The Hole Shebang

Perimenopause fatigue has more than one cause, and the right fix depends on which kind of tired you have. In this episode of The Hole Shebang, Kristen talks with Dr. Jessica Drummond, a physiotherapist with a doctorate in clinical nutrition and founder of the Integrative Women's Health Institute, about why perimenopause so rarely arrives to a perfectly healthy body. Dr. Drummond shares a sleep test for sorting ordinary exhaustion from deeper fatigue, explains why hormone therapy can burn when mast cells are involved, and describes how a frozen shoulder can be part of an estrogen story. You will also hear why menopause symptoms, chronic illness and long COVID overlap, why no scan finds the driver, and why she asks for months of small changes with a practitioner who listens. A rapid fire round covers cold plunges, seed cycling and castor oil packs. Timestamps [00:00] Welcome, and why this starts with endometriosis [03:27] Where the immune system, chronic pain and hormone shifts meet [05:23] Why perimenopause rarely arrives to a perfectly healthy body [14:04] What fatigue is: POTS, ME/CFS and post exertional malaise [16:30] The sleep test for sorting one kind of tired from another [17:57] When you cannot sleep, and why sleep can feel unsafe [25:48] What to start earlier: protein, lifting weights and recovery [29:12] Vaginal estrogen, dryness and when mast cells change the plan [35:11] Why the driver matters, and why hormones are not the whole answer [40:42] When it is just hormones: the frozen shoulder example [43:16] Rapid fire on cold plunges, glucose monitors, seed cycling and castor oil packs [48:12] Where to find her, and a free hot flash relief guide [49:02] Theme song What listeners will learn: a simple way to start sorting your tiredness, why a hormone that helps one person can burn another, and why slowing down with a practitioner who listens is part of the treatment. About Dr. Jessica Drummond: Dr. Drummond, DCN, CNS, PT, is the founder and CEO of the Integrative Women's Health Institute, which has taught 3,500 graduates in 62 countries. She is a physiotherapist who earned a doctorate in clinical nutrition, the author of Outsmart Endometriosis, and the host of the weekly Integrative Women's Health Podcast for professionals. Theme Song: American Cars by Noah Kahan Key topics covered Perimenopause, chronic illness and long COVID overlap Fatigue, the sleep test and the nervous system Hormone therapy order, mast cells and a frozen shoulder example Resources and References Mentioned Hot Flash Relief Guide, free from the Integrative Women's Health Institute Integrative Women's Health Institute Integrative Women's Health Institute on Instagram, @integrativewomenshealth More on The Hole Shebang Perimenopause Isn't All in Your Head: Empowering You with the Knowledge You NEED with Jessica Caceres Chronic Pelvic Pain: Real Even When Your Tests Are Normal with Carolyn Vandyken The Missing Link in Endometriosis Care with Physiotherapist Jill Mueller Pelvic health physiotherapy at Blueberry Therapy Connect with Dr. Jessica Drummond Instagram: @integrativewomenshealth Website: integrativewomenshealthinstitute.com Listen and subscribe Subscribe to The Hole Shebang at podcast.blueberrytherapy.ca, leave a review if this helped, and visit blueberrytherapy.ca for more. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth.

