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Fibromyalgia is a chronic disorder characterised by muscle pain throughout the body, fatigue, sleep problems and cognitive difficulties. The condition predominantly affects women, but men can also suffer from it. However, they often do so in silence, as they face cultural, medical and psychological barriers to being taken seriously and receiving treatment.

While the disorder itself is well-documented, the male experience remains under-discussed, which only furthers its invisibility.

Fibromyalgia affects 2-4 % of the world’s population. Of this percentage the vast majority are women, which has led research to focus mostly on women, with most cases in men being unnoticed or misunderstood.

Underdiagnosis in men

Gender bias plays a significant role in making fibromyalgia invisible among men. Diagnosis is more frequent in women, meaning male patients are under-represented in clinical studies and diagnoses.

However, this imbalance may exist because diagnostic criteria and assessment tools do not always capture symptoms as they present in men. A recent study found that, in specific subgroups of patients reporting pain in multiple areas of the body, men were less likely to receive a formal diagnosis of fibromyalgia compared to women, despite presenting with similar symptoms.

Additionally, society often associates chronic pain and vulnerability with women. Males, culturally, are pressured to suffer in silence or seek alternative explanations that conform more closely to traditional expectations of masculinity.

This social pressure can lead to them not seeking medical help, or to health professionals minimising their symptoms.

Men’s experiences, in their words

The experiences of men with fibromyalgia are still under-explored in clinical settings. However, qualitative – as opposed to quantitative – studies are beginning to shed light on a complex and unique reality.

This methodology allows us to capture nuances and delve deeper into the specific challenges faced by men with the disease, revealing aspects that are often overlooked in quantitative studies.

These experiences include quotes such as the following taken from a study entitled
“I can’t have it; I am a man. A young man!” – men, fibromyalgia and masculinity in a Nordic context”:

“One [male] doctor said that I have this [fibromyalgia] because I am fat. I had already lost more than 10 kilos then. You are fat. Grannie’s illness. Overweight. Lose more … And he was a skinny kind of a guy, 170 cm tall and weighted like 40 kilos … I could have twisted him into a knot if I wanted to … And he comes and says that you are nothing but fat! Lazy bastard you are … Fuck, I could have lifted him on the wall! … But the nurses are different … they have this compassion in them … when they hear that you have this illness, they kind of put the professional role aside and the human person steps in … But when you get to see the male doctors … their attitude is different … much more negative … they belittle the symptoms, say that it’s all in the head and so on … It is so fucking infuriating!”

Other studies have interviewed male sufferers on how the condition affects them in specific contexts. The following are taken from an article entitled “‘I just want my life back!’ – Men’s narratives about living with fibromyalgia”, and detail men’s experiences of fibromyalgia in a number of different areas.

“For example, somebody comes to my office with a question or a
problem … and I am just like … ??? … I don’t necessarily even
understand what this person asked … and it takes time … and he is
like ‘are you not going to answer’ … and I have to ask ‘what was your
question again?’ … it always comes out of the blue, unexpectedly … I really have to struggle to be able to answer at least
something.”

In day to day life:

“I have always been a very sport-oriented person, but I had to give up
some hobbies … I used to do competitive dancing, but I noticed that
my body did not tolerate it anymore … It was too burdening
… as fun as it was … I just had to admit that my body does not
tolerate it anymore … ”

Getting a health checkup:

“I was in a physical test where you had to lift 10 kg weights above your
head … there was a male sports instructor who looked like a body-
builder … I felt that they wanted to check if I was faking or something
… so I decided that I would really try my best … My result was the
best he had ever seen and he doubted if he could have done the
same … but they did not see how much pain I had … they just did not
see it … it does not matter how many times I can lift the weights …
life is not just about lifting weights above your head, is it?”

How to talk about fibromyalgia in men

We should keep the following in mind when listening to someone talking about fibromyalgia and men:

Expectations of masculinity and psychological barriers: Masculine stereotypes and pressures may lead men to minimise their symptoms or not seek help for chronic pain. Admitting weakness or vulnerability may go against social expectations.
Impact on quality of life: Fibromyalgia not only causes physical pain, it also affects sufferers’ cognitive and emotional capacities.
Possible gender imbalances in medical treatment: As the aforementioned studies show, some men feel a lack of understanding and empathy from health professionals, especially from other men.
Treatment needs to be personalised: Fibromyalgia is complex, making it essential to adopt treatment approaches that account for individual factors like gender, and psychological or social contexts.

The reality of fibromyalgia in men is complex and invisible, and influenced by gender stereotypes that hinder proper diagnosis and treatment. It is essential to acknowledge men’s experiences and adapt healthcare approaches to reduce stigma and provide effective support. Only by doing this can we improve quality of life and ensure more equitable and empathetic treatment for all patients. Läs mer…

Two Australian teenagers are severely ill in hospital in Thailand after experiencing suspected methanol poisoning while they were travelling in Laos.

The pair are reportedly among several foreign nationals to become ill after unknowingly consuming alcoholic drinks containing methanol in the south-east Asian country.

So what is methanol, and how does it make people sick?

Methanol versus ethanol

Methanol is an alcohol, like the familiar ethanol we consume in alcoholic beverages.

Like ethanol, methanol is a colourless, flammable liquid. It has a smell similar to ethanol as well.

