Full Transcript Progesterone Dosing and Uterine Protection 0:01 Now, they're going to have bleed when 0:01 Now, they're going to have bleed when they're doing rhythmic dosing. Make sure 0:03 they're doing rhythmic dosing. Make sure 0:03 they're doing rhythmic dosing. Make sure that you're using a good enough dose to 0:05 that you're using a good enough dose to 0:05 that you're using a good enough dose to keep that lining thin just to make sure 0:07 keep that lining thin just to make sure 0:07 keep that lining thin just to make sure there is no thickening of that line. 0:09 there is no thickening of that line. 0:09 there is no thickening of that line. [music]
Introducing Vaginal Progesterone 0:14 Can you use oral progesterone vaginally? 0:14 Can you use oral progesterone vaginally? Hi, I'm Dr. Valarie Davidson from the 0:16 Hi, I'm Dr. Valarie Davidson from the 0:16 Hi, I'm Dr. Valarie Davidson from the Progressive Health podcast. 0:17 Progressive Health podcast. 0:17 Progressive Health podcast. >> And I'm Dr. Mackey from the Progressive 0:19 >> And I'm Dr. Mackey from the Progressive 0:19 >> And I'm Dr. Mackey from the Progressive Health podcast. Uh so, this is a little 0:21 Health podcast. Uh so, this is a little 0:21 Health podcast. Uh so, this is a little bit more of a 0:23 bit more of a 0:23 bit more of a of a you know, newer popular topic um 0:25 of a you know, newer popular topic um 0:25 of a you know, newer popular topic um using progesterone vaginally. 0:27 using progesterone vaginally. 0:27 using progesterone vaginally. >> Yeah, we've used progesterone vaginally 0:30 >> Yeah, we've used progesterone vaginally 0:30 >> Yeah, we've used progesterone vaginally um for years, you know, vaginal 0:31 um for years, you know, vaginal 0:31 um for years, you know, vaginal capsules. Um you can even use cream, 0:34 capsules. Um you can even use cream, 0:34 capsules. Um you can even use cream, which we'll do that a different episode 0:36 which we'll do that a different episode 0:36 which we'll do that a different episode on using progesterone cream vaginally. 0:38 on using progesterone cream vaginally. 0:38 on using progesterone cream vaginally. But, doing it vaginally, inserting like 0:41 But, doing it vaginally, inserting like 0:41 But, doing it vaginally, inserting like a vaginal capsule of progesterone, can 0:43 a vaginal capsule of progesterone, can 0:43 a vaginal capsule of progesterone, can actually be really healthy for the 0:45 actually be really healthy for the 0:45 actually be really healthy for the microbiome of the uterus, or sorry, the 0:47 microbiome of the uterus, or sorry, the 0:47 microbiome of the uterus, or sorry, the microbiome of the vaginal vault, and 0:49 microbiome of the vaginal vault, and 0:49 microbiome of the vaginal vault, and then it can also protect the uterine 0:50 then it can also protect the uterine 0:50 then it can also protect the uterine lining from getting too thick if you're 0:52 lining from getting too thick if you're 0:52 lining from getting too thick if you're doing an HRT that involves estradiol. 0:54 doing an HRT that involves estradiol. 0:54 doing an HRT that involves estradiol. >> Yeah, and really that's what we're
Oral vs Vaginal Progesterone Tolerance 0:56 >> Yeah, and really that's what we're 0:56 >> Yeah, and really that's what we're talking about is a woman on estrogen, 0:59 talking about is a woman on estrogen, 0:59 talking about is a woman on estrogen, um how can you still you have to protect 1:01 um how can you still you have to protect 1:01 um how can you still you have to protect the uterus if she still has one? So, 1:03 the uterus if she still has one? So, 1:03 the uterus if she still has one? So, what's the best option if a woman does 1:05 what's the best option if a woman does 1:05 what's the best option if a woman does not tolerate oral progesterone? 1:07 not tolerate oral progesterone? 1:07 not tolerate oral progesterone? >> Cuz you're right, there are you know, 1:09 >> Cuz you're right, there are you know, 1:09 >> Cuz you're right, there are you know, there is a percentage of women that do 1:10 there is a percentage of women that do 1:10 there is a percentage of women that do not tolerate oral progesterone. So, 1:13 not tolerate oral progesterone. So, 1:13 not tolerate oral progesterone. So, usually when I have a patient and we're 1:14 usually when I have a patient and we're 1:15 usually when I have a patient and we're using maybe a sustained release, they 1:16 using maybe a sustained release, they 1:16 using maybe a sustained release, they might feel Some women love their 1:18 might feel Some women love their 1:18 might feel Some women love their sustained release oral progesterone. 1:19 sustained release oral progesterone. 1:19 sustained release oral progesterone. They sleep like a baby, wake up the next 1:21 They sleep like a baby, wake up the next 1:21 They sleep like a baby, wake up the next morning, feel great. Then there's other 1:22 morning, feel great. Then there's other 1:23 morning, feel great. Then there's other women that'll say, "I feel kind of 1:24 women that'll say, "I feel kind of 1:24 women that'll say, "I feel kind of groggy the next morning." And then I'll 1:26 groggy the next morning." And then I'll 1:26 groggy the next morning." And then I'll switch it to an instant release 1:27 switch it to an instant release 1:28 switch it to an instant release progesterone. And then if they're still 1:29 progesterone. And then if they're still 1:29 progesterone. And then if they're still having trouble tolerating that, then 1:31 having trouble tolerating that, then 1:31 having trouble tolerating that, then we'll do a vaginal capsule of 1:33 we'll do a vaginal capsule of 1:33 we'll do a vaginal capsule of progesterone. 1:33 progesterone. 1:33 progesterone. >> Yeah. Now, um 1:36 >> Yeah. Now, um 1:36 >> Yeah. Now, um the oral progesterone converts to what's 1:39 the oral progesterone converts to what's 1:39 the oral progesterone converts to what's allopregnanolone. 1:41 allopregnanolone. 