The Menstruality Podcast - 155. A Trauma-Informed Approach to Healing Pelvic Pain (Dr Peta Wright)

Episode Date: July 18, 2024

24% of women and people who bleed in the UK suffer from chronic pelvic pain, it’s 1 in 5 in Australia where our guest today, gynecologist Dr Peta Wright lives and works. Dr Peta wrote her book Healing Pelvic Pain: transforming the trauma of period pain, endometriosis and chronic pelvic distress to explore a wide range of treatments which often aren’t prescribed, including lifestyle changes, stress management and particularly therapeutic work focused on locating trauma in the body. Because, over years of extensive research and working with women and menstruators with pelvic pain, she she’s seen a huge correlation between nervous system dysregulation, early childhood trauma, chronic stress and chronic pain. She says, “as I began to see more and more women through this more holistic lens, I realised that time, care and love were just as important as drugs, surgery and physiotherapy - if not more so. This is, in essence, the first part of establishing safety and stability for the traumatised nervous system - which nearly every patient with chronic pain has".We explore:A brief history of period and pelvic pain - from ancient female healers like Hildegard von Bingen and the wise women of Egypt, and how the mind-body dualism birthed with Descarte's “I think therefore I am” philosophy impacts the way we understand pelvic pain today. (Including modern medical racism where Black women’s pain is regularly dismissed).How the nervous system acts as a mind-body bridge in the healing process. As Dr Peta says “your pelvic pain is not simply the result of a lesion or all in your head. We need to learn to listen and uncover the missing pieces that live in the space between mind and body”.The research that documents the connection between pelvic pain and trauma, starting with the famous ACEs study from the 1990s, all the way to the latest cutting edge science including polyvagal theory and how our perception of danger effects how we experience pain (as well as every other system in our bodies). ---Receive our free video training: Love Your Cycle, Discover the Power of Menstrual Cycle Awareness to Revolutionise Your Life - www.redschool.net/love---The Menstruality Podcast is hosted by Red School. We love hearing from you. To contact us, email [e-mail]---Social media:Red School: @redschool - https://www.instagram.com/red.schoolSophie Jane Hardy: @sophie.jane.hardy - https://www.instagram.com/sophie.jane.hardyDr Peta Wright: @verawellness.com.au - https://www.instagram.com/verawellness.com.au

Welcome to the Menstruality Podcast, where we share inspiring conversations about the power of menstrual cycle awareness and conscious menopause. This podcast is brought to you by Red School, where we're training the menstruality leaders of the future. I'm your host, Sophie Jane Hardy, and I'll be joined often by Red School's founders, Alexandra and Sharni, as well as an inspiring group of pioneers, activists, changemakers and creatives to explore how you can unashamedly claim the power of the menstrual cycle to activate your unique form of leadership for yourself, your community and the world. Hey, welcome back to the podcast. Thank you so much for joining us today. This is such a powerful conversation. I'm so glad you're here. So in the UK, 24% of women and people who bleed suffer from chronic pelvic pain.

And it's one in five in Australia where our guest today, gynecologist Dr. Peter Wright, she's amazing. That's where she lives and works. So Dr. Peter Wright wrote her book, Healing Pelvic Pain, Transforming the Trauma of Period Pain, Endometriosis and Chronic Pel and chronic pelvic distress to explore a wide range of treatments which often aren't prescribed for chronic pelvic pain including lifestyle changes, stress management and particularly therapeutic work focusing on locating trauma in the body because over years of extensive research and working with women and menstruators with pelvic pain she's seen a huge

correlation between nervous system dysregulation and early childhood trauma and chronic stress the kind of chronic stress that many of us experience in our cultures and chronic pain she says as I began to see more and more women through this holistic lens, I realised that time, care and love were just as important as drugs, surgery and physiotherapy, if not more so. This is in essence the first part of establishing safety and stability for the traumatised nervous system which nearly every patient with chronic pain has. For me personally, as a woman who's lived with chronic pelvic and gut pain for many years, I learned so much from this conversation about pain, trauma, the nervous system,

and a lot of which I'm going to be implementing in my life. So I'm so personally grateful. I hope it's inspiring for you. Let's get started with a trauma-informed approach to healing pelvic pain with Dr. Peter Wright. Thank you so much for being with us today, Peter. I, reading this book, was very moved as a woman who's had chronic pain and thinking of all of the women and people in our community who experience pain and just how helpful this book is. And I'm really grateful to be in conversation with you. And we can see how we can tease open some of the amazing teachings specifically around or particularly around healing pelvic pain and trauma. I think it's, it's huge. So thank you so much for making

the time to be with us today. Thank you so much for having me. And thank you for reading the book as well. It's always exciting when people have read the book. So thank you. Yeah, yeah. So well, let's start with a cycle check in like we always do. I'm on day 14, which means that being up at 430 in the morning is actually quite a delight. Oh, goodness. Yes. Oh, I'm glad. I'm here in sort of summer solstice vibe. So it's very light already light already and yeah just feeling a lot of rising energy and feeling strong in myself how about you where are you at in your cycle how's it feeling um I'm about day two so potentially the opposite of you um it's kind of um this is my day off where I'm not seeing patients clinically. So it kind of is quite nice that this is that it's falling today.

