The Specialist GP

How comfortable are you managing Mary? She’s 45, fit, still having regular periods, but struggling with poor sleep, anxiety and irritability. Is this stress or the start of perimenopause?
Dr Louise Kuegler talks with reproductive endocrinologist Dr Megan Ogilvie about the early, often missed phase of the menopausal transition. Long before cycles become irregular, fluctuating hormones can drive mood change, worsening PMS and PMDD, migraines, joint pain and sleep disturbance, leaving many women feeling unlike themselves.
We explore why perimenopause is a time of heightened mood vulnerability, who is most at risk, and how to recognise symptoms that do not fit the classic teaching.
The discussion moves into practical, primary care management, including when to consider SSRIs, the combined oral contraceptive pill, menopausal hormone therapy, or cycle suppression, and how to navigate the growing interest in natural therapies safely and realistically.
A clinically grounded, myth busting conversation designed to help you spot perimenopause earlier and treat with confidence.
Practical clinical pearls:
Early symptoms: Mood changes may precede menstrual changes; affect ~25% of women. Symptoms can mimic cardiology or rheumatology presentations.
Alternative preparations: Have a limited role; use with caution and be aware of potential interactions.
Combined oral contraceptive pill: Can provide both symptom control and contraception.
Menopause Hormone Treatment: Use initially as a cyclical trial, then consider moving to continuous therapy after 6–12 months. Annual review once stabilised. Always consider ongoing contraception needs. Investigate abnormal PV bleeding.
Consider newer agents and cycle suppression for PMS/PMDD: Seek specialist input if needed.
Guest bio:
MEGAN OGILVIE Business Director at ERH Associates Subspeciality expertise in menopause, PCOS, athlete hormone health. PMS/PMDD, VSCs and gender-affirming medicine. Megan completed her endocrinology training in Auckland and then undertook a fellowship in London at St Bartholomew's and University College of London Hospitals. Since returning to New Zealand, Megan has worked in both general and reproductive endocrinology at Fertility Associates and at Auckland District Health Board, and now at ERH Associates. Megan has particular reproductive endocrine interests in menopause, polycystic ovarian syndrome, gender-affirming care, as well as athlete hormone health and energy deficiency. Megan was a founding member of WHISPA (a medical advisory board to High Performance Sport New Zealand, now disestablished) and has run training workshops for High Performance Sport NZ in the area of female athlete hormone health. Megan is the New Zealand representative on the board of the Australasian menopause society.
Resources:
https://www.menopause.org.au/images/stories/education/docs/AMS_Diagnosing_Menopause_Symptom_Score.pdf
https://www.menopause.org.au/hp/information-sheets/perimenopause
Magraith K, Stuckey B, Baber R. Perimenopausal Hormone Therapy Assessment and Prescribing. Medicine Today. 2022 August (23):61-67
Maki PM, Kornstein SG, Joffe H, Bromberger JT, Freeman EW, Athappilly G, Bobo WV, Rubin LH, Koleva HK, Cohen LS, Soares CN. Guidelines for the Evaluation and Treatment of Perimenopausal Depression: Summary and Recommendations. J Womens Health (Larchmt). 2019 Feb;28(2):117-134.
Faculty or Sexual and Reproductive Healthcare. FSRH Guideline for women aged over 40 years. Contraception for Women aged over 40 years. FSRH Clinical...

Dr. Louise Kuegler and Dr. Sid Ogra discuss the clinical presentation, implications, and management of hooded eyelids. They explore the functional and cosmetic concerns associated with this condition, emphasising the importance of proper assessment and referral pathways. Dr. Ogra shares insights on the surgical options available, the criteria for referral, and the long-term outcomes and patient satisfaction associated with eyelid surgery. The conversation highlights the often-overlooked functional component of hooded eyelids and the need for primary care physicians to recognise and address these issues.
Practical clinical pearls:
Ask about function, not just appearance. Patients may present for cosmetic reasons, but targeted questions about visual fields, eye strain, or difficulty with reading/driving often reveal functional impairment.
(Function is more commonly impaired than you think and most patients with this issue present for functional reasons)
Use simple examination tools. A visual field test, photographs, or even observing brow elevation can help demonstrate functional impact in primary care before referral.
(All important markers of functional impact are easy to diagnose without special equipment)
Document carefully. Insurers and specialists often require evidence of functional impact (e.g., reduced visual fields, visual obstruction) — clear notes and photos can strengthen a referral.
Blepharoplasty has evidence-based benefits. Beyond cosmesis, studies show improvement in visual fields and patient-reported outcomes — it can be both functionally effective and cost-effective when appropriately indicated.
Know your referral pathways. Many specialties perform this surgery, but referral for functional assessment should occur when there is any concern about impairment or underlying eye pathology.
Guest bio:
Dr Sid Ogra. MBChB, FRANZCO. Specialist in eyelid and tear duct disorders (Oculoplastics) – in adults and children. Specialist in Cataract surgery including premium lenses and correction options:
Oculoplastic Fellowship, Hereford, UK 2019
Observerships in Stanford (USA), and Seoul (South Korea)

