162: Decoding Hormonal Balance: The Power of Progesterone with Dr. Jerilynn Prior

Ask a woman to keep a record of her experiences in menstrual cycles, as we kind of give the reproductive systems and doctors or husbands or whatever instead of owning it. And we're the only ones who can possibly understand it. Most people, for some reason, that doesn't make sense to me, think that estrogen is the only thing that can effectively help hot flushes and night sweats. We've shown twice now in randomized controlled trials in pyrimenopausal women and in menopausal women that progesterone alone is effective in decreasing night sweats and hot flushes. By listening to the Coherence Code podcast, you agree to not use this podcast as medical advice to treat any medical condition, either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code podcast, where we explore how the mind and body work together so you can move from stress and inter-conflict to clarity, calm, and alignment. My name is Lauren Brown. I'm a doctor of traditional Chinese medicine and a clinical therapist. And through my work, I've seen that healing happens when we move what gets in the way and allow the body and the nervous system to do what they're designed to do to heal. Welcome to the Coherence Code podcast. I want to introduce Dr. Jarelin Pryor and I thought for our conversation today, we'll talk about your research and also talk about fertility and auditory disorders and talk about parry and menopausal symptoms. I like to use the word disturbances rather than disorders. Sounds good. You can correct me when you're talking. They sound like diseases and in almost every case, it's an imbalance. Well, now you're talking like a Chinese medicine doctor. Of course. The balance between this dial and progesterone is very similar to the concepts between yin and yang. They certainly are. And why I wanted to have you on the podcast is because I remember back when we met in the early days, being the pioneer in talking about it's not estrogen deficiency, it's estrogen fluctuation, and there's a progesterone deficiency issue. And people were thinking you were a little cray cray back to the end and here you are still pushing. And I can't tell you how many women I have seen that get the progesterone support because the research you've done or the books that you've written or practitioners, you have educated that tell them that have now peace, right? Because they found other ways to get back into balance. Yeah, it's important. But it, I mean progesterone is definitely important, but it's also important to understand the context in which this is occurring. Because I mean, I just got an email this morning from a woman that I encouraged to start taking progesterone and pairing menopause. And now she's saying, well, why isn't everything all better? I was still having symptoms in the she's taking it cyclically. And in the follicular face, well, let's becaus pairing. Lennipause estrogen is swinging the heck out of itself. Right. Yeah. And that can be very uncomfortable. Today, we're going to talk about auditory disorders and symptoms ago in paramanopause. So before you had that last menstrual period and menopause after a year later, that your cycle's end because she's the expert in this area. Let me tell you who Dr. Jareland prior is. So because some of you may not know who she is. She's a 40 plus year University of British Columbia endocrinology professor. She's also an award-winning clinician scientist, the Michael Smith Foundation for Health Research in 2019. And her innovative concepts are changing women's reproduction. Progesterone needs to be in balance with estridol for well-being and fertility during the premenopausal years and for lifelong good health. And this is important because the fertility patients I see are in that paramanopause stage. Most of them are 40 and beyond. She founded the UBC Center for Mensral Cycle and Auditory Research. And that website, by the way, I'm going to say this a few times is Semcor is C-E-M-C-O-R dot UBC dot C-A. We're going to put that in the show notes, by the way, because that in itself has so much information. Thank you for creating that. Dr. Pryor is an internationally recognized thought leader on menstrual cycles, ovulation, paramanopause, menopause, osteoporosis prevention, and night sweat treatments with an H index of 70. I don't know what that means, but I'm assuming that means you've done a lot of research. It means 75, it's actually 75 now. 75 publications have been 40 to 50 times. Wow. Okay. So there you go. Thank you for publishing because your research is being cited a lot. And her controlled trials show progesterone decreases menopause of VMS, vascular motor symptoms, and increases bone formation. Dr. Pryor grew up in a last-confishing village. She got an honors MD from Boston University back in 1969, just a year after I was born. And she became a Canadian in 1983. And that was motivated her to come to Canada because she believed in universal healthcare. Dr. Pryor, welcome to the Coherence Code podcast. I'm happy to be with you, Laura. No, I don't know if you may not know this because I think we talked about it. We've done some talks in the past together. We've broken bread together. You've spoken at the integrated fertility symposium, which has been a fan favorite for our audience. We were once at CFES, the Canadian fertility and dr. Alessia Sadi. And this is probably 15 years ago, maybe it was a while back. And I remember you were presenting your research on progesterone. And this is when I had my aha moment, like how important you were from two levels. One is Chinese medicine looks at the young herbs to help with the bones versus the end. And we think of young like progesterone, in like estrogen. You need both. But in Chinese medicine, it was not all this yin tonics. It was a lot of yong tonics. And you were talking about how progesterone was important for bone formation. But the thing that I was like, I'm going to fall or this woman around is because I'm a fan of people that think outside the box isn't afraid to ride outside the lane. And after your talk, there was a few physicians gather around a table