And also because we're coming up to the winter solstice in Australia, there's lots of inward energy, those longer nights. And so I think it really suits having a period around the winter solstice, although the moon is almost about to be full, which is a bit probably suits you more. But it is, yeah, it's really nice to be able to have that time where I'm able to do a bit more freely rather than, you know, sitting at a desk all day when I'm bleeding.

So, yeah, and really nice to be talking about this and have the first question be about that. That's so exciting. So thank you for asking. I wish there were more conversations about it and there was more, it was infused into our day-to-day language more that would start to change the world yes yeah I often forget that not everyone does cycle check-ins at the start of every day so sometimes you drop off and I'll be talking

about my period and people will be a bit baffled by me so it's interesting I was talking to Dr. Lara Owen she's one of the early trailblazers of the menstrual cycle awareness movement and she was talking about how we what we were talking about was the menstrual cycle and menopause in the workplace and how wonderful it would be if there was menstrual leave for everybody so it just feels very beautiful to feel you in your day off client work on your day two and how you're honoring that and yeah I think that's changing the world too yeah and I also always love speaking to people when they're on their bleed because it feels there's a sacredness to it so and that you're

in the winter solstice on your bleed and I'm in the summer solstice ovulating feels very fun I know very aligned very aligned so I'd love to hear about what inspired you to write Healing Pelvic Pain. I know it's a big story, but if you could begin to walk us into that. So I am a gynecologist and I was trained very conventionally. So I guess the way we're all trained in medical school and in gynecology, which weirdly, when I look back on it, you know, I read somewhere the other day that medicine is the study of disease. And it's not really the study of, you know, health, really. It's all about the pathology and that was certainly my experience at medical school and in my specialty training where we kind

of learnt to view the body as the problems that women would come in with always as a pathology that was intrinsic to the body of the woman. And all of the fixes were things that we did often with pharmaceuticals or surgeries. And, I mean, the very, like the backbone of our specialty is built on that, you know, even the way in Australia we have Medicare and the way that there are item numbers

for surgeries but the item numbers or the amount that a patient gets back or the doctor gets paid from the government for consults, taking the time to listen to women is actually very small because the government kind of expects that our doctors would do lots of surgery and that's where they earn their money, right? And so it's just really built on this, you know, pathology and what we can do to women without educating them

about their bodies, without educating them about their bodies, without teaching them about how their environment is absolutely critical in how things come up in their bodies, how their menstrual cycle is affected. Because often just by like teaching women about that, you can start to help heal a lot of their problems. So anyway, I was in this system and, you know, being trained with our training was pain, have to do a laparoscopy, have to look for endo or the pill, menstrual suppression of any type. And, you know, if we don't find endo, okay sorry it's probably a gastro and a gastro thing like go and see a gastroenterologist um which is very unsatisfying for the patient and it became

incredibly unsatisfying for me because the more I did it and the more I actually listened to women and especially when I started doing private work so I would have more time and I would follow up my own patients. I would be like, this actually isn't working. This model isn't really working very well. And the more and more I spoke to women, there was similarities in their stories. There was a huge association. This isn't the case for everybody, but, you know, the evidence bears this out. And it was certainly my experience in clinical practice that there's a huge correlation between, you know, trauma is like a very broad word. I would say nervous system dysregulation, early childhood trauma,

chronic stress, something that results in nervous system dysregulation, early childhood trauma, chronic stress, something that results in nervous system dysregulation and chronic pain, which you can only tease out by giving someone the time to hear their story, right? And so the more I learned about this and then the more I realized actually the surgery isn't really working very well and often women are coming in not wanting to be on the hormonal things that they've been put on and they're just feeling very confused and dissatisfied and like there has to be another way and I thought there's got to be another way there has to there's a route here that I can see that's coming up with so many, for so many women.

How can we start to acknowledge that? And, you know, when I first started learning about it, I was kind of very angry with them when I went back to the research and found, say, the ACEs research, like the Adverse Childhood Events research that was done in the 90s, which showed that adverse childhood events and then and the more you have the more it's correlated with adverse physical things in later life and they could be anywhere from we would expect you know you'd expect mental health challenges

but pain immune autoimmune disease cancer heart, heart disease, so many things. And I remember reading, it was like an opinion piece from the doctor who originally oversaw this study saying that we are already kind of society has failed people who have had trauma and we've not acknowledged it. But as medical professionals, if we continue to not acknowledge it, we're further traumatising people and we're adding to their pain. And I was like, how come I never learnt about this at medical school?