1:41 allopregnanolone. There is a subset of women, very small 1:43 There is a subset of women, very small 1:43 There is a subset of women, very small subset relatively, um that just does not 1:46 subset relatively, um that just does not 1:46 subset relatively, um that just does not tolerate oral progesterone. Now, the 1:48 tolerate oral progesterone. Now, the 1:48 tolerate oral progesterone. Now, the grogginess though, I do think the 1:49 grogginess though, I do think the 1:49 grogginess though, I do think the grogginess part, which is why you would 1:52 grogginess part, which is why you would 1:52 grogginess part, which is why you would use oral progesterone, I think the 1:53 use oral progesterone, I think the 1:53 use oral progesterone, I think the grogginess 1:55 grogginess 1:55 grogginess uh is uh sometimes when they have a 1:58 uh is uh sometimes when they have a 1:58 uh is uh sometimes when they have a little bit of a, you know, sleep debt, 2:01 little bit of a, you know, sleep debt, 2:01 little bit of a, you know, sleep debt, um they experience a bit more grogginess 2:03 um they experience a bit more grogginess 2:03 um they experience a bit more grogginess in order to 2:04 in order to 2:04 in order to kind of recuperate or sort of get 2:06 kind of recuperate or sort of get 2:06 kind of recuperate or sort of get themselves out of that sleep debt. Uh 2:09 themselves out of that sleep debt. Uh 2:09 themselves out of that sleep debt. Uh and then from there, like I said, if 2:10 and then from there, like I said, if 2:10 and then from there, like I said, if they're still groggy after, you know, a 2:12 they're still groggy after, you know, a 2:12 they're still groggy after, you know, a week, 10 days, you know, give or take,
Rhythmic Dosing and Bleeding 2:14 week, 10 days, you know, give or take, 2:14 week, 10 days, you know, give or take, you know, then it just might not be they 2:15 you know, then it just might not be they 2:15 you know, then it just might not be they just can't tolerate. 2:16 just can't tolerate. 2:16 just can't tolerate. >> Yeah, absolutely. So, you can kind of 2:18 >> Yeah, absolutely. So, you can kind of 2:18 >> Yeah, absolutely. So, you can kind of work with it, work with the patient. 2:20 work with it, work with the patient. 2:20 work with it, work with the patient. Fact, I have a patient where I do a, you 2:22 Fact, I have a patient where I do a, you 2:22 Fact, I have a patient where I do a, you know, I do a lot of rhythmic dosing 2:23 know, I do a lot of rhythmic dosing 2:23 know, I do a lot of rhythmic dosing where you're changing the estradiol 2:25 where you're changing the estradiol 2:25 where you're changing the estradiol levels throughout the 28-day cycle to 2:27 levels throughout the 28-day cycle to 2:27 levels throughout the 28-day cycle to mimic like an ovarian cycle, and then 2:29 mimic like an ovarian cycle, and then 2:29 mimic like an ovarian cycle, and then you put the progesterone in. I have a 2:30 you put the progesterone in. I have a 2:30 you put the progesterone in. I have a few of them that they just can't 2:32 few of them that they just can't 2:32 few of them that they just can't tolerate that progesterone orally. 2:34 tolerate that progesterone orally. 2:34 tolerate that progesterone orally. I might use a cream, which I'll, like I 2:35 I might use a cream, which I'll, like I 2:35 I might use a cream, which I'll, like I said, we'll do another podcast 2:37 said, we'll do another podcast 2:37 said, we'll do another podcast >> Yeah, that's that's another another 2:38 >> Yeah, that's that's another another 2:39 >> Yeah, that's that's another another topic. 2:39 topic. 2:39 topic. >> That's a good one. But, um 2:41 >> That's a good one. But, um 2:42 >> That's a good one. But, um I Now, I do actually with the rhythmic 2:43 I Now, I do actually with the rhythmic 2:43 I Now, I do actually with the rhythmic dosing, if I will do more of the 2:45 dosing, if I will do more of the 2:45 dosing, if I will do more of the progesterone capsules vaginally for a 2:48 progesterone capsules vaginally for a 2:48 progesterone capsules vaginally for a lot of women. Now, they're going to have 2:50 lot of women. Now, they're going to have 2:50 lot of women. Now, they're going to have a bleed when they're doing rhythmic 2:51 a bleed when they're doing rhythmic 2:51 a bleed when they're doing rhythmic dosing, which is great. We want We want 2:54 dosing, which is great. We want We want 2:54 dosing, which is great. We want We want to have that monthly cycle when you're 2:55 to have that monthly cycle when you're 2:55 to have that monthly cycle when you're doing rhythmic dosing HRT. Now, someone 2:57 doing rhythmic dosing HRT. Now, someone 2:58 doing rhythmic dosing HRT. Now, someone that's on static dosing and you're using 2:59 that's on static dosing and you're using 2:59 that's on static dosing and you're using a vaginal capsule of progesterone, you 3:02 a vaginal capsule of progesterone, you 3:02 a vaginal capsule of progesterone, you do want to make sure that you're using a 3:04 do want to make sure that you're using a 3:04 do want to make sure that you're using a good enough dose to keep that lining 3:06 good enough dose to keep that lining 3:06 good enough dose to keep that lining thin, and then, you know, 3:08 thin, and then, you know, 3:08 thin, and then, you know, some women I might even send them in for 3:10 some women I might even send them in for 3:10 some women I might even send them in for a transvaginal ultrasound every so often 3:13 a transvaginal ultrasound every so often 3:13 a transvaginal ultrasound every so often just to make sure there is no thickening 3:15 just to make sure there is no thickening 3:15 just to make sure there is no thickening of that lining. 3:15 of that lining. 3:15 of that lining. >> Right. Yeah, cuz you don't want uh No, 3:18 >> Right. Yeah, cuz you don't want uh No, 3:18 >> Right. Yeah, cuz you don't want uh No, we use those terms back and forth, 3:20 we use those terms back and forth, 3:20 we use those terms back and forth, static dosing, rhythmic dosing. Rhythmic 3:22 static dosing, rhythmic dosing. Rhythmic 3:22 static dosing, rhythmic dosing. Rhythmic dosing encourages a period, static 3:24 dosing encourages a period, static 3:24 dosing encourages a period, static dosing bleeding. 3:26 dosing bleeding. 3:26 dosing bleeding. Um bleeding is not really an option. You 3:28 Um bleeding is not really an option. You 3:28 Um bleeding is not really an option. You can't continue to keep bleeding when 3:30 can't continue to keep bleeding when 3:30 can't continue to keep bleeding when you're on static dosing. That's the 3:31 you're on static dosing. That's the 3:31 you're on static dosing. That's the whole point of using the progesterone. 3:33 whole point of using the progesterone. 3:33 whole point of using the progesterone. Um the number one rule, granted I'm 3:35 Um the number one rule, granted I'm 3:35 Um the number one rule, granted I'm getting a little off topic here, but the