and they were dismissing the research. They were a little cynical. They're kind of like assholes to be honest. And I was like, you were saying something that a lot of people aren't saying, but it made a lot of sense from me from a Chinese medicine perspective. I want to talk though, because you got research behind this, can you kind of start to introduce to our audience why you're into this research and why are you such an advocate around progesterone research? I guess the fundamental reason is I become so aware that the basic concepts that were taught in our culture by gynecology in particular and that medical students are still taught are often unfazed in science, their mythology rather than evidence. And for example, one of the examples is a regular normal month-of-part cycle is normally obligatory. Well, that isn't proven. In fact, the opposite is proven. There's lots of variation in the amount of progesterone and cycles may not be obligatory at all or maybe obligatory, but with too little progesterone or too short, a duration of progesterone. So the fundamental concepts that we have are not appropriate, hence our therapies are not appropriate, our explanations to women are insufficient and women suffer. Because of that. Well, and we're here to educate and empower. So let's talk about this research on the menstrual cycle, follicular luteal phase, verabilities. And you published a paper in human reproduction on this research. So I want to kind of unpack what you said. So it doesn't go over our heads. I've often heard that if you're having bleeds every 28 plus or minus days, then you're probably ovulating. But your research says that's a myth. Yeah. And in fact, textbooks. It's prominent. The most important internal medicine textbook by a very specialized and revered physician says the luteal phase or time after ovulation until the next flow is fixed, cool, and scare crotes fixed at 13 or 14 days. And that's just just nonsense. Your research showed it can vary the luteal phase. So I want to understand kind of the mechanism. I'm familiar with like how the stress and and and the environment can impact a woman's ovulation as an effect of follicular. I mean, I see it clinically. So it's I don't even need to see research. I see it because women are monitoring their cycles. The luteal phase, I'm curious on the mechanism why that would happen because in my mind, I think of you got the follicle, the corpus luteum, sorry, the follicle releases the egg. The follicle collapse becomes the corpus luteum. Why would that change then? Is it based on the quality of the follicle? So it doesn't have the Power to do progesterone for 14 days, is that the issue or is there something causing it to stop prematurely in the flutil phase? We don't actually know like the mechanism. The corpus luteum by the time it is formed has a certain potential. And that potential is altered by even as minor things as an argument with your partner or a boss who is riding your case or a good friend who said something hurtful to you. In other words, a lot of personal stressors. And once we don't think of necessarily as a problem or we just don't understand that there might be a connection with reproduction, can alter the potential of that corpus luteum to create a full length, whole progesterone, ovulatory phase. So one of the sort of teleologic ways I think about it is that progesterone makes demands on the body energy demands. Because when it's around it raises our basal temperature by two tents or so or more of a degree Celsius, that means we need it extra energy. But also we need a bolderation, progesterone, luteal phase in order to be fertile. So if we're in a state of such stress, then that's not a good time to have a baby. And so our body does it for us by preventing us from becoming pregnant when we optulation. And for our audience, we have multiple episodes on how to manage stress. So you have more resilience for those that are concerned. You know, I heard a reproductive mannequinologist say to me, and this ties into your research, this was over a decade ago, they said that luteal phase defect went out in the 1980s. And I asked why he said, well, because we have many women that have spotting or short luteal phase. And when we give them an ovulation drug, then it was cloned, and lectures always being used then. And they can ovulate and have babies. So luteal phase went out in the 80s. What's your response to that? That's quite true. Psychonicologists don't believe in any disturbance of the luteal phase length. And fixed luteal phase. But exactly the early scientists, one I learned from said it's a variable. It exists that short luteal phase and ovulation within regular cycles together. We call them silent, ovulatory disturbances are common. It's part of our life. Only when it's persistent, does it become a problem? And that that's the way we ought to think of it. These are adaptable and we're totally reversible. It helps us as individuals understanding what is bothering us and having the tools to deal with it and to not allow it to disturb our equilibrium, to become, as you said, resilient. Develop that resilience. But I'd like to emphasize something you just said that you said it's kind of something that we observe. It's common that you'll have a silent or a non-ovatory cycle. You'll have a bleed, but there is no ovulation or you may have an ovulation, a short luteal. And it's only an issue if this is something that keeps recurring. So if somebody has a couple of these in a calendar year, that's not necessarily needing treatment. Your body is just adapting and it's not what you're considering a problem on using that word loosely. Just so if somebody has a non-ovatory cycle in a year, that's not a need to see a doctor, for example, because it's going to happen to most people. I can't help but thinking that the messaging around ovulatory disturbances went out the window decades ago as assisted reproductive technologies to go over our concepts. Yeah, okay. So you have that kind of technology available where you're talking to you like a Chinese medicine doctor. We like that we have these technology tools to support us. But what's the