20 March 2021

Premenstrual Dysphoric Disorder (PMDD)

photo credit: ID: 152646115, Antonioguillem,

Have you ever felt like you were going crazy just before your period? That you were moody, irritable, couldn’t focus, had sleep disturbance? Perhaps you have PMDD.

PMDD is premenstrual dysphoric disorder. It is a more severe form of PMS (premenstrual syndrome) that occurs from 5 to 7 days before the commencement of a woman’s period. In addition to the physical symptoms of PMS like breast tenderness, headache, bloating, body aching – all of which might be more severe in PMDD; additionally, there are psychological symptoms that are prominent in PMDD; these include sadness, worthlessness, anger, irritability or depression. It becomes difficult to concentrate at work, there is a reduction in interest to socialize or strained interactions with other people – partners, kids, colleagues, friends. These symptoms resolve 2 to 3 days after the period commences. These symptoms repeat nearly every month.

While there is no clear cause of PMDD, it is thought that the brain’s response to the presence of hormones in different women causes these experiences. Non-medical lifestyle management options are available and if appropriate, pharmacological and medical options may also be appropriate.

If this sounds like you, please feel free to book an appointment and we can have a discussion about the possibility of PMDD or please see your doctor.

Obesity and Pregnancy

2 April 2021

Obesity and Pregnancy

photo credit: ID: 99358731, Kreangkrai Indarodom,

Overweight and obesity are defined as abnormal or excessive fat accumulation that poses a risk to health of the individual. For women, it can increase your risk of infertility, increase complications in pregnancy and increase adverse consequences for mother and child.

Some women with obesity have elevated levels of insulin and insulin resistance, causing a hormonal imbalance which can lead of excess androgens that can prevent ovulation from occurring. Without ovulation, a woman cannot fall pregnant. Obesity in pregnancy can mean it takes longer for you to fall pregnant. It has been shown that for women with BMI (body mass index) from 29kg/m2, the chance of conception falls by 4% every year for every 1kg/m2 gained. (Stubert et al, 2018)

The risks of miscarriage and recurrent early miscarriages were also significantly higher for obese women (Lashen et al, 2004). During pregnancy, the relative risks for gestational diabetes and pre-eclampsia (elevated blood pressure) increases by 10% when there is a 10% increase in pre-pregnancy BMI. (Shummers et al, 2015). Congenital malformation risks have also been shown to have a strong correlation with maternal obesity. These include heart defects, orofacial cleft and limb malformations.(Stubert et al, 2018).

Preventative measures to achieve a normal BMI is important to allow for successful conception and an uncomplicated pregnancy to achieve success with a healthy mother and healthy baby.

Please book an appointment for further discussion about weight management in preparation for a pregnancy or during pregnancy or please talk to your own doctor.


Lashen, H, Fear, K, & Sturdee, DW, 2004, ‘Obesity is associated with increased risk of first trimester and recurrent miscarriage: matched case control study’, Human Reproduction, 19(7): 1644 1646.

Shummers, L, Hutcheon, JA, Bodnar, LM, Lieberman, E & Himes, K, 2015, Risk of adverse pregnancy outcomes by prepregnancy body mass index: A population-based study to inform prepregnancy weight loss counselling’, Obstetrics & Gynaecology, 125(1): 133-143.

Stubert, J, Reister, F, Hartmann, S & Janni W, 2018, ‘The risks associated with obesity in pregnancy’, Deutsches Ärzteblatt International, 115: 276–83.

Are you concerned about your spider veins or varicose veins?

23 May 2021

Are you concerned about your spider veins or varicose veins?

Photo 214265712 / Spider Veins © Pongsak Deethongngam |

Photo 88916434 / Spider Veins © Zlikovec |

What are they?

