Monthly Archives: January 2017

Taking a break from your diet helps long-term weight loss

Taking a break from your diet helps long-term weight loss

March 14, 2016 6.13am AEDT

How many times have you attempted to lose weight only to fall short and fail? For many people it is extremely challenging to stick to a strict dietary and exercise program for more than a few weeks. The good news is research now shows that having intermittent breaks from your diet may actually help you keep the weight off in the long term.

A study receiving a lot of attention found weighing yourself daily and hence adjusting your food and exercise intake helps you achieve a clinically significant weight loss over a two-year period if you take frequent breaks from your diet. This doesn’t require a fixed calorie-counting or structured exercise regime, but it does require recording your weight daily and monitoring the trajectory over time.

This is referred to as the “Caloric Titration Method”, where weight loss is achieved in small amounts. First the individual loses 1% of their body weight, and is then encouraged to maintain their new weight for about a week. This period of weight maintenance allows the individual to eat more or perhaps exercise less than they would while trying to lose weight.

The goal is then to achieve another decrease of 1% in body weight, followed by another “break” (weight maintenance). This routine would be followed until the final weight-loss goal is achieved.

This approach is challenging the body to redefine its baseline body weight by having frequent breaks along the way. As with all weight-loss approaches, it doesn’t work for everyone, but if it’s two to three kilograms of weight you are trying to shift, this may be a very suitable option that is a proven strategy in the longer term.

Allowing yourself a treat every now and then will stop you failing in the long run. from

Weigh yourself at the same time each day, but look at weight-loss trends over the week or month. Day-to-day fluctuations can vary significantly with different types of food. These are a reflection of change in body water content rather than fat mass (for example, carbohydrates bind more water than proteins).

Focus on making small changes (amounting to deficits of 100 calories per day) such as: skipping dessert a few times per week; occasionally using a meal replacement for lunch or dinner; and eliminating snacking on pre-packaged (and often energy-dense, nutrient-poor) foods most days of the week.

Intermittent fasting

Another approach also receiving a lot of attention, and with growing evidence, is that of “intermittent fasting” or “alternate day fasting”. This involves following a reduced-calorie diet for some days of the week, with “normal” eating on the other days.

In a recent study conducted in mice, researchers restricted and fixed the amount of food in the continuous diet, but for the intermittent diet they allowed the mice to eat as much as they wanted for fixed periods of time each week, from one to three days.

Interestingly, both groups of mice achieved the same weight loss over the 15-week period, despite the intermittent diet group eating more food. Evidence for this approach is increasing in humans too.

Perhaps having a break from our diet and exercise regime allows us to keep our goals longer because our lifestyle is not affected and we feel as though we are being “treated” every once in a while. Research shows we lose motivation after a certain period of dieting if we lose sight of the bigger picture or aren’t achieving our weight-loss goals.

We still have a way to go in proving the true efficacy of strict dieting followed by ad lib periods of eating if we are to say it is a superior approach for losing weight compared to traditional continuous programs of diet and exercise. However, intermittent fasting does appear to present as a valid option and suitable alternative.

No one approach is suitable for everyone who wants to control their weight, but this dietary strategy is becoming internationally recognised. Importantly, this approach may assist with sticking to a program in the longer term, due to the breaks (and hence allowance for our indulgences) or ad lib periods of eating it allows.

Diet and Fracture Risk in Postmenopausal Women

Diet & Fracture Risk in Postmenopausal Women

JAMA Intern Med; ePub 2016 Mar 28; Haring, et al

April 12, 2016

A healthy dietary pattern, including a higher adherence to a Mediterranean diet, may play a role in maintaining bone health in postmenopausal women and lower the risk of fractures. This according to results from the Women’s Health Initiative (WHI) and 90,014 participants (mean age 63.6 years). The WHI food frequency questionnaire was used to derive nutrient and food intake at baseline and diet quality and adherence were assessed by scores on the alternate Mediterranean diet (aMED). Researchers found:

• During a median follow-up of 15.9 years, there were 2,121 cases of hip fractures and 28,718 cases of total fractures.