Vaginal pH, Microbiome, and Irritation 3:37 getting a little off topic here, but the 3:37 getting a little off topic here, but the number one rule for HRT is you never 3:39 number one rule for HRT is you never 3:39 number one rule for HRT is you never give a woman unopposed estrogen. Okay? 3:42 give a woman unopposed estrogen. Okay? 3:42 give a woman unopposed estrogen. Okay? That's the whole point of us talking 3:44 That's the whole point of us talking 3:44 That's the whole point of us talking about progesterone. 3:46 about progesterone. 3:46 about progesterone. Uh and just trying to find the right 3:48 Uh and just trying to find the right 3:48 Uh and just trying to find the right option for them as far as the 3:49 option for them as far as the 3:50 option for them as far as the progesterone um uh, dose and form, oral, 3:53 progesterone um uh, dose and form, oral, 3:53 progesterone um uh, dose and form, oral, vaginal, uh um, you know, whatever or 3:56 vaginal, uh um, you know, whatever or 3:56 vaginal, uh um, you know, whatever or cream, whatever it might be. 3:57 cream, whatever it might be. 3:57 cream, whatever it might be. >> Yeah, and so, of course, this is for 3:59 >> Yeah, and so, of course, this is for 3:59 >> Yeah, and so, of course, this is for education, la la la, not for medical 4:01 education, la la la, not for medical 4:01 education, la la la, not for medical advice, but you can get progesterone 4:04 advice, but you can get progesterone 4:04 advice, but you can get progesterone capsules. If you use a compounding 4:05 capsules. If you use a compounding 4:05 capsules. If you use a compounding pharmacy, you can pretty much get any 4:07 pharmacy, you can pretty much get any 4:07 pharmacy, you can pretty much get any dose that you want. Um, now, if you're 4:09 dose that you want. Um, now, if you're 4:09 dose that you want. Um, now, if you're using more of a big box pharmacy, 4:11 using more of a big box pharmacy, 4:11 using more of a big box pharmacy, there's only a couple of doses, that's 4:13 there's only a couple of doses, that's 4:13 there's only a couple of doses, that's the 100, the 200, and some of those big 4:16 the 100, the 200, and some of those big 4:16 the 100, the 200, and some of those big box, you know, the big box pharmacy for 4:18 box, you know, the big box pharmacy for 4:18 box, you know, the big box pharmacy for the progesterone might have peanut oil 4:20 the progesterone might have peanut oil 4:20 the progesterone might have peanut oil in there. So, if someone's allergic to 4:22 in there. So, if someone's allergic to 4:22 in there. So, if someone's allergic to peanuts, you would not want to put that 4:24 peanuts, you would not want to put that 4:24 peanuts, you would not want to put that inside your vagina. 4:26 inside your vagina. 4:26 inside your vagina. It would not be good. 4:27 It would not be good. 4:27 It would not be good. >> But, you can always And then sometimes 4:29 >> But, you can always And then sometimes 4:29 >> But, you can always And then sometimes they, you know, women, I always say put 4:31 they, you know, women, I always say put 4:31 they, you know, women, I always say put it in at night, you know, if you're 4:32 it in at night, you know, if you're 4:32 it in at night, you know, if you're going to insert that progesterone 4:34 going to insert that progesterone 4:34 going to insert that progesterone capsule vaginally, put it in at night, 4:36 capsule vaginally, put it in at night, 4:36 capsule vaginally, put it in at night, maybe wear a little panty liner, cuz 4:37 maybe wear a little panty liner, cuz 4:37 maybe wear a little panty liner, cuz there can be a little bit of discharge 4:39 there can be a little bit of discharge 4:39 there can be a little bit of discharge or oily or white discharge depending on 4:42 or oily or white discharge depending on 4:42 or oily or white discharge depending on what um, type of progesterone you're 4:44 what um, type of progesterone you're 4:44 what um, type of progesterone you're using. If you're using the big box 4:45 using. If you're using the big box 4:45 using. If you're using the big box pharmacy ones, there's going to be a 4:47 pharmacy ones, there's going to be a 4:47 pharmacy ones, there's going to be a little bit of like a milky oily 4:48 little bit of like a milky oily 4:48 little bit of like a milky oily discharge. If you're using one where 4:50 discharge. If you're using one where 4:50 discharge. If you're using one where you're getting it compounded from a 4:52 you're getting it compounded from a 4:52 you're getting it compounded from a compounding pharmacy, you can usually 4:54 compounding pharmacy, you can usually 4:54 compounding pharmacy, you can usually kind of change up the excipients and 4:56 kind of change up the excipients and 4:56 kind of change up the excipients and make it a little bit more vaginal 4:58 make it a little bit more vaginal 4:58 make it a little bit more vaginal eco-friendly. So, it kind of depends on 5:00 eco-friendly. So, it kind of depends on 5:00 eco-friendly. So, it kind of depends on the person cuz I've had some women say 5:02 the person cuz I've had some women say 5:02 the person cuz I've had some women say it made them feel a little uncomfortable 5:03 it made them feel a little uncomfortable 5:03 it made them feel a little uncomfortable or itchy, and then I will switch it over 5:06 or itchy, and then I will switch it over 5:06 or itchy, and then I will switch it over to a compounded and make sure that it's, 5:07 to a compounded and make sure that it's, 5:07 to a compounded and make sure that it's, you know, the excipients in there are 5:09 you know, the excipients in there are 5:09 you know, the excipients in there are really clean. So, that's one one thing 5:11 really clean. So, that's one one thing 5:11 really clean. So, that's one one thing to think about when you're, you know, 5:13 to think about when you're, you know, 5:13 to think about when you're, you know, having to use this. If you're doing it 5:15 having to use this. If you're doing it 5:15 having to use this. If you're doing it static, you're going to have to put that 5:16 static, you're going to have to put that 5:16 static, you're going to have to put that progesterone in every night. 