158: How to Balance Your Hormones with Dr. Lara Briden

I would somebody know that they have hormonal problems in. Why do they seek you out? - I think the first step is to reframe a cycle as an ovulatory cycle. So everyone thinks about the period as the main event of the menstrual cycle, but actually ovulation is the main event. Ending mechiosis, I would argue, is less a hormonal condition and more a bunch of other stuff. The problem with PTS is that you're not ovulating and you potentially have insulin resistance. The pale suppressor's ovulation and promotes insulin resistance. - 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 intercom 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 remove 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. (soft music) - We have Dr. Lara Briden. And she's actually practiced lives in New Zealand, but she is a fellow Canadian from Alberta, Canada. She is a naturopathic doctor and bestselling author of the book's Period Repair Manual and Hormone Repair Manual. Practical guys to treat period problems with nutrition, supplements and bio-identical hormones. And so grateful to Lara because she was a man covering indeed an integrative talk with our local naturopath, Kalea Mekizek and also the Fiona McCollock. And we started to give some of your books away as door prizes and people are really appreciative of that as well. So thank you. She has a strong science background. Lara sits on several advisory boards and is the lead author on a couple of peer reviewed papers as well. She has over 20 years experience of women's health and currently has consulting rooms in New Zealand where she treats women with PCUS, PEMS, endometriosis, paramedmine pause and many other hormone and period related health problems. Lara, I'm so glad that I get to talk to you on our podcast today. Thanks for having me, Lauren. And of course, we got to meet in person last year, which was fun. It was nice. In this era of everything over Zoom and everything online. We got to do an online event. It was nice. We had people online and we had people in the room with us. And that was, you know, that was now it's getting a little more common. 2023 is we record this. But yeah, it was nice to be in your presence. Now, I wanted to chat with you because you've written a lot about hormonal health and it's a big part of your practice. And I think about the women that we see and our approach are similar, our clinic and how you approach that, you know, a healthy cycle seems to be important, not just for people's well-being, but also to create a healthy baby and to optimize your fertility. I'm assuming you subscribe to that idea. Oh, yeah. Although it's just a little full disclosure, I don't treat a lot of fertility because I'll just tell you why because female hormones are only one small part of that puzzle as you know, like those, you know, egg quality, which relates to hormones, but there's a immune function in the woman and then there's all the whole male side of things, which is huge. So yes, I mean, I can slide in on the female hormone side of things, but it's always just one part of fertility. That's why I wanted to talk to you is because when it comes to reproductive health, one of the things we look at is do you have healthy hormonal cycles, do you have balanced hormones? Because that's going to contribute to the environment that's going to support the maturation of the egg and it reaches its peak fertility potential. So what is considered a healthy cycle then? Because I see women saying my cycle's normal. My medical doctor said my cycle's normal and normal doesn't always mean healthy. So how would somebody know that they have hormonal problems then? I think the first step is to reframe a cycle as an ovulatory cycle. And that's from a general health perspective as well as obviously from a fertility perspective. But I don't know if people, your listeners realize, but it's actually quite common to have what are called an ovulatory cycle. So you could be even having stony regular bleeds and potentially not ovulating at all or having what's called subclinical ovulatory disturbance where you maybe are ovulating, but you're not forming like a strong corpus leitine. You're not getting that robust leitille phase. So yeah, an answer to your question. The step one is to ask the question, am I ovulating with these cycles and track that preferably with temperatures. I'm guessing you've had guests before that talked about a bit about cycle tracking and using under the ton temperatures for tracking ovulation. It's extremely helpful. And then there's some salivary testing or sorry, not salivary urinary testing that you can do to test to see if you've ovulated that they look for the downstream metabolites of the progesterone even like the actual. Oh, yes. Actually, there are some progesterone urin test. Yeah, I haven't used those clinically, but that's another option. And there's blood tests. But you're saying just having a bleed does, although usually the doctors will say, if you're bleeding monthly, you're