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Published by Dr Alecia Macrow GP with Cherie Noble EP
Unravels the complexities of endometriosis and persistent pelvic pain one conversation at a time. Join Dr Alecia Macrow, GP and founder of Thrive Family Practice, and Exercise Physiologist Cherie Noble, as they explore the tangled threads of pelvic pain with compassion, curiosity, and clinical insight. From hormones to hypermobility, trauma to treatment gaps, Endo Untangled dives into the real-life experiences and science behind one of the most misunderstood conditions in women’s health. We talk to experts, share stories, and challenge outdated thinking.
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Waiting for a pelvic pain appointment can feel like being stuck in limbo. But there are a few useful things you can get underway now, from organising some basic tests and screening to finding the right GP and starting to understand what might be contributing to your symptoms. In this episode, Alecia and Cherie talk through practical things that may help while you wait, including what your bowels may be telling you, why breathing mechanics matter, whether hypermobility could be part of the picture, menstrual hibernation, and the value of finding a GP who can help coordinate your care. There are 10 ideas in total, but this is not another giant to-do list. Pick one thing; start there.Resources mentioned in this episode: 💩 Bristol Stool Charthttps://www.england.nhs.uk/publication/constipation-resources-for-carers/ 🚽 Constipation Scoring System / Cleveland Clinic Constipation Scorehttps://thepelvicfloorsociety.co.uk/_userfiles/pages/files/Cleveland%20constipation%20score.pdf 🦓 Hypermobility: Beighton Score + Five-Part Questionnairehttps://www.ehlers-danlos.com/assessing-joint-hypermobility/ 💳 Medicare Safety Nethttps://www.servicesaustralia.gov.au/medicare-safety-nets 🧪 Cervical screening and self-collectionhttps://www.health.gov.au/resources/collections/self-collection-for-the-cervical-screening-test As always, this podcast provides general information and is not a substitute for individual medical advice.
What happens when you add ADHD to an already complicated pelvic pain picture? Dr Emilie Staehr joins us to unpack ADHD through a female lens: why it’s so often missed in women, how hormones can change the way symptoms show up, and what happens when executive dysfunction collides with the demands of managing chronic pain. We talk periods, pregnancy and perimenopause, masking and burnout, and why asking someone to manage medications, appointments, physio, sleep, movement, bowel and bladder strategies can become almost impossible when ADHD is part of the picture. And perhaps most importantly: what changes when you realise you’ve been living life on hard mode?
Is it really okay to skip periods? Do you need to have a bleed every month? Every few months? And what do you do when the pill that’s meant to stop your bleeding… doesn’t? Dr Jess Floreani is back for a practical follow-up to our episode Is the Pill Just a Band-Aid? We talk about why suppressing periods can be useful for people with painful periods, pelvic pain and endometriosis, and tackle some of the common worries about whether it’s safe to skip periods and what happens when you eventually stop the pill. Then we get into the practical stuff: Slinda versus the combined pill, when to start, whether to take the sugar pills, how to skip periods, what to expect in the first few months, and how to troubleshoot breakthrough bleeding. We also cover the four-day “reset”, and when ongoing bleeding or pain might mean it’s time to try something different. And we introduce a new way of thinking about period suppression: menstrual hibernation . The bear isn’t gone. She’s just having a well-earned sleep.
Join GP Dr Alecia Macrow as she interviews interventional radiologist Dr James Hillhouse and nurse practitioner candidate Sarah Thorncraft to explore one of the most overlooked contributors to persistent pelvic pain: pelvic venous disease. Together they unpack: why pelvic venous disease is often missed how venous pain differs from endometriosis the symptoms that should raise suspicion why a "normal" scan doesn't always rule it out which investigations to order and when to refer current interventional treatment options, including embolisation Resources Meissner MH, Khilnani NM, et al. The Symptoms-Varices-Pathophysiology (SVP) classification of pelvic venous disorders . This is the consensus paper James refers to during the episode and provides an excellent framework for understanding pelvic venous disorders. Open-access article (PMC)
Thinking about a Mirena but feeling nervous? Heard horror stories about IUDs and aren't sure what to believe? In this episode, GP Dr Jess Floreani joins Dr Alecia Macrow and exercise physiologist Cherie Noble to unpack everything you need to know about hormonal and copper IUDs. We cover: • Mirena vs Kyleena vs copper IUDs • How they actually work • Why they can be so effective for endometriosis, pelvic pain and heavy periods • What insertion is really like • Common side effects and what to expect afterwards • Mood, weight gain and other common myths • Risks such as perforation, infection and expulsion, and how common they really are • When an IUD might (and might not) be the right choice Whether you're considering an IUD yourself or you're a health professional supporting people with pelvic pain, this episode aims to replace fear with evidence and practical advice. This podcast is for education only and is not a substitute for personalised medical advice. Please speak with your own healthcare professional about your individual circumstances.