5:18 progesterone in every night. 5:18 progesterone in every night. >> Yeah. Yeah, yeah. Cuz at that point, if 5:20 >> Yeah. Yeah, yeah. Cuz at that point, if 5:20 >> Yeah. Yeah, yeah. Cuz at that point, if you're, like I said, if you're using 5:22 you're, like I said, if you're using 5:22 you're, like I said, if you're using some form of estrogen, estradiol or 5:25 some form of estrogen, estradiol or 5:25 some form of estrogen, estradiol or biest or something, the goal there is to 5:27 biest or something, the goal there is to 5:27 biest or something, the goal there is to protect the uterus. 5:28 protect the uterus. 5:28 protect the uterus. >> Yeah. And then you're also thinking 5:29 >> Yeah. And then you're also thinking 5:29 >> Yeah. And then you're also thinking about the vaginal microbiome. Now, 5:32 about the vaginal microbiome. Now, 5:32 about the vaginal microbiome. Now, estro- estrogen is beautiful for the 5:33 estro- estrogen is beautiful for the 5:34 estro- estrogen is beautiful for the vaginal mic- microbiome and for the 5:35 vaginal mic- microbiome and for the 5:35 vaginal mic- microbiome and for the lactobacillus and whatnot, but so is 5:37 lactobacillus and whatnot, but so is 5:37 lactobacillus and whatnot, but so is progesterone, cuz progesterone doesn't 5:39 progesterone, cuz progesterone doesn't 5:39 progesterone, cuz progesterone doesn't alter the lactobacillus species that are 5:41 alter the lactobacillus species that are 5:41 alter the lactobacillus species that are in that's in our vaginal vault, 5:44 in that's in our vaginal vault, 5:44 in that's in our vaginal vault, but sometimes some of them can change 5:46 but sometimes some of them can change 5:46 but sometimes some of them can change the pH. Everybody is different, but you 5:48 the pH. Everybody is different, but you 5:48 the pH. Everybody is different, but you can't really test a capsule for pH, you 5:50 can't really test a capsule for pH, you 5:50 can't really test a capsule for pH, you know, you can't open it up test the pH. 5:52 know, you can't open it up test the pH. 5:52 know, you can't open it up test the pH. So, one thing that I'll tell women if 5:54 So, one thing that I'll tell women if 5:54 So, one thing that I'll tell women if they're feeling like oh, I'm a little 5:56 they're feeling like oh, I'm a little 5:56 they're feeling like oh, I'm a little itchy or there's, you know, cuz maybe 5:59 itchy or there's, you know, cuz maybe 5:59 itchy or there's, you know, cuz maybe I'm getting a yeast infection or 6:00 I'm getting a yeast infection or 6:00 I'm getting a yeast infection or something or I'm getting bacterial 6:01 something or I'm getting bacterial 6:01 something or I'm getting bacterial vaginosis or something, is I'll have 6:04 vaginosis or something, is I'll have 6:04 vaginosis or something, is I'll have them actually buy you can buy vaginal 6:06 them actually buy you can buy vaginal 6:06 them actually buy you can buy vaginal test strips where you can test the pH of 6:08 test strips where you can test the pH of 6:08 test strips where you can test the pH of your vaginal vault. 6:10 your vaginal vault. 6:10 your vaginal vault. The vaginal vault really does want to be 6:11 The vaginal vault really does want to be 6:11 The vaginal vault really does want to be more acidic, so it's usually around 6:13 more acidic, so it's usually around 6:13 more acidic, so it's usually around like, you know, 3 and 1/2 it's less than 6:15 like, you know, 3 and 1/2 it's less than 6:15 like, you know, 3 and 1/2 it's less than 4. So, you want to So, you could always
Compounding, Dosage, and Practical Use 6:18 4. So, you want to So, you could always 6:18 4. So, you want to So, you could always test your own vaginal vault with those 6:20 test your own vaginal vault with those 6:20 test your own vaginal vault with those strips and if it's uh closer to 5, you 6:22 strips and if it's uh closer to 5, you 6:22 strips and if it's uh closer to 5, you know, if 6:23 know, if 6:23 know, if over 4 and 1/2 5, then you know that 6:25 over 4 and 1/2 5, then you know that 6:25 over 4 and 1/2 5, then you know that that pH is starting to change. And when 6:28 that pH is starting to change. And when 6:28 that pH is starting to change. And when that pH changes, so either vaginal vault 6:30 that pH changes, so either vaginal vault 6:30 that pH changes, so either vaginal vault becomes more um alkaline, the pH goes 6:32 becomes more um alkaline, the pH goes 6:32 becomes more um alkaline, the pH goes up, then that causes the beneficial 6:35 up, then that causes the beneficial 6:35 up, then that causes the beneficial bacteria like the lactobacillus species 6:37 bacteria like the lactobacillus species 6:37 bacteria like the lactobacillus species to go down. So, that's one thing that we 6:39 to go down. So, that's one thing that we 6:39 to go down. So, that's one thing that we I kind of keep an eye on with women when 6:41 I kind of keep an eye on with women when 6:41 I kind of keep an eye on with women when they're using it vaginally. 6:43 they're using it vaginally. 6:43 they're using it vaginally. >> Uh does that same pH change happen just 6:46 >> Uh does that same pH change happen just 6:46 >> Uh does that same pH change happen just from menopause in general? 6:47 from menopause in general? 6:47 from menopause in general? >> It can, yeah. So, if somebody, let's 6:49 >> It can, yeah. So, if somebody, let's 6:49 >> It can, yeah. So, if somebody, let's say, aside from progesterone, HRT, all 6:52 say, aside from progesterone, HRT, all 6:52 say, aside from progesterone, HRT, all that, they're going into menopause, that 6:54 that, they're going into menopause, that 6:54 that, they're going into menopause, that estrogen is declining, it does change 6:56 estrogen is declining, it does change 6:56 estrogen is declining, it does change the uh the species cuz it cuz that 6:59 the uh the species cuz it cuz that 6:59 the uh the species cuz it cuz that estrogen really does feed the 7:00 estrogen really does feed the 7:00 estrogen really does feed the lactobacillus. It helps the the mucosa 7:02 lactobacillus. It helps the the mucosa 7:02 lactobacillus. It helps the the mucosa of the vaginal vault, you know, stay 7:04 of the vaginal vault, you know, stay 7:04 of the vaginal vault, you know, stay