Lorne Brown

By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either 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 guest or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose. I want to introduce Dr. Jerilynn Prior and I’m so excited to have her on the Conscious Fertility Podcast. I thought for our conversation today, we’ll talk about your research and also talk about fertility and auditor disorders and talk about peri and menopausal symptoms. You’re up.

Jerilynn Prior 

I like to use the word disturbances rather than disorders.

Lorne Brown 

Sounds good. You can correct

Jerilynn Prior 

Me when they sound like diseases and in almost every case it’s an imbalance.

Lorne Brown 

Well, now you’re talking like a Chinese medicine doctor. Of course.

Jerilynn Prior 

The balance between dial and progesterone is very similar to the concepts between yin and yang.

Lorne Brown

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 and 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 Craig Craig back then and here you are still pushing and can’t tell you how many women I have seen that get the progesterone support because of the research you’ve done or the books that you’ve written or practitioners you have educated that tell them that have now piece right, because they found other ways to get back into balance.

Jerilynn Prior 

Yeah, it’s important, but I mean progesterone is definitely important, but it’s also important to understand the context in which this is occurring

Lorne Brown 

Because

Jerilynn Prior 

I mean, I just got an email this morning from a woman who was encouraged to start taking progesterone and perimenopause and now she’s saying, well, why isn’t everything all better? Why am I still having symptoms in the, she’s taking it cyclically and in the follicular face. Well, it’s because of perimenopause. Estrogen is swinging the heck out of itself,

Lorne Brown 

Right? And that can be very uncomfortable. Today we’re going to talk about auditory disorders and symptoms that go in perimenopause. So before you have that last menstrual period end menopause after a year later your cycles end because she’s the expert in this area. Let me tell you who Dr. Jerilynn Prior is though, 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 balanced with estradiol for wellbeing and fertility during the premenopausal years and for lifelong good health. And this is important because the fertility patients I see are in that perimenopause stage. Most of them are 40 and beyond. She founded the UBC Center for Menstrual Cycle and Auditory Research. And that website, by the way, I’m going to say this a few times, is emcor is C-E-M-C-O-R ubc.ca. And 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. Prior is an internationally recognized thought leader on menstrual cycles, ovulation, perimenopause, menopause, osteoporosis prevention, and night sweats 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.

Jerilynn Prior 

It means 75, it’s actually 75 now. 75 publications have been quoted 50 times.

Lorne Brown 

Wow. Okay. So there you go.

Jerilynn Prior

Yes.

Lorne Brown 

Thank you for publishing because your research is being cited a lot. And her controlled trials show progesterone decreases menopausal VMS vascular motor symptoms and increases bone formation. Dr. Prior grew up in Alaskan Fishing 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 motivated her to come to Canada because of her beliefs in universal healthcare. Dr. Prior, welcome to the Conscious Fertility Podcast.

Jerilynn Prior 

I’m happy to be with you, Lorne.

Lorne Brown 

Now, I don’t know if you may not know this. 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 c, the Canadian Fertility Andrology Society, 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, how important you were from two levels. One is Chinese medicine looks at the yang, herbs to help with the bones versus the yin. And we think of yang like progesterone and yin like estrogen. You need both. But in Chinese medicine it was not all these yin tonics. It was a lot of yang tonics and you were talking about how progesterone was important for bone formation. But the thing that I was like I’m going to follow this woman around is because I’m a fan of people that think outside the box and aren’t afraid to ride outside the lane. And after your talk, there were a few physicians gathered 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 for me from a Chinese medicine perspective. I want to talk though, because you got research behind this, can you start to introduce to our audience why you’re into this research and why are you such an advocate around progesterone research?

Jerilynn Prior

I guess the fundamental reason is I’ve become so aware that the basic concepts that we’re taught in our culture by gynecology in particular and that medical students are still taught, are often unbiased in science, their mythology rather than evidence. And for example, one of the examples is a regular normal month apart cycle is normally ovulatory. 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 ovulatory at all or may be ovulatory, but with too little progesterone or too short a durational 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

Lorne Brown 

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 variabilities, 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 bleeding every 28 plus or minus days, then you’re probably ovulating. But your research says that’s a myth.