Sid is a well-established adult and paediatric eyelid specialist and also has a busy cataract surgery practice. He is also servicing Queenstown as well as most regions in Auckland.
After graduating medical school (with distinction) in Auckland, Sid knew that Ophthalmology was the right fit for him. He completed his Ophthalmology training in Auckland, Rotorua, and Wellington, and was able to travel to the UK to further refine his skills in Oculoplastic surgery. Further experience followed at the prestigious Byers Eye Institute in Stanford, USA, as well as Samsung Medical Centre in Seoul, South Korea.
He has a strong belief that doctors and patients must work together as a team to achieve the best results. This means empowering his patients with all the relevant knowledge, discussing the options, and coming to a decision together regarding the best fit for them.
Resources:
Domela Nieuwenhuis, I., Luong, K. P., Vissers, L. C. M., Hummelink, S., Slijper, H. P., & Ulrich, D. J. O. (2022). Assessment of Patient Satisfaction With Appearance, Psychological Well-being, and Aging Appraisal After Upper Blepharoplasty: A Multicenter Prospective Cohort Study. Aesthetic Surgery Journal, 42(4), 340–348. https://doi.org/10.1093/asj/sjab389
An, S. H., Jin, S. W., Kwon, Y. H., Ryu, W. Y., Jeong, W. J., & Ahn, H. B. (2016).
Effects of upper lid blepharoplasty on visual quality in patients with lash ptosis and dermatochalasis. International Journal of Ophthalmology,...

Decompression illness, an umbrella term that includes decompression sickness and arterial gas embolism which may occur after diving, aviation, and spaceflight. with Professor Simon Mitchell we explore what happens in the body during these conditions, the key risk factors, and how they can present with sometimes subtle and nonspecific symptoms. Simon discusses how to recognise and assess those who may have decompression illness, the role of investigations, and the principles of treatment including recompression and hyperbaric oxygen therapy. We also cover who to call, what to expect in the management pathway, and clinical pearls for primary care and emergency clinicians.
Practical clinical pearls:
Decompression illness is an umbrella term covering decompression sickness and arterial gas embolism occurring after diving, aviation, and even spaceflight.
Symptoms most commonly present immediately or with in the first hour of resurfacing.
Sick divers need urgent assessment including a thorough neuro examination.
First aid includes 100% oxygen, Non-steroidal anti-inflammatories and IV fluids and consider recompression.
Talk to a friend at the NZ Emergency diving services by calling 0800 433 711- they will advise next steps including the need for evacuation to a hyperbaric oxygen chamber.
If diving overseas consider joining DAN- Divers alert network, use their insurance and call them if you run in to trouble USA +19196849111