But the two have different chemical structures. Methanol is composed of only one carbon atom, while ethanol has two.

Methanol (left) and ethanol (right) have differing chemical structures.
Wikimedia Commons, CC BY

That one carbon atom makes all the difference. It means methanol is processed differently in our bodies and is much more toxic than ethanol.

Methanol is used in a variety of industrial and household products, such as windshield cleaning fluids, antifreeze and fuel. It’s not safe for human consumption.

What makes methanol toxic?

The difference is in how methanol is metabolised, or broken down in our bodies.

Ethanol is metabolised into a chemical compound called acetaldehyde. Acetaldehyde is toxic, but is rapidly converted to acetate (also known as acetic acid, found in vinegar). Generating an acid may sound bad, but acetate actually produces energy and makes important molecules in the body.

By contrast, methanol is metabolised into formaldehyde (a chemical used in industrial glues and for embalming corpses, for example) and then to formic acid (the chemical in some ant bites that makes them hurt so much).

Unlike acetate, which the body uses, formic acid poisons the mitochondria, the powerhouses of the cells.

As a result, a person exposed to methanol can go into severe metabolic acidosis, which is when too much acid builds up in the body.

Methanol poisoning can cause nausea, vomiting, and abdominal pain. The acidosis then causes depression of the central nervous system which can cause people with methanol poisoning to fall unconscious and go into a coma, as well as retinal damage leading to vision loss. This is because the retinas are full of active mitochondria and sensitive to them being damaged.

Death is not inevitable if only a small amount of methanol has been consumed, and rapid treatment will greatly reduce damage.

However, permanent vision damage can occur even at non-lethal doses if treatment is not administered quickly.

What does treatment involve?

Treatment is mainly supportive care, such as intubation and mechanical ventilation to help the patient to breathe.

But it can also involve drugs such as fomepizole (which inhibits the generation of toxic formic acid) and dialysis to remove methanol and its metabolites from the body.

Methanol poisoning can cause serious illness and death.
NATNN/Shutterstock

How does methanol get into alcoholic drinks?

Methanol can turn up in any alcoholic beverage, but it’s most likely in beverages with higher alcohol content, such as spirits, and traditionally brewed drinks, such as fruit wines.

Methanol can get into alcoholic beverages in a number of ways. Sometimes it’s added deliberately and illegally during or after manufacturing as a cheaper way to increase the alcohol content in a drink.

Traditional brewing methods can also inadvertently generate methanol as well as ethanol and produce toxic levels of methanol depending on the microbes and the types of plant materials used in the fermentation process.

We don’t yet know how the Australian teenagers came to be poisoned in this tragedy. But it is a good idea when travelling (particularly in areas with traditionally fremented drinks, such as south-east Asia, the Indian subcontinent and parts of Africa) to always be careful.

The Australian government’s Smartraveller website advises that to avoid methanol poisoning you should be careful drinking cocktails and drinks made with spirits, drink only at reputable licensed premises and avoid home-made alcoholic drinks.

Drinking only mass-produced commercial brews can be safer, though understandably people often want to try locally made drinks as part of their adventure. Läs mer…

The government says it will take “big money” out of election campaigns – or, more realistically, curb it – with its legislation imposing donation and spending caps and real-time disclosure.

But crossbenchers and other critics are up in arms, about the effect on small players and the fact the package is being rushed through parliament in a fortnight.

On this podcast we are talking with Special Minister of State Don Farrell about the bill and the criticisms.

Why the rush? Farrell argues people knew what was coming:

Nothing in this bill is a surprise to anybody who’s been involved in the process that has taken place over the last two and a half years. We went to the last election saying we were going to reduce the disclosure threshold, saying that we were going to introduce real-time disclosure of donations, saying that we were going to introduce caps on spending and donations. And that’s exactly what we’ve done in this legislation and there’s now been two Senate inquiries into this legislation. And all of the parties have absolutely adequate time to have looked at the recommendations.

Why do we need to get it through so quickly? Well, these are significant changes to the electoral system. They’re probably the most significant changes to the Australian electoral system in decades. And it’s going to take time to set up the systems that are going to be required to implement this.

Farrell has introduced truth-in-advertising provisions but he won’t push them this time, given a lack of bipartisan support. They will be a matter for another term:

We’ve had truth in political advertising in South Australia. We had a [state] byelection in South Australia last weekend and that legislation was used to clarify some statements that the opposition were claiming against the state government. So I think it’s a good provision. I’ve said all along that I want to get the maximum support for any piece of legislation in the electoral space.

Just at the moment, we haven’t been able to convince enough people that the legislation is worth their support. But I’m going to be continuing to work on that and one day we will get legislation through for truth in advertising.

Labor’s changes have also been criticised for not disallowing certain groups and industries from donating, such as those associated with the gambling industry. Farrell says:

If we were to do what you’re suggesting there, and then ban some companies, I think we would run into exactly the issues that [constitutional expert] Anne Twomey was talking about in her article in The Guardian Australia. One thing that would guarantee a challenge and perhaps a successful challenge is if we started to pick which companies in this country could donate. The cap that we’re applying, $20,000, really does limit the ability of any company, or any union for that matter, or any other party, or any individuals to dramatically influence the outcome.