Jerilynn Prior 

And in fact, textbooks 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 and scarecrows fixed at 13 or 14 days and that’s just nonsense.

Lorne Brown 

Your research showed it can vary the luteal phase. So I want to understand the mechanism I’m familiar with, how the stress and the environment can impact a woman’s ovulation as an effective follicular. I mean I see it clinically, so I don’t even need to see research. I see it because women are monitoring their cycles, the ltil phase. I’m curious about the mechanism why that would happen because in my mind I think if you got the follicle, the corpus, the follicle releases, the egg, the follicle collapse becomes the corpus lutetium. 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 flu till phase,

Jerilynn Prior

We don’t actually know quite the mechanism. The corpus lithium by the time it is formed has a certain potential

And that potential is altered by even minor things such as an argument with your partner or a boss who’s writing 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 lium to create a full length full progesterone ovulatory phase. So one of this sort of teleologic ways I think about it is that progesterone makes demands on the body’s energy demands because when it’s around, it raises our basal temperature by two tenths or so or more of a degree Celsius. That means we need extra energy and also we need a full duration 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 optimally shouldn’t.

Lorne Brown 

And for our audience, we have multiple episodes on how to manage stress so you have more resilience for those that are concerned. I heard a reproductive endocrinologist 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, we have many women that have spotting or short ltil phase and when we give them an ovulation drug then it was ch clomid, Letrozole wasn’t being used. Then they can ovulate and have babies. So the luteal phase went out in the eighties. What’s your response to that?

Jerilynn Prior 

That’s quite true. The gynecologists don’t believe in a disturbance of the luteal phase length, hence the fixed luteal phase. But exactly the early scientists 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’s the way we ought to think of it. These are adaptable and we’re totally reversible. It involves 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,

Lorne Brown 

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 atory cycle, so you’ll have a bleed, but there is no ovulation or you may have an ovulation, a shore, 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’s just adapting and it’s not what you’re considering a problem. I’m using that word loosely just so somebody has a non atory cycle in a year that’s not a need to see a doctor, for example, because it’s going to happen to most people.

Jerilynn Prior 

I can’t help but think that the messaging around ovulatory disturbances went out the window decades ago as assisted reproductive technologies took over our concepts.

Lorne Brown

Okay. Where you have that kind of technology available where you’re talking again 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, 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 technologies, not to try and override the body. So we’re still not looking for a pregnancy in Chinese medicine. We’re looking for a healthy baby with a healthy parent at the end of it. So we wouldn’t ignore it if somebody had auditory disorders or short luteal phases. In my practice, we don’t ignore that. Even if you’re going to do Clomid or IVF, we still want to see if we can regulate that and give you support and tools to help have that resilience. So you may not need the ART and if you do peak egg potential, peak sperm potential.

Jerilynn Prio

One of the motech tools that I’ve 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. We kind of give the reproductive system to doctors or husbands or whatever instead of owning it. And we are the only ones who can possibly understand it. People like you and me that councilwomen can only help them to understand it. We can’t understand it for them.

Lorne Brown

I agree a hundred percent 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, the only ones that can experience it on this research. I want to unpack a few other things that you had brought up. One is on, there’s so many apps out there, so how does this impact or what’s your thinking on these apps end? 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?

Jerilynn Prior 

Yes. Very few of the tools currently available accurately assess the luteal phase and its length. Most of them are not validated.

Lorne Brown 

And so for somebody that wants to track ovulation, are you still, 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.

Jerilynn Prior 

Yeah, so I don’t know. I look back on it and think, God, that’s a little brilliant, but I felt I needed something quantitative, not just the DBT, their basal body temperature thing. And so I worked with statisticians way back in the 1980s and we developed a simple way, which is on the emcor website of analyzing it is ahead 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.

Lorne Brown 

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 it in through the lens of Chinese medicine that I’m asking 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 wellbeing and could predict lifelong good health?

