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.

Sue – The 65-Year-Old Deciding If Prolapse Surgery Is Right for Her

Sue lived with a mild prolapse for 20 years without it bothering her — until new bladder symptoms, recurrent UTIs and a worsening bulge made her start asking whether it was finally time to consider surgery.

In this episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson is joined by Obstetrician and Gynaecologist Dr Anna Clare to unpack how women and their care team decide if, and when, prolapse surgery is the right call. Using Sue's case as a guide, they walk through what actually goes into that decision, what recovery involves, and how bladder symptoms, recurrence risk and life stage all shape the outcome.

You'll learn:

• Surgery isn't a last resort, but it isn't the easy option either — the right choice depends on symptoms, lifestyle, general health and what matters most to each woman at her stage of life.
• Bladder symptoms can improve, worsen or stay the same after prolapse surgery, and a pre-op pessary trial can help predict how the bladder will respond.
• Recurrence is real — anterior repair recurrence sits around 30%, which is why timing, pre-op preparation and getting it right the first time matter so much.
• Recovery means avoiding heavy lifting for three months, staying on top of bowel habits, and no sex for six weeks — a real consideration for active grandmothers like Sue.
• Good decision-making is a team effort — pelvic health physio, GP and gynaecologist all play a part, whether a woman chooses surgery, a pessary, or a conservative approach for now.

If you or someone you love is weighing up whether prolapse surgery is the right next step — or you just want to understand what that conversation with a gynaecologist actually involves — this episode is for you.

Resources

• Link to previous Prolapse Puzzle episodes on prolapse types, staging, and pessary use (episode 1 and episode 2)
• Learn more about Dr Anna Clare and how to book with her at Woom: https://www.thewoom.com.au/about/anna-clare/
• Book an appointment with the team at FitRight Women's Health - https://fitrightwomenshealth.au/bookings/
• Learn more about our women's health exercise classes - https://fitrightwomenshealth.au/exercise-classes/
• Follow us on Instagram and Facebook for more evidence-based women's health education

Please note: This episode includes a fictional case study to illustrate a common clinical presentation and how a multidisciplinary team might approach it. This story is entirely fictional, drawn from a mix of experiences in clinical practice — any resemblance to real people is purely coincidental. The information shared is for educational purposes only and should not replace personalised advice from your healthcare provider.

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.

Louise has spent years avoiding heavy lifting because she was told it might make her prolapse worse. Now she's preparing for life as a grandmother and has recently been diagnosed with osteopaenia, leaving her with a frustrating question: how can she protect both her pelvic floor and her bones?

In this episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson explores one of the biggest challenges facing midlife women—balancing prolapse management with the strength and impact training needed for healthy ageing.

You'll learn:

• Whether exercise can actually make prolapse worse.
• Why avoiding resistance training may do more harm than good for long-term health.
• How women with prolapse can safely lift weights and exercise with confidence.
• The connection between prolapse, bone health and healthy ageing.
• How pelvic floor rehabilitation, pessaries and strength training can work together to keep women active throughout midlife and beyond.

If you've been told to "just stick to Pilates" because of prolapse—or you're wondering how to exercise safely during perimenopause or after menopause—this episode is for you.

Resources

• LIFTMOR Trial: Heavy Resistance Training and Bone Health
• Link to Episode 1 - Learn more about what is prolapse, what do the types and stages mean
• Link to Episode 2 - Learn more about what is a pessary and how can it help prolapse
• 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. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might benefit. Every share helps more women access evidence-based, multidisciplinary women's health care.

Natalie has lived with prolapse symptoms for years, assuming pelvic floor exercises were the only treatment option. But as her symptoms worsen—and opening her bowels becomes increasingly difficult—she realises it's finally time to seek help.

In this episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson uses a fictional case study to explore posterior vaginal wall prolapse (rectocele), why not all prolapses behave the same way, and why treatment should always be tailored to the individual.

You'll learn:

• What a rectocele (posterior vaginal wall prolapse) is and how it differs from other types of prolapse.
• Why some women struggle to empty their bowels with a rectocele.
• Whether pelvic floor exercises can improve every type of prolapse.
• When pessaries or surgery may be more appropriate than pelvic floor exercises alone.
• How a multidisciplinary team—including physiotherapists, GPs, dietitians and gynaecologists—can help women manage prolapse symptoms and improve quality of life.

If you've ever wondered why your prolapse hasn't improved despite doing your pelvic floor exercises, this episode explains why the answer isn't always as simple as "do more Kegels."

Resources

• Book an appointment with the team at FitRight Women's Health.
• Learn more about our multidisciplinary approach to prolapse management.
• 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. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might benefit. Every share helps more women access evidence-based, multidisciplinary women's health care.

Karina is a mum of three who's finally ready to make time for herself again. She wants to get back into running, but every time she heads out, she's met with the familiar feeling of vaginal heaviness. After reading conflicting advice online, she's left wondering whether prolapse means she'll have to give up running forever—or whether a vaginal pessary could help.

In this episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson uses a fictional case study to unpack the role of vaginal support pessaries, returning to high-impact exercise after childbirth, and how women with prolapse can confidently get back to doing the activities they love.

You'll learn:

• Whether women with prolapse should avoid running.
• What a vaginal support pessary is and how it's fitted.
• Who is a good candidate for a pessary.
• Whether a pessary treats prolapse or simply manages symptoms.
• How pelvic floor rehabilitation, strength training and multidisciplinary care can help women stay active long-term.

If you've been told to stop running because of prolapse—or you've wondered whether a pessary might be right for you—this episode is packed with practical, evidence-informed advice to help you make informed decisions.

Resources

• Return to Running Guidelines (full consensus statement Goom et al 2019)
• Return to Running Patient Checklist from FitRight HQ
• Book an appointment with the team at FitRight Women's Health.
• Learn more about our women's health exercise programs.
• Follow us on Instagram and Facebook for more 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. If you enjoyed this episode, please subscribe, leave a review, and share it with someone who might benefit. Every share helps more women access evidence-based, multidisciplinary women's health care.

Four weeks after welcoming her first baby, Sascha notices a bulge and heaviness in her vagina after a walk. She's terrified that she's caused permanent damage, wonders if she'll need surgery, and questions whether she'll ever be able to have another baby.

In this episode of The Pelvic Puzzle, Pelvic Health Physiotherapist Taryn Watson unpacks this common postnatal scenario using a fictional case study to explore what early prolapse symptoms can mean—and, importantly, what they don't.

You'll learn:

• What pelvic organ prolapse actually is.
• Why prolapse happens after childbirth, and whether it can be prevented.
• What an early assessment with a pelvic health physiotherapist looks like.
• The role of pelvic floor exercises, exercise rehabilitation, pessaries and multidisciplinary care.
• What the long-term outlook is for women diagnosed with prolapse after birth, including future pregnancies and surgery.

Whether you're newly postpartum, supporting someone who is, or you're a health professional wanting a better understanding of prolapse, this episode offers practical, evidence-informed reassurance.

Resources

• Book an appointment with the team at FitRight Women's Health (located in Applecross, WA, telehealth available)
• Learn more about our Baby&Me exercise classes.
• Follow us on Instagram and Facebook for more women's health education
• Sign up for our Monday email newsletter

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 you enjoyed this episode, please subscribe, leave a review, and share it with someone who might benefit. Every share helps more women find evidence-based, multidisciplinary women's health care.