We’re seeing Clive Palmer putting at the last election, $117 million dollars into the electoral process. I don’t think that’s what Australians want to want to see. But if I was to ban, say, the companies I don’t like from donating, I think that would result in a challenge to this legislation.

When asked if he intends to serve out the rest of his term as a senator (which isn’t due to end until 2028) Farrell says

Yes.

I love my job. I’ve got three terrific portfolios trade, tourism and special minister of state. I enjoy all of them equally. I think I can continue to contribute to political debate in this in this country. Just in my trade space: we started with $20 billion worth of trade impediments from China. We’ve managed to get that removed, or certainly by the end of the year to get that removed.

I think I can look back on a number of things in the tourism space – we’ve pretty much got back to where we were pre-COVID.

I like being involved in politics. I enjoy the process. And I’d like to continue doing it. Läs mer…

The Northern Territory and Australian Capital Territory have won bragging rights for having the fastest growing economies within Australia.

Their growth was highlighted in annual data on gross state product, released by the Australian Bureau of Statistics on Wednesday.

The ABS defines GSP as the total market value of goods and services produced in a state or territory after the costs of goods and services used in production are deducted.

It is the state and territory equivalent of gross domestic product.

Unsurprisingly, New South Wales and Victoria, the most populous states, have the largest GSP. They account for 31% and 23% of our national economy.

But the Australian Capital Territory, with a population of 473,000, has a larger GSP than Tasmania despite the Apple Isle’s bigger population of 576,000.

Where the growth occurred

The fastest growing economy in 2023-2024 was the NT, which expanded by 4.6% followed by the ACT, whose GSP was up by 4.0%. These figures, given in real terms, exclude the impact of inflation. Unlike many recent years, the figures are not distorted by the impact of the COVID lockdowns.

The ABS attributes the NT’s strong growth in 2023-24 to

a bounce back in mining production which was hampered by maintenance work and plant shutdowns in 2022-23.

The ACT economy was boosted by “the expansion of government agencies”.

The bronze medal went to Queensland, but it was well behind the territories. Its economy grew by 2.1%, helped by increased coal production.

The laggard was Western Australia, whose economy grew by only 0.5%. Mining and oil and gas production fell due to weather disruptions.

Tasmania’s economy expanded by the national average of 1.4%. But given population growth has been much less there, Tasmania was the only state (along with the territories) whose economy expanded in per person terms.

The recession-proof economy?

Collection of the GSP data started in 1989-1990. Since then the fastest average growth has been recorded by Queensland and the ACT, an annual average of 3.6%.

Last year, the ACT could claim the unique status of being the only state or territory never to have economic activity contract in any of these years. The statisticians have now revised the 1995-96 number (the year the Howard government came in with plans to cut the public service) to a minuscule -0.1% contraction.

But it is still the case that being more services-based makes the ACT economy less volatile.

Growth is down but WA still the wealthiest

The state with the highest level of real GSP per person is Western Australia. It has led in every year the data have been compiled. Real GSP per person has been lowest every year in Tasmania.

WA’s GSP per person is more than double that in Tasmania. This means WA has GSP per person higher than global leaders such as Norway and Switzerland.

Tasmania’s is more like that in Poland. To put it another way, the real GSP per person in Tasmania is only now where the rest of Australia was in 1999.

What causes the differences?

One important cause of these differences is the different structure of industry in the various states.

WA (and the Northern Territory) benefits from its mineral resources. Mining accounts for almost half of WA’s income. Mining is no longer the labour intensive activity it was when men were swinging a pick “down the pit”. It now takes few people to generate a lot of mining revenue.

Tasmania has the smallest proportion of its population working (58% compared to a national average of 64%). One reason is that more than a fifth of Tasmanians are aged over 65. This is the highest proportion of any state.

Furthermore, only a quarter of Tasmanians hold a university degree compared to almost half of Canberrans.

These data on economic performance do not mean the quality of life or wellbeing is lower in Tasmania.

GSP does not reflect factors like the world’s cleanest air being found in Tasmania, for example. Läs mer…

Next month’s federal budget update is expected to revise down company tax receipts for the first time since 2020, amid continued low economic growth in the near term.

In his Wednesday ministerial statement on the economy, the forecasts remained subdued but Treasurer Jim Chalmers emphasised the upside.

Chalmers said any growth was welcome, given many countries’ economies have gone backwards. Treasury was expecting a gradual recovery “driven by rising real incomes thanks to our cost-of-living relief, jobs growth and progress bringing inflation down,” he said.

Consumer confidence was already showing a modest recovery and households were feeling more confident about the next year, Chalmers said.

“This is the soft landing we have been planning for and preparing for,” he said. “Inflation coming back to band, an economy still growing and unemployment with a 4 in front of it.”

Chalmers said while there was still data to come, including on the national accounts and tax collection, before the December budget update (titled the Mid-Year Economic and Fiscal Outlook), the Treasury’s current estimate was that any revenue upgrade would be a “sliver” of Labor’s earlier budget updates.

In each of Labor’s earlier budget updates, revenue upgrades averaged $80 billion.

But this trend is diminishing with the labour market softening, and problems in the Chinese economy hitting commodity prices. Iron ore prices are down more than 30% since the start of the year.

Treasury’s latest inflation forecasts are generally in line with the May budget.