And that was, you know, in the 2000 and something, like 20 years after. So then I was in a position where I was seeing lots of, lots of people trying to give them lots of time, but also working in a very, it was a really male dominated gynae clinic, which seems like a weird thing, but it was, they were all men. And I thought, oh, I just was so, I did some more, um, training in like integrative medicine. I read lots of books I like and this is also coming from a place where I was 36 I think I was 35 and a bit when I went

off the pill so I was on the pill for a really long time and when people would say to me is it okay like mothers of teenagers would say is it okay to go on the pill? And I was taught from my mentors back when I was a junior trainee to say, yes, it's totally fine. Everybody, every gynecologist in the city who's smart, who's savvy, of course, why would you want a period? So of course we're all on the pill and it's fine unless they're pregnant or breastfeeding. And I would say this and it makes me want to vomit now. And I went off the pill at like 35 and that was fortunate enough to fall pregnant and then had my baby and then I think then I was like a veil was kind of lifted from my eyes too um with how I felt differently in my body and um

yeah and then I went down this track where I was like everybody needs to know more about their body I can't believe we're not teaching women about this because if they knew how their body works the things that can affect it then there's so much they can do before then they're labeled with a pathology that they probably don't actually have which then they need to identify with and so I remember going to um do you know Lucy Peach? I love Lucy yeah we've interviewed her on the podcast yeah. I was like seeing all of her stuff and she was coming over to Brisbane where I'm based to do something and I reached out to her and said oh would you like to collaborate I think it would be so cool to do a an event where we raise money for charity and we also do like a big educational event and I can talk about medical stuff and you can do your show

and it'll be really cool and she was really down with it and And I remember going to my, I was so excited, and I remember going to the, like, all-male board of the groups that I worked in to say, this is, like, an amazing opportunity. Like, we can do things really differently and start to really empower women rather than just be, you know, fixing their problems or telling them they're broken and then we can come to the rescue, right? And I had this whole presentation and I remember sitting around this boardroom and I was like right at the end

of the boardroom table and they all kind of looked at me like I was crazy. And then I remember getting in my car afterwards and just like bursting into tears and being like, why? And then angry, like why and then angry like why did I even think I had to ask permission to do that as like a 38 year old woman who is a medical specialist in you know uh and then I rang my friend who's a naturopath and she said screw it let's do it together and we did and it was amazing and we had these two incredible shows one for younger girls and one

for women and it was just incredibly beautiful and from there I was like this is the way I want to practice like the heart of everything is teaching women what's right with their bodies and how they can live more in alignment so that their bodies work well and they're as healthy as they can be rather than us all running around in this kind of very suboptimal place for our bodies to work and then when it doesn't feeling like we're broken and we're a failure um so and then I left that old work and then created um this place that's out in the hills outside of Brisbane and it's in nature and we have just an amazingly beautiful team and we just do things in a really aligned beautiful way and I'm more aligned so that that shows I think to patients as well so, and then the book came out of basically just I guess the other thing is getting frustrated about, and I don't know what it's like in the UK, but while there is more awareness of the understanding of period pain and pelvic pain, and it seems like a controversial thing for me to even to say but there's awareness but it's

all very very simplistic and it's all very focused on endometriosis as a lesion and this kind of feeling that it all needs to be diagnosed early and that means an early operation but the problem with that is from someone who has worked in this area and done those operations and also seen those operations done by the best people, they don't, they really treat the tip of the iceberg and sometimes make it worse. And especially if you're not addressing the other factors that contribute to pelvic pain, it just is harmful, I think. And so that narrative, I think, I mean, if we think about it over the course of the last, say, 30 years, I think, at least in Australia, pelvic pain and period pain has just risen exponentially. You know, I would say that the more women have been on the pill than ever,

so to suppress periods and stuff, and yet still there is this increase in pain. And we've probably had more awareness about endometriosis and have done more surgeries than ever. And yet more and more women are suffering with pain. And so there is something wrong with the paradigm, and that's why I wrote the book, to try to teach women about all the other things that are contributing to their pain so that when they go down the conveyor belt of the conventional, I've got pain, it must be endo, I have to have an operation, and then they're not better, they don't then think, oh, my God, I must really be broken it must be endo, I have to have an operation, and then they're not better. They don't then think, oh, my God, I must really be broken then because even this, which is given to me as the thing

that everyone should be having, hasn't fixed me. And it's much deeper than that and it's more nuanced and there's just I don't think there's room or understanding of complexity in the media. And so I just and I was kind of sick of seeing women, 10 laparoscopies down the track, feeling broken, that it was their identity, having no way out, feeling completely disempowered.

And I just knew that there was a limited number of people that I could see one-on-one. And so I just really, really wanted to write this book to help give women the information to empower them that they have choices and they have options and that give them the knowledge and help them remember the knowledge that I think we all have in our bones. It's so beautiful to hear you. And I feel your alignment, you know, when you said, you know, I'm here in this in Vera is called isn't it Vera wellness in the countryside, and we're doing things in an aligned way is always just an honor and a gift for me to be with a woman who is fully in her calling. And I can feel it in you you um I have a question about that but just first

there was a there was a point in your book where you said flipping the script to one of such positivity may not be easy at first and you're talking about moving from this fixing model to empowerment model if you see your body as the enemy and have suffered immensely you may want to throw this book at the wall right now I don't blame you something in me just when I read that it was just feeling so tender with the huge frustration of month after month after month or maybe just consistently throughout the month the pain that women and people who bleed are in. So it just feels important to say that to anyone listening that's like, oh, I'm in so much pain, I don't know how to do this, that you're, yeah, you're really with them, aren't you?

