Endo Untangled

Why do we have periods at all, when most mammals don’t?In this episode we catch up with Dr. Deena Emera, evolutionary biologist and author of A Brief History of the Female Body, and look at menstruation through an evolutionary lens that shifts the usual framing.We unpack what’s actually happening between the brain, ovaries and uterus, and why menstruation may be less about a monthly inconvenience and more about an active, coordinated process. One of the more interesting ideas is the uterus behaving less like a passive lining and more like a kind of checkpoint, responding to what’s happening upstream.We also get into how far modern cycles have drifted from what the body likely evolved for. More cycles across a lifetime, higher hormone peaks, and a different symptom burden. That context matters when you’re thinking about pain, PMS, and conditions like endometriosis.If you work in this space, or you’re trying to make sense of your own cycle, have a listen to this great hour of evolutionary insight.Find Dr Emera's great book here:https://www.amazon.com.au/Brief-History-Female-Body-Evolutionary/dp/1728275156More on Prof Beverly Strassman: https://sites.lsa.umich.edu/bis/

We call it the “swinging balls” problem.Because pelvic pain isn’t driven by one thing. It’s multiple systems hitting each other and keeping pain in motion.In this episode, we zoom out and examine some of the main drivers of persistent pain and how they interact, in particular, our key swinging balls: menstrual cycling, bowels, pelvic floor and the nervous system.If you’ve tried everything and you’re still stuck, this is the episode to listen to.

So much of pelvic pain care focuses on finding and fixing a single cause.But what happens when the system itself becomes part of the problem?In this episode, we’re joined by psychologist Laura Grace to explore:how the nervous system learns painwhy dismissal, delay, and fragmentation matterthe impact of trauma and “micro-traumas” in healthcarehow neurodivergence changes the way pain shows upand what it actually means to feel safe in your body againThis is about making sense of pain, not dismissing it.About Laura GraceLaura Grace is a Brisbane-based registered psychologist with a focus on pelvic pain, chronic illness, and women’s health. She has training in both health and clinical psychology and works with patients navigating complex, long-standing conditions.Her approach is trauma-informed and centred on the nervous system, helping patients understand pain, build safety in the body, and make sense of their experiences.She supports people with persistent pelvic pain, medical trauma, neurodivergence, and the broader impacts of chronic illness.Laura Grace Psychology: https://www.lauragracepsychology.com.auPelvic Pain Foundation of Australia: https://www.pelvicpain.org.auNOI Group (pain science resources): https://www.noigroup.com

Is the pill just a band-aid for pelvic pain and endometriosis? It’s a question many patients ask, and one that comes up again and again in clinics and online.In this episode of Endo Untangled, Dr Alecia Macrow and Cherie Noble are joined by women’s health GP Dr Jessica Floreani to unpack how hormonal treatments actually work. From the basics of the menstrual cycle through to combined pills, progestogen-only options, ovulation suppression and withdrawal bleeds, this conversation explores why these treatments are used and what they are trying to achieve.They also tackle some common misconceptions around “synthetic hormones”, why one pill can feel completely different from another, and why finding the right option is often a process of trial and adjustment. A practical, thoughtful episode for anyone navigating pelvic pain, endometriosis or heavy periods.In this episode we discuss• How estrogen and progesterone drive the menstrual cycle• Why endometrial tissue responds to hormones• How hormonal treatments help manage pelvic pain and bleeding• Why different pills contain different progestogens• Combined pills vs progestogen-only options• Why one pill may suit someone while another does notOur guestDr Jessica Floreani is a specialist women’s health GP and director of Aware Women’s Health in Adelaide. She has extensive experience in contraception, endometriosis care and women’s health education, and has previously worked with SHINE SA as a LARC coordinator and medical educator.More about Dr Jess: https://www.awarewomenshealth.com.au/jessica-floreani

If you've got pelvic pain, you probably know it's not just about the endometriosis lesions. But did you know how much your muscles are contributing to your symptoms?Pelvic health physio Caz Berry is back to explain the anatomy that matters. She's brought her pelvis model and she's not afraid to use it.In this episode, we're covering the three things Caz wishes every patient knew before walking into her clinic: understanding your core (spoiler: it's not about abs), why breathing actually matters for pelvic pain, and yes—how to poo properly.Caz explains why that "just breathe" advice isn't a brush-off, why pushing on the toilet is working against you, and why that deep stabbing pain might not be your ovary at all—it could be a cranky hip muscle called the obturator internus.We also get into the nitty gritty: tight activewear as a pain trigger, why sitting with your knees together isn't helping, and how trauma and stress literally change what's happening in your pelvis.Practical, honest, and genuinely useful information for anyone dealing with pelvic pain, endometriosis, or bowel and bladder issues.