• Women scoring in the highest quintile (Q5) of the aMED index had a lower risk for hip fractures (HR=0.80), with an absolute risk reduction of 0.29% and a number needed to treat of 342.

• No association between the aMED score and total fractures was observed (Q5 HR=1.01).

Citation: Haring B, Crandall CJ, Wu C, et al. Dietary patterns and fractures in postmenopausal women: Results from the Women’s Health Initiative. [Published online ahead of print March 28, 2016]. JAMA Intern Med. doi:10.1001/jamainternmed.2016.0482.

Commentary: Previous research has shown that both osteoporosis and osteoporotic fractures are lower in Mediterranean countries than in northern European countries. The Mediterranean diet emphasizes plant foods, fish, nuts, and monounsaturated fat. It has been shown to decrease the risk for diabetes and cardiovascular disease and in addition has been associated in some studies with a decreased risk of hip fractures.1,2 While the decrease in the risk of osteoporotic hip fractures was modest at 20%, that combined with positive metabolic effects make the Mediterranean diet an attractive option to recommend to patients. —Neil Skolnik, M

1. Benetou V, Orfanos P, Pettersson-Kymmer U, et al. Mediterranean diet and incidence of hip fractures in a European cohort. Osteoporos Int. 2013;24(5):1587-1598. doi:10.1007/s00198-012-2187-3.

2. Esposito K, Maiorino MI, Ciotola M, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes: A randomized trial. Ann Intern Med. 2009;151(5):306-314. doi:10.7326/0003-4819-151-5-200909010-00004.

Effect of testosterone therapy on the female voice.

Climacteric. 2016 Apr;19(2):198-203. doi: 10.3109/13697137.2015.1136925. Epub 2016 Feb 9.

Effect of testosterone therapy on the female voice.

Author information

  • 1a Millennium Wellness Center, Dayton and Wright State University Boonshoft School of Medicine , Department of Surgery , Dayton , Ohio , USA ;
  • 2b York Data Analysis , Seattle , WA , USA ;
  • 3c 1st Department of Ob-Gyn , Athens University Medical School, Athens, Greece and National Institutes of Health, NICHD , Bethesda , MD , USA.



This prospective study was designed to investigate the effect of testosterone, delivered by subcutaneous implants, on the female voice.


Ten women who had opted for testosterone therapy were recruited for voice analysis. Voices were recorded prior to treatment and at 3 months, 6 months, and 12 months while on testosterone therapy. Acoustic samples were collected with subjects reading a sentence, reading a paragraph, and participating in a conversation. Significant changes in the voice over time were investigated using a repeated-measures analysis of variance with the fundamental frequency (F0) as a response variable. Demographic variables associated with characteristics of the voice were assessed.


There were no significant differences in average F0 related to smoking history, menopausal status, weight, or body mass index. There was no difference in average fundamental speaking frequency (sentence, paragraph, conversation) between the pre-treatment group and any post-treatment group at 3 and 12 months. There was an increase in sentence speech F0 at 6 months. Two of three patients with lower than expected F0 at baseline improved on testosterone therapy.


Therapeutic levels of testosterone, delivered by subcutaneous implant, had no adverse affect on the female voice including lowering or deepening of the voice.

No, You Do Not Have to Drink 8 Glasses of Water a Day

No, You Do Not Have to Drink 8 Glasses of Water a Day

AUG. 24, 2015

Aaron E. Carroll

If there is one health myth that will not die, it is this: You should drink eight glasses of water a day.

It’s just not true. There is no science behind it.

And yet every summer we are inundated with news media reports warning that dehydration is dangerous and also ubiquitous.

These reports work up a fear that otherwise healthy adults and children are walking around dehydrated, even that dehydration has reached epidemic proportions.

Let’s put these claims under scrutiny.