You're really with them. Yeah, and of course you don't come to this overnight, especially when we live in a culture that is so conditioned us from children before even like in the in the like people talk about generational trauma like there's that that we carry before we we can't even verbalize how we know that you know um but such negativity about periods and cycles and that this expectation that it's going to be you know a hassle at best there's no reverence for it there's no um there's no um acknowledgement or celebration for what the menstrual cycle is doing. You know, as I say to the women that come and see me, the period, the bit that we see, the period is the end

of the process of how we make our hormones, which is so important to our life force and our brain and our energy and our skin and our bones. And it's a product of that. And also I think it's really hard when we live in a society that's so patriarchal and capitalist where the model of success is seen as do, do, do, do, do, productivity at all costs, rest, and that rest isn't seen as what we want to achieve, right?

And I think we can all to some degree see that this model of society is to the detriment of our society, our planet, our people. You know, we see it in the lives of chronic stress that we live every day and how that impacts our natural world. And what I would love women to know is that we are not separate from nature. We are nature. And I think sometimes that's the very thing that is threatening to that patriarchal capitalist growth at all costs model is

that women's bodies or the bodies of people who menstruate or have a cycle have that that's not linear. And we mirror the cycles, the seasons of nature every month. And, you know, just like we would never expect an apple tree to grow fruit every single day of its life we see that there are seasons for that and I think when we understand that as as people who have this cycle rather than seeing the period as this hassle because I think the thing is about pain part of the reason I think we have so much pain is because um we have to pretend that it's not happening and we have to

keep going and um if we could see it for what it is which is this time of um this downtime this going inward this resetting this slower pace um I think there'd be way less women in my doctors, in my office. I think we have this huge advantage that we can reset and like follow those seasons of nature, which is so much more sustainable overall. My husband always says to me, I wish I had a period that I could have like the time where I get to have my bath and, you know, have you call me and say, can you bring me some chocolate and whatever. I think maybe all people have, you know, we have so much to learn from the bodies of people who cycle and menstruate

because they teach us about nature. And if we can realise that and that power comes from that reset, that inner going inwards, then like that's hugely powerful to me. Hugely. Yeah. Red School was really born from one of our co-founders, Alexandra, in immense pain, which suddenly came on when she was 30,

saying, okay, my body is speaking to me. Sending me a message. Yeah. It's speaking to is speaking to me sending me a message that yeah it's speaking to me sending me a message I'm gonna listen and she she was a psychotherapist so she was able to work her life around this and she was able to take one or two days to fully rest and and listen and be with her body and it was that process of being with her body that led to all of the work and the naming of the inner seasons of the menstrual cycle, everything that's come from it. And she was also over time able to heal the pain. So she turned towards it rather than tried to protect and resist it.

Yes. Yeah. And she was supported to do that by her specific culture that she was in and I want to speak about women and pain specifically there was a piece in your book where you said pain and suffering seem to have afflicted women since eve in our ancestral lineage as women in our culture and in the stories that have seeped into our veins we have been conditioned to expect pain um there's something going on here isn't there and i also loved oh i love this bit where you you went back and named well i think it's something like the history of pelvic pain you have a whole section and you talk about all the male led and then all the female healers throughout history like Hildegard von Bingen and the ancient female healers in Egypt and what's my question here

yeah can we speak about women in pain really yeah I mean I think there's a couple of things I think yeah what you were talking about with Alexandra and the listening to pain as a message like so there's a big Australian study that showed like with heaps thousands of women and it showed like something like 95% of women have experienced some pain or discomfort with their periods and it's an inflammatory process so I think I think as well the thing about our lives and our humanness is that we pain is an inevitable part of our lives suffering is less so right and I think that I think that pain is amplified when or the suffering that comes with pain firstly is amplified when we expect that we're not ever going to have any pain or when we become so

uncomfortable with any discomfort and so fearful of any discomfort and we make no space for our bodies to feel different right um then anything that deviates from the normal state of our bodies is going to feel threatening and scary and fearful. And we know with pain, especially that when we're fearful or stressed, our pain increases because pain is a danger signal and our brain will produce more pain and our body will respond in fear as well. You know, if we're all crunched in and immobile and breathing up in our chest rather than in our belly um we have more fear and then combined with the uh fear of like the fear narrative of endometriosis and you have to have a surgery or it's going to like ravage your insides and um cause everybody infertility um which also increases fear and then pain. So I think that if we think about the experience of pain

or discomfort with a period is a common thing, whether or not if we lived in a different world in which we all were allowed to have two days off or work from home or lie down or acknowledge that we're having a period, that probably would be less, I think. I think that our modern lifestyles exacerbate and make that experience of pain generally far more common. And I think that if we're allowed to do that, it would be better. But we also have to think it's a message from our body, right? It's telling us if so many women have that message, we have to listen to it rather than

ignore it because we know that when we resist something, it persists. If we protect against pain, it will keep knocking on the door saying, hey, you're not listening, you're not listening. And then much of the way our body and our mind responds with that resistance, because it's like, I'm resisting this thing, it's got to be dangerous, therefore, it's going to be more painful. So I really feel like we have to listen to it as a message and think, just like Alex did, what do I need to do? What do I need to change in my life to honour my body and my cycles? And I think need to change in my life to, to, um, honor my body and my, um, cycles. And I think that's going to, that would help a lot of women firstly.

