TMI Talk with Dr. Mary

In this episode, Dr. Theresa Pugh and I talk about what’s actually happening in perimenopause, especially the information that isn’t explained clearly. If you're in your 30s or 40s  or you work with women in this age range, this podcast episode is for you.

Dr. Theresa Pugh is a board-certified family practitioner with over 20 years of experience in family medicine. She received her MD degree from the  Medical College of Virginia at Virginia Commonwealth University and completed residency at Carilion Health Systems where she was able to train with the sports medicine department at Virginia Tech. 

A lifelong horsewoman, she continues to ride and compete in hunter/jumpers and became trained in equine assisted learning in the Epona method. She is a facilitator for an Austin-based non-profit called Horselink who provides sanctuary for retired competition horses while providing equine programs for people who have experienced trauma. Dr. Pugh became interested in integrative medicine after being diagnosed with Sjogren's Syndrome. 

Through her own healing journey, she gained valuable insight and experience into utilizing different healing modalities to balance mind, body and spirit. She is currently in private practice at Resilient Health in Austin and enjoys helping others with autoimmune conditions as well as practicing precision,  personalized healthcare using advanced testing and medical genomics. 

We cover:

• Why perimenopause starts earlier than most people realize
• The difference between estrogen dominance and low progesterone in perimenopause and how they can show up together
• What’s really happening when you wake up at 3am or feel ragey
• How symptoms like constipation, hip pain, frozen shoulder, and anxiety can all be hormone-related
• Why labs don't always tell the full story
• What to know about DIM, methylated B vitamins, and hormone detox
• How fascia, nervous system dysregulation, and stress play into it
• Why some people don’t tolerate progesterone and what to do about it
• We also talk about why so many women are told they’re “too young” to be in perimenopause and how to track symptoms so you can advocate for yourself or your patients. This is the conversation I wish more providers were having. It’s time we stop writing off women’s symptoms and start looking at the full picture.

Timestamps:

00:00 Introduction and Welcome

00:26 Understanding Perimenopause Symptoms

02:18 Hormonal Changes and Their Effects

03:37 Estrogen Dominance vs. Perimenopause

05:58 Progesterone and Its Impact

08:04 Detox and Lifestyle Adjustments

13:41 Emotional and Physical Changes

16:50 Hormone Replacement Therapy

29:25 Stress and Hormonal Balance

34:45 The Importance of Connection and Laughter

37:18 Small Changes for Big Impact

37:58 The Importance of Sleep

38:37 Infertility and IVF Stress

42:07 Understanding Menopause and Perimenopause

45:02 Managing Hormonal Fluctuations

50:32 Tracking Symptoms and Seeking Help

57:25 The Role of Vitamins and Supplements

01:07:54 Validating Perimenopause Experiences

01:12:06 Conclusion and Final Thoughts

You can learn more about her and the practice she works at, Resilient Health below:

https://resilienthealthaustin.com/

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

I’m joined by Dr. Sally Sarrel to discuss the hidden layers of pelvic pain that often get dismissed, misdiagnosed, or misunderstood.

Dr Sallie Sarrel is a pelvic physical therapist and person with endometriosis. After diagnosis took 23 years of sheer frustration with the medical system, Sallie created a practice to be a safe haven for all with endometriosis and its associated disorders. 

Together with Dr Andrea Vidali, she founded The Endometriosis Summit to unite surgeons, patients, practitioners and caregivers to drive endometriosis forward. 

She has a passion for treating people with endometriosis with leg, bladder, and groin pain , Sallie gives voice to all who struggle with endometriosis and adenomyosis. Reminding the endometriosis community that you are worthy and together we can ignite change

We dig into:

• What an occult (aka hidden) hernia is, and why it’s often missed on imaging
• Why so many people with groin pain or endometriosis are told "it's your ovary"... when it’s not
• The role of the ilioinguinal and genitofemoral nerves in chronic pelvic pain
• How what we think are yeast infections, are nerve compression causing itching 
• Why your feet, fascia, and diaphragm might be contributing to your symptoms
• How misused medical language can tank a person’s healing and hope
• The role of thoracic mobility, gait, lymph, and nervous system regulation in long-term recovery
• How as pelvic floor physical therapists we have much more skillsets to help our patients besides internal treatments.