I was a co-author of a paper back in 2007 in the BMJ on medical myths. The first myth was that people should drink at least eight 8-ounce glasses of water a day. This paper got more media attention (even in The Times) than pretty much any other research I’ve ever done.

It made no difference. When, two years later, we published a book on medical myths that once again debunked the idea that we need eight glasses of water a day, I thought it would persuade people to stop worrying. I was wrong again.

Ryan Kerrigan of the Washington Redskins sipped water during N.F.L. football training camp in Richmond, Va.
Phys Ed: For Athletes, the Risk of Too Much WaterAUG. 26, 2015

Many people believe that the source of this myth was a 1945 Food and Nutrition Board recommendation that said people need about 2.5 liters of water a day. But they ignored the sentence that followed closely behind. It read, “Most of this quantity is contained in prepared foods.”
There is no formal recommendation for a daily amount of water people need. Credit Todd Heisler/The New York Times

Water is present in fruits and vegetables. It’s in juice, it’s in beer, it’s even in tea and coffee. Before anyone writes me to tell me that coffee is going to dehydrate you, research shows that’s not true either.

Although I recommended water as the best beverage to consume, it’s certainly not your only source of hydration. You don’t have to consume all the water you need through drinks. You also don’t need to worry so much about never feeling thirsty. The human body is finely tuned to signal you to drink long before you are actually dehydrated.

Contrary to many stories you may hear, there’s no real scientific proof that, for otherwise healthy people, drinking extra water has any health benefits. For instance, reviews have failed to find that there’s any evidence that drinking more water keeps skin hydrated and makes it look healthier or wrinkle free. It is true that some retrospective cohort studies have found increased water to be associated with better outcomes, but these are subject to the usual epidemiologic problems, such as an inability to prove causation. Moreover, they defined “high” water consumption at far fewer than eight glasses.

Prospective studies fail to find benefits in kidney function or all-cause mortality when healthy people increase their fluid intake. Randomized controlled trials fail to find benefits as well, with the exception of specific cases — for example, preventing the recurrence of some kinds of kidney stones. Real dehydration, when your body has lost a significant amount of water because of illness, excessive exercise or sweating, or an inability to drink, is a serious issue. But people with clinical dehydration almost always have symptoms of some sort.

A significant number of advertisers and news media reports are trying to convince you otherwise. The number of people who carry around water each day seems to be larger every year. Bottled water sales continue to increase.

This summer’s rash of stories was inspired by a recent study in the American Journal of Public Health. Researchers used data from the National Health and Nutrition Examination Survey from 2009 to 2012 to examine 4,134 children ages 6 to 19. Specifically, they calculated their mean urine osmolality, which is a measure of urine concentration. The higher the value, the more concentrated the urine.

They found that more than half of children had a urine osmolality of 800 mOsm/kg or higher. They also found that children who drank eight ounces or more of water a day had, on average, a urine osmolality about 8 mOsm less than those who didn’t.

So if you define “dehydration” as a urine osmolality of 800 mOsm/kg or higher, the findings of this study are really concerning. This article did. The problem is that most clinicians don’t.

I’m a pediatrician, and I can tell you that I have rarely, if ever, used urine osmolality as the means by which I decide if a child is dehydrated. When I asked colleagues, none thought 800 mOsm/kg was the value at which they’d be concerned. And in a web search, most sources I found thought values up to 1,200 mOsm/kg were still in the physiologically normal range and that children varied more than adults. None declared that 800 mOsm/kg was where we’d consider children to be dehydrated.

In other words, there’s very little reason to believe that children who have a spot urine measurement of 800 mOsm/kg should be worried. In fact, back in 2002, a study was published in the Journal of Pediatrics, one that was more exploratory in nature than a look for dehydration, and it found that boys in Germany had an average urine osmolality of 844 mOsm/kg. The third-to-last paragraph in the paper recounted a huge number of studies from all over the world finding average urine mOsm/kg in children ranging from 392 mOsm/kg in Kenya to 964 in Sweden.