ovulating monthly, and you have, you know, through the research that you've been involved in, that sometimes you can have a bleed and it was a non-ovetory bleed. Exactly. And ovulatory. So that, some of that research is coming directly from your neighbor, scientists, Geraldine Pryor. Right. At Sam Gore, which is pretty close to you, actually, just a few blocks away. She did a study, she's a famous Canadian scientist, a big expert on ovulation, she runs a public center for ovulation, menstruation, ovulation research. And she discovered that it was close to like a third of cycles or an ovulatory. It's invisible and ovulatory cycles. And that's just in women who are basically healthy, but ovulation is one of the first things to go with health, right? Like, ovulation is hard to do. So as soon as there's any kind of stress or even just like social stress or emotional stress or illness or nutrition not dialed in, ovulation slows down. The guy there stopped, doesn't happen. Or like I said, it can, ovulation could happen, but not robustly. And a lot of that's to do with egg quality, right? Like, that's to do with the, not just the format, not just that in that cycle, the formation of the corpus latheum, which is what makes progesterone, but all the kind of month-leaving up to that and the health of the follicles, the little baby eggs that the little baby follicles as they were on there, what I call a hundred days to ovulation on their journey to ovulation. Many to be fully nourished have all the right hormonal signaling, including stress hormones and not too much inflammation and not too high insulin and all those things happening. So that when they, when one of them wins the race to ovulation and ovulates, that that's a nice strong follicle that forms a nice corpus latheum and makes lots of progesterone, that's what you want. - So I want to kind of unpack that a bit. What you shared is that sort of that hundred days. So that follicular genesis determine that egg quality. That last hundred days is that time when the follicle and they can reach its peak for tilly potential. And the follicle is kind of, I've heard people call it like, it's the baby house, it's supporting the egg. So I'm getting my dicondrule health, good blood flow. Like you said, what's the blood sugar levels like? What's the hormonal signals like? Inflamation signals, nutritional profile. Here's something, Lara, I shared this once with a reproductive endocrinologist and they said, if theoretical, they said it makes sense. You know, we got to do more research because they didn't consider spotting an issue in the reproductive endocrinologist. They're like, oh, Lutil phase defect went out in the 80s. It's kind of to grow. And I know as an atropathic physician, you don't want to see spotting. You look at that as a sign of an imbalance, right? - Correct, yeah. - I mean, there could be lots of reasons for it, but yeah. - Yes, definitely, yep. - And so I said, well, here's my thought. And I came from a Yin-Yong Chinese medicine perspective. So you got the egg in the follicle or one. They're together at one point in time. And then as you shared, the egg is released into the tube and the corpus luteum, the follicle becomes the corpus luteum that produces a progesterone. So one way to kind of assess the quality of the egg is, if the corpus luteum cannot produce progesterone for those 14 days or there's a lot of spotting or you have that Lutil phase defect, well, since they were once one and it's the follicle that's charging supporting the egg during those 100 days, then if the corpus luteum doesn't look great through how we seen progesterone, theoretically, I speculate that maybe the egg isn't great as it could be because it didn't have that great follicular support. - Yeah, that's exactly, yeah, you articulated that very well. That's what I was sort of leading on said, to some extent. But yes, the journey of the follicles is gonna result in both a healthy egg itself and that that quality is important for fertility and the corpus luteum that formed from the follicle that held the egg, yeah, they're one and the same. I think that's-- - And progesterone is important 'cause it helps with the window of implantation and maintains a line. So you don't want it to grab some really good curls from you. The things that I think of where we get, where some of the hormonal and balances are obvious are conditions like endometriosis and PCOS and PCOS is a really common obligatory disorder can be. So you're seeing this in your practice 'cause you've written about it. - For sure, yeah, those are probably the two most common conditions, I guess. I'm happy to talk about them. They're quite different from each other. Actually, they're very, very different. And endometriosis, I would argue, is less hormonal condition and more a bunch of other stuff, including immune. I mean, we could come back to that, but with-- Thanks. everything condition. It is and I'll share we that's where we gave several of your books away and people are so appreciative and you