expression don't throw the baby out with the bath water? You know, garbage in garbage out. If you're going to use those technologies, we want the egg and the sperm to be at their peak potential at the time of using those not to try and override the body. So we're still looking for, we're not looking for a pregnancy in Chinese medicine. We're looking for a healthy baby and a healthy parent at the end of it. So we wouldn't ignore if somebody had auditory disorders or short luteal phases. In my practice, we don't ignore that even if you're going to do clomad or IVF, we still want to see we can regulate that and give you support and tools to help have that resilience. So A, you may not need the ART and if you do peak egg potential, peak sperm potential. One of the no tech tools that I found most helpful is to ask a woman to keep a record of her experiences in menstrual cycles. And then a person can see for herself whether the things that relate when she feels low energy, when she feels low self-worth, when she's frustrated and understand, start understand the connections between the reproductive system and the rest of her life. As we kind of give the reproductive systems and doctors or cousins or whatever instead of owning it and we're the only ones who can possibly understand it. People like you and me that counsel women can only help them to understand it. We can't understand it for them. I agree 100% to that. We help facilitate, we can educate, we can support, provide resources and then they have the experience and they get to learn about their bodies because they're the only ones that can experience it. So on this research, I want to kind of unpack a few other things that you had brought up. One is on, you know, there's so many apps out there. So how does this impact or what you're thinking on these apps and because if you're seeing these variations in both the follicular and luteal phase and this is part of the body's adaptive mechanisms and a lot of these auditory apps are algorithms based on when your last period was, does this mean that they'd be less accurate? Yes, very to you of the tools currently available, accurately assess the luteal phase and its link. Most of them are not validated. Right. And so for somebody that wants to track ovulation, are you still like you can lose the LH surge and you can use body temperature and then obviously a blood test to see if you've ovulated with progesterone testing after your ovulation. Yeah. I don't know. I look back on it and think, God, that's a little brilliant, but I needed, I felt I needed something quantitative, not just the BBT, their basal body temperature thing. And so I worked for statisticians way back in the 1980s and we developed a simple way, which is on the SEMP4 website of analyzing it as a head of all the temperatures in one full cycle divided by the number of days, find an average and then you can see where your own temperature goes above that average and it needs to stay about that average until at least the day before the next period. It is simple, but we validated it. I like it. That's why we again, you said we're going to talk today, not about myths, but science evidence. So thank you for sharing that. I have another question for you. And again, I'm going to bring in through the lens of Chinese medicine that I'm asking you that do you have you found that that's still a myth or do you have evidence or science to kind of agree with this concept Chinese medicine. We as practitioners really want to understand a menstrual cycle. We do a detailed history because the menstrual cycle is predictive of a woman's health. And so when we see a cycle that is not in balance, we take that as a sign that other things are out of balance. Do you have any research or science to show that ovulation reflects a woman's well-being and can predict lifelong good health? Yes, there's two parts to that question. The first is its reflection of well-being. So during the pandemic and I have to confess at the beginning that I've not yet been able to get this published, but during it happened that during the pandemic we were doing a study where we asked women to collect data over one cycle. We ended up with difficulty having 108 women who had complete cycle information and population information. We ended up asking them, well, first of all, almost a third of all of those cycles and the cycle lengths were not that variable, surprisingly. Almost a third had not formulated in that cycle. One third, we had a little more than one third normally ovulatory, one third short loodial phase and one third an ovulatory. And we created a resilient scale using the diary records for feeling of self-worth and feeling of energy as positive things, anxiety, negative, depression, negative on the daily diary. and women's reported self-health, in other words, how they evaluated their health. We put those together and created this resilient scale. And the ambulatory cycles had higher resilience than the short-liudial phase cycles than the anobulatory cycles. And it made a significant phase related difference. So that's strong evidence that the anobulation reflects wealthy. - And I'll share with you in Chinese medicine. When we look at the cycle, often a woman will share with me that she has severe PMS symptoms or pain with her period, a very bad cramping and clotting, for example, lots of clots. And she will say her doctor said it's normal. And I will say, well, in Chinese medicine, normal doesn't mean healthy. Normal means a lot of people have it. It doesn't mean it's healthy. And in Chinese medicine, a healthy cycle is minimal to no PMS, minimal to no pain, no clots. That's what we look for when we look for what we're saying, well, being in a menstrual cycle. Where I was confused when I read that research that you shared about the menstrual cramps is, I always thought that cramps would indicate, although we don't want the cramps in ovulation, we like to treat that in Chinese medicine. We do not want to have a lot of pain around ovulation. I always thought it was an indicator of ovulation. And a lot of women think they're ovulating based on that. But your study makes me think I'm in a