Yeah. And what do we need to change in the world? The structure that we need to change in the world to make it available for everybody to do that. Yes. A hundred percent. Yeah. And also, and also I think it's kind of, it's infuriating when people say, well, it's ridiculous. The economy would go to its knees if everyone had menstrual leave. I mean, but that's perhaps what needs to happen, you know, and probably it wouldn't. And I also feel so annoyed when anyone ever talks about the problem of period pain as in days of lost productivity and, like,

the cost of lost weight. I mean, I just think it's through such a capitalistic, ridiculous lens that when you think about, and all of the surgeries that are often unhelpful, that if we think, okay, well, maybe if we just stopped women having to fight against what's happening in their bodies and to learn how to go with that flow rather than against it, then there's probably going to be way less operations,

way more productive time because women know how to care for themselves or if they're working from home and just being able to care for themselves better, they're probably actually being more productive, to be quite honest, or they're having a rest and then they're going to be more productive on days five and six. So it's 50% of the population. Like why shouldn't our needs be considered? I'm going to pause the conversation with Peter for just a moment to share an invitation.

If you're feeling called to connect to your menstrual cycle more deeply, either because of pain or other health symptoms, or because of an inner knowing about the power and authority, creativity and meaning that lies within this ebb and flow of the cycle. We'd love to invite you to join our menstruality leadership program. We're starting in February next year in 2025, and we're hosting a free introductory webinar on July the 24th, all about the program. You can register for the July the 24th all about the program you can register

for the webinar and find out all about the training the curriculum hear stories from our graduates at menstrualityleadership.com on the MLP you'll be held by Sharni and Alexandra and this amazing community of cycle passionate inspiring brilliant people that gather every year for the program to understand how to harness the real depths of the practice of menstrual cycle awareness or cycle awareness post-menopause as your personal tailor-made spiritual path to experiencing more wholeness safety vitality power peace good. You can find out more and register for the program and for the free webinar at menstrualityleadership.com. Just so many times in my life as a woman and in and in this work it comes back to I think therefore I am

it's moments Descartes when the mind and the body were split and then that ripples out across history religious philosophical it's it's the water that we're swimming in yes it's never made sense to me and I loved when I read from Eve Ensler who wrote the vagina monologues I feel therefore I am yes always has just stayed with me as truth in my body yeah you talk about in the mind body bridge is the nervous system yeah and I think that's important to talk about because what I see happening, and it's very complicated to tease out, but what I see happening is that because women's pain, and when I say pain, I don't just mean physical pain because I think physical pain is often a representation of pain at the soul level.

That's what I think. And that's how it comes up. And I think that for so long women's pain, oppression, et cetera, has been dismissed and with the mind-body dualism thing of, well, you've got pain, and then if we can, it's such a, I mean, it really is a very simplistic model of thinking about things now that we understand the complexity of the human body, but to say, well, okay, well, then let's look inside that part of your body. And if we can see something, which by the way, we don't even know if say some bits of endometriosis might not be part of a normally menstruating person. And there are lots of people, including me, who thinks that part of it may be

physiological. You know, even the French guidelines would say that endometriosis is not always a pathological process. But if we have the model of, okay, well, you've got pain, we're going to look inside you, and the model of what's real is held up as a physical thing that we can see that's in the body, and we disregard anything that has to do with the mind or the spirit, which is what that whole mind-body dualism is about, and we say that's not real. And people who deal in that, they're like the healers

and the witches and whatever, and we are a very serious authority and we only deal with what we can see with our eyes, which was the establishment of the modern medical system, which was all often men at the very beginning, and discrediting a lot of what healers and midwives and things were the kind of work they were doing. But so if we're in this culture of only that is real, then women who have pain and want care and validation will want that diagnosis and that treatment

because that's the only way in this model their pain and their trauma can be validated. Does that make sense? So we then get into this position where women are, it's almost, you know, the tears I've seen in recovery rooms when women have been, had an operation and not had endometriosis found, which, by the way, it's like six out of ten is the number of women who don't have endometriosis who have a laparoscopy. So six out of ten people have pelvic pain and don't have endo. So there are other things going on. And even for the ones that do have endo, there's still probably those other things going on too. We have become like I understand women's need to have that because that's the only way they've been able to get treatment.

And if they don't have it, then they're told, oh, it's in your head or completely discredited, not validated, not given any help whatsoever. And I think that the continued upholding of this model, it fails both women who have been diagnosed with endometriosis because they often don't get better with that model if we're just focused on the lesion. And it also fails the six out of 10 women who don't have endometriosis because then they're told they're crazy and there's nothing there. So when we understand that the mind and the body are not separate, in fact, the nervous system is, yeah, like a bridge. Well, it's not even, I mean, I use the word bridge, but I would say that it's all one, comprising our central nervous system,

our peripheral nervous system, our autonomic nervous system, which is the oldest part of our nervous system that kind of controls our breathing, our heart rate, our digestion. It's a bridge to the environment as well. it's always checking are we safe in the environment and so that's where what happens to us matters because what happens to us in the external environment or what we perceive as danger alchemizes into our body it changes our physiology to help us survive which is really clever except that if we stay stuck in a survival state, which is like we might have heard of fight or flight or freeze. In a concept called polyvagal theory, we talk about the sympathetic nervous system where we have lots of cortisol and adrenaline. We might feel

more anxious and angry and irritable and just can't settle, more stressed. And we talk about the dorsal vagal or the freeze state where everything is just so overwhelming that you just can't. And both of those states are survival states where our body is perceiving danger, whether there is real danger or not. And in those states, I love to explain to people it's not just how we physically feel, but it actually changes our body. So it decreases our, changes our microbiome and the bacteria in our gut. It makes our gut more leaky.

