail to relax adequately, resulting in difficulty evacuating stool. This is seen in 25–50% of patients with chronic constipation, is more common in women, and may overlap with features of irritable bowel syndrome. Pelvic floor physiotherapy helps target the root causes of bowel dysfunction associated with pelvic dyssynergia by restoring the coordination, strength and relaxation of pelvic muscles. It treats conditions like faecal incontinence, dyssynergic defecation and incomplete colon emptying by using muscle re-training, biofeedback and postural adjustments. Importantly, pelvic floor physiotherapy helps to reduce reliance on medication or surgery and can be highly effective, with rehabilitation and biofeedback therapies showing significant symptom improvement in a large majority of patients. Additionally, simple but highly effective adjustments are suggested to toilet mechanics, such as using a footstool to elevate the knees above the hips and leaning forward or backwards, which helps align the rectum and relax the pelvic floor. Further, incorporating breathing techniques with central core coordination by learning deep, diaphragmatic breathing and avoiding breath-holding helps to minimise dangerous downward pressure (straining) and relaxes the pelvic floor naturally. In our gastroenterology practice, we see pelvic floor physiotherapy and rehabilitation as essential partners in the management of the conditions discussed above. To take a deeper dive into this subject, we are joined by physiotherapist Varsha Bhikha. Varsha completed her Bachelor of Physiotherapy at Monash University in 2013 and then went on to complete a Post-Graduate Certificate in Pelvic Floor Physiotherapy in 2016. She has gained extensive experience in both Musculoskeletal and Pelvic Health Physiotherapy and works in both the maternity ward at Saint John of God Hospital Berwick and within private practice settings. Varsha also has a broad-based experience in treating women prenatally and postnatally and has further expertise in Clinical Pilates. Please welcome Varsha to the podcast. References: Varsha Bhikha www.gihealth.com.au PubMed Central Park et al., (2026). Biofeedback therapy and pelvic floor physical therapy in the treatment of constipation and fecal incontinence are very different in real-world practice. Neurogastroenterology & Motility, 38(8), e70412. https://doi.org/10.1111/nmo.70412 

Diverticular disease is both very common and largely asymptomatic. It is increasingly prevalent with age. Less than 10% of 40-year-olds have diverticulosis; however, the figure increases to 30–40% by age 60 years and 50–70% by age 80 years. It is more common in industrialised countries and associated with low fibre diets, obesity, sedentary lifestyle and smoking. NSAID use and corticosteroids are quoted to increase complication risk, such as bleeding and perforation. The natural history includes 70–80% of patients with diverticulosis remaining asymptomatic lifelong. Approximately 15–20% of patients eventually become symptomatic, but with uncomplicated diverticulitis that may be managed as an outpatient with bowel rest, analgesia and antibiotics. Some 12–15% of diverticulitis cases, however, will eventually become complicated and require hospital care with administration of intravenous antibiotic therapy and potentially surgical review. That is, overall, about 4–5% of patients with diverticulosis will eventually experience complicated diverticulitis during their lifetime, and of these, 3–5% will experience a diverticular bleed. Diverticulitis has a tendency to recur, and the recurrence rate for acute diverticulitis ranges between 16% and 35%, with roughly 20% of patients experiencing another episode within 5 to 10 years following their initial attack. The risk of future attacks increases if the first episode was complicated or if it occurred in patients under the age of 50 years. The risk increases with each flare-up. After a second episode, the recurrence rate jumps to roughly 55% over a 10-year period. Younger patients (typically under 50) and those with more complicated presentations tend to experience higher recurrence rates. Pips, seeds and nuts are irrelevant to episodic diverticulitis, although they have grown to occupy myth status in this regard. Major complications requiring hospital admission include acute diverticulitis warranting intravenous antibiotic therapy, pain management and bowel rest, abscess development, perforation, fistula development, bowel obstruction and peritonitis. Some acute diverticulitis events may be secondary to micro-perforation, with inflammation developing in and around diverticula. Such cases typically present with left lower quadrant pain, fever, raised inflammatory markers and altered bowel habit. Diverticular bleeding occurs with a ~3–5% lifetime risk and is usually painless, large-volume