Return to running after baby is one of the most searched questions in postpartum recovery, and the guidelines most clinicians use were co written by this week's guest. Grainne Donnelly, Advanced Practice Pelvic Health Physiotherapist, Editor in Chief of the Journal of Pelvic, Obstetric and Gynaecological Physiotherapy and editor of the new Elsevier textbook Sports Medicine and the Pelvic Floor, joins Kristen to talk about leaking during exercise, pelvic floor dysfunction in female athletes and what a decade of new research has changed about postpartum return to sport. From compression shorts and pessaries to the evolutionary reason human pelvic floors work so hard, this is the conversation for anyone who runs, lifts or coaches. This episode is brought to you by SRC Health. Shop SRC garments at blueberrytherapyshop.ca and use the code SRC15 for 15% off. In This Episode [02:29] The short straw: how a maternity rotation labelled a waste of six months became a career [04:57] Nearly half of 325 athletes at the Lima U20 World Championships reported pelvic floor symptoms, and why the research is only catching up now [08:55] Assessing a young athlete: history, bladder diary, real time ultrasound and leaking as a warning sign of underfuelling (RED-S) [15:44] The 2019 return to running guidelines: why they were written and what they screen for [19:56] What changed: the 881 woman study, the three week minimum and why 12 weeks is an average, not a rule [24:13] The product menu: pessaries, Uresta, Poise Impressa and the compression shorts her PhD put through gait analysis [30:28] Run quieter and lean in: free strategy changes that reduce load on the pelvic floor [33:31] The evolutionary chapter: what walking upright cost the pelvic floor, sparked by a chance meeting with Dan Lieberman [41:27] Load capacity in practice: the six double unders method [44:41] The Chrome browser brain: why understanding a symptom changes the symptom What You Will Learn How to tell a load capacity problem from a structural one, what a graded return to running actually looks like, which support products exist and how they work, and why pelvic floor symptoms touch at least one in three women without being anyone's fault. About Grainne Donnelly Grainne is an Advanced Practice Pelvic Health Physiotherapist and founder of Absolute Physio in Northern Ireland. She co wrote the returning to running postnatal guidelines (2019) with Tom Goom and Emma Brockwell, is Editor in Chief of JPOGP and edited Sports Medicine and the Pelvic Floor: Science to Practice (Elsevier, 2026). Her PhD research at Cardiff Metropolitan University investigates compression garments for pelvic floor symptoms in runners. Theme Song: Jump Around by House of Pain and Maniac 2000 by Mark McCabe (she filled in the form twice and we kept both) Resources and References Mentioned Sports Medicine and the Pelvic Floor: Science to Practice (Elsevier, 2026) Returning to running postnatal guidelines (Donnelly, Brockwell and Goom, 2019) The Lima 2024 World Athletics U20 study on athlete pelvic floor symptoms (Giagio et al.) Grainne's research on ResearchGate Products discussed: pessaries (fitted at Blueberry Therapy), Uresta, Poise Impressa, Efemia and Diveen urethral supports, targeted compression garments (SRC Health garments) Keep Listening on The Hole Shebang Pelvic Floor for Athletes: Your Hidden Force Absorber with Dr. Rachel Selman The New Postpartum Exercise Guidelines That Ditch the Six Week Rule with Dr. Margie Davenport Menopause Joint Pain: Why Everything Aches and What Helps with Michelle Lyons Birth Prep: The Movement Work Nobody Taught You with Gina Conley Connect with Grainne Website: absolute.physio Instagram: @grainnedonnelly_absolutephysio Our Sponsor: SRC Health SRC makes medical grade compression garments for pregnancy, bladder leaks and mild pelvic organ prolapse. The Restore short is the one Kristen reaches for most in clinic. It supports your pelvic organs while you and your pelvic floor physiotherapist do the strengthening work. Blueberry Therapy has carried SRC garments for years. Shop the full range at Blueberry Shop, same price as buying direct and shipped from the clinic in Canada. Use the code SRC15 for 15% off. Many extended health plans cover compression garments with a prescription, so check your benefits before you assume you are paying out of pocket. Ready for Support? Blueberry Therapy offers pelvic health physiotherapy, pessary fittings and return to sport planning in Dundas, Ontario and virtually across the province: blueberrytherapy.ca Subscribe to The Hole Shebang at podcast.blueberrytherapy.ca, leave a review if this episode helped, and connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth.