“Treasury expected inflation to be back in the [Reserve Bank’s target band of 2–3%] by the end of this year, and that’s what happened,” Chalmers said.

He said government spending wasn’t the main driver of prices and the government’s budget surpluses were assisting the fight against inflation – “points Governor Bullock has repeatedly made”.

With wages growing and inflation falling, “real wages are growing again. They were going backwards by 3.4% when we came to office,” Chalmers said.

“Real wages grew by 0.7% in the year to September – the largest annual increase in over four years, and there’s now been four consecutive quarters of real wages growth.

”The average full-time worker is now earning $159 more per week since we came to office. For women it’s $173 per week more. Since we came to government, wages in industries dominated by women have risen by more than 8%,” Chalmers said.

In his reply, Shadow Treasurer Angus Taylor said there was “nothing soft” about the landing.

He said prices were still rising, and “there is nothing soft about the pain Australians are feeling”.

“On nearly every metric, Australians are not better off than they were almost three years ago,” Taylor said.

Labor had added $315 billion of spending, boosting inflation. “That is $30,000 per household of extra spending,” he said. “The RBA has said extra government spending is making their job harder.” Läs mer…

Schoolies season is here – and with it, warnings about staying safe while partying. For girls and women, this often means being told to watch their drinks while out at a bar or club to avoid them being spiked.

We tend to imagine drink spiking as a male stranger adding drugs to a woman’s drink at a bar without her knowing, usually with the aim of sexually assaulting her.

This is certainly a risk. But the full picture of drink spiking is more complex and can involve intimate partners, at home, as the recent horrific case of Gisèle Pelicot in France has made clear.

Yet public messaging about drink spiking continues to focus on what women should “watch out for”. Our research shows this makes them entirely responsible for their own safety, reinforcing blame and shame if it happens. It also erases perpetrators – and why they do it – from the story.

What do we know about drink spiking?

We recently reviewed the global literature on sexual violence facilitated by alcohol and other drugs.

We looked at 53 studies – mostly involving US university students – and found there was inconsistent data about how common it was. Most studies focused on victim-survivors with limited attention paid to perpetration.

But we found in most cases, the perpetrator was male and knew the victim-survivor.

The most common substance used to “spike” drinks is alcohol. For example, the perpetrator might buy double shots instead of single ones, without the victim-survivor knowing.

Sexual violence facilitated by drugs and alcohol was most likely to happen in a private residence, not a public venue. That could be at a house party or after a date or party, when the victim-survivor may already be intoxicated and the perpetrator gets them alone.

In some cases the perpetrator has a premeditated plan. This is known as “proactive” drug and alcohol facilitated violence, and is what most people imagine when we talk about drink spiking.

But sexual violence facilitated by drugs and alcohol is often opportunistic. This means exploiting someone’s impairment and inability to consent, for example if they are already very drunk.

‘It’s not us who should feel shame’

In interviews we did with eight victim-survivors across Victoria, those who were sexually assaulted talked about the shame they experience and how this impacts them.

Some of those we spoke to were actually able to get to safety after becoming incapacitated. While they weren’t sexually assaulted, they told us the spiking itself had a significant impact on their lives, including difficulty leaving the house.

In Pelicot’s case, her husband is on trial along with dozens of men who he allegedly invited to rape while she was drugged without her knowing. (He has pleaded guilty but some of the men have denied the charges.) While this is an extreme example, her story shows how sexual violence facilitated by drugs can be used in intimate partner abuse.

Importantly, Pelicot’s bravery, in deciding for the trial to be public, has highlighted the need to foreground the perpetrator’s actions, rather than the victim-survivors. She has said, “It’s not us who should feel shame, it’s them”.

Women forced to do the work to stay safe

Yet perpetrators are rarely talked about with drink spiking. Instead, the focus is on what women should do to stay safe.

They are often forced to think about their actions when in public, constantly engaging in “safety work”. This may include being hyper-vigilant of their drinks and surroundings or sharing their location with friends.

As our research shows, this is partly in response to media reporting, which often blames victims – for example, highlighting whether they were drunk. This reinforces rape myths that suggest women are to blame for the violence done to them.

Even listing what women should do to keep themselves safe (or promoting drug-detecting gadgets) can perpetuate this.

As our research shows, we need to change misconceptions around drink spiking, and alcohol and other drug facilitated sexual violence more broadly.

This includes shifting the focus to a culture of men’s entitlement and power, as well as addressing harmful alcohol cultures.

What to do if you suspect someone’s drink has been spiked

We don’t adhere to narratives that simply tell women to “keep themselves safe”. But we know women are nevertheless doing this safety work, particularly at events such as schoolies.

It’s important to know how to support people who may have had their drink spiked. We’ve developed a resource for bar staff to help patrons to get home safely.

It encourages them to identify the risks, such as the most common perpetrator being a friend or date. And it involves believing and listening to the victim and responding to their needs. This could include helping arrange safe transport home or calling an ambulance if necessary.

This information may also be useful for friends and bystanders. But the real action needed is cultural change that challenges men’s sexual entitlement and encourages respect for women’s consent.

What else is needed?

Research has tended to focus on young heterosexual women who frequent bars and clubs. But we know this happens in other settings and to other groups, such as older people, in the LGBTQ+ community and between intimate partners.