It leads to more immune dysregulation. It leads to more inflammation. It changes our brain and if our brain is in a survival state it's it's like sort of it's like a dial is turned up to a hundred in terms of sensitivity to picking up more danger so we might be more reactive in the things that happen externally but also more reactive to things that happen internally so there's a word called interoception and it means that it's the way we interpret internal sensations. So things that might be painful, like potentially painful,

like a period, like ovulation, things that are inflammatory in nature can become even more so because that dial is turned up to like 100. Things that are non-painful can become painful. So people who have real chronic pain, who start to have pain every day, might have, you know, pain in everywhere in their body. Or even like if you touch their skin, they might have pain. So it's this turning up of the danger signals, which increases pain and changes our brain. And yeah, it changes everything. So

if you understand, and that is and there's a big word for that which is scientific which i think helps people who also need to understand the science or whatever it's called psychoneuroimmunology which explains that our brain what happens in our brain our immune system our thoughts thoughts, belief, conditioning, even, and you can add another bit of the word that means our hormones, our endocrine system, it's all connected and it can't, like we don't operate like in a bubble or a vacuum. Our nervous system responds to what's going on around us.

So that's where that piece of what happened, who was there for you, were you able to understand or become aware of your own nervous system and be able to tether back to safety becomes really important. And people can have awful things happen to them, but if they had an ability to process it, to go back to their bodies, to find safety in their bodies, then often those effects aren't lasting. But if they've had no way to understand what's happening to their bodies and be able to return to safety or had someone to help bring them back there, which is so many people in our society, you can get stuck in those states

and then that's where a lot of disease happens. So not just chronic pelvic pain but, you know, many other things. But it's something I see. I would say 100% with chronic pelvic pain would have dysregulated nervous systems. And, you know, and then with period pain itself, I think a lot of the same things feed that. And so there's so much promise in that because when women understand that and then they can also understand if I can explain to them like, okay,

so when you get that pain with your period, what are you thinking? What are the thoughts in your head? Like are you afraid? Are you like thinking about a the thoughts in your head? Like, are you afraid? Are you like thinking about a painful time in the past? Are you anticipating a painful time in the future or scared that it won't stop or anticipating it to be painful? Because pain is a subjective experience. And it is born out not just of like a physical stimulus so for example with a period the inflammation and the contraction of the muscle and the hormonal changes but it's born out of

our past experiences what we expect our fear our cultural conditioning the levels of stress like how we're able to care for ourselves. So many things go into the construction in the brain of how painful something will actually be. And there's a thing called predictive coding, which is like a neuroscience term when you start to understand the neuroscience of pain, is that because our brains have got so much stuff

to have to contend with and process every day, it's like starts to make shortcuts. And predictive coding is the term used to describe the shortcuts our brain can make, which may not be representative of the actual painful stimulus that's in front of you right then and there, but it's that culmination of all those other things I just talked about. So we understand that pain isn't as simple as damage, danger, something terrible is going on, and it is all of those things, then it's great because we can start to work on all of those things which are very changeable because our bodies have changed to help to protect us.

That's what our body is trying to do with pain. It's trying to protect us. But if we can help to teach our bodies that we're safe, then we can retrain our bodies into a place of safety where pain is going to be far less likely. And surgery doesn't do that. And drugs don't do that, although they can certainly be part of the picture,

but it's just so important to have that as the foundation, I believe. And I feel like women who may have previously been like, when you don't understand that, it's like, of course, the only way I can get validated is through the surgery. But when I speak to women and I explain all of that, they're like, oh, okay, this makes sense. it is with a surgery but when I speak to women and I explain all of that they're like oh okay this makes sense and um I can see that you're validating me because you're letting me tell my story you're telling me that my pain is real you're listening to me and you don't need to do an operation to

validate that um because whether or not there's endo there, your pain is real and your story is valid. And also we're also exploring the roots of it, which might have nothing to do with that physical expression of pain. It might be, you know, and very commonly is stuff like complex trauma in their childhood they've never recognized it might be sexual trauma that they've never no one's ever been able to give them a place or a space to discuss and the work also isn't like delving in and like re-traumatizing with this stuff, but it's like just putting the pieces together, joining the dots so women can start to see that kind of timeline of how their bodies have

gone into that survival state to protect themselves, which is a really beautiful thing for their bodies to do. And I think from that place, not only can they understand how they got there, understand the tools that can get them out, but also have deep compassion for their bodies, which adapted so beautifully to help them survive in a period of time which they perceived to be dangerous and that their bodies are not broken their bodies are amazing and um just responding to the environment exactly the way they're supposed to and then we can go about trying to change the environment sorry that was a long answer don't

apologize that was wonderful I knew this was going to be a good conversation but I didn't realize just how good yeah you're really speaking to the past 15 years of my life because I've had chronic pain pelvic and gut well it got but like reading your book I was like hey it is in my pelvis it's like even that I haven't really been able to locate it necessarily um but the amount of gaslighting that's gone on because I've never really gone down the route of trying to understand because of all the reasons you're saying of trying to understand what the pain is and when I say that I mean no one has like looked inside my body to understand it um and because of that I've never had a thing to say to people like I have X, Y, Z. I just I've just been in chronic pain.