That hasn’t stopped more recent studies from continuing to use the 800 mOsm/kg standard to declare huge numbers of children to be dehydrated. A 2012 study in the Annals of Nutrition and Metabolism used it to declare that almost two-thirds of French children weren’t getting enough water. Another in the journal Public Health Nutrition used it to declare that almost two-thirds of children in Los Angeles and New York City weren’t getting enough water. The first study was funded by Nestlé Waters; the second by Nestec, a Nestlé subsidiary.

It’s possible that there are children who need to be better hydrated. But at some point, we are at risk of calling an ordinary healthy condition a disease. When two-thirds of healthy children, year after year, are found to have a laboratory value that you are labeling “abnormal,” it may be the definition, and not their health, that is off.

None of this has slowed the tidal push for more water. It has even been part of Michelle Obama’s “Drink Up” campaign. In 2013, Sam Kass, then a White House nutritional policy adviser, declared “40 percent of Americans drink less than half of the recommended amount of water daily.”

There is no formal recommendation for a daily amount of water people need. That amount obviously differs by what people eat, where they live, how big they are and what they are doing. But as people in this country live longer than ever before, and have arguably freer access to beverages than at almost any time in human history, it’s just not true that we’re all dehydrated.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs on health research and policy at The Incidental Economist, and you can follow him on Twitter at @aaronecarroll.

The science is in: gardening is good for you



The science is in: gardening is good for you

September 26, 2016 5.30am AEST

Disclosure statement

Chris Williams does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.


University of Melbourne provides funding as a founding partner of The Conversation AU.

As the weather warms and days lengthen, your attention may be turning to that forgotten patch of your backyard. This week we’ve asked our experts to share the science behind gardening. So grab a trowel and your green thumbs, and dig in.

“That’s all very well put,” says Candide, in the final line of Voltaire’s novel of the same name, “but we must go and work our garden.”

I studied this text at high school before I became a gardener and professional horticulturist. We were taught that Candide’s gardening imperative was metaphorical not literal; a command for finding an authentic vocation, not a call to take up trowels and secateurs.

In fact, Voltaire himself really believed that active gardening was a great way to stay sane, healthy and free from stress. That was 300 years ago.

As it turns out, the science suggests he was right.

The science of therapeutic horticulture

Gardens and landscapes have long been designed as sanctuaries and retreats from the stresses of life – from great urban green spaces such as Central Park in New York to the humblest suburban backyard. But beyond the passive enjoyment of a garden or of being in nature more generally, researchers have also studied the role of actively caring for plants as a therapeutic and educational tool.

“Therapeutic horticulture” and “horticultural therapy” have become recognised treatments for stress and depression, which have served as a healing aid in settings ranging from prisons and mental health treatment facilities to schools and hospitals.

Gardening and school

Studies of school gardening programs – which usually centre on growing food – show that students who have worked on designing, creating and maintaining gardens develop more positive attitudes about health, nutrition and the consumption of vegetables.

They also score better on science achievement, have better attitudes about school, and improve their interpersonal skills and classroom behaviour.

Research on students confirms that gardening leads to higher levels of self-esteem and responsibility. Research suggests that incorporating gardening into a school setting can boost group cohesiveness.

Gardening and mental health

Tailored gardening programs have been shown to increase quality of life for people with chronic mental illnesses, including anxiety and depression.

Another study on the use of therapeutic horticulture for patients with clinical depression sought to understand why gardening programs were effective in lessening patient experience of depression. They found that structured gardening activities gave patients existential purpose. Put simply, it gave their lives meaning.

In jails and corrective programs, horticultural therapy programs have been used to give inmates positive, purposeful activities that lessen aggression and hostility during and after incarceration.

In one detailed study from a San Francisco program, involvement in therapeutic horticulture was particularly effective in improving psychosocial functioning across prison populations (although the benefits were not necessarily sustained after release.)