We need nationwide data that listens to the experiences of victim-survivors and gives a broader understanding of who it affects.

The diversity of victim-survivors needs to be better researched. More difficult, but crucial, is to understand who perpetrates this violence and why. Läs mer…

Ten years ago, a late-night cigarette started a fire that spread rapidly up 13 storeys on the Lacrosse apartment building in Melbourne. The November 24 fire caused more than A$5.7 million in damages, but thankfully no lives were lost.

Investigators found Lacrosse was covered in flammable cladding. It’s a building defect that increases serious fire risk.

Ten years on, has enough changed to reduce such defects, or is there more to do?

Our research finds progress is being made, but the construction industry has a long way to go. For example, even the basic work of identifying which buildings have flammable cladding is not complete in many locations. We have identified four key areas – design and construction, regulation and compliance, quality assurance and consumer protection – where changes are still needed.

What has happened since Lacrosse?

The Lacrosse fire prompted the Victorian Building Authority to investigate the use of flammable cladding in the CBD and inner city. Its findings revealed a high rate of non-compliance with building standards for external wall cladding materials. Yet it was deemed that, aside from one building, the safety of occupants was not at risk.

The following year (2017), 72 lives were lost in the Grenfell Tower disaster in the UK. The state government then formed the Victorian Cladding Taskforce. The taskforce found “significant public safety issues, which are symptomatic of broader non-compliance across a range of areas within the industry”.

Other reports followed in Australia and overseas. Among these were the 2018 Hackitt report (UK) and 2018 Shergold and Weir report (Australia) that identified systemic failings across the design and construction sectors. These reports found there were ongoing challenges, despite the earlier building fires, and a history of dangerous defects such as asbestos and structural building issues.

In Australia, changes to the National Construction Code have followed. Flammable aluminium composite panels and the use of rendered expanded polystyrene as external wall cladding were banned.

More than 3,000 residential buildings in Australia were identified as having flammable cladding. Making these buildings safe has been costly. It has had major impacts on the finances, health and wellbeing of apartment owners.

A decade on from the Lacrosse fire, it is time to reflect on what we have learned. Beyond creating fire-safe buildings, we need to think about how to avoid the next deadly housing defect.

What needs to change?

Our research finds change is needed in four key areas.

1. Design and construction

The construction industry has systemic issues that stand in the way of ensuring it designs and constructs buildings that are liveable, defect-free, high-quality and sustainable.

The focus on costs over quality means limited consideration is given to what happens to buildings once they have been handed over to owners. The industry must take greater responsibility for delivering buildings that meet the needs of occupants now and into the future. If we build right to begin with, we can avoid many defect issues.

2. Regulation and compliance

Regulation is typically slow to change. The construction industry often resists reforms. There have also been too many grey areas and “gaps” in regulation that have been open to interpretation.

Stronger regulations need to be enforced. There must be significant consequences for non-compliance. This will better protect consumers and ensure the industry, at the very least, is meeting minimum standards.

Construction companies should strive to go beyond these standards and demonstrate corporate social responsibility, especially towards the people who occupy their buildings. Corporate greed and unethical practices, such as falsifying fire tests, have contributed to the loss of life.

3. Quality assurance systems

Cladding fires and other defects exposed gaps in building material safety checks.

Materials used in construction need to be recorded in a central and accessible repository. The work of finding where flammable cladding is located is still not complete in many locations because we do not know what materials are in which buildings.

Building material passports offer an example of how materials could be located efficiently and in a transparent way. This is where information of the materials and technologies used in a development (including their location and other relevant information such as maintenance requirements) are stored in one place – typically an online platform. This solution is being explored in other countries.

More than four years after the Lacrosse fire, another cladding fire broke out in Melbourne at the Neo200 apartment building.

4. Consumer protection and support

Building warranties have not protected consumers from defects, unlike other industries. Consumers have often found that, even within the warranty period, they cannot get remedial work done as builders and others know how to “play the system”.

Stronger and enforceable warranties are essential. Companies must also not be allowed to “phoenix” – closing one company and starting up another – to escape their responsibilities.

Also needed are clearer processes for households, industry and government to follow when dangerous defects emerge. These should include providing safe temporary housing and other support after a fire or other disaster.

Ten years on from Lacrosse, we still see flammable cladding fires around the world. Progress on recommendations from key reports on the construction industry’s issues has been limited. We remain at risk of another deadly defect emerging.

And, importantly, design and construction still do not adequately consider the protection of the building’s future occupants. We can do much more to improve residential construction. It will require further systemic changes, beyond banning flammable cladding. Läs mer…

Periods can feel like an unwanted guest for many women and gender diverse people who menstruate, bringing cramps, mood swings and exhaustion.

But how do you know if what you are experiencing is standard premenstrual syndrome (PMS), or something more severe?

Premenstrual dysphoric disorder (PMDD) and the premenstrual exacerbation of an existing mental illness can also occur in the lead up to your period.

What’s the difference?

Premenstrual syndrome

This is an umbrella term for mild to moderate emotional and physical symptoms that start a few days before your period. This includes bloating, mood swings, irritability and fatigue. Up to 98% of women experience PMS during their reproductive years.

While many PMS symptoms are uncomfortable, most women can effectively manage them without much issue. You might feel cranky or tired, but you can still manage daily tasks.