Spider veins are small dilated veins just below the skin, most commonly on the legs. These are mostly red, purple, or with a bluish tinge. Varicose veins are deeper and bigger. They are often green or purplish-blue. Spider veins are often just unsightly but do not cause any significant symptoms. Varicose veins are often unsightly with bumps or small bulges on the surface of the skin if they are significant, but they can be subtle and not visible early in their formation. They can cause itching, aching, pain and in worse cases, changes in the colour of the skin, skin irritation and ulceration.

How will I know if I only have spider veins or varicose veins as well?

An ultrasound to look at the blood flow in the veins can be organised to determine the severity of the problem.


Depending on the severity of varicose veins, they may need to be removed to alleviate the symptoms or to prevent complications. This can be done as a clinic-based ablation procedure or it may need an operation. If you have varicose veins and spider veins, varicose veins need to be treated first. If you treat spider veins first when you have varicose veins, the treatment will be futile, as the spider veins will return. Spider veins alone often don’t need to be treated. But many people wish to have them treated to improve appearance.


Sclerotherapy is a procedure to inject a liquid solution into the spider veins. This solution then irritates the walls of the veins causing them to collapse and constrict. It eventually forms a fibrous cord which the body breaks down and then the vein disappears. This procedure can be done in a clinic and can be repeated to improve the appearance of the legs.

If you have any questions or concerns regarding spider veins or varicose veins, please talk to your doctor.

Acupuncture for osteoarthritis of the knee or hip

9 May 2021

Acupuncture for osteoarthritis of the knee or hip

Photo credit ID: 5182288, Yanik Chauvin,

In the National Health Survey conducted by the Australian Bureau of Statistics (ABS) 2016-2017, 2.2million Australians (9.3%) suffered from osteoarthritis. It is a chronic and progressive condition where the cartilage that protects the ends of your bones is worn down over time. It can affect any joint, but commonly affects hands, spine, hips and knees. It is the predominant condition that leads to hip and knee replacement surgery in Australia. (Australian Institute of Health and Welfare, 2020).

In a study completed in Germany, acupuncture for patients with knee and hip osteoarthritis receiving needle acupuncture, averaging 10 session over 3 months shows a statistical improvement in subjective measure of symptoms of osteoarthritis, including pain, physical function and stiffness, using Western Ontario and McMaster Universities Arthritis Index (WOMAC) when used in addition to standard routine care. (Witt et al, 2006) It also showed that the quality of life improvements were maintained through to 6 months (3 months post completion of acupuncture), more prominent in the acupuncture than control group, though not statistically significant. (Witt et al, 2006).

Acupuncture is applicable to only a limited number of medical conditions and its role is appropriate only in addition to standard medical care.

Please book an appointment to find out more or talk to your doctor.


National Health Survey, 2017-2018, Table 3.1 Long-term health conditions(a), Persons  — Persons, Australian Bureau of Statistics, viewed on 5 April 2021,

Australian Institute of Health and Welfare 2020. Osteoarthritis. Cat. no. PHE 232. Canberra: AIHW. Viewed 05 April 2021,

Witt, CM, Jena, S, Brinkhaus, B, Liecker, B, Wegscheider, K & Willich, S, 2006, ‘Acupuncture in patients with osteoarthritis of the knee or hip’, Arthritis & Rheumatism, 54(11), 3485-3493.

What about an intrauterine devince (IUD) for contraception?

25 April 2021

What about an intrauterine device (IUD) for contraception?

Photo 173256751 © Alena Menshikova |

(IUDs have also been known as IUCD- intrauterine contraceptive device)

What is an IUD?

An IUD is a small T-shaped contraceptive device that sits inside the uterus. There are 2 types, the first is a hormone-based where progestogen is contained within a cylinder that forms the stem of the device. The second is non-hormone-based, where copper is wrapped around the stem of the device.

How does it work?

IUDs work by thickening cervical mucous to reduce sperm movement and survival and it makes the uterine lining (endometrium) inhospitable to a fertilized egg.

Is it an effective contraception?

IUDs are at least 99% effective.

Who can be considered for an IUD?