Whether you're a patient, a provider, or both, this episode brings truth, education, and advocacy in a way the pelvic health world desperately needs.

00:00 Introduction to TMI Talk with Dr. Mary

00:13 Meet Dr. Sally Rell: Pelvic Floor Specialist

01:06 Episode Overview: Topics on Pelvic Pain

03:14 Welcome to the Show, Dr. Sally Rell

03:42 Understanding Occult Hernias

07:24 Diagnosing Hidden Hernias

08:52 Physical Therapy Approaches for Pelvic Pain

14:35 The Role of the Diaphragm and Thoracic Mobility

18:11 Challenges in the Medical System

23:44 The Importance of Holistic Treatment

28:08 Hydration and Heart Rate Management

28:24 Empowering vs. Traumatic Diagnoses

28:55 Personal Experiences with POTS and Endometriosis

32:03 The Role of Fascia in Health

33:17 Endometriosis: A Surgical Disease

36:17 Diaphragmatic and Lung Endometriosis

41:33 Educating Healthcare Practitioners and Patients

47:29 The Future of AI in Medical Diagnosis

50:57 Conclusion and Contact Information

You can learn more about Sallie at https://salliesarrel.com

If you are interested in the endometrosis summit, you can learn more here 

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

We’re calling out the outdated, fear-based, and sometimes downright harmful approaches that still dominate the fitness and rehab industries.

I’m joined by Autumn Halazon, a personal trainer, Pilates instructor, and founder of Halazon Fitness with over 27 years of experience. From her early days in a full-contact boxing gym to her evolution into fascia-based, intuitive movement coaching, Autumn brings a no-nonsense, whole-body perspective to fitness for women over 40.

We explore how the “textbook form” obsession, aesthetic pressure, and shame-based coaching create pain—not progress. We also unpack how overtraining, instructor ego, and nervous system dysregulation sabotage long-term results for clients…and what to do instead.

Whether you’re a clinician, fitness pro, or just sick of toxic wellness culture, this one’s for you.

What You’ll Learn in This Episode

• Why many fitness certifications don’t prepare you for real bodies
• How form obsession and body shaming sneak into even “wellness”-based spaces
• The harmful legacy of ‘knees over toes,’ posterior tilts, and ‘don’t arch your back’
• How exercise intolerance, chronic pain, and burnout are often signs of nervous system dysregulation
• What happens when movement is used as a trauma response
• Why interoception—body awareness—is the real foundation of strength
• How to coach clients who say “I don’t like strength training” (without forcing it)
• Why overcorrecting or over-cueing is harmful

Timestamps:

00:00 Introduction to TMI Talk with Dr. Mary

00:35 Meet Autumn Halazon: A Fitness Journey

01:19 Challenging Traditional Fitness Norms

03:37 Real-Life Client Experiences

05:02 The Importance of Individualized Training

06:27 Addressing Body Image and Trauma

08:54 Ego and Exercise: A Personal Reflection

11:06 Bridging the Gap Between PT and Fitness

13:23 Empowering Clients Through Education

14:37 Understanding and Teaching Body Awareness

22:47 Healing Relationships with Exercise

27:33 Unlearning Old Fitness Myths

28:31 The Importance of Strength Training

29:49 Motivating Reluctant Clients

31:57 Balancing Self-Love and Discipline

34:03 The Influence of Social Media on Fitness

42:58 The Role of Certifications and Intuition

48:30 The Value of Referrals and Holistic Approaches

50:20 Conclusion and Contact Information

You can learn more about Autumn below:

https://www.halazonfitness.com

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

In this episode, I’m joined by Dr. Mitch Abrams to talk about the real science behind what we feel but often can’t explain: heart coherence, energetic regulation, and the quantum field’s role in healing.