Jerilynn Prior 

Yes. There’s two parts to that question. The first is its reflection of wellbeing. 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 ovulation 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 tedd in that cycle. One third we had a little more than one third normally ovulatory, one third short luteal phase and one third and ovulatory. And we created a resilience 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-help. In other words, how they evaluated their health. We put those together and created this resilience scale. And the ovulatory cycles had higher resilience than the short luteal phase cycles than the anovulatory cycles, and it made a significant phase related difference. So that’s strong evidence that ovulation reflects wellbeing.

Lorne Brown 

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, very bad cramping and clotting, for example, lots of clots. And she’ll say, her doctor said it’s normal. And I’ll say, well, in Chinese medicine, normal doesn’t mean healthy. Normal means a lot of people have it. It doesn’t mean 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, wellbeing 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 is an indicator of ovulation and a lot of women think they’re ovulating based on that. But your study makes me think I am in a myth.

Jerilynn Prior 

Yes, that’s true. In fact, in the same data I just talked about, we compared the ovulate cramps in the normally ovulatory cycles with the long and enough lal phase length with the cramps in anovulatory cycles, and they were worse and they lasted longer in anovulatory cycles.

Lorne Brown 

All right, so we can no longer assume that because you’re having menstrual cramps that that means you’re ovulating.

Jerilynn Prior 

That’s exactly right. And looking back at it, it’s a very good example of the problem with how women’s health, reproductive health has been managed. A study showing that was published in the 1930s. Oh really? No one afterwards confirmed the myth that only ovulatory cycles get cramps. I mean, come on. Science requires confirmation,

Lorne Brown 

Right? Repetition, reproducibility.

Jerilynn Prior 

So we did, as far as I know, the first clear demonstration that first of all, the myth is wrong, that cramps occur in cycles of all sorts, but also shows that cramps are worse in an ovulatory cycles without progesterone.

Lorne Brown 

Okay, now we’re going to start to, we’re going to, can stay on the reproductive side of the fertility side. We’re not quite ready to talk about auditor disorders like polys six ovarian syndrome. I think your term is androgen and auditor access, or maybe I got the a’s mixed up in the order, but a E, we’ll talk about that. But before that, I want to talk about again, this auditor and the balance between the follicular and luteal and possibly how it can affect reproductive health. Going back to that physician that said ltil phase defects went out in the eighties, interesting enough clinics starting in around 2023, the IVF clinics here we are recording this late 2024. They now measure progesterone before they do a transfer. So obviously that’s telling me that if the progesterone is on a certain level, they’re concerned about implantation. I remember, and I was curious, the number in our units and the metric system, when somebody does a mid ltil serum level, there is a number where you are hoping for that progesterone to to show that you’re having that robust ovulation or that corpus lutetium is in wellbeing because I think the number is it 15, if it’s over 15, you kind of have a confirmation of ovulation.

But at the mid ltil, that would not excite you as in a wellbeing or a healthy ovulation.

Jerilynn Prior 

Okay. I don’t know the optimal peak of the gluteal 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 NAL per liter.

Lorne Brown 

Okay. 9.5 NMOS per liter for our American listeners, you’re going to have to go to the web and convert that.

Jerilynn Prior 

Okay. Three nanograms per milliliter.

Lorne Brown 

Oh, there you go. She knows. So depends on which lab, Canadian, us versus the rest of the world for your measurements. Okay.

Jerilynn Prior 

But what’s interesting is that we did a large study, a population-based study, about 4,000 women in Norway. It 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. And what we did was to ask if they were cycle day 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 action 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.

Lorne Brown 

So what does that tell you? What do you take from that

Jerilynn Prior 

Ovulatory disturbances? Reversible. Treatable ovulatory disturbances are common

Lorne Brown 

And common as in it’s your body’s adapting during that cycle.

Jerilynn Prior

That’s right.

Lorne Brown 

Why do we care so much about progesterone? What are 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 perimenopause 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 tell us about estrogen, progesterone, the cycle, what the roles are and 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 and progesterone, the benefits of both and what happens when they’re out of balance, in particular, let’s emphasize progesterone.

Jerilynn Prior 

Okay, so every tissue in almond’s body has receptors or estradiol or estrogen. And estrogen is a very important and powerful growth stimulator. We say in scientific terms, it causes cells to proliferate or to grow like crazy, okay? 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 estrogens proliferation and it makes the cell more specialized or differentiated, which means co-dependent if you will.