Pelvic girdle pain affects about one in two pregnancies, and most women who have it are told a story about relaxin, loose ligaments and an unstable pelvis that research disproved back in 2012. In this episode of The Hole Shebang, Kristen Parise sits down with Dr. Sinead Dufour, PT PhD, Associate Clinical Professor at McMaster University, to explain what pregnancy related pelvic girdle pain is: a sensitive, protective nervous system rather than a structural failure. They cover the real risk factors, the three step treatment model, symphysis pubis dysfunction as a harmful label and how virtual pelvic health physiotherapy is reaching women who could never get to a clinic. This episode is brought to you by kGoal. Shop kGoal smart pelvic floor trainers at blueberrytherapyshop.ca and use the code kGoal15 for 15% off. In This Episode [01:01] Twin mama first: how twins during a PhD pulled Sinead into pelvic health [03:46] One foot in the clinic, one in research, and why both get better [07:14] One in two: how common pelvic girdle pain is in pregnancy and the first postpartum year [08:50] Normal pregnancy aches versus pain that persists [11:23] The relaxin story, and why twins with 3.6 times the relaxin disprove it [14:29] Not a stability problem, a sensitivity problem: nociplastic pain explained [17:08] Beliefs beat biomechanics: the harm in the label symphysis pubis dysfunction [19:42] The eight or nine established risk factors, and none of them are structural [21:48] Guarding, the threat response and what good treatment looks like [23:52] Three steps: making sense of pain, exposure with control, lifestyle [34:18] Virtual pelvic health care, and when you still need hands and eyes in person [40:09] The Ontario fix: pelvic health in the public health nurse visit, and teaching teens their bodies [44:47] Theme song: Bitter Sweet Symphony What You Will Learn How to tell an ordinary pregnancy ache from pelvic girdle pain that needs care, why the relaxin and instability explanations failed the evidence, which risk factors matter (previous trauma, second pregnancies, fear, depleted energy, smoking, higher BMI, a history of episodic low back pain, synthetic progestin use and lack of belief that things will improve), what modern treatment involves and how virtual care opens the door for women far from a pelvic physiotherapist. About Dr. Sinead Dufour Sinead Dufour, PT PhD, is an Associate Clinical Professor in the School of Rehabilitation Science at McMaster University, where she teaches across medicine, nursing and rehabilitation science. She practices virtually through the National Pelvic Health Collective, is a founding partner of The WOMB perinatal care centres, led the SOGC guideline on conservative care of urinary incontinence and co authored FIFA's decision aids for pregnant and postpartum footballers. Her course Reframe Pelvic Girdle Pain retrains clinicians worldwide. Theme Song: Bitter Sweet Symphony by The Verve Resources and References Mentioned Reframing beliefs and instiling facts for contemporary management of pregnancy-related pelvic girdle pain (British Journal of Sports Medicine, 2022) Understanding and managing pelvic girdle pain from a person-centred biopsychosocial perspective (Beales, Slater, Palsson and O'Sullivan) Reframe Pelvic Girdle Pain: A 21st Century Approach (Sinead's course for clinicians on Embodia) Listen to More Episodes Like This All at podcast.blueberrytherapy.ca: Chronic Pelvic Pain: Real Even When Your Tests Are Normal with Carolyn Vandyken (Ep101), Sinead's research collaborator on the nociplastic pain side of this story The New Postpartum Exercise Guidelines That Ditch the Six Week Rule with Dr. Margie Davenport (Ep66), who named Sinead on air as a leader in remote pelvic care Empowering Exercise During Pregnancy with Dr. Christina Prevett (Ep6) Pregnant or postpartum and dealing with pelvic girdle pain, incontinence or prolapse, or wondering about a pessary fitting like the ones mentioned in this episode: the Blueberry Therapy team offers pelvic health physiotherapy in Hamilton and virtual consultations across Ontario at blueberrytherapy.ca. Our Sponsor: kGoal kGoal makes smart pelvic floor trainers that show you what your pelvic floor is actually doing. Doing Kegels in the dark is the most common reason they do not work, and real time biofeedback replaces the guessing with something you can see. Blueberry Therapy carries the full kGoal range. The Classic is the insertable trainer most people start with. The Boost is a sit-on-top trainer you use fully clothed, which makes it the one Kristen recommends for pelvic pain, early postpartum and anyone who finds insertion uncomfortable. Both train the pelvic floor to release as well as contract. Shop kGoal at blueberrytherapyshop.ca and use the code kGoal15 for 15% off. Not sure which trainer fits, call the clinic at 289-238-8383 and a member of the pelvic health team will help you choose. Connect with Dr. Sinead Dufour McMaster experts page National Pelvic Health Collective (virtual care) Instagram @dr.sinead Subscribe to The Hole Shebang at podcast.blueberrytherapy.ca, leave a review if this episode helped you and connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth.