Gardening has been shown to help improve the lives of military veterans and homeless people. Various therapeutic horticulture programs have been used to help people with learning difficulties, asylum seekers, refugees and victims of torture.

Gardening and older people

As populations in the West age, hands-on gardening programs have been used for older people in nursing homes and related facilities.

A systematic review of 22 studies of gardening programs for older adults found that gardening was a powerful health-promoting activity across diverse populations.

One study sought to understand if patients recovering from heart attack might benefit from a horticultural therapy program. It concluded:

[Our] findings indicate that horticultural therapy improves mood state, suggesting that it may be a useful tool in reducing stress. Therefore, to the extent that stress contributes to coronary heart disease, these findings support the role of horticultural therapy as an effective component of cardiac rehabilitation.

Horticulturist and nurse Steven Wells talks about his work at Austin Health.

While the literature on the positive effects of gardening, reflecting both qualitative and quantitative studies, is large, most of these studies are from overseas.

Investment in horticultural therapy programs in Australia is piecemeal. That said, there are some standout success stories such as the Stephanie Alexander Kitchen Garden Foundation and the work of nurse Steven Wells at the Royal Talbot Rehabilitation Centre and beyond.

Finally, without professionally trained horticulturists none of these programs – in Australia or internationally – can take place.

Nonhormonal management of menopause-associated symptoms:

Nonhormonal management of menopause-associated vasomotor
symptoms: 2015 position statement of The North American
Menopause Society
Objective: To update and expand The North American Menopause Society’s evidence-based position on
nonhormonal management of menopause-associated vasomotor symptoms (VMS), previously a portion of the
position statement on the management of VMS.
Methods: NAMS enlisted clinical and research experts in the field and a reference librarian to identify and
review available evidence. Five different electronic search engines were used to cull relevant literature. Using the
literature, experts created a document for final approval by the NAMS Board of Trustees.
Results: Nonhormonal management of VMS is an important consideration when hormone therapy is not an
option, either because of medical contraindications or a woman’s personal choice. Nonhormonal therapies include
lifestyle changes, mind-body techniques, dietary management and supplements, prescription therapies, and others.
The costs, time, and effort involved as well as adverse effects, lack of long-term studies, and potential interactions
with medications all need to be carefully weighed against potential effectiveness during decision making.
Conclusions: Clinicians need to be well informed about the level of evidence available for the wide array of
nonhormonal management options currently available to midlife women to help prevent underuse of effective
therapies or use of inappropriate or ineffective therapies.

Recommended: Cognitive-behavioral therapy and, to a
lesser extent, clinical hypnosis have been shown to be effective in reducing VMS. Paroxetine salt is the only
nonhormonal medication approved by the US Food and Drug Administration for the management ofVMS, although
other selective serotonin reuptake/norepinephrine reuptake inhibitors, gabapentinoids, and clonidine show evidence
of efficacy.

Recommend with caution: Some therapies that may be beneficial for alleviating VMS are weight loss,
mindfulness-based stress reduction, the S-equol derivatives of soy isoflavones, and stellate ganglion block, but
additional studies of these therapies are warranted.

Do not recommend at this time: There are negative, insufficient,
or inconclusive data suggesting the following should not be recommended as proven therapies for managing VMS:
cooling techniques, avoidance of triggers, exercise, yoga, paced respiration, relaxation, over-the-counter supplements
and herbal therapies, acupuncture, calibration of neural oscillations, and chiropractic interventions.
Incorporating the available evidence into clinical practice will help ensure that women receive evidence-based
recommendations along with appropriate cautions for appropriate and timely management of VMS.

Alarm over ‘adrenal depletion’ wellness trend

Alarm over ‘adrenal depletion’ wellness trend

A growing alternative health trend to label people with ‘adrenal depletion’ and treat them with potentially dangerous steroid supplements has been criticised by a leading endocrinologist.