Premenstrual dysphoric disorder

This is a more severe form of PMS, occurring in 3–9% of women. Symptoms include extreme mood changes, anxiety, anger and even depression in the days leading up to a period.

Premenstrual dysphoric disorder symptoms are more severe than PMS. Mood changes can feel overwhelming and make even small daily tasks feel much more challenging. Symptoms can be so intense, it can be hard to go to school, work, or to socialise.

Premenstrual exacerbation

This is a similar premenstrual condition, where symptoms of existing mental health conditions noticeably worsen in the days leading up to a period.

If you already experience an anxiety condition, for example, premenstrual exacerbation could see your anxiety heightened in the days leading up to your period.

What causes these conditions?

These conditions are linked to the natural rise and fall of hormones during the menstrual cycle.

Two key hormones – estrogen and progesterone – shift throughout the month, particularly in the second half of the cycle (luteal phase) when progesterone increases, and estrogen decreases.

Hormone levels change throughout the cycle.
Shutterstock

These changes can affect brain chemicals such as serotonin, which help regulate mood, leading to irritability, mood swings and low energy.

Not all women experience these symptoms in the same way. Some are more sensitive to hormonal changes, which may be influenced by factors such as genetics, past trauma, or pre-existing mental health conditions. These differences help explain why some women have more severe or distinct symptoms compared to others.

How are these conditions diagnosed?

GPs and mental health practitioners such as psychiatrists and psychologists play a key role in identifying potential issues by understanding what is classified as normal premenstrual symptoms for each woman.

But menstrual history is often overlooked in mental health assessments.

For a correct diagnosis, GPs and mental health practitioners should ask detailed questions about both physical and emotional symptoms across the menstrual cycle, such as:

do you experience mood swings, irritability, or feelings of sadness at specific times in your cycle?
do you have physical symptoms such as bloating, breast tenderness or headaches?
how do these symptoms affect your daily life or relationships?
do the symptoms disappear completely once your period starts or shortly after?

Clinicians can diagnose PMS and premenstrual dysphoric disorder. But premenstrual exacerbation is not a formal diagnosis: it describes the worsening of existing mental health conditions. This may require referral to a mental health professional for further assessment.

Premenstrual exacerbation can mimic mood swings seen in bipolar disorder, so it’s important your GP and/or mental health provider make detailed inquiries about menstrual patterns and symptoms to avoid misdiagnosis.

Clinicians should ask about both physical and emotional symptoms.
Claudia Wolff/Unsplash

Diagnosing premenstrual dysphoric disorder can be a lengthy process, as it requires patients to track their symptoms over at least two menstrual cycles and keeping daily records.

Symptoms must meet specific thresholds, including at least five out of 11 key symptoms listed in diagnostic criteria (such as marked mood swings, irritability, or physical discomfort) and demonstrate significant interference with daily life.

Symptoms must be tracked for two full menstrual cycles to confirm these patterns and rule out other conditions, such as depression or anxiety, that may not follow a cyclical pattern.

What are the treatment options?

If your GP suspects you have PMS, premenstrual dysphoric disorder or premenstrual exacerbation of an existing mental health condition, treatment options can include:

Lifestyle changes

Regular exercise, a balanced diet and good sleep hygiene can help manage PMS symptoms, but not premenstrual dysphoric disorder or premenstrual exacerbation.

Medication

Hormonal treatments can effectively manage premenstrual dysphoric disorder or premenstrual exacerbation symptoms, as both are linked to hormone fluctuations. Hormonal contraceptives, for instance, can help stabilise hormone levels and reduce the intensity of emotional and physical symptoms.

My (Jayashri) recent research has shown the oral contraceptive Zoely, which contains bioidentical hormones, is effective in treating the mood symptoms of premenstrual dysphoric disorder. Bioidentical hormones are chemically identical to those the body naturally produces, so they may cause fewer side effects than synthetic hormones.

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are another option for premenstrual dysphoric disorder, either taken continuously or for seven to ten days before menstruation.

For women with premenstrual exacerbation, adjusting existing medications or adding hormone treatments during the premenstrual period can be beneficial.

Therapy

Cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT) have been shown to help women manage the emotional impacts of worsening mental health symptoms before a period.

CBT targets negative thought patterns and behaviours to improve emotional regulation, while DBT builds skills like mindfulness and distress tolerance to manage intense emotions and relationships.

Supplements

Some women may find relief with over-the-counter supplements such as calcium or magnesium for PMS, but not premenstrual dysphoric disorder or premenstrual exacerbation.

Don’t just put up with it

The lingering stigma surrounding discussions about periods and menstrual health still leads many women to feel like they must just put up with their symptoms or worry that their experiences aren’t “bad enough” to warrant discussion. This results in unnecessary suffering.

Even when women notice these symptoms, convincing health care practitioners can be challenging, as the link between menstrual hormone fluctuations and mental health is poorly understood.

It’s crucial women are able to discuss these issues openly and are empowered to get the help they need. Läs mer…

Economic harm – restricting access to, sabotaging or exploiting another person’s financial resources, and impeding their economic autonomy – is increasingly recognised as a form of family violence. And it can happen to anyone.

According to our ongoing research and previous studies, one in seven New Zealanders has experienced economic harm in their intimate relationships.

