Show Notes
Fiona came to see Jess about her bladder. Almost as an afterthought, she mentioned a hip niggle too — one she assumed someone else already had covered. It turns out the two were never separate problems at all. In this episode of The Perimenopause Puzzle, Taryn is joined again by Jess Vanson, hybrid Sports/MSK and Pelvic Health Physiotherapist, to explore a connection most women have never heard of — the link between the hip and the pelvic floor. Using Fiona's story, they unpack why a hip issue in mid-life that never fully resolved with a standard glute-strengthening program might actually be tangled up with pelvic floor tension, why lateral hip pain (often called "hip bursitis") becomes so much more common during and after perimenopause, and why doing more pelvic floor exercises can sometimes make things worse, not better. You'll learn: Why the hip, pelvis and spine function as one connected system — the deep hip rotators and the back of the pelvic floor are literally neighbouring structures, so treating one in isolation rarely gets to the bottom of things. What's often called "hip bursitis" is more accurately Greater Trochanteric Pain Syndrome (GTPS) — a compression-related tendon issue that becomes far more common after menopause, driven by hormonal changes, muscle loss, and stiffer, less elastic muscle tissue. Why two of the most common pieces of hip advice — To do pilates-style clams and side-lying leg lifts — aren't always helpful Why a tight, "gripping" pelvic floor can actually contribute to hip pain, and why doing more pelvic floor exercises in that case can make things worse — a reminder of why a proper global assessment matters before starting any exercise plan. Why getting the full picture for hip pain at this life stage might mean pulling in a musculoskeletal physio, a pelvic health physio, and a Women’s Health GP
If you've ever been told your hip pain is "just wear and tear," or you've been doing your pelvic floor exercises without any real change in your symptoms, this episode connects some dots you probably didn't expect. Resources Link to Episode 3 with Jess Vanson — a deep dive on stress incontinence Link to Episode 1 with Dr Miranda Quenby — GP management of perimenopause Link to Season 1 Bonus Episode: Demystifying Pessaries with Jess Vanson Book an appointment with the team at FitRight Women's Health Learn more about our women's health exercise classes Follow us on Instagram and Facebook for more evidence-based women's health education
Please note: This episode uses a fictional case study to illustrate a common clinical presentation. Any resemblance to real people or their experiences is purely coincidental. The information shared is for educational purposes only and should not replace personalised medical advice. Thanks for listening to The Pelvic Puzzle. This is still a fairly new podcast, so if this episode resonated with you, a quick review genuinely helps more women find it — please consider leaving one, and share it with a friend who might need to hear it too.
More from Pelvic Puzzle
Sally is 47 and feels like she's doing everything "right." She's eating less, exercising more than ever before, and yet the scales continue to creep up. After years of calorie counting and trying different diets to get back to her ‘pre-pregnancy weight’ (some of which have worked short term in the past), she’s recently put on a significant amount of weight and none of the previous strategies are helping. She's left wondering whether it's just part of getting older - or if something else is going on. In this episode of The Perimenopause Puzzle, Pelvic Health Physiotherapist Taryn Watson is joined by Dietitian Maddi Pearce to unpack why midlife weight gain is so much more complicated than "eat less, move more" - and why so many of the diets recommended to women like Sally were never going to deliver lasting results in the first place. They also discuss the sensitive topic of weight conversations in healthcare - how to balance the principles of Health at Every Size with the very real health risks associated with rapid weight gain and increasing visceral fat. You'll learn: Why Sally's previous diets worked short-term and then stopped working — and why "what have I done wrong" usually isn't the right question to be asking. Whether intermittent fasting has a genuine place in perimenopause and postmenopause, or whether it can work against you at this life stage. The fact that women can lose up to 40% of their gut bacteria diversity through perimenopause. Maddi describes it like losing almost half the soil a plant needs to grow: you can't expect it to thrive without restoring the soil first. Optimising gut health and adding prebiotics as ‘the fertiliser’ may even help delay the onset of perimenopause symptoms, and make them less bothersome when they do arrive. Why symptoms like fatigue and hair thinning might be connected to gut health, nutrition, or other medical issues - and not simply written off as part of "getting older." Why the goal at this time of life shouldn't be a number on the scale - and what to focus on instead, including muscle mass and body composition Whether all the hype around protein, and the importance of eating breakfast, are worth listening to Whether your goal is your "pre-baby weight," or you're just exhausted by diets that stop working, this episode reframes the whole conversation. Resources Book an appointment with the multidisciplinary team at FitRight Women's Health - Dietitian, GP, Pelvic Health Physiotherapy and Musculoskeletal Physiotherapy Learn more about our Clinical Exercise Classes and women's health exercise programs Follow FitRight Women's Health on Instagram and Facebook for more evidence-based women's health education Please note: This episode uses a fictional case study to illustrate a common clinical presentation. Any resemblance to real people or their experiences is purely coincidental. The information shared is for educational purposes only and should not replace personalised medical advice. Thanks for listening to The Pelvic Puzzle. This is still a fairly new podcast, so if this episode resonated with you, a quick review genuinely helps more women find it — please consider leaving one, and share it with a friend who might need to hear it too