Naturopaths and wellness practitioners are claiming that people who feel run down and burnt out are displaying symptoms of “adrenal fatigue”.

However, this is unscientific and potentially harmful, says Professor David Torpy, deputy director of the endocrine and metabolic unit at the Royal Adelaide Hospital.

Professor Torpy told Australian Doctor he was increasingly seeing patients who had been given hormone supplements and synthetic steroids by alternative health practitioners, resulting in excessive cortisol levels and Cushing’s syndrome.

“This is a trend, and in our practice, we are seeing cases where people have developed symptoms of excess cortisol,” he said.

Related News:

“It is an example of overmedicalisation of life. There’s no doubt some people’s lives are giving them excessive stress that is wearing them down and they are developing mood disorders and even physical problems.

“However, the problem here is not the adrenal glands,” he said. “Adrenal insufficiency is a real disorder, but it is very uncommon and is not a result of excessive life stress.

“These people don’t need evaluation of their adrenal glands and nor do they need adrenal hormone supplementation — the treatment should be centred around lifestyle,” he said

The prevalence of adrenal insufficiency was about 3/10,000, which meant the average GP with 2000 patients was unlikely to see many cases, Professor Torpy said.

“It’s a pity to see the naturopaths resorting to a physical explanation for things that they know are due to lifestyle factors.”

However, a Melbourne GP who practises integrative medicine but does not wish to be named, rejected the idea that adrenal insufficiency was uncommon and unrelated to stress.

“I see a whole stack of patients who present with this complex symptomatology of adrenal insufficiency. I think we are on a spectrum, and the endocrinologists are only looking at a very small select group at one end of the bell-shaped curve … but there are all these other people in the middle of the curve who suffer from symptoms of adrenal insufficiency, such as fatigue and infections,” he said.

Adrenal insufficiency could be diagnosed with saliva tests, and patients responded well to treatments, including dehydroepiandrosterone, melatonin and ginseng, he said.

Low-cost tool in the fight against childhood obesity

Low-cost tool in the fight against childhood obesity: Water dispensers in NYC public schools associated with student weight loss

NYU Langone Medical Center, 01/20/2016

Kids appear to choose ‘Good Ol’ H2O’ when given the option, NYU Langone researchers find.
Making water more available in New York City public schools through self–serve water dispensers in cafeterias resulted in small but statistically significant declines in students’ weight, according to new findings. The study, published January 19 in the online issue of JAMA Pediatrics, was conducted by researchers at NYU Langone Medical Center, New York University’s Institute for Education and Social Policy, and the Center for Policy Research at Syracuse University’s Maxwell School of Citizenship and Public Affairs. The research team reports on analysis of more than one million students in 1,227 elementary and middle schools across the city. The paper, which compares students in schools with and without the water dispensers, called water jets, is the first to establish a link between the program and weight loss.

Blood Clots and HRT

The advantage of hormonal  troches and creams is that they are transdermal(through the skin). Taking any hormones as a pill increases the risk of a blood clot.

Risk of venous thromboembolism associated with local and systemic use of hormone therapy in peri- and postmenopausal women and in relation to type and route of administration

Menopause, 05/24/2016

The point of the study was to evaluate the risk of venous thromboembolism (VTE) associated with systemic hormone therapy as indicated by sort and route of administration and the risk of VTE associated with locally administered estrogen. The risk of VTE risk is higher in users of systemic combined estrogen–progestogen treatment than in users of estrogen only. Besides, the risk of VTE was lower for women who utilized local estrogen than among those using oral estrogen only. Transdermal estrogen just treatment and estrogen for local impact appear not to be identified with an increased risk of VTE.


  • In this case-control study, conducted in Sweden between 2003 and 2009, they included 838 cases of VTE and 891 controls with a mean age of 55 years.
  • Controls were matched by age to the cases and randomly selected from the population.
  • The authors used logistic regression to calculate odds ratios (ORs) with 95% CIs and adjusted for smoking, body mass index, and immobilization.