myth. Yes, that's true. In fact, in that same, the same data I just talked about, we compared the ovulate cramps in the ovulatory, normally ovulatory cycles with the long enough lardial baseline with the cramps in an ovulatory cycles. And they were worse, and they lasted longer in an ovulatory cycles. All right, so we can no longer assume that because you're having menstrual cramps, that that means you're ovulating. That's exactly right. And looking back at it, it's a very good example of the problem with how women's health is that reproductive health has been managed. That a study showing that was published in the 1930s. Oh, right. But the old one afterwards confirmed it, that the myth that only ovulatory cycles get cramps. I mean, come on. Right. Okay. Science requires confirmation. Right. Repetition. Reproducibility. So we did, as far as I know, the first clear demonstration that, first of all, the myth is wrong, that cramps occur in all cycles of all sorts, but also shows that cramps are worse in an ovulatory cycles without progesterone. Hey, I have an hour. We're going to start to. We're going to stay on the reproductive of the fertility side. We're not quite ready to talk about auditory disorders like polycystal verin syndrome. I think your term is engine and auditory access, or maybe I got the A's mixed up in the order, but A-A-E, we'll talk about that. But before that, I want to talk about, again, this auditory and the balance between the follicular and luteal and possibly how it can affect reproductive health. Going back to that physician that said, luteal phase defect went out in the 80s. Interesting enough, clinic starting in round 2023, the IVF clinics, here we are recording this late 2024. They now measure progesterone before they do a transfer. So before, so obviously that's telling me that if the progesterone's under a certain level, they're concerned about implantation. I remember, and I was curious, the number in our units in the metric system, when somebody does a mid-luteal serum level, there is a number where you kind of are hoping for that progesterone to be to show that you're having a robust ovulation or that corpus luteum is in well-being. Because I think the number, if it's over 15, you kind of have a confirmation of ovulation, but at the mid-luteal, that would not excite you as in a well-being or a healthy ovulation. OK, I don't know the optimal peak of the luteal phase progesterone. I was taught it's about 40. But the threshold that I think makes sense for saying, this is an ovulatory cycle, or it's not, is 9.5 animals per liter. OK, 9.5 animals per liter for our American listeners, you're going to have to go to the web and convert that. OK, 3 nanograms per milliliter. Oh, there you go. She knows. So depends on which lab, Canadian, US versus the rest of the world for your measurements. OK. But what's interesting is that we did a large study, a population-based study, about 4,000 women in Norway, was totally random by women and by day of the cycle. And we knew when their last cycle began, and we knew their usual cycle length. At what we did was to ask if they were cycle, they 13 or greater, if they had a 9.5 for progesterone level. So everybody had an estrogen, and everybody had a progesterone level. And 28% of women with perfectly normal length cycles did not have ovulation or a normal ovulation in that particular cycle. These will be only population-based data which have an ovulation at the moment, and it was just a single cycle. So what does that tell you? What do you take from that? That ovulatory disturbances, reversible, treatable, ovulatory disturbances are common. And common as in, it's your body's adapting during that cycle. That's right. Why do we care so much about progesterone? What is its health benefits? And then I'd like us to lead into auditory disorders like the common term PCOS, and please share how you have a different term for it. And then we'll talk about it in the Parymentopause and Menopausal stages as well. But can you just talk a little bit about-- because estrogen seems to get all the hype. I thought maybe the other half of the coin should get a little time today. And that seems to be your expertise where you do a lot of your research. Can you tell us-- I may be told us about estrogen progesterone the cycle, what the roles are in their health benefits, and what happens when one is not-- we use the word controlling in Chinese medicine. There's this five element. One helps with support, and one is there to contain. So can you talk about estrogen progesterone, the benefits of both, and what happens when they're out of balance? In particularly, let's emphasize progesterone. OK. So every tissue in all men's body has receptors or estradiol or estrogen. And estrogen is a very important and powerful brokestimulator. We say in scientific terms, it causes cells to proliferate or to grow like crazy. OK. Every single place where estrogen receptors are progesterone receptors also are. And what we know is that progesterone controls the proliferation caused by us, that progesterone controls estrogen's proliferation. And it makes the cell more specialized or differentiated, which means they're co-dependent, if you will. There is a yin yin relationship. On the very basic level, we eat both. Now, specifically, we showed a long time ago, and then confirmed it later. We showed in doing the internal publication in 1990, and we confirmed it with a metamorphosis of studies from around the world. That regular cycles, but more disturbed ovulation than average versus greater than average disturbances of ovulation, if that makes any sense. Those women with disturbed ovulation were losing almost 1% spinal bone and speak a year. Now, why would that happen? Because estrogen prevents bone loss when it's at a steady and normal level. But when estrogen levels drop, that increases bone loss. So in the normal menstrual cycle, we reach a peak at the middle, and then it drops towards the next flow. So there's increased resorption built into the normal menstrual cycle. We need progesterone to prevent net bone loss. Progesterone causes increased bone formation, and it counterbalances