did the the documentary film below the belt related to endometriosis and how it's misdiagnosed, underdiagnosed and just all the suffering and so it was just nice to introduce people to your work through giving out your and so thank you for giving us this book so we could share them with the people that came to our workshop. So can we start? So I'd like you to talk about both. PCS is one of my favorite things to treat so I think it's one of the things that responds well to the kind of medicine that you're practicing. But I'd like to hear a little bit about your endometriosis because a lot of women may have it but don't know they have it and so if you can talk a little bit about some of the symptomology to show that there's an issue there and then I'd love to hear about your approach to polycystic ovarian syndrome as well. Okay so in my books the angle I take and I have a YouTube video about this I've spoken about it some length actually on my blog and on YouTube and it's primarily I would argue a disease of immune immune dysfunction. It's in the territory of autoimmune disease very close to that. It's influenced by hormones and endometriosis is influenced by hormones of course as almost everything is but it's very influenced by estrogen. Estrogen is just like gasoline on the fire endometriosis. It's you know hard to have any active endometriosis lesions without estrogen being present but my approach with my patients because I also estrogen is very beneficial so the medical approach as you know is to kind of shut down estrogen unless you're showing propregnancy and then they try other strategies but I feel like a way better approach is to dial down the inflammation which usually involves dialing down the inflammatory reaction in the immune response which a lot of it's to do this won't surprise you I think from a TCM lens it's a lot to do with the gut microbiome is quite a strong degree of intestinal permeability with endometriosis specifically sounds weird but specifically some of the bacterial toxins someone called LPS that's exiting the gut basically ending up in the pelvis and inflaming those lesions so the that gives us a really good way in as natural health practitioners we can fix the gut a lot of it links with endometriosis a lot of it links to a condition called SIBO or small intestinal bacterial overgrowth which you've probably had guests talk about before plus there's always going to be a genetic vulnerability endometriosis does seem to be quite strongly genetic so some women just would never never get endometriosis no matter what kind of the state of their gut or state of their estrogen or anything that's just never going to happen for them it you sort of have to have the system primed for a few and a few ways including having a certain that autoimmune type of immune system or vulnerability but the other thing that's going on with endo I'll be honest the last couple years I've been talking to some other practitioners there's a brilliant book coming by a Australian gynecologist I'm going to give her a plug now her name is Peter Wright her book is coming out later this year in 2023 and she's really raising some very interesting questions about just separating out pelvic pain like acknowledging that pelvic pain and endometriosis kind of get sort of mushed together but they're actually separate and there's some of the real question marks around for some women what the presence of those endometriosis lesions how significant that even is like how much that's actually related to the pain so there's some question that possibly Peter Wright says I hope I'm quoting her properly but like she thinks some of these lesions in some women are just physiological like a little bit of retrograde administration that ended up there but the body is going to clean it up and it doesn't really mean anything per se and yet other women can have quite active inflammatory lesions so this is what I mean about endometriosis is a very complicated condition and certainly it can affect fertility I think it's affect on fertility is a lot to do with just the inflammatory environment and the whole pelvis not just the lesions themselves but just that we talked about the follicles need a safe happy environment to grow up in when that whole pelvis is inflamed that leads to poor egg quality in endometriosis that's one of you know I've been seeing more women in clinic saying to me I do not feel like myself they're sharing that their sleep is off they have brain fog their mood or anxiety feels really different and even things like joint pain and itchy ears are showing up and they're wondering is this just stress or something more if you're in your 40s or early 50s this could be the paramedicos phase for you and it often comes with no clear explanation and that's why acu balance is hosting the M factor 2 speaker summit it's an online event on Tuesday June 16th we'll be screening the M factor 2 followed by a panelist insisting on naturopathic doctors Chinese medicine doctors a medical doctor a pharmacist a fitness and nutrition