Sydney GP: “For nineteen years I told women it was their weight. I was looking at the wrong thing.”

If the scales have barely moved but your rings won’t go on by three o’clock, you are not putting on weight — you are holding fluid. There is a five-second test you can do tonight that tells you which one it is.

The woman who came in about her wedding ring

Margaret was fifty-four and she did not come in about her weight.

She came in because her wedding ring had not come off in four months and she was worried she would have to have it cut. That was the whole complaint. One ring.

I did what I had been trained to do. I checked her blood pressure, ordered bloods, and when they came back unremarkable I told her what I had told several hundred women before her: that a bit of weight creeps on in your fifties, that it is very common, and that if she could manage a walk most days and go easy on the salt she would probably notice a difference.

She nodded. She had heard it before. She had heard it from me, actually, eighteen months earlier.

What I did not ask her — and this is the part I think about — was whether the ring was tight in the morning.

Because it wasn’t. She told me nine months later, when she finally came back, that she could get the ring on and off perfectly well at seven in the morning. By three in the afternoon it would not budge.

That single detail should have stopped me in my tracks, because it rules out the thing I had spent two appointments telling her she had.

For nineteen years I had ten minutes, and I used them badly

I want to be careful here, because I am not about to tell you your GP is hiding something from you. She isn’t. I wasn’t.

I had ten minutes. In those ten minutes I had to take a history, examine you, rule out the things that will actually hurt you, order the tests, do the paperwork and get you out the door before the waiting room turned. When someone came in about swelling, my job was to rule out the dangerous causes — the heart, the kidneys, a clot. When those came back clear, I had roughly ninety seconds left and no good answer, so I reached for the one that was true often enough: weight, salt, movement.

I want to give you a sense of how normal this gap is. The Australasian Lymphology Association — the professional body for exactly this — currently runs an awareness campaign aimed not at the public, but at Australian doctors. It is called “Put lymphoedema on the list.” When a peak medical body has to run a campaign reminding practitioners to consider something, that tells you where it sits in the training.

It is not a conspiracy. It is a timetable.

But you have been on the receiving end of that timetable for years, and you have drawn a conclusion from it: that this is your fault, that it is your age, and that it is what you weigh.

I would like to take that off you.

Fat does not change between breakfast and dinner

Here is the distinction that took me nineteen years to start using properly, and it is not complicated.

Fat is slow. It does not appear in an afternoon and it does not go away overnight. If you genuinely put on two kilos of fat, it took weeks, and it will be there in the morning exactly as it was at night.

Fluid is fast. It moves with gravity, with heat, with how long you have been sitting, with what you ate, with where you are in your cycle or where you are past it. It pools. It collects in the lowest and loosest parts of you — the ankles and feet, the hands and fingers, the face when you have been lying flat, and the soft tissue around your middle.

So when a woman tells me her jeans do up at eight in the morning and do not do up at eight at night, she has already answered the question. Nothing on earth puts on fat during a Tuesday.

Australians have a good phrase for this and I wish we used it clinically. You do not say “I have peripheral oedema.” You say “I’m holding fluid.” That is exactly right, and it is exactly the problem. Holding. Not making, not gaining. Holding — which implies that it is meant to be going somewhere, and it isn’t.

Test it on yourself, right now

Do not take my word for it. I would rather you proved it to yourself before you read another paragraph, and it takes about five seconds.

None of that is weight. You cannot gain and lose two kilos between the school run and the news.

And I want you to notice something about all four of those tests: they are free, they take a minute, and you did not need me. That is the first honest thing anyone has told you about this in years.

So why is your body holding on to it?

You have two systems of plumbing.

The first is your blood. It is a closed loop with a pump in the middle of it — your heart — and it beats about a hundred thousand times a day whether you think about it or not.

The second is your lymphatic system. It is the drainage network. It collects the fluid that leaks out of your blood vessels into your tissues all day long — several litres of it — and carries it back to be reused.

It has no pump.

There is no organ beating away in the background moving your lymph. There is no equivalent of a heart. The vessels are thin, they run just under the skin, they have one-way valves in them, and that is essentially the whole apparatus.

So it moves when you move. Every time your calf muscle contracts, it squeezes the vessels running through it and pushes fluid up past the next valve, and the valve stops it falling back. Every step is a pump stroke. Your breathing helps. That is the system.