Pelvic pain doesn’t exist in isolation — and neither does the nervous system that processes it. In this episode, world-renowned pelvic health physio and storyteller Michelle Lyons explains why what happens in the vagus nerve shows up everywhere.We explore persistent pelvic pain through a nervous-system lens, unpacking how the vagus nerve connects pain with the gut, bladder, pelvic floor, immune system and stress response. Michelle breaks down why pain can persist even when scans are normal or tissue has been treated, and how an upregulated nervous system can keep the body stuck in protection mode.This episode offers a compassionate, science-based reframing of pelvic pain — moving beyond “just the pelvis” toward understanding the whole person. If you’ve ever felt like your symptoms don’t make sense, or that your body is reacting bigger than expected, this conversation may finally connect the dots.Michelle's website: https://celebratemuliebrity.com/Michelle's podcast: https://podcasts.apple.com/au/podcast/celebrate-muliebrity-with-michelle-lyons/id1689238440Book we discussed:Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping . https://www.amazon.com.au/Why-Zebras-Dont-Ulcers-Stress-Related-ebook/dp/B0037NX018

Forget the candles and face masks. This episode gets real about what self-care actually looks like when you live with endometriosis or chronic pelvic pain.Dr Alecia Macrow and exercise physiologist Cherie Noble break down the Circle of Control and why so much energy gets wasted on things you can’t change. They explore how pain, sleep, work stress, and relationships all feed into each other, and share practical ways to take back a sense of control.You’ll learn why “no” is a complete sentence, why most people are either in turbo mode or wiped out, and how to take small, meaningful steps without piling on pressure.If you’re navigating chronic illness, invisible symptoms, or just the overwhelm of life, this episode offers real, practical strategies that actually work.

Next in our Summer Series - Interviews from the 2025 Pelvic Pain Foundation of Australia Annual Practitioner Seminar.*we'll be back with our long form eps in late Jan*What does a physio educator wish you knew about pain? In this episode of Endo Untangled, Alecia and Cherie sit down with Emma, a physiotherapist and pelvic pain educator, to break down the complexities of pain, especially pelvic pain. Discover the different types of pain, why pain isn’t always a sign of damage, and how understanding your body can help you manage discomfort. Emma shares practical tips, movement strategies, and resources to empower young people and anyone living with ongoing pain. Emma Kirkaldy is an educator with PPEP Talk, the Periods, Pain and Endometriosis Program run by the Pelvic Pain Foundation of Australia.PPEP Talk: https://www.pelvicpain.org.au/ppep-talk-schools-programEasy Stretches to Relax the Pelvis; an excellent resource from the Pelvic Pain Foundation of Australia: https://www.pelvicpain.org.au/wp-content/uploads/dlm_uploads/2024/07/Easy-Stretches-to-Relax-the-Pelvis-5_5_2023.pdfThrive Endo Clinic's endo yoga series, presented by Endo Untangled's Cherie Noble: https://thriveendoclinic.com.au/endo-yoga

In this Fast and Curious episode from the Pelvic Pain Foundation annual seminar, Michelle Nielsen talks about PPEP Talk, the Periods, Pain and Endometriosis Program. PPEP Talk is an engaging, medically accurate education session for secondary students that helps young people understand what normal period pain looks like, when pain is concerning, what endometriosis is, and practical strategies to manage pain and seek help. It has been delivered to more than 65,000 students across Australia, with data showing that before PPEP Talk many students did not know what endometriosis was but that knowledge rises dramatically after the session, empowering young people with new understanding. A high proportion of students report severe period pain and many miss school or work because of it, and there are marked differences in impact between regional, rural and metropolitan students. Michelle discusses what schools and clinicians find valuable about the program, how it supports students in sport and study, and why early education like this matters for long term health and wellbeing. Find out more about the PPEP talk program: https://www.pelvicpain.org.au/ppep-talk-schools-program/PPEP talk Menstrual Education Video:https://www.youtube.com/watch?v=EF2K7luhGPkQENDO app:https://www.qendo.org.au/the-appPIPPA tool:https://www.canberrahealthservices.act.gov.au/services-and-clinics/services/canberra-endometriosis-centre/period-impact-and-pain-assessment-pippa/period-impact-and-pain-assessment-pippa-online-screening-tool