Guest bio: Simon Mitchell is an anaesthesiologist at Auckland City Hospital, a diving physician at North Shore Hospital (Auckland), and Professor of Anaesthesiology at the University of Auckland.
He is widely published, with two books and over 170 scientific papers or chapters, including co-authorship of the 5th edition of Diving and Subaquatic Medicine and the Hyperbaric and Diving Medicine chapters in the last four editions of Harrison’s Principles of Internal Medicine.
Simon has twice served as Vice President of the Undersea and Hyperbaric Medicine Society (USA) and received the Behnke Award for scientific contributions to diving medicine in 2010. Since 2019, he has been Editor-in-Chief of the Diving and Hyperbaric Medicine Journal.
Outside of medicine, Simon has had a long career in sport, scientific, commercial, and military diving. He has participated in exploratory wreck and cave diving expeditions worldwide and in 2002 performed what was then the deepest dive to a shipwreck. In 2023, he was part of the Wet Mules expedition to the Pearse Resurgence in New Zealand, where a 230 m hydrogen dive was conducted — the first of its kind in over 30 years. He is a Fellow of the Explorers’ Club of New York and was named Rolex Diver of the Year in 2015.
Resources:
Mitchell, Simon J, Michael H Bennett, and Richard E Moon. “Decompression Sickness and Arterial Gas Embolism.” Ed. by C. Corey Hardin. The New England journal of medicine 386.13 (2022): 1254–1264. Web.
Mitchell, Simon J et al. “Pre-Hospital Management of Decompression Illness: Expert Review of Key Principles and Controversies.” Diving and hyperbaric medicine 48.1 (2018): 45–55. Web.
https://www.nzunderwater.co.nz/emergency
https://dan.org/
Local healthpathways.
Email me:
[email protected]

Listen Here:
Apple: https://podcasts.apple.com/us/podcast/the-specialist-gp/id1845748299

What does it mean to be a Specialist GP — and why does it matter?
In this episode, I’m joined by Dr Samantha Murton, Fellow of the Royal New Zealand College of General Practitioners (FRNZCGP). Together, we unpack what Fellowship really represents, why the title Specialist GP is so important, and how it sets us apart from general registrants or other health professionals.
We talk about the training pathway, the value of the title, and how recognition translates into patient trust and safer care. Sam also explores the international perspective — why family physicians in the UK are paid on par with hospital specialists — and asks why New Zealand still lags behind.
This conversation is a call to action: for GPs to proudly use their specialist title, for patients to understand its importance, and for all of us to advocate for recognition and pay parity in primary care.
In this episode we cover
What FRNZCGP means and why it matters
Why the title “Specialist GP” makes a difference
The importance of distinguishing Specialist GPs from other health professionals
The training pathway and what it represents
How recognition impacts patient care and trust
International comparisons: the UK vs New Zealand
Why advocacy is crucial for the future of General Practice
What we can each do to support the cause

Email me
[email protected]

Listen Here:
Apple: https://podcasts.apple.com/nz/podcast/specialist-gp-why-recognition-matters-w-dr-samantha-murton/id1845748299?i=1000743708878
Spotify: https://open.spotify.com/episode/1955idYIvAmXOyO9tuSMC2?si=QqgAmS_VSjGeGP_LedYnrQ

Dr. Louise Kuegler discusses the rising prevalence of oral tobacco and nicotine products, particularly among youth in New Zealand, with Dr. Jude Ball. They explore the differences between oral tobacco and nicotine products, their usage patterns, safety concerns, and the implications for public health. The conversation also touches on the role of these products in smoking cessation, regulatory challenges, and the need for further research in this area.
In this episode we cover:
Who is using oral nicotine products
Safety and harms
The role of oral nicotine in smoking cessation
A case discussion
Policy, advocacy, and guidance
Looking forward

Practical clinical pearls:
Know what’s out there – pouches and lozenges are on the rise.
Ask routinely – patients may use them alongside smoking or vaping.
Safer ≠ safe – risks include nicotine dependence, oral disease, and cardiovascular harm.
Evidence is limited – they don’t outperform proven NRT.
Advocate – clinicians and parents should push back against normalisation of nicotine and call for strong regulation.

Guest bio:
Dr Jude Ball is a senior research fellow affiliated to the ASPIRE Aotearoa tobacco control research centre University of Otago, HePPRU, and the Adolescent Health Research Group (the team behind the Youth 2000 survey series). She joined the Department in November 2014 with a background in critical psychology, health promotion and applied research. She completed a PhD in 2019 exploring the drivers of long-term trends in adolescent risk behaviour, in particular smoking, cannabis use, binge drinking and sexual behaviour. Her research focuses on the impact of the changing social context on youth trends, and the inter-relationships between smoking and other risk behaviours in young people. Alcohol and drug harm and mental health promotion are also areas of research interest.
Resources:
https://www.phcc.org.nz/briefing/oral-tobacco-and-nicotine-products-quitting-aid-or-teen-addiction-risk