haematochezia. This is the most common cause of lower GI bleeding in older adults and is confronting for patients. Often, bleeding stops spontaneously (~70–80%), but with a recurrence rate of ~20–40%, which may require radiologically targeted embolisation or surgical intervention. Abscess formation occurs in ~15% of acute diverticulitis cases. Both frank perforation and peritonitis are less common. Other diverticular complications include fistula formation, with a frequency of about ~2–4%. The most common fistula is colovesical, presenting with pneumaturia, recurrent UTIs and faecaluria. Whilst most cases of acute complicated diverticulitis can be managed conservatively without surgery, I like to involve surgeons early in the hospital management of patients. For a deeper dive into this subject, we are joined by colorectal surgeon Asiri Arachchi, who is frequently called for his expert advice and intervention and provides an excellent service for both emergency and elective care across all colorectal pathologies in Southeast Melbourne. Asiri trained in high-volume colorectal units at Monash Health Victoria, Austin Health, North Shore Hospital Auckland and Christchurch Hospital, and is proficient in laparoscopic, open and robotic surgery. Please welcome Asiri to the podcast. References: Dr Asiri Arachchi: caseysurgicalgroup.com.au Colorectal Surgery Australia and New Zealand CharityPubMed Central NIH – Diverticular Disease 

Patients with ulcerative colitis (UC) and Crohn's disease (CD) involving the colon are at an elevated risk of developing colorectal cancer (CRC), secondary to long-term chronic mucosal inflammation. The level of risk depends primarily on disease duration, the extent of colonic involvement, and the presence and grade of precancerous cell changes (dysplasia) present. While most IBD patients never develop CRC, the risk, compared to the general population, is significantly higher. For ulcerative colitis, the cumulative risk is generally estimated as 1% to 2% at 10 years from diagnosis, 3% to 8% at 20 years since diagnosis, and 7% to 18% at 30 years' duration. The risk also depends on the severity and extent of the colitis. For patients with Crohn's colitis, a level of CRC risk similar to those with UC is noted when comparable extents of large intestine inflammation are involved. During colonoscopic surveillance of patients with IBD, dysplasia is looked for histologically, reflecting abnormal, precancerous cellular changes, and is categorised into low-grade (LGD) and high-grade (HGD) forms. Patients with LGD are approximately 3.5 times more likely to develop advanced neoplasia compared to those without dysplasia, in the absence of intervention. HGD is very dangerous. Approximately 40% of IBD patients with initial HGD findings on endoscopy will progress to colorectal cancer over a 15-year period if untreated. Risk magnifiers include disease duration of 8 years or longer, colitis activity, and extent of disease involvement, including colitis that extends beyond the rectum into the left side of the colon or involves the entire colon (pancolitis). Due to these risks, guidelines recommend starting surveillance colonoscopies 8 to 10 years after symptom onset. The gold standard technique for dysplasia detection at endoscopy involves the engagement of high-definition chromoendoscopy, followed by targeted biopsies of visible lesions rather than relying solely on random biopsies. Routine surveillance every 2 years helps identify dysplasia early, enabling proactive management and preventing progression to cancer. If PSC is diagnosed, annual colonic surveillance is recommended. To discuss this subject in further detail, we are joined by Dr Ali Eqbal. Ali has expertise in advanced colonic interventional endoscopy and inflammatory bowel disease. He completed a two-year advanced endoscopy fellowship at King's College Hospital, London, where he developed expertise in the diagnosis and management of complex colonic polyps using techniques including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). He also undertook a clinical research fellowship in complex IBD at the Austin Hospital in Melbourne. He is widely respected and recognised for his advanced technical skills and commitment to minimally invasive treatment options. He has published and presented both nationally and internationally. Please welcome Ali to the podcast. References Ali Eqbal:  https://www.gihealth.com.au Gastroenterological Society of Australia (GESA) NIH PubMed Central (PMC). Primary sclerosing cholangitis as an independent risk factor for colorectal cancer in the context of inflammatory bowel disease: A review of the literature. https://pmc.ncbi.nlm.nih.gov/articles/PMC4112886/ 