Lorne Brown 

There is a yin yang relationship.

Jerilynn Prior 

So at the very basic level,

We need both. Now specifically, we showed it a long time ago and then confirmed it later. We showed it in a New England Journal publication in 1990 and we confirmed it with a meta-analysis of studies from around the world that regular cycles but disturbed, 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 density 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 also. There’s a large study that was done in the Netherlands and women collected day 22, cycle day 22 urines 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 heart 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 analyzed the urine or estrogen, testosterone and progesterone. And what they found was estrogen wasn’t different between heart attacks and not testosterone wasn’t different, but progesterone was lower. Showing that progesterone is important for prevention of heart attacks. And when there’s other heart related stuff that progesterone also does, for example, acute, the QT

Lorne Brown

Interval

Jerilynn Prior 

Is lengthened by estrogen, which risks arrhythmias, 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 can’t prove the latter here.

Lorne Brown 

And so again, why is it that we only hear about, especially in the perimenopause 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 of 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 risks. So why is it that they’re still focusing on estrogen?

Jerilynn Prior 

That’s a hard why

Lorne Brown 

Or do you see it changing? Is it changing

Jerilynn Prior 

Kind of gynecology decides something is right and then sticks with it no matter what. And also they’re often closely tied with pharma

Lorne Brown 

Which

Jerilynn Prior 

Promotes estrogen. So the combination of those two major forces mean the culture focuses on estrogen.

Lorne Brown :

I don’t

Jerilynn Prior 

Know if it’s changing.

Lorne Brown 

Is there no money for the pharma in selling progesterone medications?

Jerilynn Prior 

Well, there should be, but it hasn’t happened.

Lorne Brown 

Okay. And then so is birth control pill the answer, is there a difference between progesterone and progestins?

Jerilynn Prior 

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 acted 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. That’s why progesterone makes more sense because at least we can learn how it works.

Lorne Brown 

And what form is that? What’s that? A two part question is how does somebody advocate for themselves then when they say to their doctor, this is what I want, this is what the medication’s called if they want a 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 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 is your research? Have you done it, is it oral vaginal? And again, not to forget that part 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?

Jerilynn Prior 

So what I’ve researched is oral micronized, progesterone, little round bowls,

Very peculiar as a therapy. They bounce like crazy if you drop one and each little round bowl, at least in Canada is a hundred milligrams, but it takes three of them 300 milligrams only at bedtime because you could only take it at bedtime. Otherwise causes too much drowsiness or needed to keep the blood level of progesterone in the luteal phase range for 24 hours. So how can a woman advocate? I want oral micronized progesterone. I don’t want Med Roxy progesterone, say Med Roxy. Progesterone has an increased risk for clots. It has an increased risk for breast cancer, and we don’t know how it works in many tissues in the body. I want oral micronized progesterone because I know that it’s helpful in counterbalancing high estrogen effects, for example in perimenopause because it’s been proven to improve hot flushes and night sweats and because we know that it doesn’t increase clotting risks.

Lorne Brown 

Thank you for that. And you said in Canada it’s a hundred milligram white pills and you’re taking 300 milligrams at night.

Jerilynn Prior:

That’s right.

Lorne Brown 

And a lot of this,

Jerilynn Prior 

I think I should call capsules

Lorne Brown

Because capsules. Okay.

Jerilynn Prior 

Perfectly spherical

Lorne Brown

And it’s a while ago, but I’m pretty sure you talk about this on your [email protected] website. Do you have information on this handout?

Jerilynn Prior

Oh yeah,

Lorne Brown 

Yeah. Okay.

So just for our listeners, that website has so much information, which makes me think about auditory disorders like PCOS. So a lot of the women, I ask when they go, why they were on birth control pills, I do my history, and they say because they regulate their cycle. 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 pills for women with PCOS. Obviously they’re not trying to conceive. I would defeat the whole purpose, I think you said, but the birth control pill can aggravate insulin resistance or blood sugar. So 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 obligatory disorders that have a western diagnosis of PCOS? What’s your angle on it? You tend to not even want to use that term because you see differently.