Tracey's Light Bladder Leakage (AKA Stress Urinary Incontinence) had been mild and manageable since she had her kids, until the past year when it’s gotten worse during her regular gym classes. When a friend was diagnosed with a vaginal prolapse, Tracey started to worry the same thing was happening to her. But was it? In this episode of The Perimenopause Puzzle, Taryn is joined again by Jess Vanson, hybrid Sports/Musculoskeletal and Pelvic Health Physiotherapist. As well as busting one of the most common misconceptions in pelvic health: that leaking always means prolapse, and prolapse always means leaking, they use Tracey's story to unpack the real mechanics behind stress urinary incontinence and why it can worsen during perimenopause even when nothing else has changed. They chat through what treatment options might look like — including a closer look at pelvic floor training, the concept of ‘it’s not what you do, it’s how you do it’, and continence pessaries as a real alternative to jumping straight to surgery. You'll learn: Why leaking doesn't always mean prolapse, and prolapse doesn't always mean leaking — sometimes a prolapse can actually "kink off" the bladder, masking leakage until it's supported and straightened by a pessary. The two different sources of stress incontinence — a lack of "backstop" support behind the bladder and urethra, versus weakness in the urethra itself — and why they need different treatment approaches. Why fluctuating and declining hormones in perimenopause genuinely change the tissue of the urethra and pelvic floor, which is why symptoms that were mild for years can suddenly get worse. Why you don't have to choose between giving up high-impact exercise and wearing pads forever — load management, technique changes, and targeted "anterior" pelvic floor training can shift the outcome without giving up the activity you love. How continence pessaries differ from prolapse pessaries — offering targeted support behind the urethra, and sometimes near-instant relief during exercise for some women, while other rehab work continues in the background.
Amanda – The 47-Year-Old Whose Overactive Bladder Won't Let Her Leave the House Anymore Amanda has never had children. Yet for years she's joked about having a "weak bladder" and a pelvic floor that's "shot." Recently, things have taken a sharp turn — sudden, overwhelming urges, leaking on the way to the toilet several times a day, and two embarrassing accidents that have left her staying home rather than risk being caught out again. In this episode of The Perimenopause Puzzle, Pelvic Health Physiotherapist Taryn Watson uses Amanda's story to unpack overactive bladder (OAB) — what it actually is, why it's not the same thing as a "weak" bladder or pelvic floor, and why it can worsen significantly in perimenopause, even in women who've never given birth. Taryn breaks down the real difference between stress and urge incontinence, busts some common fluid and toileting myths, and explains why Amanda's pelvic floor turned out to be too tight, not too weak. You'll learn: Why an "overactive" bladder usually means a bladder — and pelvic floor — working too hard, not one that's weak or failing. The real difference between stress incontinence and urge incontinence, and why they need different treatment approaches. Why drinking more water isn't always the answer — hidden fluid sources like tea, coffee and smoothies can push daily intake well past what the bladder actually needs, and make urgency worse. How chronic constipation can be a genuine driver of bladder urgency, not just a separate, unrelated issue. How declining oestrogen in perimenopause can make bladder and vaginal tissue more sensitive, worsening both urgency and pain with sex — even in women without classic symptoms like hot flushes. If you've ever told yourself you "just have a weak bladder," or you're noticing new urgency symptoms as you move through perimenopause, this episode will change how you think about what's actually going on. Resources Link to Season 2, Episode 1 with Dr Miranda Quenby — more on differentiating perimenopause symptoms Book an appointment with the team at FitRight Women's Health Learn more about our women's health exercise classes Follow us on Instagram and Facebook for more evidence-based women's health education Please note: This episode uses a fictional case study to illustrate a common clinical presentation. Any resemblance to real people or their experiences is purely coincidental. The information shared is for educational purposes only and should not replace personalised medical advice. Thanks for listening to The Pelvic Puzzle. This is still a fairly new podcast, so if this episode resonated with you, a quick review genuinely helps more women find it — please consider leaving one, and share it with a friend who might need to hear it too.