Colon polyps develop on the inner lining of the large intestine or rectum and are medically significant, as a small percentage may subsequently develop into colon cancer. They affect roughly 15% to 40% of all adults and become increasingly frequent with age. Whilst we are now observing an increasing prevalence of polyps and colon cancer in young adults, they are still relatively uncommon before the age of 40 years. Colorectal polyps are found in about 25% of adults aged 45 years. By age 50 years, approximately 40% to 50% of people will develop at least one polyp, slightly more in men than women. Polyps generally fall into two main categories: non-neoplastic, including hyperplastic polyps, inflammatory polyps and hamartomas; and potentially neoplastic polyps, which include adenomas and sessile serrated polyps. While harmless initially, adenomas and sessile serrated polyps are considered precancerous and may develop into invasive cancer over time. Fortunately, only a small minority, approximately 5% to 10% of conventional adenomas and an estimated 2% to 6% of isolated non-dysplastic sessile serrated polyps (SSPs), will ever progress to malignancy. Conventional adenomas progress to cancer via a traditional adenoma-to-carcinoma pathway, a relatively slow process that may take 10 to 15 years. By contrast, sessile serrated polyps (SSPs) develop through an alternative biological pathway. They are flat, often hidden under a mucus cap, tend to be more right-sided in location, and are historically difficult to spot during a colonoscopy. For an isolated non-dysplastic SSP, the 10-year cumulative risk of becoming cancerous is relatively low, at around 2% to 6%. When dysplasia is present, however, the malignant potential is much higher. The bottom line is that colorectal surveillance by colonoscopy is essential. Colon cancer surveillance and screening have been shown to reduce colorectal cancer (CRC) incidence by approximately 50% to 90%. This dramatic reduction is achieved primarily because colonoscopy allows direct detection and removal of precancerous polyps before cancer development. To discuss this important topic in more detail, particularly focussing on large colonic polyp management, we are joined by Dr Ali Eqbal. Ali has expertise in advanced colonic interventional endoscopy and inflammatory bowel disease. He completed a two-year advanced endoscopy fellowship at King's College Hospital, London, where he developed expertise in the diagnosis and management of complex colonic polyps using techniques including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). He also undertook a clinical research fellowship in complex IBD at the Austin Hospital in Melbourne. He is widely respected and recognised for his advanced technical skills and commitment to minimally invasive treatment options. He has published and presented both nationally and internationally. Please welcome Ali to the podcast. References Dr Ali Eqbal, www.gihealth.com.au GESA  National Center for Biotechnology Information (NCBI). Colonic Polyps. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430761/ PubMed Central 

In the preceding episode with Dr Peverelle, we reviewed pharmacologic approaches to obesity management. In this episode, we review an alternative approach to bariatric surgery referred to as Endobariatrics. These are endoscopic interventions sitting between lifestyle-pharmacotherapy and bariatric surgery and are suited for patients with BMI’s between 30-40 kg/m2 who don’t want surgery or are not surgical candidates. The main interventions include: Intragastric balloons, which are temporary devices associated with 10-15% weight loss. Endoscopic sleeve gastroplasty, reducing gastric volume with 15-20% efficacy and currently the preferred Endo Bariatrics technique. Duodenal mucosal resurfacing and duodenal-jejunal bypass liners. To discuss these options with us in more detail, please welcome back Dr Matthew Peverelle. Matthew is a gastroenterologist who completed his advanced training in gastroenterology at Monash Health and Austin Health, including the Victorian Liver Transplant Unit. Matthew went on to complete a hepatology fellowship at the prestigious Kings College Hospital in London and has developed a strong interest in both hepatology, luminal gastroenterology and Endobariatrics. Thank you for joining us as he brings his expertise to the podcast. References: Dr Matthew PeverelleEndoscopic Weight Loss Options, Danse & Jirapinyo. Endocrinol Metab Clin N Am 54 (2025) 149-162 https://pubmed.ncbi.nlm.nih.gov/39919871/ Endoscopic Bariatrics: Current Therapies and Future Directions. Reja et al. Transl Gastroenterol Hepatol. 2022 Apr 25; 7: 21. pmc.ncbi.nih.gov Outcomes of Endoscopic Sleeve Gastroplasty: A Systematic Review. Vargas et al. Medicina. 2025 Oct 11; 61(10): 1821 https://www.mdpi.com/1648-9144/61/10/1821 