TW: Fertility is discussed here, and we know this can be a painful subject for those with endo and pelvic pain. If this raises concerns for you, give yourself permission to skip this episode.In this episode, we talk with Professor Louise Hull, a reproductive medicine specialist and world-leading researcher in endometriosis. Louise shares her story, from IVF training at Cambridge to leading national research and policy here in Australia. She gives one of the clearest explanations of how endo causes pain, inflammation and damage, and how this links to fertility.We explore:Prof Louise's take on how endo actually causes pain The link between endo and infertility, and what patients should know earlyWhen surgery helps fertility, and when it might reduce ovarian reserveEgg and embryo freezing, and how to make that decisionImpact of hormone treatments on long term fertilityWhat GPs and other health professionals often get wrong about fertility and endoThe myths, the gaps, and what Louise wishes every patient understoodThis is a grounded and compassionate conversation that will be useful for patients, GPs, and anyone supporting someone with endo.Louise is also the lead investigator behind EndoZone, a national digital platform that gives patients and clinicians access to evidence-based, user-friendly information about endometriosis. Check out this excellent resource at www.endozone.com.au

In this episode we sit down with world class excision surgeon and leading pelvic sonologist Dr Matthew Leonardi to explore how high quality pelvic ultrasound transforms the way we understand endometriosis. Matthew explains how advanced ultrasound maps disease in three dimensions, reveals deep lesions that laparoscopy can miss, and helps patients build a clearer, more accurate story of what is happening in their pelvis.We break down the full spectrum of ovarian cysts, from follicular and haemorrhagic cysts to dermoids and endometrioma, and unpack why the term “complex cyst” causes unnecessary fear and needs to disappear. Matthew shares how recognising an endometrioma is often just the start, and how detailed ultrasound guides safer, more precise surgical planning. Dr Leonardi also takes us through his thoughts and insights on modern excision surgery.We finish with his interdisciplinary Endometriosis 360 model, where imaging, pelvic physio, dietetics and psychology work together to support better long term endo care.

If you’ve been told your ultrasound was normal but your pain isn’t, this episode is for you.Join us on Endo Untangled as Dr Alecia Macrow and Cherie Noble sit down with Alison Deslandes – clinical academic sonographer, endometriosis researcher and founder of Astute Ultrasound Education – to explore how advanced imaging is reshaping the diagnostic landscape for people living with endometriosis and pelvic pain.In this episode you’ll hear:​Why a “normal” scan doesn’t always mean everything’s fine – and what to ask if the standard ultrasound isn’t giving you answers​How specialised transvaginal ultrasound protocols and the “sliding sign” technique help detect deep-disease and posterior pouch involvement that many imaging pathways miss. ​Who the hell is Douglas and why is he in my pelvis? and other anatomy including where to find the uterosacal ligaments and where exactly is the peritoneum in the pelvis.​The real-world impact of Australia’s new Medicare rebate for endometriosis imaging, and why access still hinges on finding ultrasound services with the right training and expertise. ​The emerging role of artificial intelligence in sonographer training – and what that could mean for future scans, reporting and surgical planning. Alison DeslandesWhether you’re a healthcare practitioner committed to improving care, a patient seeking better diagnostic clarity, or a partner navigating the care journey together – this episode offers practical insight, nuance and hope. Tune in, open your mind and equip yourself with the language and questions to get the ultrasound conversations you deserve.

In this episode of Endo Untangled, Dr Millie Mardon PhD shares how her long trips from Port Augusta to Adelaide as a teenager shaped her work in pain science. She explains how understanding what pain really is can help us change it, slowly but surely.We talk about where pain discussions go wrong, how what we think, feel and see can shift the way pain shows up, and why personal stories matter in research and recovery.This one will change how you think about pain.

In Episode 08, we dive deep (no pun intended) with specialist colorectal and pelvic floor surgeon Dr. Chris Gillespie as he lifts the lid on everything your bowels don’t want you to ask. From the anatomy and reflexes behind a good poop, to what’s going on when your colonoscopy is “normal” but symptoms persist, we cover it all. We unravel the role of anorectal manometry, bust common myths (do laxatives really make your bowel “lazy”?), and get his go-to strategies for managing bowel dysfunction in real life. Whether you’re a clinician, patient, or just poop-curious — this one’s for you.Tune in, flush away the stigma, and get the inside track on what your gut’s been trying to tell you.

Titled Pelvic Health Physios Alycia Scannell and Carolyn Berry explain how overprotective pelvic floor muscles can tighten and guard, leading to stabby pains, bladder urgency, bowel changes, deep pelvic aching, tailbone pain, or painful sex.They share how treatment goes far beyond exercises. It is about calming the nervous system, teaching the body safety again, and helping people reconnect with their pelvic floor through awareness, breathing, and gentle retraining.