Jacinta assumed perimenopause meant hot flushes. Since she'd never had one — and her periods were still regular — she put her worsening sleep, mood swings, painful sex and dropping libido down to sheer life stress. Turns out that's one of the most common presentations GPs see. In this season-opening episode of The Pelvic Puzzle, host and Pelvic Health Physiotherapist Taryn Watson kicks off Season 2, The Perimenopause Puzzle, with Women's Health GP Dr Miranda Quenby. Using Jacinta's fictional story, they walk through what a proper Well Woman Check actually involves, how to tell perimenopause apart from burnout, stress or thyroid issues, why regular periods don't rule anything out, and a grounded, myth-busting look at menopausal hormone therapy (MHT) — covering the real risk numbers, the benefits beyond symptom relief, and the biggest misconceptions still doing the rounds. You'll learn: What a Well Woman Check actually covers — far more than symptoms alone, including family history, cycle tracking, and a metabolic health check (cholesterol, diabetes risk) as part of a broader "45-49 year old health check." Why there's no reliable blood test for perimenopause — hormones fluctuate too much day to day, so diagnosis comes down to age, symptoms and timeline, not a number on a page. Why regular periods don't rule out perimenopause — with up to 60 possible symptoms, period changes are often not the first sign women notice. The real numbers behind MHT risk — breast cancer risk with combined therapy sits at around 9 cases per 10,000 women-years, lower than the risk linked to inactivity or heavy alcohol use — alongside real benefits like osteoporosis prevention and delayed onset of type 2 diabetes. Four common myths, busted: that you have to wait until your periods stop to seek help, that vaginal estrogen is off-limits after breast cancer, that pregnancy isn't possible in perimenopause, and that "bioidentical" hormones are safer simply because they're natural. If you've ever dismissed your own symptoms because you don't have hot flushes, or you're not sure whether it's "just stress" or something more — this is the episode to start with. Resources Book a Well Woman Check with Dr Miranda Quenby or Dr Brodie Thorpe at FitRight Women's Health in Applecross Season 1, Episode 4 — more on the LIFTMOR trial and bone density, referenced in this episode Learn more about FitRight’s women's health exercise classes Follow us on Instagram and Facebook for more evidence-based women's health education Sign up for our Monday Emails - weekly newsletters with lots more great nuggets of women’s health like this! Please note: This episode uses a fictional case study to illustrate a common clinical presentation. Any resemblance to real people or their experiences is purely coincidental. The information shared is for educational purposes only and should not replace personalised medical advice. Thanks for listening to The Pelvic Puzzle. If this episode resonated with you, share it with a friend or leave a quick review — it helps more women access this kind of information.
Think pessaries are only for elderly women who can't have surgery? Or that once it's fitted, it stays in for months untouched? This episode sets the record straight, and explains how often pessaries can be the missing puzzle piece for prolapse management. In this bonus episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson is joined by her colleague Jess Vanson — a hybrid Sports and Pelvic Health Physiotherapist and Clinical Lead at FitRight HQ — to demystify everything about pessaries, from what they actually are to how they fit into everyday life, sex, exercise, and even preparing for surgery. You'll learn: Why pessaries suit far more than "elderly women who can't have surgery" — from mums wanting to get back to running, to women managing worsening symptoms as they take on grandmother duties, to everything in between. The difference between self-managed and non-self-managed pessaries, and why "insert and forget for months" isn't the full picture. Honest answers to the questions women actually ask — can you exercise with a pessary in, can you have sex with it in, will it hurt? Pessaries aren't risk-free, but the risks are generally low and manageable — and why co-managing with a GP or gynaecologist matters. How a pessary can be used as "pre-hab" before surgery, giving tissue a break from constant stretch and helping predict how your bladder and bowel might respond once everything is lifted back into position. If you've ever wondered whether a pessary might be right for you — or you just want to understand this option before ruling it in or out — this episode is for you. Resources Episode 5 — more on how a pessary can support surgical decision-making and outcomes Episode 1 - prolapse types, staging and ring pessaries Book a pessary consult with the team at FitRight Women's Health Learn more about our women's health exercise classes Follow us on Instagram and Facebook for more evidence-based women's health education Please note: The information shared in this podcast is intended for education only and should not replace personalised advice from your healthcare provider. Some episodes include fictional case studies to illustrate common presentations and how a multidisciplinary team might approach them. These stories are entirely fictional, drawn from a mix of experiences in clinical practice — any resemblance to real people is purely coincidental. Thanks for listening to The Pelvic Puzzle. If this episode resonated with you, share it with a friend or leave a quick review — it helps more women access this kind of information.