the tendency to loss produced by that dropping estrogen level. So that's one example. So there's bone. We also, there's a large study that was done in the Netherlands, and women collected day 22, cycle day 22, yearns three in a row, and they just froze them. And they followed all the women in the regional hospitals to see those who had new card attacks looked at those women. And when there were, I don't know, 50 or so heart attacks in those women eight years later, after the collection of urine, then they matched each woman with a heart attack with three others and analyze the year and for estrogen testosterone and progesterone. And what they found was estrogen wasn't different between heart attacks and not. The testosterone wasn't different, but progesterone was lower. Showing that progesterone is important for preventing a part attacks in women. There's other heart related stuff that progesterone also does, for example, below a cues, the QT integral is lengthened by estrogen, which risks a rhythmia, whereas it's shortened by progesterone. For example, then we know for sure that if you have estrogen chronically without enough progesterone that you're at risk for endometrial cancer, I also think there's a risk from not enough progesterone for ovarian and breast cancer. At the moment, we don't we can't prove those latter issues. And so again, why is it that we only hear about especially in the parimenopause, menopause, the idea that there's an estrogen deficiency, and I remember talking to you, you're like it's not a deficiency, it's a massive fluctuation estrogen, but it sounds like if you're not ovulating or ovulating regularly or having the short luteal phase, you don't have the progesterone to oppose estrogen where you have a lot of these health risk. So why is it that they're still focusing on estrogen? That's a hard why. Yeah. Or do you see changing? Is it changing? Because gynecology decides something is right and then sticks with it no matter what. And also they're often closely tied with this pharma, which promotes estrogen. So there's a the combination of those two major forces, mean the culture focuses on estrogen. But it's changing. Is there money? Is there no money for the pharma in selling progesterone medications? Well, there should be. It hasn't happened. And then so is birth control pill the answer? Is there a difference between progesterone and progestins? Very very much so. The only thing a progestin has to do is to preserve an existing pregnancy and to cause the secretory changes in the endometrium that are typical of progesterone. A progestin can do all kinds of other stuff in other tissues. For example, medroxyprogesterone, which is probably the pharmacologic closest relative that progesterone has, acts through a glucocorticoid receptor in the breast to increase breast cancer. So most of the time we don't know how those progestins work in other tissues. All the rest of the tissues over body. That's why progesterone makes more sense because at least we can learn how it works. And what form is that? What's that? I, I, two part question is how does somebody advocate for themselves in when they say to their doctor, this is how I, this is the, what I want. This is what the medications call if they want to progesterone versus a progestin. And then have you studied the difference in application for benefit. So there's oral, there's vaginal suppositories, there's people that put it on the skin. And then the, there's even injections that they do in the IVF clinics where they'll inject you as well during a frozen embryo transfer. What are you aware of the different forms to have that benefit? Or what are your, what research have you done on? Is it oral vaginal? And again, not to forget that part for the to advocate. What are they asking their doctor for so they can get prescribed the medicine that's going to give them the most benefit? So what I've researched is oral, micro niacinus progesterone. Okay. Little oral balls. Very peculiar as, as a, as a therapy, they bounce like crazy if you drop one. And each little round bowl, at least in Canada, is 100 milligrams. But it takes three of them, 300 milligrams, only a bedtime because you could only take it at that time. Otherwise, causes too much drowsiness or need it to keep the blood level of progesterone in the loodial saves range for 24 hours. So how can a woman advocate? I want oral, micro niacinus progesterone. I don't want medroxy progesterone. Say medroxy progesterone has an increased risk for, it has an increased risk for breast cancer. And we don't know where it how it works in many tissues in the body. I want oral, micro niacinus progesterone because I know that it's helpful in counterbalancing high estrogen effects. For example, in very menopause, because it's been proven to improve, not flushes and night sweats. And because we know that it doesn't increase clotting risks. Thank you for that. And you setting Canada, it's 100 milligrams white pills and you're taking 300 milligrams at night. That's right. Great it. And a lot of this, you should call of capsules capsules. Okay. Perfectly spherical. I'm, it's a while ago, but I'm pretty sure you talk about this on your website at the semcore.ubc.ca website. You have information on this handout. Yeah. Okay. So just for our listeners, that website has so much information, which makes me think about other tearyory disorders like PC us. So a lot of the women I ask when they go out, why they were on birth control pill, because I do my history. And they say, because they regulate their cycle, like they weren't having cycles. I remember talking to you back in the day. So this is my memory. I may not have remembered it correctly, but I remember asking you your thoughts on birth control pill for women with PC us. Obviously, they're not trying to conceive because I would defeat the whole purpose. I think you said, but the birth control pill can aggravate insulin resistance or blood sugar. So it's, it wasn't your choice. And there's better ways to help regulate a cycle. Can you talk to us about this disorder? Why are we having an auditory disorder that have a Western diagnosis of PC us? Like what's