expert and pelvic floor therapist and I'll be moderating so if you've been wondering what's going on with your body and more importantly wanting to get real answers please go to acu balance dot c a and register for this online event all right let's get back to the conversation of this podcast and we lose we lose eggs the quality is diminished and we also you don't receptivity becomes an issue as well for sure yeah and the like implantation like the intrametral lighting becomes yeah but what what you you highlight here though I really want to emphasize is the inflammation but so much the the gut health and yeah so diet and lifestyle stress and emotions can impact our our got microbiome and I think even in the reproductive world mainstream conventional they're starting to to to think about the microbiome the vaginal microbiome and the uter microbiome at least it's becoming more of a understanding that it has a systemic effect on the body for sure yeah there's a lot of research into endometrics in the microbiome and what I'm actually talking about is the pelvic microbiome which is weird like we think of the gut microbiome and as you pointed out there's the uter end microbiome for sure vaginal microbiome is actually a microbiome in the pelvic cavity itself and women with endometriosis have I think it's like six times higher levels of E coli particular bacteria in the pelvis which is how would you how do you address it then because we know the conventional way they're there's obviously um excision surgery there is you know shutting down the hormonal system like you know loop run drugs like that what would be your approach is somebody has been diagnosed with endometriosis what it's kind of your approach for that antimicrobials to start with often yeah I mean it depends on the case obviously and it's in antimicrobial herbal medicines you cannot use during pregnancy so you'd have to sort of weigh that up and decide what treatment protocol you're going to do but I and I'm curious again because I know you are a TCM practitioner so I can get you to weigh in like I'm doing is burberrying some of the burberrying containing herbs that from a TCM perspective that you know that clears dampness that clears some of that damp heat which is microbial basically well similar like your colleague and friend doctor keelie mccasica at her clinic at acu balance we tag team we integrate and so she will do the antimicrobial yeah my carburels um she does that dietary changes and this is after testing sebow you know doing the gut microbiome test and then we will use the herbal but there's not like a one-size-fits-all you know in the terms medicine it's how they're presenting because not all women diagnosed with endometriosis present the same symptoms either and so we really look at how is the body presenting and then it is there's mind body stuff there's the supplements there's the diet and lifestyle sometimes there's certain antibiotics and antimicrobial that you talked about and then it sometimes needs to be a pelvic therapy like a physical therapy component to endo-addepends because there is there's a whole pelvic floor spazum and the nervous system of hell that can become quite overactive yeah hyperactive and so that's endo and it's a big one and we and we're not doing an endo talk today but we just wanted it to talk and but I wanted to just it just because you're here it's it's always good to go into your knowledge and then yeah I'm just thinking like like PCS for example because I did you not just was it when you were here were you involved in some PCS research or review yeah well this was yeah good memories so I was in Vancouver to meet up with Jarlyn Pire who we just mentioned she's at her she's the endocrinologist local retired yeah she's a research her research lab is just blocks away from you and they've been running I think they're close to finishing it a clinical trial of what's called cyclic progesterone therapy for PCOS so that's using natural progesterone essentially but they've been using you know the vermitrium which is the prepared version of body identical progesterone and one of the papers I wrote actually was with Jarlyn Pire about kind of the mechanisms of progesterone for PCOS because progesterone can have quite a nice anti-entrogen so testosterone lowering effects in women and it also can promote ovulation by providing this sort of beneficial negative feedback to the hypothalamus to the brain and because as you pointed out one of the key features of PCOS can be an ovulation or just not regular ovulation so and that's important reestablishing ovulation is important for fertility obviously but also for general health because it's by ovulating regularly then women make more estrogen and progesterone and then that in itself can help to relieve some of the angrigen symptoms and even the medicine of the metabolic symptoms so So yeah, I mean a PCOS, all I said to go over is syndrome is kind of by definition the situation of endogen access or access testosterone in women when all other causes of