We dive into:

• What heart coherence actually is—and how it's measurable
• How your nervous system sets the tone in every session
• Why compassion and intention shift patient outcomes
• How the Global HeartSync Project is tracking collective coherence globall
• What the quantum field has to do with clinical care (and why it’s not “woo”)

If you’re a practitioner who knows there’s more to healing than protocols, this conversation is your confirmation—and your next step.

0:00 Introduction to Dr. Mitch Abrams and Heart Coherence

01:07 Dr. Abrams' Personal Healing Journey

03:22 The Intersection of Eastern and Western Medicine

07:28 The Science of Compassion and Healing

19:57 The Role of Practitioners in Patient Healing

39:35 Global Implications of Heart Coherence

43:46 Using Cell Phones for Biofeedback

44:09 Global Magnetometers and Coherence

45:07 The Global Consciousness Project

47:13 Impact of Collective Intention

49:03 Understanding Quantum Field and Coherence

51:04 The Power of Intuition and Non-Locality

58:14 The Role of Arts in Global Transformation

01:02:00 Challenges and Opportunities in Modern Society

01:04:34 The Future of Social Infrastructure

01:13:22 Empowering the Youth for Change

01:16:21 Conclusion and Call to Action

You can learn more about Dr. Mitch Abrams below

https://nexgenhealth.solutions

https://globalheartsync.com

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

I sit down with Dr. Jill Stephenson, an orthopedic and pelvic floor physical therapist, hypermobility/POTS specialist, and the newest member of our ResilientRx team.

We dive into the overlap of hypermobility, Ehlers-Danlos, POTS, neurodivergence and sensory processing issues and how these often misdiagnosed or misunderstood patterns can drastically change how someone experiences pain, movement, fatigue, and even relationships.

You’ll hear both our clinical and personal perspectives navigating these diagnoses, how they shaped our work, and what the traditional rehab model often misses with this population.

We cover:

• Why POTS and hypermobility show up together more often than you'd think and how impaired connective tissue affects blood flow, energy, and exercise tolerance

• How neurodivergence (especially ADHD and autism traits) changes the way people feel their bodies, process pain, and respond to cues

• What "fatigue" actually means in this population and why pushing through can backfire

• Why some patients need sensory-safe environments just as much as they need strength programs

• How to spot when someone is overwhelmed and what about our language might be triggering without even realizing it

Whether you're a patient who's felt dismissed or a provider wanting to better your these clients, this one’s for you.

00:00 Introduction and Guest Introduction

00:40 Personal Experiences with POTS and Hyper-mobility

03:50 Understanding POTS and Its Clinical Presentation

06:07 Challenges and Misdiagnoses in Chronic Illness

08:23 Intersections of Neurodivergence and Hyper-mobility

14:21 Navigating Healthcare and Building Support Systems

29:41 The Importance of Self-Care and Sustainable Growth

38:02 Understanding Neurodivergence and Hyper Mobility

39:16 The Impact of ADHD on Daily Life

39:48 Challenges and Misconceptions in Diagnosing Neurodivergence

41:53 The Importance of Community and Support

42:09 Navigating Hormonal Changes and Neurodivergence

45:09 The Role of Physical Therapy in Managing Symptoms

49:08 Balancing Rest and Activity

01:04:54 Creating a Sensory-Friendly Environment

01:09:10 Final Thoughts and Resources

Dr Jill works at my practice in Austin, TX. You can find more about her there or on IG:

resilient-rx.com

instagram.com/learnwithdrjill

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

We explore a connection most clinicians overlook: the link between the feet and the pelvic floor. Whether you treat pelvic health directly or not, understanding this relationship can drastically improve patient outcomes, especially for those with chronic tightness, pain, or pelvic floor dysfunction. You'll learn how fascia, the nervous system, and postural mechanics all play a role—and why traditional Kegels alone often miss the mark.