You know, chronic pelvic pain is a diagnosis unto itself as well. We can say I have chronic pelvic pain. Yeah, because I think that's what a lot of people who say who have had a laparoscopy and the only language we have to talk about it or to give that validation is endo but if you don't have that they're like completely not validated and it's like well what do I say and it's your experience is chronic pelvic pain and that is I mean I'm not a massive diagnosis fan I'm but because but that is your experience like your experience is I have I experience chronic pelvic pain and that's a very valid thing for sure but when you go out in the world and the same with IBS oh it's just it's I it's just IBS it doesn't just feel like freaking IBS it

freaking hurts you know it's changed my life profoundly the way I'm able to work the way I'm able to move what I'm able to do and when you speak about danger and safety it's like just slowly over time because I've been blessed to be supported by lots of people I've just seen oh my body feels like it's in danger most of the time and yeah the last I just feel like I've just been a decade of finding safety finding safety and beautifully although there is a little bit of pain now that I've made lots of lifestyle changes that I'm very privileged to be able to make and I'm you know it's very minimal how it impacts my life now but I wish I had heard this conversation 12 years ago because the amount of validation of my experience of honoring of my experience and then gateways of possibility for

changing my experience you know I'm just so glad that we're having this conversation now and that people listening can yeah feel the hope that is here and the possibility that's here. I'm glad you got were supported to to help you to realize that that sense of safety impacted your symptoms and but but I often see women who again have had that that IBS diagnosis and their only treatment is because it isn't like a thing that you can see, is, you know, the ridiculously restrictive diets. And often then it kind of heightens that anxiety or that nervous system dysfunction because there's so much preoccupation with the food and then how it's going to affect the gut and um i like love the work of and i don't know if you do um say the gut directed hypnotherapy have you heard of that not really no tell me about it so it works on the premise of the mind body like the vagal nerve connection so the vagus nerves

um for people listening so the two nerves that big nerves that come down from the back of our neck and down to our lungs, heart, gut, actually all the way down to our cervix. And it takes lots of cues from our body to our brain of safety or danger. So about 80% of the messages go from our body to our brain up the vagus nerve and there's a big huge connection with the gut and so that's often why when we're feeling nervous or anxious or something happens we feel sick or we have tummy pain or we feel butterflies or whatever and also when we think about being in that fight or flight or freeze states um that effect on the gut microbiome on gut motility because our brains like well i'm in danger i don't need that and so digestion is massively affected so um i always so there was a group of of uh um researchers they were at cambridge or oxford

somewhere clever i can't remember which one and they came up with this gut related hypnotherapy and found that basically you're not hypnotizing the gut but you're working with mindfulness with breath so that's like what we would talk about bottom when we talk about integrated therapy with our body and our mind and our nervous system that would be bottom up so um helping us to establish cues of safety safe messages to go up our vagus nerve to our brain so breath posture um those kinds of things and then like um self-talk which is you know top down therapy about safety safety and they found that when they did that with people over a period of time um 80 they had 80 percent decrease in symptoms or improvement in symptoms which which was comparable to people on like a really restricted low FODMAP diet and but without doing the restricted eating which is amazing that would be amazing because my diet is hugely restricted

and I just I just live inside it now and it's yeah that's great to hear okay there's an app there's an app called Nerva N-E-R-V-A and it's excellent so I've had patients who have had both IBS and pelvic pain who've gone away and got done that and also maybe just seen a physio or something who've come back and just said their pain was so much better and they've actually been able to introduce foods that they previously thought they could never eat again so I think because that is really working on that nervous system the nervous system route so it's really a good thing to do I see it very simply because I'm very lucky to have a sister-in-law that lives in France when I'm on holiday with her I can eat a chocolate eclair

and it doesn't like I don't have the same symptoms I'm like oh I'm I'm not I'm I'm relaxed I'm not in this like do-do-do productivity mode so that's I'm gonna get that out thank you that's really helpful yeah it's really good I'm so grateful get that app thank you that's really helpful yeah it's really good I'm so grateful for this podcast as my like own personal therapy that's when you know you're doing something important if it benefits you you know it's going to benefit other people yeah yeah for sure yeah I guess just to summarize this piece around trauma with what we're really talking about is establishing safety I think that people often think I don't have trauma and I think if you go looking for like capital T traumas or whatever it's not about that it's about being able to figure out if someone's been able to embody that be in their bodies whether they've

felt safe in their bodies whether so if you're not living a life authentic to you that's also kind of a I feel that I would say I would use the word trauma and I would define it as things that happen either as a single event or continuously to bring you into a state of nervous system dysregulation. That's how I would and it can be, you know, and like I think about women as a collective, we and I think Gabor Marte says, women are the shock absorbers of society and women at the most basic level are not able to live authentically

because we have to pretend and, in fact, not even pretend, most women are so unaware of the fact that we have those four distinct parts of our cycle but we have to pretend that we're only that we're either kind of at ovulatory energy or like early luteal energy because the rest of it is unacceptable to society um and that linear way is just the way and so we kind of operate just even from that very basic biological lens in an inauthentic state. I think it's really important to add to that for Black women, for women of colour, there's that next level of whiteness is also the kind of the standard. And so yes, from whiteness is the next levels of burden and pressure and obstacles. Totally, exactly.