endogen access have been ruled out. It was always the kind of it's in an in essence is kind of an umbrella diagnosis. It's like anyone who's got high endogen so it doesn't fit into some other category gets thrown under the PCOS umbrella which is so which does mean different people can need different things. It's perfect for Nech-Pathic medicine and integrative medicine because you can treat the individual to figure out. Yeah. And the reason you're talking about the the ovulation and how it's so important with in PCOS is because if you're not ovulating then we have a lack of progesterone. Exactly. So we're missing that. And do you find like a lot of the women that we'll see have been put on birth control pill. These are the ones that we're trying to conceive but that's how they are managing their PCOS-like symptoms. Is that a beneficial approach or how do you see that from your natural pathoclens? Well my books, my books are essentially all about how to come off the pill, how to not take the pill like all the ways you can avoid pregnancy and treat menstrual symptoms. So what's why, what through your lens, what is what's the reason why you want to support women not needing or helping the come off the birth control pill. What is the bias there for you that you know that they may not be aware of that you have an interest in them not needing that? Because women benefit from their own hormones, estu-dial and progesterone that are not the hormones in the pill. I mean I think maybe I've come to realize a lot of people do and even doctors do kind of think that the pill contains estu-dial and progesterone. It doesn't. It contains sort of analogues of those hormones but the big difference is in progestes dens which are the synthetic, the diversions of progesterone used in the pill and real progesterone. They have very different effects in the body, very, very different effects. In particular, one of the best examples of, well there's two examples that illustrate how different the pill hormones or the contraceptive drugs are from real hormones is one is around breast cancer risk, all types of hormonal breast control carriers. A slight breast cancer risk, I don't like to overstate that. I'm just, it's small, but it's mostly from the progestin. Whereas arguably progesterone, our own progesterone that we make or you can take as a pro-metrium, according to Professor Pryor, it probably reduces the risk of breast cancer. So that's one example of how they're different. The other way they're different is progesterone is really good for the brain and progestins are not. Here's an example, the progesterone that we make with a natural menstrual cycle converts to what's called a neuro steroid. It's kind of like a neurotransmitter/ hormone called aloe-pregnant alone. People don't have to remember the name of it, but just know the brain loves it. It's really good for the brain and the progestins in all types of hormonal breast control, none of those progestins convert to aloe-pregnant alone. So when you put a young woman on any type of hormonal breast control, you've essentially robbed her of her own progesterone and replaced it with a medication that it's not the same at all, especially for the brain. And that might be why, for example, we're shutting to see some worrying signs in the research that especially young people, girls who are put on hormonal breast control as teenagers grow up to have a triple the risk of depression and anxiety later in life, even once they stop the pill because that formative years of brain health is so important. And that's when we benefit from real hormones, as to dial and progesterone. I always talk about how this cavalier way that we're like, "Oh, women don't need their own hormones. Come on, we'll just put them on the pill." And they just only let them ovulate when they're ready to have a baby. That would be like saying to men, "Oh, come on, you don't need your own testosterone. What are you worried about? Well, just suppress your testicular function and suppress your testosterone and replace it with this drug that's only kind of like testosterone, but mostly like estrogen. And it's probably going to cause depression and affect your brain development over your life. But don't worry because that's what everyone else takes. That's essentially where we're at with the pill right now. And that's why I wanted to talk to you and I'm so glad you're writing your books. And so what would be some of the natural approaches then to help somebody with a metabolic disorder like polycystalabrarian syndrome? You know, you're using dietary tools. Yeah. So PCOS responds incredibly well to natural treatments and it answers to your previous question of why not take the pill for PCOS because the problem with PCOS is that you're not ovulating and you potentially have insulin resistance. The pill suppresses ovulation and promotes insulin resistance. So it has done nothing. So we got to say that again because we even talked earlier about egg quality, how blood sugar regulation can impact it quality. And so