The first 1000 days of life, from before conception to a child's second birthday, set the foundation for lifelong health, and most of us have never been told the window exists. In this episode of The Hole Shebang, Kristen sits down with Dr. Deb Sloboda, professor and Associate Chair of Research in Biochemistry and Biomedical Sciences at McMaster University and Tier 1 Canada Research Chair in Early Origins of Health and Disease, to walk through the developmental origins of health and disease in plain language. They cover preconception health for both partners, why the placenta is a fetal organ with a sex, epigenetics explained as dimmer switches, stress hormones in pregnancy, the gut microbiome and The Art of Creation, her arts based science translation project now headed to the British Science Festival. This episode is brought to you by kGoal. Shop kGoal smart pelvic floor trainers at blueberrytherapyshop.ca and use the code kGoal15 for 15% off. In This Episode [01:02] From French major at Guelph to falling for embryology at the Ontario Veterinary College [04:10] What the developmental origins of health and disease means [06:30] The first 1000 days, the window nobody talks about [08:18] The placenta is the baby's organ, and it has a sex [11:14] Male preconception health, the gap in research and healthcare guidelines [12:36] The six month preconception checklist for the partner with the sperm [14:17] Birth weight, famine cohorts and the metabolic thread in the research [18:00] Epigenetics explained: dimmer switches on your DNA [20:30] Stress in pregnancy and the placenta's cortisol gatekeeper enzyme [25:57] How first and third pregnancies reshape the gut microbiome differently [30:42] The Art of Creation: rappers and sculptors inside a pregnancy lab [35:57] Art Gallery of Hamilton to the British Science Festival in Southampton [38:00] The five words a Hamilton rapper said after a month in the lab [41:16] Art workshops for clinicians and where to find Deb [42:35] Theme song time What Listeners Will Learn Listeners will leave understanding that health trajectories begin before birth, that preconception advice applies to sperm as much as eggs, that the placenta actively protects a baby from everyday maternal stress, and that serious depression in pregnancy deserves treatment rather than guilt. They will also hear how art carried this science to the public better than any lecture. About Dr. Deb Sloboda Dr. Deborah Sloboda is a professor and Associate Chair of Research in the Department of Biochemistry and Biomedical Sciences at McMaster University and holds a Tier 1 Canada Research Chair in Early Origins of Health and Disease. She has published 147 papers and 17 book chapters, won the 2015 Nick Hales Award, the 2017 Hamilton YWCA Woman of Distinction Award in Science and McMaster's 2024 President's Award for Excellence in Graduate Supervision, and is a founding co president of the DOHaD Society of Canada. She leads The Art of Creation, an arts based knowledge translation program. Theme Song: Once in a Lifetime by Talking Heads Key Topics Covered Developmental origins of health and disease and the first 1000 days Preconception health and sperm health The placenta, epigenetics and stress during pregnancy The gut microbiome in pregnancy Arts based knowledge translation Resources and References Mentioned The Sloboda Lab: slobodalab.com The Art of Creation: artofcreationstudy.com Sloboda Lab on YouTube (LT the Monk's spoken word piece and the art pieces) The Art of Creation results paper (Journal of Developmental Origins of Health and Disease, July 2026) DOHaD knowledge and diet quality in pregnancy, from the Mothers to Babies study (Maternal and Child Nutrition) Maternal diet, placental hypoxia and fetoplacental immune balance (Biology of Reproduction, 2025) Paternal obesity and placental blood vessel development (Biology of Reproduction, 2022) Paternal obesity and the sperm epigenome (eLife) Dr. Sloboda's publications on Google Scholar Listen to More Episodes Like This Find them all at podcast.blueberrytherapy.ca: Secrets to a Healthy Pregnancy Journey with Dr. Kristi Adamo (Ep18) Healing the Gut for Hormone Balance with Stephanie Singh (Ep7) The Fertility Factors Nobody Talks About with Rachel Corradetti Sargeant (Ep31) It's More Complicated: Understanding Hormones with Dr. Stacey Ritz (Ep28) Understanding Severe Maternal Morbidity with Dr. Giulia Muraca (Ep9) Our Sponsor: kGoal kGoal makes smart pelvic floor trainers that show you what your pelvic floor is actually doing. Doing Kegels in the dark is the most common reason they do not work, and real time biofeedback replaces the guessing with something you can see. Blueberry Therapy carries the full kGoal range. The Classic is the insertable trainer most people start with. The Boost is a sit-on-top trainer you use fully clothed, which makes it the one Kristen recommends for pelvic pain, early postpartum and anyone who finds insertion uncomfortable. Both train the pelvic floor to release as well as contract. Shop kGoal at blueberrytherapyshop.ca and use the code kGoal15 for 15% off. Not sure which trainer fits, call the clinic at 289-238-8383 and a member of the pelvic health team will help you choose. Connect with Dr. Deb Sloboda Website: slobodalab.com and artofcreationstudy.com Instagram: @sloboda_lab and @aoc_study LinkedIn: linkedin.com/in/deborah-sloboda Connect with The Hole Shebang If this episode made you feel less alone, that is the entire point of this show. Subscribe, leave a review and tell us what you want to hear next. If you are planning a pregnancy or in one now, Blueberry Therapy's multidisciplinary team supports every stage, book at blueberrytherapy.ca. Follow The Hole Shebang on Instagram at @blueberrytherapypelvichealth