really nice and hydrated. It helps with 7:06 really nice and hydrated. It helps with 7:06 really nice and hydrated. It helps with that lubrication. It helps with the 7:07 that lubrication. It helps with the 7:07 that lubrication. It helps with the tissue resiliency. It's when that 7:09 tissue resiliency. It's when that 7:09 tissue resiliency. It's when that estrogen goes down, it's like, you know, 7:12 estrogen goes down, it's like, you know, 7:12 estrogen goes down, it's like, you know, that lactobacillus doesn't have the most 7:14 that lactobacillus doesn't have the most 7:14 that lactobacillus doesn't have the most beautiful environment to live in. So, 7:16 beautiful environment to live in. So, 7:16 beautiful environment to live in. So, you will see that change. Same with 7:17 you will see that change. Same with 7:17 you will see that change. Same with women in perimenopause when their 7:19 women in perimenopause when their 7:19 women in perimenopause when their progesterone starts to go cuz that's one 7:21 progesterone starts to go cuz that's one 7:21 progesterone starts to go cuz that's one hallmark of perimenopause is that 7:22 hallmark of perimenopause is that 7:22 hallmark of perimenopause is that progesterone start starts to drop, 7:25 progesterone start starts to drop, 7:25 progesterone start starts to drop, you know, pretty pretty good and then 7:27 you know, pretty pretty good and then 7:27 you know, pretty pretty good and then you'll see the estrogen bouncing around. 7:29 you'll see the estrogen bouncing around. 7:29 you'll see the estrogen bouncing around. Then they might have, you know, some 7:30 Then they might have, you know, some 7:30 Then they might have, you know, some issues with that vaginal vault and 7:32 issues with that vaginal vault and 7:32 issues with that vaginal vault and that's where sometimes we'll do the 7:33 that's where sometimes we'll do the 7:33 that's where sometimes we'll do the progesterone vaginally with um 7:34 progesterone vaginally with um 7:34 progesterone vaginally with um perimenopausal women, too. 7:36 perimenopausal women, too. 7:36 perimenopausal women, too. >> Yeah, right. Now, we're going to do a 7:37 >> Yeah, right. Now, we're going to do a 7:37 >> Yeah, right. Now, we're going to do a separate one on this, but this is also 7:39 separate one on this, but this is also 7:39 separate one on this, but this is also why you hear a lot of talk about using 7:41 why you hear a lot of talk about using 7:41 why you hear a lot of talk about using estrogen to control UTIs. 7:44 estrogen to control UTIs. 7:44 estrogen to control UTIs. Uh 7:45 Uh 7:45 Uh now, uh what about progesterone? Does 7:47 now, uh what about progesterone? Does 7:47 now, uh what about progesterone? Does progesterone have 7:49 progesterone have 7:49 progesterone have uh sort of a beneficial impact that way, 7:51 uh sort of a beneficial impact that way, 7:51 uh sort of a beneficial impact that way, or are we just using progesterone 7:53 or are we just using progesterone 7:53 or are we just using progesterone basically to offset the estrogen for the 7:55 basically to offset the estrogen for the 7:55 basically to offset the estrogen for the most part? 7:56 most part? 7:56 most part? >> Usually, well, when you're using the 7:58 >> Usually, well, when you're using the 7:58 >> Usually, well, when you're using the progesterone vaginally and someone has a 8:00 progesterone vaginally and someone has a 8:00 progesterone vaginally and someone has a uterus, you're using it to protect the 8:01 uterus, you're using it to protect the 8:01 uterus, you're using it to protect the uterus because they can't tolerate the 8:03 uterus because they can't tolerate the 8:03 uterus because they can't tolerate the oral progesterone. 8:05 oral progesterone. 8:05 oral progesterone. >> And and they don't have a choice. They 8:06 >> And and they don't have a choice. They 8:06 >> And and they don't have a choice. They have to use some form of progesterone, 8:08 have to use some form of progesterone, 8:08 have to use some form of progesterone, which we're trying to get across. 8:09 which we're trying to get across. 8:10 which we're trying to get across. >> Yeah, so you're bypassing that 8:11 >> Yeah, so you're bypassing that 8:11 >> Yeah, so you're bypassing that first-pass liver. I think they call this 8:12 first-pass liver. I think they call this 8:12 first-pass liver. I think they call this more of a first-pass uterine. So, you're 8:15 more of a first-pass uterine. So, you're 8:15 more of a first-pass uterine. So, you're using it more uterus rather than having 8:17 using it more uterus rather than having 8:17 using it more uterus rather than having that progesterone have to go through the 8:18 that progesterone have to go through the 8:18 that progesterone have to go through the liver if you're taking it orally. So, 8:20 liver if you're taking it orally. So, 8:20 liver if you're taking it orally. So, you're really trying to protect that 8:21 you're really trying to protect that 8:21 you're really trying to protect that uterus, but women will also tell me that 8:23 uterus, but women will also tell me that 8:23 uterus, but women will also tell me that they feel good on that progesterone 8:26 they feel good on that progesterone 8:26 they feel good on that progesterone vaginally. I'm not sure how much um you 8:28 vaginally. I'm not sure how much um you 8:28 vaginally. I'm not sure how much um you know 8:29 know 8:29 know you know, clinical science or research 8:31 you know, clinical science or research 8:32 you know, clinical science or research or studies are out there about how you 8:33 or studies are out there about how you 8:33 or studies are out there about how you know, vaginal progesterone can help the 8:35 know, vaginal progesterone can help the 8:35 know, vaginal progesterone can help the mood, but someone will say, "Oh, I feel 8:36 mood, but someone will say, "Oh, I feel 8:37 mood, but someone will say, "Oh, I feel so much better on it this way. I'm not 8:38 so much better on it this way. I'm not 8:38 so much better on it this way. I'm not groggy anymore." I have some women that 8:40 groggy anymore." I have some women that 8:40 groggy anymore." I have some women that take oral progesterone and they get 8:42 take oral progesterone and they get 8:42 take oral progesterone and they get anxious. They get very anxious. So, then 8:45 anxious. They get very anxious. So, then 8:45 anxious. They get very anxious. So, then you definitely want to, you know, switch 8:46 you definitely want to, you know, switch 8:46 you definitely want to, you know, switch from that oral to something else, and 8:48 from that oral to something else, and 8:48 from that oral to something else, and that's where I feel like the vaginal 8:49 that's where I feel like the vaginal 8:49 that's where I feel like the vaginal application using it an oral vaginal 8:52 application using it an oral vaginal 8:52 application using it an oral vaginal capsule is really nice to get that dose 8:55 capsule is really nice to get that dose 8:55 capsule is really nice to get that dose in there. 