you're sharing that if you go on birth control pill that ovulation, it doesn't fix ovulation, even though you may be getting a bleed. It's not an auditory bleed. And the hormones that you are replacing do not have the same impact on the body as the bioidentical. Your goal is to get them ovulating so they have their natural estrogens and progesterones. Correct. And just to say again, because we know that the conscious of the drugs in the pill compared to our real estrogen and progesterone, those conscious of drugs do seem to promote or worsen insulin resistance. And that kind of paradox has been known for a while. It's been a few papers about that. It's like, oh, wait, wait, why are we giving medications essentially that cause insulin resistance to women that already have insulin resistance? It's not ideal. And that was the best tool that conventional medicine has. That's why they're doing it. But there are other paradigms or practices of medicine like naturopathic medicine. And you guys address this differently. And so diet, there's supplements you do to help regulate sugar. Yeah. So the top supplement everyone should know about. I always feel like I'm doing an informational for it is inocital with my own. You know, I do it because I'm a little heavy in the way. So I started taking it for that reason because blood sugar regulation. I'm taking it for sleep actually. So I feel like I'm doing an informational for an also it does lots of things actually. It's good for thyroid. It's helps with intercellular signaling. So it gets right down into the nuts and bolts of kind of hormonal signaling for a few hormones that enhances insulin sensitivity and promotes ovulation. It's yeah, it's like inexpensive. It's safe when you're trying for pregnancy. This is why I feel like. Do you ever use the deciral with the myonocital or used to quit? With the myonocital? I have a podcast episode about that. So if anyone wants to check that out, you could put it in the show notes. Yes. Let's just let's give a shout out to your podcast so they know how to find it. Do you know the episode number by chance or the title? No, I don't. I've only been only honestly got like 12 episodes. I think defined it's in summer in the middle. It's just inocital is in the name of the episode. And yeah, I was researching that episode. I really was able to finally get my head around it. Like deciral, you need to be careful with deciral with PCS. So it doesn't it does it compared to myonocital deciral inocital does promote insulin sensitivity. It's okay to have a little bit of it in there, but too much deciral can prevent ovulations. So the 40 to one ratio is what most of the ones find. Yeah, that's what you can do 40 to one or you can do straight myonocital. Yeah, whichever is kind of easier and more accessible. I think that's fine. You just wouldn't want to do straight deciral at least not for PCS. So yeah, so there's that. Yeah, there's what else. So zinc, zinc is my other favorite one anti-anogen for women and it was like, like, pretty fun therapy. So that's what I can tell you one of my favorites. You didn't say one of my favorites. I'm going to check it with you. I bet you. So the mine also tall sometimes with the deciral 40 to one ratio. And I love inocital cystine. Yes. Yeah. Yeah, I prescribe it for a lot of things as I prescribe it for endometriosis as well. Same. For its anti-inflammatory effects. Yeah, I think it's great. It's great. So that's a good. Actually, PCS can respond to lots of different strategies. Again, it can be very individualized for what's going on for the woman. And then there's the cyclic tissue therapy, which we mentioned before that gel in prior just probably finished a clinical trial on that. And they, one of the problems they had with recruitment for that trial, of course, they had to, women participants had to agree to not take the pill. They had to use psych like progesterone instead of the pill. I think they've finally finished it now and will hopefully publish those results. So she'll be great to see. Well, great thing about progesterone is it induces a bleed. So it can give you those withdrawal bleeds at least at first. But unlike the pill, it actually promotes ovulation rather than suppresses it. So it's safe when you're trying, it's also when you're trying for pregnancy, you can use it. And it's because it's the cyclical. Like, you know, if you're taking it, because you're not taking it all month long, you're taking it and having a break. And it's that cyclical use is what's going to help support ovulation. Yes. Exactly. Yeah. I mean, this is what, and I remember we do the cyclical progesterone often in Kaley's greatly influenced by Jareland's work and from her connecting with you as well, how we use it. And again, the acupuncture, the supplements, it's just a really nice imbalance metabolic disorder. It responds to the diet, the supplements, the acupuncture, the cyclical progesterone. And have you found, because it's been my experience is, you know, when you give somebody birth control