Jerilynn Prior

I’ve conceded that PCOS is what people recognize. So when on the website we now say PCOS or an ovulatory androgen access

Period. What’s interesting is the diagnosis of polycystic ovary syndrome, if you will, is made by or apart or irregular cycles and by evidence either of SM and acne or air loss or biochemical tests showing that testosterone’s too high, we don’t even check to see if ovulation is happening. But ovulation is almost inevitably not present. And I think the reason for that, which I also think is fundamental, is that the hypothalamus messaging is like a nerve signal. It’s pulsing and the pulsatile rate is the message and it turns out that gonadotropin 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 progesterone slows that rapid pulsing and it also slows the pulsing of LH and lowers luteinizing hormone, which is too high almost always in PCOS. So we’ve just recently done a feasibility study in women with PCOS and genic PCOS and given them cyclic progesterone. We asked them about their quality of life on a P-C-O-S specific scale at the beginning and after six months of taking cyclic progesterone therapy they had a remarkable improvement in quality of life. So I think that the fundamental missing variable in ECOS, which 10% of women worldwide have is ovulation, is progesterone

Lorne Brown 

And common sense. If you are having oligomenorrhea like delayed ovulation or O amenorrhea, no ovulation, then you’re not having progesterone to oppose the estrogen.

Jerilynn Prior 

Okay, let me back it up a bit. Amenorrhea means no cycles. Oligomenorrhea means far apart cycles,

Lorne Brown 

Yes.

Jerilynn Prior 

Neither of them refers to ovulation. They only refer to the cycles. So in a whole spectrum, and I like to think of it, I actually wrote a paper and called it, I call it my iceberg paper, but I like to think that the whole spectrum of disturbances of menstrual cycles and ovulation are part of the same mechanism, the hypothalamic protection of the body by altering something. So the very tip of the iceberg is the few women who have amenorrhea, but more women who have all legal amenorrhea, but the bulk of the iceberg as we understand it, is below the waterline and includes short lial phase and anovulation. We’re not seeing the connections with the ovulatory disturbances because they’re not above the water,

Lorne Brown 

But if they’re having these obligatory disturbances, they’re not ovulating in that cycle. Right?

Jerilynn Prior 

Yep. When I say ovulatory disturbances, I mean short lal phase and I mean anovulation. So they may be ovulating but not adequately,

Lorne Brown 

And if they had a short lal phase, then again that sufficient progesterone may not be released. So there’s the imbalance, the benefit of progesterone, you may not be having enough of it or long enough those close to 14 days of your luteal phase.

Jerilynn Prior 

Yes. So years ago we showed in women who had amenorrhea, oligomenorrhea and ovulation Andre cycles or short luteal phase in regular cycles. We randomized them to cyclic Med Roxy progesterone, 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 it was because of the cyclic red Roxy progesterone, which also acts on many of the progesterone receptors or it was learning more about themselves, understanding why these disturbances happen.

Lorne Brown 

So again, you’re talking my language of the Conscious Fertility podcast because one of our messages is inner work, which is knowing yourself. So the cyclical progesterone was a way to correct these auditor disturbances then from your research. That’s

Jerilynn Prior 

Right. So the gluteal phase replacement

Lorne Brown 

And then today, because back then that form of progesterone was available, but today you use micronized progesterone though.

Jerilynn Prior

That’s right, and I would use 300 milligrams for 14 days in the menstrual cycle. If you have a normal length cycle, then days 14 through 27,

Lorne Brown

What would you do for those that have cycles would become delayed and stuff, and they’re trying to conceive still, which means sometimes you may be, it’s possible the progesterone may be happening in the follicular. If you’re just going to take it for 14 days and take a break, a break, then do 14 days. Do you have a pattern for those women? An approach?

Jerilynn Prior 

Yes. Look on the SEMCOR 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 this second,

But if you’re getting flow before you finish the 14 days of the progesterone, it means that estrogen is overriding. You’re still having 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 stretchy mucus, which is an indicator of estrogen, go away first before starting the progesterone, or have an LH surge first before starting the progesterone because you don’t want to interfere with the LH surge.