And so I would, yeah, exactly add that. So if you're a person of colour, if there's poverty, if there's any of those other things, there are further layers of where your experience isn't really honoured and you're not being able to be authentic. And so that's in itself difficult and um and you know there's so much um but when I talk to women there's often way more than that and I just think like this is why I think this work is so important I think menstrual

cycle awareness is so important because it's from that most basic level teaching people with cycles that they don't have to pretend give them the knowledge that they can have that awareness because gosh the people who come and say to me oh they'll describe to me a perfect menstrual cycle I have this thing and like it ovulation at this point I have like a bit more bloating and I feel like a bit more energy and then about four days before my period gosh I get a bit more like I want to be alone, and I get a bit more crampy. And I'm like, yeah, you're just describing them, but they don't have any idea about the correlation, right? So they think, again, something is wrong with me. And especially say women who've been on the pill for a long period of time, they go off it. And then they're like, why isn't my body the same

all the time? And there's that, it's just almost like, I don't know if it's the, right, we've got this beautiful Indigenous doctor here and she talks about colonisation, but she talks about not just, oh, decolonisation. She talks about, you know, of course we can talk about it in the ways that we often do, but we can talk about it also in terms of how women are conditioned in their lives and their cycles and, like, giving them the information about what's actually going on in their bodies so that we can start to honour our own cycles. That's also kind of a process of decolonization which I think is like super interesting um and yeah I just think it's so powerful because if you can start to realize your body isn't broken

yeah it's different to that male standard but that isn't less than it's not weaker it's not less powerful um then you just operate on a whole different energy system. And I know that if people are listening to this and they're like, well, I've got two jobs and I cannot take a day off for my period and that, like, obviously what we're wanting is system-wide change to enable that to be possible for everybody. But also there are ways, there are simple things that you can start to do. And I would say just like being aware of it in yourself,

talking about it with your family, even if you are doing like the caring at home and the other job outside of the house, just talking about it with your family so that there is that language around it because that changes culture um I have this cool app called um Stardust which we really like at Vero which um it's like a menstrual tracking thing but it teases you up with the moon and it's got these really cool features where you can add other people like so all of the people that work here my stepdaughter is all on mine and then you can like nudge your partner or whoever you want to and like cast them a spell

where it says hey I'm like day 28 bring me home some chocolate and clean the house I know it's so cool it's really really cool it's called Stardust I have no affiliation with them whatsoever I just love their app um but that starts to change culture and, like, even just small things like taking a moment to rest, having a bath, telling your kids that they can do dinner or getting something out of the freezer, taking yourself off to bed early, just those simple things can start to change the way you feel inside. And then I think from a larger trauma point of view,

we have to start acknowledging in society that so many things, not just pelvic pain, have their root in the lack of support that parents have and the, again, no reverence for family life and parenting and childhood and, you know, the way even mothers who stay at home or parents who stay at home are kind of seen as or not paid, not seen as a valuable thing when it's such a valuable thing and the lack of support which often then leads or not paid, not seen as a valuable thing when it's such a valuable thing. And the lack of support, which often then leads to that traumatic stuff and that generational trauma.

It's not like anyone's going out of their way to hurt young people, but it's just this lack of awareness about that really vulnerable time in people's, in children's lives and helping to support parents. And there's really good research that if you support parents in that early childhood stage, then you can actually reduce a lot of these things later on. There's some really good research from the States on that. So we need to have that awareness and like bring in awareness about nervous system into schools so that even if people have suffered with stuff, they can start to have that insight into where they are and start to learn tools to bring themselves back to safety. Even if they're in a challenging place like that kind of language is also really important, I think.

A hundred percent. Thank you, Peter. Peter I mean this has been really supportive for me personally I know it will be for so many of our listeners how can our listeners connect with you and your work? They can find our website which is verawellness.com.au they can find my book, which is Healing Pelvic Pain. I think you can buy it on all online, Amazon, et cetera. We will have a podcast ourselves, actually, which I'm about to go and do the second episode of, which will be released in August, and it's called Women of the Well. And we are also developing some online resources for women women with pelvic pain so there'll be healing pelvic pain online resources and courses which will also be

available from august so you'll be able to find that on our vero website amazing thank you so so much this is like the best way to start my day i really really appreciate everything you do thank you peter thank you no problem thank you have a beautiful day bye oh wow that was incredible I learned so so much from Peter it was definitely worth getting up at 4 30 in the morning for. What an amazing conversation. I'd love to hear your takeaways, how it was for you. You can always tag us on social media at red.school or me at sophie.jane.hardy.

Or you could write to me, sophie at redschool.net. Always love hearing from you. Would love to hear who you'd like us to be talking to, what topics you'd like to be exploring. really want this to be a conversation and if you know anybody who is suffering from pelvic pain please do forward this episode to them so they can benefit from Peter's brilliant advice okay that's it for this week I'll be with you again next week and until then keep living life according to your own brilliant rhythm