This is a special combined episode of Endo Untangled and the Australian POTS Foundation. We're joined by Dr Marie-Claire Seeley, CEO of the Australian POTS Foundation, and Dr Fraser Burling, New Zealand rheumatologist and internationally recognised expert in hypermobility and connective tissue disorders. Together we explore why connective tissue might be the missing link for some people living with invisible illness. We discuss hypermobility, Ehlers-Danlos syndrome, mast cell activation, heavy bleeding, pelvic pain, POTS and why normal blood tests don't always mean nothing is wrong. Because sometimes, if you can't connect the issues, it's worth thinking about the connective tissues.
Why do so many people with endometriosis also have food sensitivities, bloating, bladder symptoms, migraines, fatigue, POTS or hypermobility? Is it coincidence, or are we missing part of the picture? Recorded live at the 2026 Australian POTS Foundation Conference, we sat down with internationally recognised cardiologist Dr Alexis Cutchens to talk about mast cell activation syndrome (MCAS), a topic many of us were never taught about, but one that keeps showing up in complex patients. We explore what mast cells actually do, why MCAS can look like much more than "just allergies", and why clinicians working in pelvic pain often find themselves learning about POTS, connective tissue disorders and immune dysfunction. Along the way, we discuss everything from heavy periods, bladder symptoms, medication sensitivities, hormones and pregnancy through to perimenopause, antihistamines, and the very real experience of patients who seem to collect diagnosis after diagnosis without anyone joining the dots. This is a conversation about curiosity and complexity. We don't have all the answers, but if you've ever wondered whether these conditions might be more connected than we realise, come along for this incredible ride!
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/1728275156 More on Prof Beverly Strassman: https://sites.lsa.umich.edu/bis/
Why do so many people with pelvic pain feel like they have constant UTIs… even when the tests keep coming back negative? In this episode, we sit down with urogynecologist and pelvic floor expert A/Prof Tanaka Dune to unpack the incredibly complex world of bladder pain, urgency, frequency, pelvic floor dysfunction and the nervous system. We talk about: • why bladder pain is so often misunderstood • the overlap between pelvic floor tension, endometriosis, bowel symptoms and bladder symptoms • what urogynecologists actually do • why some people may have “UTI symptoms” without a standard urine test showing infection • the emerging science around the bladder microbiome • interstitial cystitis/bladder pain syndrome • how stress, trauma, posture, gait, back pain and the pelvic floor all connect • common bladder irritants including caffeine, alcohol and carbonated drinks • why pelvic floor exams can be such a lightbulb moment for patients • and the surprisingly powerful role of mirrors in helping women reconnect with and understand their anatomy Tanaka brings a deeply compassionate and systems-based approach to pelvic pain care, and this conversation completely shifts the way you think about the bladder. This episode is for anyone living with bladder symptoms, recurrent “UTIs”, pelvic pain, painful sex, urgency/frequency, or clinicians wanting a better framework for understanding these presentations. You can find A/Prof Tanaka Dune online as “Dr Pelvic Floor”. Endo Untangled is hosted by Dr. Alecia Macrow and Cherie Noble. New episodes released fortnightly.
Have you ever wondered how a pathologist actually decides whether tissue is endometriosis? Endometriosis is often described as “endometrial-like tissue” growing outside the uterus. But what does that really mean? What does endometriosis actually look like under the microscope? Where does it come from? And what can pathology tell us about this complex disease? Joining us is anatomical pathologist Dr Rebecca Morrow, who spends her days examining endometriosis, cancer and other complex gynaecological conditions under the microscope. Together, we tackle some of the biggest questions in endometriosis: • What are pathologists actually looking for when diagnosing endometriosis? • What does endometriosis look like under the microscope? • Where does it come from? • Why do pathology reports sometimes seem confusing? • Can endometriosis be missed? • How is endometriosis different from cancer, despite some surprising similarities? • What should patients know about their biopsy results? A fascinating conversation that takes us inside the pathology lab and offers a microscopic view of one of medicine’s most misunderstood conditions
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 Deslandes Whether 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.
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 again This is about making sense of pain, not dismissing it. About Laura Grace Laura 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.au Pelvic Pain Foundation of Australia: https://www.pelvicpain.org.au NOI 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 not Our guest Dr 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/id1689238440 Book 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-program Easy 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.pdf Thrive 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=EF2K7luhGPk QENDO app: https://www.qendo.org.au/the-app PIPPA 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 early When surgery helps fertility, and when it might reduce ovarian reserve Egg and embryo freezing, and how to make that decision Impact of hormone treatments on long term fertility What GPs and other health professionals often get wrong about fertility and endo The myths, the gaps, and what Louise wishes every patient understood This 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
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