8:55 in there. 8:55 in there. >> Yeah. Uh so 8:58 >> Yeah. Uh so 8:58 >> Yeah. Uh so uh 8:59 uh 8:59 uh uh right from the pharmacy, a woman if 9:01 uh right from the pharmacy, a woman if 9:01 uh right from the pharmacy, a woman if need be, a woman could just use it right 9:03 need be, a woman could just use it right 9:04 need be, a woman could just use it right from the pharmacy. It doesn't have to be 9:05 from the pharmacy. It doesn't have to be 9:05 from the pharmacy. It doesn't have to be an actual suppository or anything like 9:07 an actual suppository or anything like 9:07 an actual suppository or anything like that. It could just be, you know 9:09 that. It could just be, you know 9:09 that. It could just be, you know >> Yeah. 9:09 >> Yeah. 9:09 >> Yeah. >> intended to be oral, but she can use it 9:11 >> intended to be oral, but she can use it 9:11 >> intended to be oral, but she can use it vaginally. 9:12 vaginally. 9:12 vaginally. >> Yeah, like I had a patient the other 9:13 >> Yeah, like I had a patient the other 9:13 >> Yeah, like I had a patient the other day, she she really just couldn't 9:15 day, she she really just couldn't 9:15 day, she she really just couldn't tolerate that she was just too tired the 9:17 tolerate that she was just too tired the 9:17 tolerate that she was just too tired the next morning, even a little depressed.
Absorption, Timing, and Partner Concerns 9:18 next morning, even a little depressed. 9:18 next morning, even a little depressed. And this is not a depressed person. 9:20 And this is not a depressed person. 9:20 And this is not a depressed person. She's so lively, so beautiful, but she's 9:23 She's so lively, so beautiful, but she's 9:23 She's so lively, so beautiful, but she's not She's like, "I felt depressed. I'm 9:24 not She's like, "I felt depressed. I'm 9:24 not She's like, "I felt depressed. I'm starting to feel depressed." I said, 9:25 starting to feel depressed." I said, 9:25 starting to feel depressed." I said, "Well, take those capsules I have 9:26 "Well, take those capsules I have 9:26 "Well, take those capsules I have prescribed for you and use them 9:28 prescribed for you and use them 9:28 prescribed for you and use them vaginally, you know, and then we can 9:29 vaginally, you know, and then we can 9:29 vaginally, you know, and then we can always um change up the dosage cuz 9:33 always um change up the dosage cuz 9:33 always um change up the dosage cuz there's not as much clinical research on 9:35 there's not as much clinical research on 9:35 there's not as much clinical research on progesterone vaginally, using an oral 9:38 progesterone vaginally, using an oral 9:38 progesterone vaginally, using an oral progesterone vaginally like for 9:40 progesterone vaginally like for 9:40 progesterone vaginally like for protecting the uterine lining as there 9:41 protecting the uterine lining as there 9:41 protecting the uterine lining as there is, you know, as oral progesterone. You 9:44 is, you know, as oral progesterone. You 9:44 is, you know, as oral progesterone. You know, that's been around forever. People 9:46 know, that's been around forever. People 9:46 know, that's been around forever. People have been using oral progesterone to 9:47 have been using oral progesterone to 9:47 have been using oral progesterone to protect the lining of the uterus for 9:49 protect the lining of the uterus for 9:49 protect the lining of the uterus for many years. So, of course, there's going 9:51 many years. So, of course, there's going 9:51 many years. So, of course, there's going to be more studies on that. But there 9:52 to be more studies on that. But there 9:52 to be more studies on that. But there are a few out there. There's There's a 9:54 are a few out there. There's There's a 9:54 are a few out there. There's There's a good amount of research saying that that 9:56 good amount of research saying that that 9:56 good amount of research saying that that using an oral progesterone into the 9:58 using an oral progesterone into the 9:58 using an oral progesterone into the vagina can be uterine protective. I 10:01 vagina can be uterine protective. I 10:01 vagina can be uterine protective. I mean, so there is some information out 10:02 mean, so there is some information out 10:02 mean, so there is some information out there. I do feel like use for me I 10:05 there. I do feel like use for me I 10:05 there. I do feel like use for me I and someone's using estrogen, I never go 10:07 and someone's using estrogen, I never go 10:07 and someone's using estrogen, I never go lower, like I said, this is not medical 10:09 lower, like I said, this is not medical 10:09 lower, like I said, this is not medical advice, this is education, but I never 10:11 advice, this is education, but I never 10:11 advice, this is education, but I never go lower than 100 mg per vaginal capsule 10:15 go lower than 100 mg per vaginal capsule 10:15 go lower than 100 mg per vaginal capsule or progesterone 10:16 or progesterone 10:16 or progesterone oral they're using it vaginally. Some 10:18 oral they're using it vaginally. Some 10:18 oral they're using it vaginally. Some women I'll go up to 200. We can do 125, 10:21 women I'll go up to 200. We can do 125, 10:21 women I'll go up to 200. We can do 125, 150 if you're using a compounding 10:23 150 if you're using a compounding 10:23 150 if you're using a compounding pharmacy, so you can change it up a 10:25 pharmacy, so you can change it up a 10:25 pharmacy, so you can change it up a little bit, but I usually don't go lower 10:27 little bit, but I usually don't go lower 10:27 little bit, but I usually don't go lower than that unless somebody's in 10:28 than that unless somebody's in 10:28 than that unless somebody's in perimenopause, they're not taking any 10:31 perimenopause, they're not taking any 10:31 perimenopause, they're not taking any estrogen, and we're really using it for 10:33 estrogen, and we're really using it for 10:33 estrogen, and we're really using it for other, you know, other issues. 