In this episode of Endo Untangled, physiotherapist Sophie Sheppard shares her lived experience of chronic fatigue as a teenager and later discovering she is autistic and ADHD. We unpack the science of persistent pain and how it reverberates through the nervous, endocrine and immune systems (the NEI ensemble), and explore how understanding the whole-system impact changes care. Sophie explains how these insights shape her work as a pain-titled physiotherapist, helping people untangle complex pain and reclaim their lives.Whether you are living with persistent pain, supporting someone who is, or working as a health professional, this episode offers understanding, compassion, and practical insights.

Welcome to the first of our Endo Untangled mini ep series, Fast and Curious.We met with A/Prof Susan Evans at the recent Pelvic Pain Foundation of Australia Annual Practitioner Seminar in Brisbane, to pick her brains on:- the relationship with the uterus, brain, nervous, and immune system- Dr Evans' work with Alyra Biotech in the development of some novel therapies for endometriosis and pelvic pain, tapping into the neuro-immune activation that underpins the pain and whole-body symptoms that are associated with endometriosis- How this new therapy came about, on the grounds of Tokyo UniversityIf you're interested in finding out more about Dr Susan's trial, please visit www.alyrabiotech.com.

From tests to treatment, here’s how to take your next steps with POTS.In Part 2 of our conversation, Dr Marie-Claire Seeley takes us deeper into the journey of postural orthostatic tachycardia syndrome (POTS). We explore what investigations can actually help, practical management strategies that make a difference, and how to start feeling better day to day. Whether you’re newly diagnosed or years into navigating POTS, this episode offers clarity, hope, and real-world tools you can use.If you find this episode helpful, share it with someone who might need it and follow Endo Untangled for more conversations that bring insight and support.

Unwell in Central Asia. Dismissed as “just anxiety.” Four kids, nursing shifts, and a fight to be believed. Today Dr Marie-Claire Seeley is CEO of the Australian POTS Foundation, using her PhD and lived experience to change care for people with POTS.

Why does endo care feel like a tug-of-war?Pill pushback • stabbing pains • surgery debates.Why do so many endo appointments leave patients feeling unheard and doctors feeling stuck? In this episode, GP Dr Alecia Macrow and EP Cherie Noble sit down with Prof Susan Evans and Dr Carmel Reynolds to unpack why care can feel like control, why “they just want to put me on the pill” is such a common refrain in forums, and how sharp “ovary pains” aren’t always what they seem.We talk about:​The disconnect across the desk and how to rebuild partnership​Why hormonal treatments are offered so often (and how to talk about them without shutting down choice)​Stabbing pains, ovary myths, and what’s really going on​Surgery: when it helps, when it doesn’t, and why it’s not the whole storyThis is a constructive, honest conversation for patients, clinicians, and anyone wanting to better navigate endo care.A/Prof Evans discusses her current clinical trial with Alyra Biotech, you can find more information here: https://alyrabiotech.com/clinical-trials/as well as her new book "When Periods Hurt – A guide to periods, pain and endometriosis for Teens" available here:https://www.pelvicpain.org.au/product/whenperiodshurt/We also discussed some of the great resources available at the Pelvic Pain Foundation, which are available hereLhttps://www.pelvicpain.org.au/find-support/download/

Ep 2: The Pelvic Pain “Super Syndrome” with Dr Sneha WadhwaniWhy the fatigue? Why the headaches? Why the lightning arse?!In this episode, we dive into the messy overlap of gut issues, pelvic floor dysfunction, heavy periods, and crushing fatigue – and why these symptoms so often show up together. Dr Sneha Wadhwani joins us to explore what we’re calling the Pelvic Pain “Super Syndrome” and how recognising these patterns can completely shift how we approach care.We talk about:​How pelvic pain can be driven – and kept going – by multiple factors across the body and brain​The difference between endometriosis as a disease and pelvic pain as a condition​Why understanding the links between gut, nerves, hormones, and the pelvic floor is so important​What patients and clinicians can do with this knowledge to get better outcomesIf you’ve ever felt like your symptoms don’t fit neatly into one box, this episode will help you see the bigger picture.Check out Dr Sne’s podcast, “Everything from A to V” on Spotify here https://open.spotify.com/episode/1snC82WBvSrfWgtmi1v0m8?si=9SZVDO_zRr6QVbKV70t4pA

Exercise Physiologist Cherie Noble and Endo GP Dr Alecia Macrow talk through the 'why' of Endo Untangled, their personal stories, and what they're most looking forward to in the podcast.

Full series dropping soon