your angle on it? Because you tend to not even want to use that term. Could you see differently? I've conceded that PC us is what people recognize. So on the website, we know it's a PC us or an ovulatory androgen excess. What's interesting is the diagnosis of all these cystic ovaries in their if you will is made by or apart or irregular cycles. And by evidence, either of prosotism and acne or air loss or biochemical tests showing that testosterone is too high. We don't even check to see if ovulation is happening, but ovulation is almost inevitably not present. And I think the why of that, which I also think is fundamental, is that the hypothalamus messaging is like a nerve signal. It's pulsing. And the ulcer tile rate is the message. And it turns that gonernitrophin releasing hormone from the hypothalamus is pulsing very, very rapidly. And it doesn't have the variability and the normal slowing that happens after ovulation. So we know that for just wrong slows that rapid pulsing. And it also slows the pulsing of LH and lower sluiting hormone, which is too high, almost always in PC us. So we've just recently done a feasibility study in women with PC us and or genetic PC us. And given them cyclic progesterone, we asked them about their quality of life on a PC us specific scale at the beginning. And after six months of taking cypid progesterone therapy. And they had a remarkable improvement in the quality of life. So I think that the fundamental missing variable in PC us, which 10% of women worldwide have is ovulation is progesterone. And common sense, if you're having oligomineria like delayed ovulation or amenorrhea, no ovulation, then you're not having progesterone to oppose the estrogen. Okay. Let me let me back it up a bit. Amenorrhea means no cycles. oligomineria means for our part cycles. Yes. Neither of them refers to ovulation. They only refer to cycles. Okay. So in a whole spectrum, and I like to think a bit, I actually wrote a paper and I call it my iceberg paper, but I like to think that the whole spectrum of disturbances of menstrual cycles and ovulation or this are part of the same mechanism, the hyposolamic protection of the body by altering something. So the very tip of the iceberg, is the or the few women who have amenorrhea, more women who have oligot amenorrhea, but the bulk of the iceberg as we understand it is below the water line and includes short, loogeal phase and an ovulation. And we're not seeing the connections with the ovulatory disturbances because they're not about the water. But if they're if they're having these auditory disturbances, they're not ovulating in that cycle, right? Yeah. When I say ovulatory disturbances, I mean short loogeal phase. Okay. And I mean an ovulation. So maybe ovulating, but not adequately. And if they had a short loogeal phase, then again, that sufficient progesterone may not be released. And so there's the imbalance, the benefit of progesterone, you may not be having enough of it or long enough, that was close to 14 days of your loogeal phase. Yes. So years ago, we showed in women who had amenorrhea, oligot amenorrhea and ovulation and regular cycles or a short loodial phase in regular cycles. We randomized them to cyclic meteroxyprogestrom, which is all we had in those days. And at the end of a one-year study, half of the women had normally ovulatory cycles. We can prove that was because the cyclic meteroxyprogestrom, which also acts on many of the progesterone receptors, or it was learning more about themselves, understanding why these disturbances happen. So again, you're talking my language, because one of our messages is inner work, which is knowing yourself. So the cyclical progesterone was a way to correct these auditory disturbances than from your research. For the blootyal phase replacement. And then today, because back then that form of progesterone was available, but today you use micronized progesterone though. That's right. And I would use it 300 milligrams for 14 days in the menstrual cycle. If you have a normal length cycle, then days 14 through 27. What would you do for those that have like cycles become delayed and stuff? And they're trying to conceive still, which means sometimes you maybe it's possible the progesterone may have been in the follicular. If you're just going like take it for 14 days and take a break, then to 14 days like do you have a pattern for those women, an approach? Yes, look on the Semicar website at the cyclic progesterone therapy. There's one whole section on cyclic progesterone therapy. And it shows how to adapt that cyclic progesterone to your own cycle. And if for example, you're getting flow early, let's not talk about fertility right in a second. But if you're getting flow before you finish the 14 days of the progesterone, it means that estrogen is overriding. You're having still too much estrogen. So there's instructions there about how you can use the flow to determine when to start the next progesterone, which means less time off of it or net greater amount of progesterone. It's confusing. If you're using cyclic progesterone in somebody who's trying to get pregnant, then it's important to either have the stretching mucus, which is an indicator of congesterogen, go away first before starting progesterone or have an LH surge first before starting progesterone because you don't want to interfere with the LH surge. Yes, that's why I was wondering the timing. And that I know our naturopathic doctors follow that on your website. And we had a layer of brain come into town one day and do a talk with our Kaylee, Mekizek, who I know has done work with you. I'm going to say that website one more time. It's C-E-M-C-U-R-S-M-C-C-O-R-D-U-B-C-D-C-A. There's so many resources there. Do check that out. We're going to move into menopause in a moment. We're not quite ready yet. Just in general then, from a reproductive health of those that are trying to conceive, then do you have anything from your research, then, that about ovulation, about progesterone therapy that you want to share before we move on? Is there anything that you've been thinking about? Because we're talking about well-being. I always share our