Which means the moment you sit still for a long stretch, drainage does not slow down.

It stops.

So the answer is just “move more”? Partly. And I know why that isn’t enough

I am not going to insult you by writing “have you tried walking.”

Nearly half of Australian workers describe their day as mostly sitting. Among 45 to 64 year olds, more than eight in ten of us do not meet the physical activity guidelines — and that is not because eight in ten Australians are lazy. It is because of desks, cars, commutes, shifts, sore knees, and days that are already full.

So yes — stand up every hour. Do twenty calf raises at the kitchen bench while the kettle boils. Walk after dinner rather than before bed. Get your feet up for twenty minutes in the evening. Every one of those is free and every one of them works, and if you do nothing else after reading this, do those.

But here is the honest limit: movement moves the fluid you shift while you are moving. It does very little about the reason you are holding more of it in the first place. And for a lot of women in their fifties, there is a reason.

Why this got worse for you around fifty

There are roughly seven million Australian women in perimenopause or menopause right now, and the average age of menopause here is fifty-one.

Fluid is one of the parts almost nobody mentions. Hot flushes get the airtime — they get the ads, they get the segments on the morning shows, they get the government campaign that is running as I write this. Fluid does not.

The mechanism is not exotic. Oestrogen encourages the body to hold water; progesterone works in the other direction, acting as a mild natural diuretic. As those two fall away — and they do not fall smoothly, they lurch — the balance between them shifts, and the body’s setting for how much fluid to hold moves with it.

That is why it is worse some weeks than others. That is why it arrived without you changing anything. And that is why it does not respond to the thing you were told to do, which was eat less.

When a thousand Australian women aged 40 to 65 were surveyed, 82% said menopause had affected their quality of life and 58% reported weight gain. Only 57% had ever raised any of it with a doctor, and a third said they did not know what to ask.

If you are in that 43%, I understand exactly why. You were braced to be told it was your weight.

If you take a tablet for your blood pressure, read this part twice

This one matters, and I want to be very clear at the start of it: keep taking your tablet. Nothing in this article is a reason to change or stop a prescription, and if you take one thing from this section, take that.

Here is what is worth knowing.

Amlodipine is the fourth most-used medicine in Australia. It is a very good blood pressure drug. And its single most common side effect is swelling in the ankles and feet — not from fluid overload, but because of how it changes pressure in the smallest blood vessels, pushing more fluid out into the tissue than the drainage system was set up to collect.

There is a detail here that catches people out. This particular kind of swelling responds poorly to fluid tablets. So if you have been given a water tablet to deal with the swelling caused by your blood pressure tablet and it did not do much, you are not imagining that, and it is not because you did something wrong.

Winter is the one nobody warns you about

Everyone expects this in January. Thirty-five degrees, the barbecue, the salty food, the wine, standing about at somebody’s place all afternoon — of course your feet swell.

What surprises people is that right now, in August, is quietly one of the worst stretches of the year. You are sitting more. You are moving less. Meals are heavier and saltier. You are in boots and closed shoes that leave a mark you do not see until you take them off at night. And because it is cold and everything is covered up, you are not looking.

Then October comes, and the first properly warm day arrives, and everything you have been accumulating since May turns up at once — and it is uncomfortable, and it is now, and you have four weeks before the wedding or the Cup lunch or the cruise.

The women who get on top of this are the ones who start in the cold months. Not because of a sale. Because the system takes a few weeks to shift, and August is when you have those weeks.

The six plants I actually went and read about

I was sceptical, and I will tell you exactly where my scepticism landed.

Herbal preparations for fluid tend to do one of two things. Some are diuretics — they lean on the kidneys to pass more urine. That does empty you out, and you will notice it, but it is the same lever the prescription pulls, and if your problem is drainage rather than volume you have not addressed the actual issue. Others work on the tissue and vessel side — the movement of fluid out of the tissue and back into circulation. That is the half that has been nobody’s job.

The traditional Western herbal preparations for this use both, and there are six that come up again and again:

Dandelion leaf — not the root, the leaf; the traditional preparation for fluid, and unusually for a diuretic it carries its own potassium. Cleavers — the classic Western herbal preparation used to support the lymphatic system specifically, which is a much shorter list than you would expect. Burdock root — traditionally used to assist the body’s natural cleansing processes. Rutin — a flavonoid found in buckwheat, traditionally used to support the small blood vessels. Kelp — iodine, thyroid support, and the thyroid sets a lot of your fluid handling. Bromelain — the enzyme from pineapple stems, traditionally used where tissue is puffy and inflamed.