Australians who are either overweight or obese are increasingly turning to pharmacological approaches coupled with dietary measures to achieve their weight loss goals before considering bariatric surgery.These therapies are typically considered for adults whose BMI’s are equal or above 30 kg/m2 or above 27 kg/m2 with associated comorbidities and include the following:Incretin based therapies including dual incretin agonists (most effective)Appetite suppressants-central acting drugsDopaminergic/opioid pathway modulation therapiesNutrient absorption inhibition therapiesThe most effective pharmacologic treatments available in clinical use are synthetic incretins. Natural incretins are gut derived hormones released after eating that enhance pancreatic insulin secretion in a glucose dependent manner.Examples in clinical use include: Exenatide (Byetta, a synthetic version of a peptide found in the saliva of the Gila monster lizard), Semaglutide (Ozempic-approved for type 2 diabetes, Wegovy-approved for weight loss with dosing up to 2.4mg per weekly dosing), Liraglutide (Saxenda with daily dosing). Another well-known GLP-1 is Dulaglutide (Trulicity).When applied for weight loss Semaglutide and Liraglutide lead to 10-15% body weight reduction. Benefits beyond diabetes and weight loss include a 30% reduction in the risk of heart attacks and strokes. These drugs also show promise in treating conditions such as fatty liver disease, obstructive sleep apnoea, and kidney disease.Side effects include nausea, vomiting, diarrhoea, gallstones and pancreatitis (0.2-0.3 % in most studies). They are contraindicated in patients with medullary thyroid cancer.Another incretin in clinical practice is Gastric Inhibitory Polypeptide (GIP) also known as Glucose Dependent Insulinotropic polypeptide. Like the GLP-1 incretin, GIP also stimulates insulin release in a glucose-dependent way, though it was first named for its weaker ability to inhibit stomach acid.The synthetic so called “twincretin” or dual action incretin called Tirzepatide combines GIP and GLP-1 agonist actions and further increases weight loss outcomes. Marketed as Mounjaro, clinical trials demonstrate it producing 20-22% weight loss for patients.Discontinuation rates for patients using incretin therapies for weight loss is quoted between 50-75 % in one year with factors including expense and side effects influencing this statistic. Recent data also points to significant weight regain over a two-year period after medication withdrawal.The centrally acting appetite suppressants include Phentermine which is a sympathomimetic noradrenergic agent used short term over weeks-months and increases noradrenaline and dopamine in the hypothalamus to reduce appetite. These therapies can expect an 8-12 % weight loss.Naltrexone combined with Bupropion acts on the POMC neurons reducing appetite and food cravings. Nausea, seizure activity and hypertension are side effects for a quoted 5-9 % weight loss.Orlistat is a gastrointestinal fat absorption inhibitor inhibiting pancreatic lipase and decreasing fat absorption by about 30 %. Steatorrhea and loss of fat-soluble vitamins are side effects for only 3-5 % weight loss.To discuss the application of these therapies in more depth we are joined by gastroenterologist Dr Matthew Peverelle. Matthew completed his advanced training in gastroenterology at Monash Health and Austin Health including the Victorian Liver Transplant Unit. He then continued his studies abroad completing a hepatology fellowship at the prestigious Kings College Hospital in London, subsequently he has developed a strong interest in both hepatology, luminal gastroenterology and Endo bariatrics.Thank you for joining us as he brings his expertise to the next two podcast episodes.References: Matthew Peverelle Australian Family Physician, Pharmacotherapy for obesity, Lee & Dixon Vol 46,7, July 2017 Niddk.nih.gov Obesity Evidence HubObesitymedicine.org Pmc.ncbi.nlm.nih.gov 

Medical cybercrime refers to criminal activities involving cyber-attacks on healthcare systems, devices and data. These attacks can range from ransomware and data breaches to the exploitation of vulnerabilities in medical devices, posing serious threats to patient safety, data privacy and the stability of healthcare operations.According to the Office of the Australian Information Commissioner in 2023, the healthcare industry tops the list for cyber-attacks. Healthcare became the most reported non-government sector for cybercrime incidents in FY2023–24 with more attacks than financial services, education and other critical infrastructure industries, highlighting its vulnerability, further ransomware attacks targeting the Australian health sector are growing.Highlighting this point 41% of healthcare organisations in Australia experienced a cyber-attack in 2023. This marks a significant rise in the targeting of this critical sector with a 71% year on year increase in global cyber-attacks targeting healthcare organisations.32% of healthcare cyber incidents involved compromised accounts or credentials, others included malware infections (17%) and compromised network infrastructure (12%).Patients are also concerned, in one survey 82% of Australians indicated they were worried about unauthorised access to personal health records and consider health information security when choosing healthcare providers. 