10:35 other, you know, other issues. 10:35 other, you know, other issues. >> Yeah, the good thing is 10:36 >> Yeah, the good thing is 10:36 >> Yeah, the good thing is especially when you bring in the 10:38 especially when you bring in the 10:38 especially when you bring in the compounding pharmacy side is that you 10:40 compounding pharmacy side is that you 10:40 compounding pharmacy side is that you have lots of options, lots of dosing 10:42 have lots of options, lots of dosing 10:42 have lots of options, lots of dosing options, and finding one that actually, 10:45 options, and finding one that actually, 10:45 options, and finding one that actually, you know, that matches the patient and 10:47 you know, that matches the patient and 10:47 you know, that matches the patient and their tolerance level. 10:48 their tolerance level. 10:48 their tolerance level. >> But the big box pharmacies are good, 10:50 >> But the big box pharmacies are good, 10:50 >> But the big box pharmacies are good, too. It's just you want to know, you 10:52 too. It's just you want to know, you 10:52 too. It's just you want to know, you know, you only have two dosings, the 100 10:55 know, you only have two dosings, the 100 10:55 know, you only have two dosings, the 100 and the 200, and they're all 10:56 and the 200, and they're all 10:56 and the 200, and they're all instant-release if you're going to use 10:58 instant-release if you're going to use 10:58 instant-release if you're going to use oral vaginal 11:00 oral vaginal 11:00 oral vaginal progesterone as a you want to you want 11:02 progesterone as a you want to you want 11:02 progesterone as a you want to you want to use an instant-release. You There's 11:03 to use an instant-release. You There's 11:03 to use an instant-release. You There's not not any reason to use a 11:05 not not any reason to use a 11:05 not not any reason to use a sustained-release vaginally cuz that's 11:07 sustained-release vaginally cuz that's 11:07 sustained-release vaginally cuz that's meant for the for the digestive for 11:09 meant for the for the digestive for 11:09 meant for the for the digestive for going into the digestion. But if you do 11:11 going into the digestion. But if you do 11:11 going into the digestion. But if you do use a big box pharmacy, some people 11:13 use a big box pharmacy, some people 11:13 use a big box pharmacy, some people don't have access to compounding or 11:16 don't have access to compounding or 11:16 don't have access to compounding or there's financial cost issues there, is 11:18 there's financial cost issues there, is 11:18 there's financial cost issues there, is just making sure that some of the 11:20 just making sure that some of the 11:20 just making sure that some of the excipients in there aren't bothering 11:22 excipients in there aren't bothering 11:22 excipients in there aren't bothering your vaginal microbio, and that you're 11:24 your vaginal microbio, and that you're 11:24 your vaginal microbio, and that you're not allergic to peanuts, so that, you 11:27 not allergic to peanuts, so that, you 11:27 not allergic to peanuts, so that, you know, that would be something. That's 11:28 know, that would be something. That's 11:28 know, that would be something. That's why I'll tell women, you know, just test 11:30 why I'll tell women, you know, just test 11:30 why I'll tell women, you know, just test your you know, test your vaginal pH. 11:32 your you know, test your vaginal pH. 11:32 your you know, test your vaginal pH. It's really easy and then you'll know if 11:33 It's really easy and then you'll know if 11:33 It's really easy and then you'll know if that vaginal, you know, oral 11:35 that vaginal, you know, oral 11:35 that vaginal, you know, oral progesterone that you're putting in 11:36 progesterone that you're putting in 11:36 progesterone that you're putting in vaginally is is disrupting it. You'll 11:38 vaginally is is disrupting it. You'll 11:38 vaginally is is disrupting it. You'll know right right away. Cuz sometimes 11:41 know right right away. Cuz sometimes 11:41 know right right away. Cuz sometimes cuz I do feel like progesterone is 11:43 cuz I do feel like progesterone is 11:43 cuz I do feel like progesterone is really nice for the vaginal vault just 11:44 really nice for the vaginal vault just 11:44 really nice for the vaginal vault just like just like estrogen is. 11:46 like just like estrogen is. 11:46 like just like estrogen is. >> Yeah, of course. So, it just gives more 11:48 >> Yeah, of course. So, it just gives more 11:48 >> Yeah, of course. So, it just gives more options, right? Because unfortunately, 11:50 options, right? Because unfortunately, 11:51 options, right? Because unfortunately, when it comes to medicine of any sort, 11:53 when it comes to medicine of any sort, 11:53 when it comes to medicine of any sort, there's not one there's not one option 11:55 there's not one there's not one option 11:55 there's not one there's not one option that solves everything for everyone. 11:58 that solves everything for everyone. 11:58 that solves everything for everyone. Now, granted, I will say that there are 12:00 Now, granted, I will say that there are 12:00 Now, granted, I will say that there are usually oral progesterone is usually 12:02 usually oral progesterone is usually 12:02 usually oral progesterone is usually pretty well tolerated, but this is you 12:04 pretty well tolerated, but this is you 12:04 pretty well tolerated, but this is you know, this gives women another option 12:06 know, this gives women another option 12:06 know, this gives women another option that 12:07 that 12:07 that if they're using estrogen therapy at the 12:08 if they're using estrogen therapy at the 12:08 if they're using estrogen therapy at the same time, which that's what we're 12:10 same time, which that's what we're 12:10 same time, which that's what we're talking about, they have to do have to 12:13 talking about, they have to do have to 12:13 talking about, they have to do have to do one of those options. 12:14 do one of those options. 