goal's healthy baby, but is there anything that comes to mind? I'd like your listeners to know that we're currently doing a study with women with endometriosis. We need people who are not in chronic pain, but who have a diagnosis of endometriosis and are willing to keep menstrual cycle diary and ovulation records, or two at least two cycles. What we're studying is something very interesting, which is called brown adipose tissue activation for activity. It turns out that when we're cooled, we can create energy from these peculiar kind of fat that is above our clubicals. The thought is that those who have endometriosis may be more able to create this brown adipose tissue activity than normal women who are healthy and have no problem because it's been shown in women with polycystic ovary syndrome that they're less able to create energy from brown adipose tissue. It's kind of a fun study. Is there information on your website for that? Absolutely. I don't know where there'll be in the study because we never know when people are listening to this, but Dr. Prior and her team are always doing research. So this study still may be open and there may be a new study. So go to semcord.ubc.ca on that. Participate. Yeah. Okay. So now let's talk about the Pyramenopause and Menopause. Many women that come to us are experiencing night sweats and hot flashes, poor quality of life, not sleeping well, your debility, brain fog. What role does and waking unwanted weight gain as well. So let I beat that'll be the listeners. Anybody was ready to turn this off? They've just we've peaked through years. Why is there weight gain in this Pyramenopause and Menopause stage? Is that have anything to do with the estrogen and progesterone, for example? And then can you share what your research has been over the last couple of decades on helping manage those symptoms? Oh, if we're talking about Pyramenopause, my feeling is that estrogen and stress are both related to the weight gain. Higher estrogen and also higher cortisol categorical means, nor up in that friend, for example, are related to weight gain. Although it's not entirely clear, I want to say something that I don't know a lot about. But what I didn't always this estrogen on average in everyone is higher in Pyramenopause. In about 20 or 30 percent of us were highly symptomatic. I was terribly symptomatic. I had sore breasts for 10 years, I swear. And without a bridge, which is why I ended up writing a novel to help Pyramenopause women called estrogen storm season. So take a look on the website. We updated, we have a re-addition on that novel, which is available both from us as a book or online as a book or as digital or audio digital. Okay. So what's important to know is that as estrogen is getting too kind, progesterone is petering out. And even in perfectly normal length, luteal phase cycles, progesterone levels are lower when we're in Pyramenopause, then they were when we were premenopausal. We don't fight know why that happens, but that is observed in many many studies. So there's less counter-balancing of the higher estrogen by progesterone in Pyramenopause. Now, most people, or some reason that doesn't make sense to me, think that estrogen is the only thing that can effectively help hot flushes and night sweats. We've shown twice now in randomized controlled trials in pyramenopauseal women and in menopausal women that progesterone alone is effective in decreasing night sweats and hot flushes. That's great news. Let's say that again for all those that aren't sleeping that are changing their clothes a couple of times a night. Over a three month period, micronized progesterone, 300 milligrams saw reduction in those vasomotor symptoms of night sweats and hot flushes. The strength of the data we have in the pyramenopause trial, which was just published last year. And I hope you'll put the link to that. All the studies we're going to put in the show notes that we've talked about that you sent me earlier to read my homework. We're all going to put them in, including a link for the endometriosis study. Oh good, thank you. So the other the other thing that's interesting, we don't quite understand how it works, but for just your own importantly, reduces sleep problems. It reduces disturbed sleep for any reason. And it reduces the sleep problems in both pyramenopause and in menopause, by which I mean you've been a year without a period. So pyramenopause because we haven't defined that for people, that is the period of time leading up to your last menstrual cycle. No, it's a period of time leading up to a year after your last menstrual cycle. All right, so and from women that can be as early as what? Like what's the common age that people start to have pyramenopauseal symptoms? The range is quite wide, but on average it's in the late 40s. Okay, I see a lot of the people we see are 42 to 45 that are having this experience already. Yeah, and the other important thing, this is controversial still, but we have good evidence that when a woman has a regular cycle, but is having night sweats and sleep problems and typical things like shorter cycles, like increased crowds, like weight gain, she can't explain like new migraines, things like that. Sleep disturbances, I already said I think. Then she can consider herself very menopausal. The doctor's not likely to because the definition of pyramenopause in current dogma is based on in e-reg. cycle. So it gives me a thought here. So if somebody's having these symptoms, but they're ovulating and you're saying you can consider yourself Pyramidiposal and they choose --Don't quote ovulation and cycle length. Okay. --If they're having cycles. --They're having cycles. --They're having these symptoms. They're having these symptoms. Their doctor may not say they're Pyramidiposal, but they're having these symptoms regardless, like they're having these experience. If they choose to get the micronized progesterone, they did it for three months, and they really didn't need it, that was in the issue. Is there a negative side effect to take a progesterone if you don't need it? --I don't know of any, and I've done multiple studies with it, and I'm up to date