Like other forms of family violence, economic and financial harm affects victims’ physical and mental health, and increases housing instability and financial insecurity.

To understand how widespread economic harm is in New Zealand, we surveyed 993 people aged 18 and over. We asked if they had experienced a list of 19 harmful financial behaviours during the previous 12 months – and how often.

The prevalence of financial abuse

The vast majority of studies on wider intimate partner violence ask between three and five questions about money while measuring other types of violence. Instead, we focused only on capturing a wide range of financial behaviours and economic harm.

Examples of what we looked at included withholding financial information, using household money for other nonessential purchases, and intentionally paying bills late to hurt a partner’s credit rating.

Some behaviours were more prevalent than others. Across all 19 behaviours, an average of one in seven respondents (15.1%) reported experiencing a given behaviour at least half the time during their relationship in the preceding 12-months. One in seven said they had experienced at least ten of the behaviours.

While caution is needed when comparing different studies, our findings are similar to research in New Zealand and elsewhere, including from the United Kingdom.

Among the most prevalent behaviours experienced was action to “withhold or hide financial information or money from you” (17.6%). This was followed by “intentionally paying bills late or not paying bills that were in your name or in both your names” (17%).

Approximately one in five respondents reported their partner using their “money or household money for excessive gambling or alcohol/drug consumption”. A similar number said their partner used “online banking or banking apps (bank technology) to ”pressure, coerce or threaten” them.

The use of online platforms such as banking apps and transactions as a tool to cause harm has led an increasing number of banks in New Zealand and Australia to explicitly name economic harm as inappropriate customer conduct in their terms and conditions.

The “historical” prevalence of economic harm (behaviours experienced in a previous relationship, more than 12 months ago) was much higher than that experienced by a current or former partner within the past 12 months.

We interpret this as evidence of money being a leading cause of relationship breakdown. This finding suggests individuals may be better able to identify their experience as abuse, or disclose harmful behaviours after the relationship has ended.

Invisible to outsiders

Economic harm rarely appears obvious to outsiders, and household income or individual earning power is not always indicative of access to financial resources. Unsafe and harmful behaviours hide behind cultural taboos around money.

Victims may also not immediately realise they are being harmed. They are unlikely to have the financial independence or agency to make decisions an outsider thinks they can or should.

Importantly, one in four survey respondents also reported knowing of someone they believed was being financially harmed. Given our general lack of understanding and awareness of economic harm, this finding offers hope.

Continual advocacy, backed by research and the many organisations and corporates working to improve knowledge and toolkits for survivors, will keep financial safety on the agenda.

As well as the often devastating personal experiences of financial harm, the cost to the broader economy is high. While figures are unclear for New Zealand, the economic impact on Australia in 2020 was estimated to be AUD$5.2 billion in lost productivity and mental health costs.

Changing the law

In the Asia-Pacific, the World Bank’s International Finance Corporation has launched the “Empower Finance” programme to help financial institutions identify and address financial harm across the region.

Family violence agencies, advocates, and financial organisations have called for New Zealand’s Family Violence Act to name economic harm as a standalone type of violence, rather than a subcategory of psychological abuse.

Such a move would bring New Zealand in line with the United Kingdom and Australia. In Queensland and New South Wales, non-physical patterns of abuse, such as economic harm, are criminalised under new coercive control laws.

While New Zealand waits for legislative change, everyone can work to understand the behaviours that cause economic harm. This can include breaking down the taboos around talking about money, particularly in relationships.

If you believe you or someone you care about is experiencing economic harm, you can find more information at Good Shepherd in NZ, and the Centre for Women’s Economic Safety in Australia. Läs mer…

Negotiations at the 29th Conference of Parties (COP29) to the United Nations Framework Convention on Climate Change (UNFCCC) are entering their second week after things got off to a rocky start.

Even before the event started, many were stunned that COP29 would again be hosted by a petro state. Just last year, COP28 was held in Dubai, United Arab Emirates, and this year it is Azerbaijan’s turn. Approximately 90 per cent of Azerbaijan’s exports are in the oil and gas sector.

The president of Azerbaijan, Ilham Aliyev, has described oil and gas resources as a “gift of god.” Meanwhile, the country’s deputy energy minister (and chief executive of COP29) has been caught on tape using the conference to advance oil investment deals.

At the same time, and despite years of COP meetings, 2023 was 1.48C warmer than the 1850-1900 pre-industrial average, and it’s looking like 2024 will be even warmer, likely surpassing the 1.5C mark for the first time.

After nearly three decades of COP meetings, the level of human-created greenhouse gases in the atmosphere is 534 parts per million — approaching twice the pre-industrial value when the gases are converted to their carbon dioxide equivalent.

The UAE Consensus, a landmark achievement of last year’s COP28, committed the parties to “transitioning away from all fossil fuels in energy systems, in a just, orderly and equitable manner in this critical decade to enable the world to reach net-zero emissions by 2050, in keeping with the science.”

This, however, begs an important question. Just what exactly does it mean to reach net-zero emissions “in keeping with the science?” I was a co-author in a recently published landmark study that may just help provide the answer.

Read more:
US politics has long shaped global climate action and science – how much will Trump’s opposition matter?

What is net zero?

Defining net zero requires an understanding of timescales. Millions of years ago, trees, ferns and other plants were abundant when the atmosphere had much higher concentrations of carbon dioxide (CO2).