33% said they were “very to extremely worried” about the security of their health information.In December 2022, Medibank, the Australian health insurance giant, was the victim of a major data breach, affecting the personal details of 9.7 million customers. The attack was believed to be linked to a well-known ransomware group based in Russia, the REvil ransomware gang.Eastern Health an operator of 4 Melbourne hospitals subsequently fell victim to a cyberattack causing certain elective surgeries to be postponed at the time. Another notable incident targeted Melbourne Heart Group.Reinforcing these concerns tech giant Microsoft has also stated that the healthcare sector (and aligned industries) is one of the top targets for cyber criminals.Types of Medical Cybercrime include: Ransomware Attacks: These attacks encrypt a healthcare organisation's data, demanding a ransom for its release, potentially disrupting critical services and delaying patient care. Data Breaches: Cybercriminals may steal sensitive patient information, including medical records, financial data, and personal details, for various malicious purposes. Medical Device Exploitation: Vulnerabilities in connected medical devices, such as pacemakers or insulin pumps, can be exploited to compromise patient safety or disrupt treatment. Supply Chain Attacks: Cybercriminals may target the healthcare organisation's supply chain, compromising vendors or partners to gain access to the primary target. Phishing Attacks: These attacks involve tricking individuals into revealing sensitive information or installing malware, often through deceptive emails or websites. Social Engineering: Attackers use psychological manipulation to gain access to systems or information.Impact of medical cybercrime on patient safety, data privacy, financial losses, operational disruptions and erosion of trust cannot be overstated.To explore and discuss this topic in more detail we are joined on this podcast by both Dave Vosnakes and Stephanie Way from The Australian Government National Office of Cybersecurity who provide an expert overview of the growing problem. Please welcome them to the podcast.References:Office of the Australian Information CommissionerAct Now. Stay SecureAustralian Signals Directorate

It is now increasingly recognised that women’s health care needs at menopause have been both under-recognised and under-treated by medical practitioners, and that menopause management has not been emphasised adequately in graduate and post-graduate education. Considering that half the world’s population spend about a third of their lives after menopause, this unmet need must be recognised and addressed. I was curious to explore this subject in greater detail and welcome the opportunity to review some basic science and definitions.Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of the reproductive stage for females. It is often defined as having occurred when a woman has not had any menstrual bleeding for a year.Perimenopause is the natural stage in a woman’s life occurring before the final menstrual period, or menopause, when a woman's body transitions away from its reproductive years. Based on these criteria, perimenopause starts when there are persistent differences in cycle length of seven or more days between consecutive cycles and continues until 12 months after the last menstrual period. During this time, the ovaries gradually become less functional, leading to changes in menstrual cycles and potential infertility.Perimenopause is a time when risk factors for chronic disease need to be considered, including acceleration of bone loss, increase in cardiovascular risk arising from adverse changes in lipids and altered glucose metabolism. Cancer screening programs, including bowel, breast, and cervical cancer should also be discussed with patients at this time.Medical treatment of perimenopause and menopause is aimed at ameliorating symptoms and to prevent bone loss and is centred on the use of menopausal hormone therapy (MHT) with replacement of oestrogens either alone, in the case of previous hysterectomy, or combined with progesterone when the uterus is present.Many of the concerns about MHT raised by older studies are no longer considered barriers to its use in healthy women. The risks arise around discussions of breast cancer, uterine cancer and cardiovascular disease including thromboembolic events and strokes.For cardiovascular disease the evidence pertaining to MHT risk relates to timing