on the current literature. As far as I know, there are no serious negative side effects or physical emotional effects of progesterone. In fact, in the Parymenopost frial, we prove that it does not increase depression. --Okay. Obviously, for cancer, you show that progesterone is needed sometimes for those cervical cancers if you have too much estrogen in that growth. --Too much endometrial cancer. --Yeah, endometrial cancer. --Or ritual is tip-on. --Yes, thank you. Endometrial cancer. I just wanted to emphasize that because if you're having these symptoms and it's impacting your quality of life, it may be worthwhile to give yourself three months to see if you feel improvement. --Yeah, that's all, because there's no -- --The main disadvantage of a boron-micronized progesterone in Canada today is its high cost, and there are many generics, but they only cost about 10 percent less, so it just still an outrageous cost. --Gotcha. --So that's the main adverse effect of progesterone today. --Right, it's just the cost. --Okay. --So we've talked about auditory disturbances today. We talked a little bit about progesterone, paramanopods, something around cycles and ovulation that I wasn't thinking of talking about, but it just came to my mind. I remember years and years ago, I asked you about exercise for those that are trying to conceive, and you sent me so much research to review on it. And I remember thinking, "Oh, exercise can impact ovulation. This is 20 years later probably that since I asked that question, can you share about exercise and menstrual cycles, and then how do we know what's too much then? Do you remember those research? Are you up to it on that?" By the way, you guys, whatever I asked Dr. for higher question, she says we have a good list of research, which I always go and read, I appreciate that. --You know, basically we, as a culture, have tended to blame exercise for the things that are associated with exercise. Like people will start doing heavy exercise because they're under stress, and they're using it as a way of dealing with or being in control of themselves. Or they will exercise and simply not eat enough calories to cover the energy they're burning with the exercise. That's not always very clear because sometimes the exercise decreases our appetite. So usually a person who maintains their weight, who pays attention to ovulation, exercise, you can ramp it up to incredible degrees. But it needs to be done slowly and let your body adapt both your reproductive system, your heart, your lungs, your legs, the whole body has to adapt to this increased demand that we give it when we exercise. --You know, I'm looking at our timer, so I want to wrap this up and just ask any parting comments or statements around the work that you've been doing, the research for those that are still trying to conceive. Those are looking for well-being, healthy cycles. Those that are in perimenopause or menopause that you like to share. And again, I can't highlight it enough. The resource that you required at the Ken's Core UBC.ca website, it's in the show notes, it's fantastic. And also check out that endometriosis study. You may be able to get involved in that. But anything you just kind of want to wrap up, we started with, does your cycle impact is an indicator of health and just love to hear your closing remarks around this. --Thank you. --Then I'll play your talking with you. So my overview is that ovulation, normal ovulation, reflects well-being and predicts lifelong bones, heart, cancer, and old health. --And for yourselves, check out the website because the information is there on cyclical progesterone, the research on PCOS, the research on these vaso motor symptoms like hot flashes, and it's just so much in your books. You have two books, don't you? I thought you'd --Yes, at least. --As you can storm, but there was another one you wrote right after that, right? --That's Gene Errors. --Okay, there we go. Dr. Pryor, I want to thank you very much for making time. I didn't realize that you're already 81. I know you're for a long time. And you're still -- She's at her office, everybody. Still working away and being available, being a resource, being a power for change, being an advocate for those that have cycles, menstruate. So thank you very much for all the work that you have done and continue to do. We really appreciate it and we are grateful I am that you were born. --But you're very welcome. Thank you. --That was such a treat for me because I met Dr. Pryor in my early days and early 2000s and she always was --Always made time to answer questions, do lectures for the public. We would do these together quite a bit and then spoke at the conference I organized and here we are on the podcast and not to mention all the emails she sends me with research when I ask her a question. I want to share with our audience that if you're having auditory disturbances, you're trying to conceive or you have paramanopausal symptoms or menopausal symptoms, at our clinic we do have that integrative approach where we have that access to the cyclical progesterone through our naturopathic doctors. We have acupuncture low-level laser therapy, herbs and supplements. As I say to put more horses on the cart and what I mean by that is you're in the cart and your journey is well-being, maybe baby or symptom relief and depending on what's going on you may need more than one horse. So cyclical progesterone's a horse, acupunctures a horse, IV therapies a horse, low-level laser therapy, which one of those is horses and often the more horses you have on your cart, the quicker and better you get to your destination. Wishing you all the best of luck on whatever your journey may be and please do visit the other podcasts, episodes as I hope they are great resources for you. Thank you for spending this time with us on the Coherence Code podcast. I'm Dr. Lauren Brown and I will see you next week for another conversation on Coherence and healing. If this conversation resonated with you, please like, subscribe or follow the show and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect and stay connected. Welcome to the Coherence Code podcast.