pill, as you shared, and then they come off of it for if they're diagnosed with PCS back when they weren't trying to conceive, it doesn't correct it. The PCS is right back to the ovular disorders. So it was like a band-aid effect. It was, it wasn't fixing the mass. Massive symptoms. Yeah, it gave you withdrawal bleeds that meant nothing. Right. Correct, the underlying ovulation problem might worsen it. We've seen witness observed anecdotally that often when we work with women that are trying to can see and we help them start get ovulating if they weren't or just have their ovulation more regular because they had such delayed ovulation like every 45 to 60 days that after having baby that they continue to cycle. Like they don't need to go back on to the end of the game. Do you see that pregnancy can be a just massive hormonal reset makes sense. Like the whole system recalibrates it. Yeah, I've certainly seen that with patients where they've been maybe had a terrible time with PCOS very worried about having to go through it all again with their second baby and I'll say, look, you may find after your first pregnancy and delivery that boom, you just everything's okay now. It's possible. So as you wrap up, I have another question then on this because most of the women I see that have a diagnosis of PCOS or we help them determine that they have that diagnosis through their physician through signs and symptoms because if they start to ovulate, they're coming to trying to get pregnant, we have that pregnancy which you said is a great reset. So I have a question because not all the women you see are trying to get pregnant but they have PCOS. If they're coming with the irregular or non-obitorial cycles and they go through your program, they work with you and they have three to four months of regular cycles, are you able to pull them off of the mine-off, the towels and all those things in cyclical progesterone and does it hold or do they need to keep going the natural approach? It's an excellent question and the short answer is it will usually hold. I talked to my patients about getting the ball rolling, like getting the boulder rolling, like once ovulatory cycles are going and robust and as long as you're healthy, they should keep going. So I certainly had patients who use cyclic progesterone for like six months and then can come off it. It depends on the individual again but no, I would say that you don't, you're not necessarily going to always need those supplements. If of all the long-term ones of myone also is a nice one because it's so good for everything, especially if someone has been kind of tending to insulin resistance and wants just a way to stay on top of that and keep their cycles going and keep their insulin sensitivity good, then I think it could be quite helpful to stay on myone also tall but in answer to your question, no, there's a hope, like they might just be able to find, well, I've just got normal cycles now, I'm ovulating monthly and everything is good, that's nationally possible. So how do they find you? So website, Instagram, your podcasts, your books which I think are excellent and we'll put them in the show notes as well. Yeah, I'm easy to find. Everything is Lara Briden, so LaraBriden.com and you can link to my podcast from there, the Lara Briden podcast and all my social media is at Lara Briden and my two books are period per manual and hormone per manual. And I don't know if I mentioned already but I'm currently writing a third book which is all about insulin resistance. So I'm very interested in that as a topic. It'll be for women primarily but yeah, there'll be lots about PCOS and paramanopause and postpartum as a time of potentially insulin resistance unfortunately. Yeah, so there's just lots of lots to look at there and it's a lot more than just, you know, it's not one size fits all diet, there's lots of things women can do. So there we go, Dr. Lara Briden, thank you very much for joining us. Thanks, Lauren. 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. You know, I've been seeing more women in clinic saying to me, I do not feel like myself. They're sharing that their sleep is off, they have brain fog, their mood or anxiety feels really different and even things like joint pain and itchy ears are showing up and they're wondering, is this just stress or something more? If you're in your 40s or early 50s, this could be the paramanopause phase for you and it often comes with no clear explanation and that's why acu balance is hosting the M factor 2 speaker summit. It's an online event on Tuesday, June 16th. We'll be screening the M factor 2 followed by a panelist, consisting of naturopathic doctors, Chinese medicine doctors, a medical doctor, a pharmacist, a fitness and nutrition expert and pelvic floor therapist and I'll be moderating. So if you've been wondering what's going on with your body and more importantly wanting to get real answers, please go to acu balance.ca and register for this online event. Alright, let's get back to the conversation of this podcast.