Six is a reasonable number. Under four and you are usually looking at a single-herb product with a nice label. Over ten and it is almost always a dusting of each so the back of the bottle looks impressive.

And this is where I ran into the actual problem, which is not the herbs. It is the format.

Every one of these that I found in a chemist was a tablet — usually two large tablets, twice a day. The reviews for the leading Australian one say the quiet part out loud: people call them horse tablets, and the single most common complaint is not that they do not work. It is that people stop taking them.

What I ended up looking at

The one I want to tell you about is called BrasaBloom Lymphatic Drainage. It is a liquid, taken as drops in a glass of water, and it contains those six plants.

I am telling you about a liquid rather than a tablet for a boring reason that turns out to be the whole thing: you will actually take it. It is a dropper into whatever you are already drinking, twice a day, and it takes about ten seconds. Nothing to swallow. There is no version of this that works if the bottle sits in the cupboard.

The claims on it are modest, and I would be suspicious if they weren’t. It is used traditionally in Western herbal medicine to help maintain a healthy lymphatic system, to help regulate body fluid, to temporarily relieve mild fluid retention, and to help reduce the occurrence of abdominal bloating. That is the whole promise. Nothing about kilos, nothing about dress sizes, nothing about weeks-to-results.

What’s actually in it

Plant	Traditionally used to
Dandelion leaf	Support healthy fluid balance and urine output
Cleavers	Help maintain a healthy lymphatic system
Burdock root	Assist the body’s natural cleansing processes
Rutin	Support healthy blood circulation to the hands and feet
Kelp	Support healthy thyroid function
Bromelain	Help relieve mild tissue swelling

Full doses printed on the label. I mention that because “proprietary blend” on a supplement label means you are not being told how much of anything you are getting, and it is almost always because the answer is not much.

What this will not do

I would rather you heard this from me than found it out.

It will not do anything about fat. If what you are carrying is the same at eight in the morning as it is at eight at night, this is not the product for you and I would rather you kept your money.

It will not work for everyone. Nothing does. Some of what you are holding is postural, some is your medication, some is the weather.

It is not a substitute for moving. If you take it and keep sitting for eleven hours you have handed a drainage system with no pump a job it still cannot do.

If the swelling is sudden, or in one leg only, or comes with breathlessness or chest pain, this is not the page for you. That is a same-day appointment, not a supplement.

What it costs, and what the chemist charges

The comparison I would make is the one on the shelf. Caruso’s Fluid Away is A$37.99 for sixty tablets at Chemist Warehouse — a thirty-day pack, so about A$1.27 a day. That is a perfectly reasonable Australian product and I am not going to pretend otherwise.

The other comparison is the one you may already have made. A lymphatic drainage massage in Sydney or Melbourne runs between A$139 and A$240 a session — I checked — and it is genuinely lovely, and it wears off.

Check availability and price →

Before you order — a few things Australians ask us

Here’s your next step

You have two paths from here, and I mean this without any drama.

The first is free. Stand up every hour. Twenty calf raises at the bench while the kettle boils. A walk after dinner. Feet up for twenty minutes in the evening. Do those and you will move some of it, and I would rather you did those than nothing.

The second is the same thing plus a hand on the drainage side — six plants, twice a day, ten seconds, about fifty cents.

What I would not do is a third thing, which is what most women reading this will do, which is nothing — because it has been ten years and nobody ever gave you a reason to think it was fixable.

Go and do the press test. If your thumb leaves a dent, you have your answer.

Check availability and price →

Dr Fiona Brennan is a general practitioner. This article is general information and is not medical advice, a diagnosis, or a substitute for your own doctor’s judgement. Always read the label and follow the directions for use. If symptoms persist, talk to your health professional. If fluid retention persists, seek medical advice. Sudden swelling, swelling in one leg only, or swelling with breathlessness or chest pain needs same-day medical attention. Not for use in pregnancy or breastfeeding. If you are taking blood thinners, lithium, or have a thyroid condition, speak to your doctor or pharmacist first. BrasaBloom Lymphatic Drainage, oral liquid, 59 mL. Active ingredients: dandelion leaf, cleavers, burdock root, rutin, kelp, bromelain.