As the years went by, plants would grow and die. This dead vegetation would fall into swampy waters and, in time, turn into peat. Over millions of years, the peat turned into brown coal, then soft coal, and finally hard coal.

Raw coal from a coal mine pours off of a conveyer belt near Trinidad, Colo. in 2011. Coal is the end product of millions of years of geologic process.
(Mark Reis/The Gazette via AP)

A similar process occurred within shallow seas where ocean plants (such as phytoplankton) and marine creatures would die and sink to the bottom to be buried in the sediments below.

Over millions of years, the sediments hardened to produce sedimentary rocks, and the resulting high pressures and temperatures caused the organic matter to transform slowly into oil or natural gas. The great oil and natural gas reserves of today formed in these ancient sedimentary basins.

Today, when we burn a fossil fuel, we are harvesting the sun’s energy stored in a life that lived millions of years ago. In burning fossil fuels, we release the carbon dioxide that had been drawn out of that ancient atmosphere — the same ancient atmosphere that had much higher levels of carbon dioxide than today.

Simply put, unless we can figure out a way to speed up the millions of years of geologic process, the idea that we can stop global warming solely through nature-based solutions or “planting a tree” simply isn’t realistic.

Read more:
Climate entropy: reflections on the ground from COP29

Reaching true net zero

A series of scientific analyses published in 2007, February 2008, August 2008 and 2009 demonstrated that the stabilization of global mean temperatures required net-zero emissions. Policymakers interpreted these findings as a green light to emit carbon as long as these were natural “offsets.” This is a gross misinterpretation of the facts of net zero.

And so I, alongside a global team of 25 scholars and scientists involved in the early research, teamed up to correct this misinterpretation and explain just what exactly is (and is not) net zero.

Our research, recently published in Nature, makes four key recommendations for reaching true net zero:

1) Stabilization of the global mean temperature at any level requires net-zero anthropogenic emissions.

2) Reliance on “natural carbon sinks” like forests and oceans to offset ongoing carbon dioxide (CO2) emissions from fossil fuel use will not actually stop global warming.

3) “Net zero” must be interpreted as “geological net zero” wherein each ton of carbon dioxide emissions released to the atmosphere through fossil fuel combustion is balanced by a ton of atmospheric carbon dioxide sequestered in geological storage.

4) Governments and corporations are increasingly seeking carbon offset credit for the preservation of natural carbon sinks. Protection of natural sinks cannot be used to offset ongoing fossil fuel emissions if net zero is to halt warming.

Steam rises from AES Indiana Petersburg Generating Station in October 2023, in Petersburg, Indiana. True net-zero emissions requires sequestering carbon in the ground where it is not at risk of re-emission.
(AP Photo/Joshua A. Bickel)

Human activities since 1750 have emitted 2,634 billion tons of carbon dioxide into the atmosphere; 1,814 billion tons (69 per cent) of our total emissions originated from the combustion of fossil fuels and 820 billion tons (31 per cent) from changes in land use such as deforestation. As such, nature-based solutions only have a limited role to play in emissions reduction and certainly can’t be used to offset future emissions from fossil fuel combustion.

Nature-based solutions do, however, have an important role to play in climate change adaptation and the preservation of biodiversity, but there is a growing danger that governments, industry and the public will come to rely on them to maintain the status quo. This impulse must be avoided at all costs.

The example of B.C.

The British Columbia New Democratic Party government has remained adamant that the province can reduce emissions to 40 per cent below 2007 levels by 2030. While admirable, there is a real risk that this target can only be achieved through creative carbon accounting and the use of natural sinks that will not stop warming.

For example, Shell Canada is now promoting its efforts to ensure “the protection and restoration of natural ecosystems such as forests, grasslands and wetlands” as a central component to its greenhouse gas mitigation strategy.

Of course, there is no mention of greenhouse gas emissions from the ever-increasing area burnt by Canadian wildfires. Nor does Shell mention the emissions being released as permafrost thaws and previously frozen organic matter begins to decompose.

Read more:
B.C. election: Party proposals on climate action point in opposite directions

The Darkwoods Forest Carbon project offers a glimpse into what is being considered by government and industry decision-makers as a means of offsetting emissions from the natural gas sector. The project aims to “offset” these emissions with carbon trading and forest conservation.

Such efforts will prove futile and, as we have shown, natural carbon sinks (like forests) do not stop warming and cannot be considered offsets.

Lessons for the negotiators

As we move into the final week of COP29, one can only hope that international negotiators acknowledge the difference between natural and geological sinks of anthropogenic carbon.

Only the latter will lead to net-zero emissions and keep warming to below 3C above pre-industrial levels. Of course, the most efficient way to reduce emissions is to rapidly decarbonize global energy systems. Everything else only delays the inevitable.

Policy negotiations should be focused on eliminating emissions at source and developing approaches to directly extract and geologically store carbon dioxide already present in the atmosphere.

Sadly, given socioeconomic inertia, ongoing political inaction and geopolitical instability, as well as the slow rate at which energy systems are transforming to become emissions free, it is almost certain that 1.5C warming will be surpassed imminently with 2C following suit within the next two decades. The Paris Agreement is in trouble.

Surely we can do better. Läs mer…