  • Current use of any hormone therapy was associated with an increased risk of VTE (OR 1.72, 95% CI 1.34-2.20).
  • For estrogen in combination with progestogen the OR was 2.85 (95% CI 2.08-3.90), and for estrogen only the OR was 1.31 (95% CI 0.78-2.21).
  • In orally administered estrogen combined with progestogen, the OR was slightly, but not significantly, higher among users of medroxyprogesterone acetate (OR 2.94, 95% CI 1.67-5.36) than among norethisterone acetate users (OR 2.55, 95% CI 1.50-3.40).
  • Transdermal estrogen combined with progestogen was not associated with VTE risk (crude and imprecise ORs ranging from 0.87 to 1.16).
  • For local effect of estrogen, there was no association with VTE risk (OR 0.69, 95% CI 0.43-1.10

Why women see their GP more than men

Why women see their GP more than men
February 8, 2016 6.06am AEDT .

Clare Bayram
Research Fellow, Family Medicine Research Centre, Sydney School of Public Health, University of Sydney

Allan John Pollack
Research analyst in Family Medicine, University of Sydney

Helena Britt
Associate professor, Director of the Family Medicine Research Centre, Sydney School of Public Health, University of Sydney

Janice Charles
Senior Research Officer General Practice, University of Sydney

Disclosure statement

The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

Women go to the doctor more often than men, particularly in their reproductive years, between the ages of 15 and 44. This difference is partly due to management of gynaecological and reproductive issues.

Because of the frequency of visits, and the sensitive nature of many of these, it’s important a woman has a good relationship with her general practitioner.

Why women go to the doctor

In a recent study, we found about 12% of problems managed for women of all ages in primary care concerned their reproductive or genital system.

Australian women visited a GP on average nearly seven times a year in 2013-14. For men, this figure was just under five times. Among those between 15 and 24, 83% of women – but only 68% of men – saw a GP at least once in any given year.

The frequency and type of these problems varied across age groups.

Throughout their lives, women experience different health issues. For instance, about 20% of women of childbearing age experience heavy bleeding during menstruation, and 15% have chronic pelvic pain. These numbers drop in older age groups.

Our study showed in the decade between 2004 and 2014, female-specific problems accounted for a quarter of all problems managed by GPs for women in childbearing years. This fell to only 10% of problems managed for those between 45 and 64 years, and 3% for those 65 and over.

Across all adult age groups, gynaecological check-ups involving pap smears were common. Other female-specific problems managed by GPs aligned with the life stages: pregnancy and contraception in younger women, menstrual problems and menopause in the middle and older age groups.

We found the most common problem managed overall for women between the ages of 15 and 64 was depression.

The most commonly prescribed medications were contraceptives and antidepressants.

Across all age groups, women were more likely to have depression than men and this was reflected in higher management by GPs.

For women 65 years and over, depression dropped down the list of problems, overtaken by a number of physical conditions. Pelvic floor disorders, such as urinary and faecal incontinence, affect about 50% of women aged 80 and older.

There are various theories about why women have higher depression rates. Environmental and biological influences, such as hormones, have been implicated, but studies on this aren’t conclusive.

Relationship with a GP

Some women feel embarrassed talking about female-specific issues, even with a health professional. One study showed only 32% of women aged 45 and over who had urinary incontinence actually mentioned this to their GP.

This is why having a regular GP is important. Studies show continuity of care in primary care is associated with better health outcomes.

Reassuringly, our study found women between 25 and 44 were more likely to attend a regular practice than men in the same age group. Across all age groups, more than 90% of women said they had a regular GP practice.

This is likely because they need repeated cervical cancer screening (pap smears) and contraceptive prescriptions, and management of chronic diseases in later years.

We hope future changes to cervical cancer screening (to replace two-yearly Pap smears with a five-yearly HPV test) and the push towards long-term contraception, despite their benefits, will not affect the relationship between women and their GP.