What You’ll Learn:

• The fascial connections from feet → diaphragm → pelvic floor
• Why tight calves, foot swelling, or poor toe mobility may signal deeper pelvic or lymphatic issues
• How the homunculus explains the foot–genital sensory link 
• How foot pressure and posture influence pelvic floor contraction
• Why traditional Kegels often miss the mark, especially for urinary leakage
• How to use weight distribution cues (big toe, pinky toe, heel) to improve pelvic floor recruitment

0:00 Introduction to Feet and Pelvic Floor Connection

01:00 Fascial Connections: The First Link

07:38 Homunculus: The Brain-Body Map

10:12 Kegels and Pelvic Floor Mechanics

14:34 Practical Tips for Clinicians

18:08 Conclusion and Final Thoughts

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

We dig into where traditional gastroenterology often falls short—and how functional medicine can fill in the gaps. I’m joined by Shefaly Ravula, PA-C a Physician Assistant and Functional Medicine Certified Practitioner, who shares how her background in GI and nutrition evolved into a more personalized, whole-person approach.

We cover common clinical red flags, what to do when patients have “normal” GI tests but still feel terrible, and how to blend diagnostics with nutrition and long-term strategy. We also explore how menopause impacts gut health, the nuance around HRT, and why patient education is everything when it comes to sustainable results.

This episode is packed with insight for healthcare professionals and curious listeners alike who want to better understand the gut-brain-body connection.

What You’ll Learn in This Episode

• Red flags that may point to deeper gut dysfunction (chronic bloating, constipation, diarrhea)
• How microbiome stool tests compare to SIBO breath testing
• Why antibiotics, low FODMAP diets, and gut supplements only offer temporary relief
• The connection between IBS and SIBO—and how many are misdiagnosed
• How functional medicine combines traditional diagnostics with root-cause care
• The relationship between estrogen, motility, microbiome health, and inflammation in menopause
• Why HRT decisions should be individualized, not one-size-fits-all
• How pelvic floor dysfunction and trauma can influence GI symptoms
• What providers can do, even in short visits, to screen more effectively

Timestamps:

00:00 Introduction to the Episode

00:12 Meet Shafaly Founder of Precision Gut Health

00:55 Episode Overview: Key Topics and Takeaways

02:32 Dr. Mary's Approach to Whole Body Healing

03:17 Shafaly’s Journey into Functional Medicine

06:13 Challenges in Integrating Functional Medicine

14:31 Understanding IBS and SIBO

18:30 The Role of Testing in Gut Health

24:09 Antibiotics and Gut Health: A Complex Relationship

29:11 Patient Advocacy and Navigating the Medical System

32:27 Chronic Constipation and Structural Issues

33:04 The Multifaceted Nature of IBS

33:56 The Role of Trauma in IBS

35:01 The Importance of Personalized Medicine

40:43 Challenges with Restrictive Diets and Antibiotics

46:16 Menopause and Gut Health

50:31 The Controversy of Hormone Replacement Therapy (HRT)

57:41 Conclusion and Contact Information

You can find Shefaly below:

IG: @precisionguthealth

https://precisionguthealth.com

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

In this episode of TMI Talk with Dr. Mary, we dive into one of the most overlooked full-body connections: the link between the jaw (TMJ) and the pelvic floor. If your clients are dealing with jaw tension, clenching, or TMJ issues—there’s a good chance they’re also holding tension in the pelvic floor. And if you’re only treating one site, you're likely missing the full picture.