Lorne Brown

Yes. That’s why I was wondering the timing, and I know our naturopathic doctors follow that on your website, and we had Lara Braden come into town one day and do a talk with our Kali MacIsaac, who has done work with you. I’m going to mention that website one more time. It’s C-E-M-C-U-R, emcor.ubc.ca. 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 the reproductive health of those that are trying to conceive. Then do you have anything from your research then 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 wellbeing, I always share our goals, healthy baby, but is there anything that comes to mind?

Jerilynn Prior 

I’d like your listeners to know that we’re currently doing a study with women with endometriosis, and 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 at least two cycles. What we’re studying is something very interesting, which is called brown adipose tissue activation or activity. It turns out that when we’re cooled, we can create energy from these peculiar kind of fat that is above our clavicles, and 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 oedipus tissue. So it’s kind of a fun study.

Lorne Brown 

And is there information on your website for that? For the treatment? Okay, so I don’t know where I’ll study. 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 emcor.ubc.ca on that. Participate. Yeah.

So now let’s talk about the perimenopause and menopause. Many women that come to us are experiencing night sweats and hot flashes, poor quality of life, not sleeping well, irritability, brain fog, what role does weight gain, unwanted weight gain as well. So I be, that will be the listeners, anybody who’s ready to turn this off, we’ve peaked their ears. Why is there weight gain in this perimenopause and menopause stage? Does that have anything to do with 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?

Jerilynn Prior 

If we’re talking about perimenopause, my feeling is that estrogen and stress are both related to weight gain, higher estrogen and also higher cortisol and chlorines. Cain norepinephrine, for example, is 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 do know is this estrogen on average in everyone is higher in perimenopause, and about 20 or 30% 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 perimenopausal women called estrogen storm season. So take a look on the website, we updated have a REIT edition on Babs novel, which is available both from us as a book or online as a book or as

Lorne Brown 

Digital or audio

Jerilynn Prior 

Digital.

Lorne Brown 

Okay.

Jerilynn Prior 

So what’s important to know is that as estrogen is getting to progesterone it is petering out, and even in perfectly normal length, luteal phase cycles, progesterone levels are lower when we’re in perimenopause than they were when we were premenopausal. We don’t quite know why that happens, but that is observed in many, many studies. So there’s less counterbalancing of the higher estrogen by progesterone in perimenopause. Now, 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 perimenopausal women and in menopausal women that progesterone alone is effective in decreasing night sweats and hot breaks.

Lorne Brown

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 a reduction in those vasomotor symptoms of night sweats and hot flashes.

Jerilynn Prior 

The strength of the data we have in the perimenopause trial, which was just published last year, and I hope you’ll put the link to that,

Lorne Brown

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.

Jerilynn Prior 

Oh, good, thank you. So the other thing that’s interesting, we don’t quite understand how it works, but progesterone importantly reduces sleep problems. It reduces disturbed sleep for any reason, and it reduces the sleep problems in both perimenopause and in menopause. By which I mean you’ve been a year without a period.

Lorne Brown 

So perimenopause, because we haven’t defined that for people, that is the period of time leading up to your last menstrual cycle?

Jerilynn Prior 

No, it’s the period of time leading up to a year after your last menstrual cycle.

Lorne Brown 

 

Alright. And some women that can be as early as what? What’s the common age that people start to have perimenopausal symptoms?

Jerilynn Prior 

The range is quite wide, but on average it’s in their late forties.

Lorne Brown 

I see. A lot of the people we see are 42 to 45 that are having this experience already.

Jerilynn Prior

The other important thing, this is controversial still, but we have good evidence that when a woman has a regular cycle, but it’s having night sweats and sleep problems, and typical things like shorter cycles, like increased cramps, like weight gain, she can’t explain like new migraines, things like that, sleep disturbance, as I already said. I think then she can consider herself perimenopausal the doctor’s not likely to, because the definition of perimenopause in current dogma is based on an irregular cycle.