and the use of oral rather than transdermal oestrogen. If oral or transdermal oestrogen therapy is initiated within 10 years or earlier since menopause or less than age 60 years, there may be a slightly reduced coronary heart disease risk.With this background I would like to introduce Dr Sugandha Kumar. Dr Kumar is an Obstetrician and Gynaecologist committed to providing comprehensive women’s health care in the south-eastern suburbs of Melbourne.Sugandha did her early specialist training at a prestigious medical institute in India (PGIMER, Chandigarh) and completed her advance training in Obstetrics and Gynaecology in Australia (Monash and Eastern Health). She holds specialist appointments at Box Hill Hospital and has a strong focus on improving outcomes for her patients by offering up-to-date and evidence-based treatment options. She provides obstetric and gynaecological and is expert in advanced laparoscopic surgery including laparoscopic hysterectomy and endometriosis surgery as well as having specialist interest in menopausal hormone therapy. Please welcome Sugandha to the podcast which we will present in two parts.References:Dr Sugandha Kumar : Create Fertility: ⁠www.createfertility.com.au⁠⁠https://www.thelancet.com/series/menopause⁠Swan Study: JAMA 2015;175:531–39

It is now increasingly recognised that women’s health care needs at menopause have been both under-recognised and under-treated by medical practitioners, and that menopause management has not been emphasised adequately in graduate and post-graduate education. Considering that half the world’s population spend about a third of their lives after menopause, this unmet need must be recognised and addressed. I was curious to explore this subject in greater detail and welcome the opportunity to review some basic science and definitions. Menopause, also known as the climacteric, is the time when menstrual periods permanently stop, marking the end of the reproductive stage for females. It is often defined as having occurred when a woman has not had any menstrual bleeding for a year.Perimenopause is the natural stage in a woman’s life occurring before the final menstrual period, or menopause, when a woman's body transitions away from its reproductive years. Based on these criteria, perimenopause starts when there are persistent differences in cycle length of seven or more days between consecutive cycles and continues until 12 months after the last menstrual period. During this time, the ovaries gradually become less functional, leading to changes in menstrual cycles and potential infertility.Perimenopause is a time when risk factors for chronic disease need to be considered, including acceleration of bone loss, increase in cardiovascular risk arising from adverse changes in lipids and altered glucose metabolism. Cancer screening programs, including bowel, breast, and cervical cancer should also be discussed with patients at this time.Medical treatment of perimenopause and menopause is aimed at ameliorating symptoms and to prevent bone loss and is centred on the use of menopausal hormone therapy (MHT) with replacement of oestrogens either alone, in the case of previous hysterectomy, or combined with progesterone when the uterus is present.Many of the concerns about MHT raised by older studies are no longer considered barriers to its use in healthy women. The risks arise around discussions of breast cancer, uterine cancer and cardiovascular disease including thromboembolic events and strokes.For cardiovascular disease the evidence pertaining to MHT risk relates to timing and the use of oral rather than transdermal oestrogen. If oral or transdermal oestrogen therapy is initiated within 10 years or earlier since menopause or less than age 60 years, there may be a slightly reduced coronary heart disease risk.With this background I would like to introduce Dr Sugandha Kumar. Dr Kumar is an Obstetrician and Gynaecologist committed to providing comprehensive women’s health care in the south-eastern suburbs of Melbourne.Sugandha did her early specialist training at a prestigious medical institute in India (PGIMER, Chandigarh) and completed her advance training in Obstetrics and Gynaecology in Australia (Monash and Eastern Health). She holds specialist appointments at Box Hill Hospital and has a strong focus on improving outcomes for her patients by offering up-to-date and evidence-based treatment options. She provides obstetric and gynaecological and is expert in advanced laparoscopic surgery including laparoscopic hysterectomy and endometriosis surgery as well as having specialist interest in menopausal hormone therapy. Please welcome Sugandha to the podcast which we will present in two parts.References:Dr Sugandha Kumar : Create Fertility: www.createfertility.com.auhttps://www.thelancet.com/series/menopauseSwan Study : JAMA 2015;175:531–39