 What You’ll Learn:

• Why tight jaws often mean tight pelvic floors
• The fascial connection from tongue → diaphragm → pelvic floor
• How diaphragmatic restriction leads to compensatory jaw and pelvic tension
• The role of the autonomic nervous system in clenching, grinding, and guarding
• Why HRV and breathwork are clinical tools, not just wellness fluff
• How digestion, posture, and stress all play into this loop

00:00 Introduction to TMJ and Pelvic Floor Connection

01:55 Understanding the Fascial Connection

05:51 Nervous System's Role in TMJ and Pelvic Floor

12:41 Impact of Digestion on TMJ and Pelvic Floor

15:49 Conclusion and Final Thoughts

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

Heather Guidone joins us to help work through all of the noise surrounding endometrosis. 

She the Program Director of the Center for Endometriosis Care and a Board Certified professional health Advocate. She has focused on 'bench to beltway to bedside' efforts in endometriosis research funding and facilitation, legislation and policy reform, education, advocacy and activism, patient-centric care, and more for over thirty years; importantly, she is also someone who has struggled with the disease. 

What we will discuss: 

-Why the "retrograde menstruation" theory falls short

-Why birth control, pregnancy, and hysterectomy aren't  cures

-The key differences between ablation and excision surgery

-Why diagnosis requires skilled listening, imaging, and sometimes biopsy

-How trauma, chronic stress, and nervous system dysregulation can influence symptoms

-The critical role of patient autonomy, informed consent, and individualized care

-How to find a skilled excision surgeon and what questions to ask

-Non-surgical ways to manage endo symptoms (like PT, stress regulation, and nutrition)

Timeline:

00:00 Introduction to Endometriosis Mismanagement

00:28 Meet Heather Guidon: Advocate and Expert

00:59 Debunking Myths: Retrograde Menstruation and More

03:55 Understanding Endometriosis: Beyond Painful Periods

13:03 The Role of Trauma and Stress in Endometriosis

15:09 Patient-Centric Care and Informed Consent

28:18 Diagnosis and Treatment Options

40:05 Understanding Excision and Ablation

42:31 Challenges in Accessing Quality Care

46:09 Questions to Ask Your Provider

49:16 The Importance of Compassionate Care

54:05 Surgical and Non-Surgical Treatments

59:27 The Role of Hormonal Treatments

01:07:01 Endometriosis: A Multifactorial Approach

01:09:35 How to Reach Out for Help

01:13:40 Conclusion and Final Thoughts

You can learn more about Heather at:

https://www.centerforendo.com/

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.

In this episode of TMI Talk, Dr. Mary announces a shift in the focus of her podcast towards addressing health and movement professionals. Dr. Mary highlights the importance of integrating mind, body, and soul in healing practices, especially for chronic pain management. She explores various techniques, including understanding biomechanics, the nervous system, fascia, lymphatic flow, somatics, and Eastern medicine principles. 

She also emphasizes the significance of addressing emotional and spiritual components in healing and the critical role of self-work for healthcare providers. The episode emphasizes a comprehensive, holistic approach to health and pain management, aiming to empower practitioners.

If you're a movement professional and want to stay in touch, sign up for my newsletter below for podcast updates, upcoming events and more.

00:00 Introduction to TMI Talk

00:33 New Studio and Direction

01:06 Focus on Health and Movement Professionals

03:16 Biomechanics and the Nervous System

04:13 Understanding Fascia and Lymphatic System

05:25 Primal Instincts and Modern Lifestyle

07:51 Somatics and Body Awareness

11:47 Incorporating Eastern Medicine

17:51 Holistic Approach to Pain and Healing

23:46 The Importance of Self-Work

31:13 Conclusion and Future Directions

Want support for perimenopause that goes beyond hormones?

Whether you (or your clients) are taking HRT but still having symptoms, not ready for it, or can’t tolerate it...there’s more we can do.

I’ll be sharing practical tools from a movement and rehab perspective, focusing on the nervous system, fascia, lymph, viscera, and musculoskeletal system.

If you want updates on workshops, resources, and strategies to support this phase of life more fully, would love you to join my email list.

Subscribe to my email list here

I’ll see you in 2 weeks!

PS:

If you are interested in being a guest on the show, please fill out the form here.