Menopause joint pain is more common than hot flushes, yet most women have never been told the two are connected. In this episode of The Hole Shebang, pelvic health physiotherapist Kristen Parise talks with Michelle Lyons, the Irish chartered physiotherapist behind Celebrate Muliebrity, about the musculoskeletal side of the menopause transition: why joints, tendons and muscles ache when estrogen falls, which perimenopause symptoms start before periods stop, what protects brain health and bone density, and how vaginal estrogen plus pelvic floor physiotherapy changes bladder symptoms, comfort and confidence. Michelle has spent 30 years in women's health, teaches clinicians worldwide and hosts the Celebrate Muliebrity podcast, which passed 100 episodes this year. This episode is brought to you by kGoal. Shop kGoal smart pelvic floor trainers at blueberrytherapyshop.ca. and use kGoal15 to save 15%. In This Episode [02:43] The symptoms nobody connects to menopause: hip pain, rotator cuff trouble and back pain, and why they beat hot flushes for prevalence [06:30] Osteoarthritis is inflammation, not wear and tear, and why that changes treatment [08:24] The realistic starting plan: sleep hygiene, morning light and what to do about wine [11:17] Hormone therapy, heavy perimenopause periods and the iron deficiency almost nobody checks [16:21] Brain fog: hydration, iron and the honest state of the estrogen and dementia evidence [18:24] What is proven for brain health: leg strength, aerobic exercise and a Mediterranean style diet [24:40] Bone health: four prunes a day, tahini for calcium, impact and balance training [27:28] Pelvic health concerns keep one in two women from exercising [29:34] Genitourinary syndrome of menopause: dryness, leakage and the bladder that fills faster [31:54] Vaginal estrogen plus 12 weeks of pelvic floor physio, the combination that works [37:04] Celebrate Muliebrity at 100+ episodes and Michelle's theme song What Listeners Will Learn Listeners will come away knowing how to spot perimenopause early, what blood work to ask for, which lifestyle levers have real evidence behind them and why treating pelvic health is the gateway to staying strong, active and confident through midlife. About Michelle Lyons Michelle Lyons, PT, MISCP, is a chartered physiotherapist from Ireland with 30 years of experience in women's health, licensed in Ireland and the US. She is the founder of Celebrate Muliebrity, where her online courses include The Menopausal Toolbox, and she hosts the Celebrate Muliebrity podcast. She co founded the Women's Health Physiotherapy community and founded Global Pelvic Physio. Theme Song: You Gotta Be by Des'ree Key Topics Covered Menopause joint pain and the musculoskeletal syndrome of menopause Perimenopause symptoms, heavy periods and iron deficiency Brain fog and what protects brain health Bone density, osteoporosis prevention and impact training Genitourinary syndrome of menopause, vaginal estrogen and pelvic floor physiotherapy Resources and References Mentioned Michelle's courses and podcast: celebratemuliebrity.com Global Pelvic Physio group for clinicians, moderated by Michelle Canadian research on vaginal estrogen with pelvic floor muscle training by Joanie Mercier Pelvic health physiotherapy at Blueberry Therapy: blueberrytherapy.ca More Episodes Like This Find them all at podcast.blueberrytherapy.ca: Menopause and Muscle: It Is Not Too Late to Get Strong with Dr. Stuart Phillips Your Vagina Is Shrinking and Nobody Told You: The Hormone Conversation We NEED with Dr. Carrie Jones Sleep, Sex and Menopause with Dr. Woganee Filate Perimenopause and Hormone Replacement with Dr. Alison Shea Sex After Menopause: The Truth Your Doctor Won't Say with Shirley Weir Connect with Michelle Website: celebratemuliebrity.com Instagram: @michellelyons_muliebrity Our Sponsor: kGoal kGoal makes smart pelvic floor trainers that show you what your pelvic floor is actually doing. Doing Kegels in the dark is the most common reason they do not work, and real time biofeedback replaces the guessing with something you can see. Blueberry Therapy carries the full kGoal range. The Classic is the insertable trainer most people start with. The Boost is a sit-on-top trainer you use fully clothed, which makes it the one Kristen recommends for pelvic pain, early postpartum and anyone who finds insertion uncomfortable. Both train the pelvic floor to release as well as contract. Use the code kGoal15 for 15% off. Shop kGoal at Blueberry Shop.  Not sure which trainer fits, call the clinic at 289-238-8383 and a member of the pelvic health team will help you choose. Enjoyed This Episode? Subscribe and leave a review, it helps other women find the show. Book a pelvic health assessment at blueberrytherapy.ca or call 289 238 8383. Perimenopause and menopause pelvic health support is one of the things our multidisciplinary team does best. Connect with The Hole Shebang on Instagram @blueberrytherapypelvichealth