  • Any woman who wants a reliable effective form of long term contraception, including any woman who has not been pregnant before
  • Any woman at low risk of contracting a sexually transmitted infection (STI)
  • Breastfeeding women

Who cannot use an IUD?

  • Pregnant women
  • Women with current undiagnosed vaginal bleeding
  • Women with current pelvic inflammatory disease (PID) or STI

What are the advantages of both the hormonal and copper IUD?

  • Long acting device (5 years)
  • Set and forget
  • Reliable and effective
  • Cheaper than other forms of contraception in the long run
  • Reversible – once removed, you can try to conceive a baby
  • For the hormonal IUD, it reduces the volume of menstrual bleeding, so it’s helpful for those with heavy menstrual bleeding. In some cases, it can stop your period completely.

What are the disadvantages?

  • It does not protect against STIs or PID
  • Insertion of the IUD requires a minor procedure that can be uncomfortable
  • During insertion, there is a small risk of perforation of the uterus, embedment into the uterus and infection
  • It is very rare risk that pregnancy, or ectopic pregnancy can occur if the IUD fails
  • For the hormonal IUD, there is a period of 3-6 months where there may be irregular spotting or bleeding before everything settles down. It may also cause bloating, headache, reduced mood, acne, reduced libido.
  • For the copper IUD, it may cause heavier and more painful periods

For a more detailed discussion of IUD, please make an appointment to see Dr. Kua or talk to your doctor.


The Women’s, The Royal Women’s Hospital, Victoria, Australia, 2021, Intrauterine Device (IUD), The Women’s, The Royal Women’s Hospital, Victoria, Australia, viewed 5 April2021, <>

Family Planning NSW, 2021, Hormonal IUD, Family Planning NSW, viewed 5 April 2021, <>

Family Planning NSW,2021, Copper IUD, Family Planning NSW, viewed 5 April 2021, <>

Is obesity linked to our genes?

9 April 2021

Is obesity linked to our genes?

Photo credit: ID: 83822327, Vchalup,

Many factors have been given for influencing body weight in humans. These include the built environment, medical conditions, human behavior, medications, but increasingly there is a strong association of a genetic role in obesity. In a landmark study, Stunkard et al 1986 found that there was a correlation between the weight of Danish adoptees and the body mass index (BMI) of their biological parents that was statistically significant, particularly for their mothers. Furthermore, he found that there was no correlation between the weight of adoptees and their adoptive parents and that this was applicable across all weight classes, not just the obese adoptees, but also those who were thin. (Stunkard et al, 1986)

Mutations in genes alone, which occur slowly, cannot explain the obesity epidemic that has occurred in the past few decades around the world. It Australia, there has been a 11.3% rise in the prevalence of obesity in Australia from 1980 to 2000 which is 2.5 times increase, over 20 years. (Cameron et al, 2003) Interest is growing in the role of the environment and the gene-environment interaction in the increase prevalence of obesity and obesity related comorbidities. Epigenetics the activation or deactivation of gene expression across certain tissues without DNA sequence changes to the genome. It is thought that through this mechanism, environmental chemicals, gut microbiota modifications and poor nutritional intake can have an impact on metabolism and contribute to obesity and its comorbidities. (Thaker VV, 2017).

If you have any questions please book an appointment or talk to your doctor.


Stunkard, AJ, Sørensen, TI, Hanis, C, Teasdale, TW, Chakraborty, R, Schull, WJ, & Schulsinger, F, 1986, ‘An adoption study of human obesity’, The New England journal of medicine, 314(4): 193–198.

Cameron, AJ, Zimmet, PZ, Dunstan, DW, Dalton M, Shaw, JE, Welborn, TA, Owen, N, Salmon, J & Jolley, D, 2003, ‘Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab)’, Medical Journal of Australia, 178 (9): 427- 432.

Thaker V. V. (2017). ‘Genetic and epigenetic causes of obesity’ Adolescent medicine: state of the art reviews,28(2), 379–405.