Lorne Brown 

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 perimenopausal, and they choose,

Jerilynn Prior 

Don’t gold equate ovulation and cycle length, if they’re having cycles,

Lorne Brown 

They’re having cycles,

Jerilynn Prior 

They’re having these symptoms,

Lorne Brown

They’re having cycles, they’re having these symptoms. Their Dr. may not say they’re perimenopausal, but they’re having these symptoms regardless, like they’re having these experiences. If they chose to get the micronized progesterone and did it for three months and they really didn’t need it, that wasn’t the issue. Is there a negative side effect to taking progesterone if you don’t need it?

Jerilynn Prior 

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 perimenopause trial, we prove that it does not increase depression.

Lorne Brown 

And obviously this is the opposite for cancer. You show that progesterone is needed sometimes for those cervical cancers if you have too much estrogen that growth

Jerilynn Prior 

Too much Endometrial cancer.

Lorne Brown 

Yeah, endometrial cancer

Jerilynn Prior 

C,

Lorne Brown 

Yes. Thank you. Endometrial cancer. And so 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.

Jerilynn Prior 

Yeah,

Lorne Brown

That’s all. Because there’s no,

Jerilynn Prior 

The main disadvantage of oral micronized progesterone in Canada today is it’s high cost and there are many generics, but they only cost about 10% less, which is still an outrageous cost.

Lorne Brown 

Gotcha.

Jerilynn Prior 

So that’s the main adverse effect of progesterone today,

Lorne Brown 

Right, is just the cost. Okay. So we’ve talked about obligatory disturbances today. We talked a little bit, we talked about progesterone, perimenopause, 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? Are you updated on that, by the way, you guys, whenever I ask Dr prior question, she sends me a good list of research, which I always go and read. I appreciate that.

Jerilynn Prior 

Basically, we as a culture have tended to blame exercise or 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 taking 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 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.

Lorne Brown 

Okay. I’m looking at our time here, 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 wellbeing 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 s core ubc.ca website and it’s in the show notes is 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 it an indicator of health? And just love to hear your closing remarks around this.

Jerilynn Prior 

Thank you. It’s been a pleasure talking with you. So my overview is that ovulation, normal ovulation reflects wellbeing and predicts lifelong bones, heart cancer, and old health. What’s important in addition to that is that I will be retiring next year. That’s July of 2025. I’ll be 82 then. And the Center for Menstrual Cycle and ovulation research will not continue unless we can get some support and unless we can persuade the dean to keep a position in endocrinology for continuing this work. So we’re going to need the help of the community to do some positive persuading and also to do some positive support in order for this work to continue.

Lorne Brown

How can people help support it? By the way, is there a place on the website for donations?

Jerilynn Prior 

Absolutely. Yes.

Lorne Brown 

Great. Perfect. And for yourselves, check out the website because the information is there on cyclical progesterone. The research on PCOS, the research on these vasso motor symptoms like hot flashes, night sweats, it is just so much. And your books, you have two books, don’t you? I thought you,

Jerilynn Prior 

Yes. At least

Lorne Brown 

Estrogen Storm. But there was another one you wrote right after that, right?

Jerilynn Prior 

Estrogen errors.

Lorne Brown 

Okay. There we go. Dr. Prior, I want to thank you very much for making time. I didn’t realize that you’re already 81. I’ve known you 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, so

Jerilynn Prior 

Thank you. You’re very welcome. Thank you.

Lorne Brown 

That was such a treat for me. I met Dr. Prior in my early days, in the early two thousands, 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 perimenopausal symptoms or menopausal symptoms. At our clinic, we do have that integrative approach where we have that access to the cyclical progesterone, 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 wellbeing, 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, acupuncture is a horse. IV therapy is a horse. Low level laser therapy. Each 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 podcast episodes as I hope they are great resources for you.

Speaker 3

If you’re looking for support to grow your family, contact Acubalance Wellness Center at Acubalance. They help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility, acupuncture, and naturopathic medicine. Download the Acubalance Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to Acubalance ca. That’s a-c-ubalance ca.

Lorne Brown

Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That’s Instagram, Lorne Brown official, or you can visit my websites, Lorne brown.com and acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.