12:14 do one of those options. >> Yeah, no, it's nice to have so many 12:16 >> Yeah, no, it's nice to have so many 12:16 >> Yeah, no, it's nice to have so many different variabilities for women. Like 12:18 different variabilities for women. Like 12:18 different variabilities for women. Like we can do there's creams, there's 12:20 we can do there's creams, there's 12:20 we can do there's creams, there's trokies, there's vaginal capsules, 12:22 trokies, there's vaginal capsules, 12:22 trokies, there's vaginal capsules, there's oral, there's so many different 12:24 there's oral, there's so many different 12:24 there's oral, there's so many different ways to do HRT. It's really tailoring it 12:26 ways to do HRT. It's really tailoring it 12:26 ways to do HRT. It's really tailoring it for that specific individual. And one 12:28 for that specific individual. And one 12:28 for that specific individual. And one thing I will say is you know, you have 12:31 thing I will say is you know, you have 12:31 thing I will say is you know, you have to do a lot at night. You know, I got to 12:32 to do a lot at night. You know, I got to 12:32 to do a lot at night. You know, I got to take off my makeup, wash my face, do all 12:34 take off my makeup, wash my face, do all 12:34 take off my makeup, wash my face, do all you know, brush my teeth and floss. It's 12:36 you know, brush my teeth and floss. It's 12:37 you know, brush my teeth and floss. It's like, oh, I have to do this vaginal 12:38 like, oh, I have to do this vaginal 12:39 like, oh, I have to do this vaginal vaginal oral progesterone. 12:41 vaginal oral progesterone. 12:41 vaginal oral progesterone. If you if you like it that way and you 12:43 If you if you like it that way and you 12:43 If you if you like it that way and you put it as part of your routine, it works 12:45 put it as part of your routine, it works 12:45 put it as part of your routine, it works perfectly. But then I have some women 12:47 perfectly. But then I have some women 12:47 perfectly. But then I have some women I'm like, okay, we're using this
Wrap-Up on Vaginal Progesterone Options 12:48 I'm like, okay, we're using this 12:48 I'm like, okay, we're using this vaginally. 12:49 vaginally. 12:49 vaginally. Did you forget? Yes, I did. Then I'm 12:51 Did you forget? Yes, I did. Then I'm 12:51 Did you forget? Yes, I did. Then I'm like, then we you know, we we got to we 12:53 like, then we you know, we we got to we 12:53 like, then we you know, we we got to we got to you know, hit the get back to the 12:55 got to you know, hit the get back to the 12:56 got to you know, hit the get back to the drawing board on this cuz you if you're 12:57 drawing board on this cuz you if you're 12:57 drawing board on this cuz you if you're on static dosing, you want to use that 12:59 on static dosing, you want to use that 12:59 on static dosing, you want to use that every day. And I will say 13:01 every day. And I will say 13:01 every day. And I will say I do 13:02 I do 13:02 I do in theory it sounds great. It just is 13:04 in theory it sounds great. It just is 13:04 in theory it sounds great. It just is how we're going to put that into our 13:05 how we're going to put that into our 13:05 how we're going to put that into our life. Now, one question that I get asked 13:08 life. Now, one question that I get asked 13:08 life. Now, one question that I get asked often is well, let's say I'm going to 13:11 often is well, let's say I'm going to 13:11 often is well, let's say I'm going to bed. I insert that oral vaginal capsule 13:14 bed. I insert that oral vaginal capsule 13:14 bed. I insert that oral vaginal capsule and you know, or insert that oral 13:15 and you know, or insert that oral 13:15 and you know, or insert that oral capsule into into my vagina and this 13:18 capsule into into my vagina and this 13:18 capsule into into my vagina and this spontaneously me and my partner want to 13:20 spontaneously me and my partner want to 13:20 spontaneously me and my partner want to have intercourse. So, you know, 13:23 have intercourse. So, you know, 13:23 have intercourse. So, you know, and as a man you know, with a male 13:24 and as a man you know, with a male 13:24 and as a man you know, with a male partner 13:25 partner 13:25 partner is something going to happen to him? Is 13:27 is something going to happen to him? Is 13:27 is something going to happen to him? Is he going to touch the progesterone? Is 13:29 he going to touch the progesterone? Is 13:29 he going to touch the progesterone? Is something going to happen to me? Am I 13:30 something going to happen to me? Am I 13:30 something going to happen to me? Am I not going to absorb it? I usually say, 13:32 not going to absorb it? I usually say, 13:32 not going to absorb it? I usually say, "Don't worry about it. Nothing's going 13:34 "Don't worry about it. Nothing's going 13:34 "Don't worry about it. Nothing's going to happen to your male partner." 13:36 to happen to your male partner." 13:36 to happen to your male partner." But, you know, you can always do another 13:38 But, you know, you can always do another 13:38 But, you know, you can always do another capsule afterwards just in case, you 13:40 capsule afterwards just in case, you 13:40 capsule afterwards just in case, you know, some of that progesterone that was 13:42 know, some of that progesterone that was 13:42 know, some of that progesterone that was supposed to go 13:43 supposed to go 13:43 supposed to go into the lining hadn't been absorbed 13:44 into the lining hadn't been absorbed 13:44 into the lining hadn't been absorbed quite quickly enough or just wait till 13:46 quite quickly enough or just wait till 13:46 quite quickly enough or just wait till the next day. One day is not going to 13:48 the next day. One day is not going to 13:48 the next day. One day is not going to mess not going to mess it up. But, that 13:49 mess not going to mess it up. But, that 13:50 mess not going to mess it up. But, that is kind of one of those logistical 13:51 is kind of one of those logistical 13:51 is kind of one of those logistical questions that people ask a lot. 13:53 questions that people ask a lot. 13:53 questions that people ask a lot. >> Men are big babies when it comes to 13:54 >> Men are big babies when it comes to 13:54 >> Men are big babies when it comes to estrogen and progesterone. They um 13:57 estrogen and progesterone. They um 13:57 estrogen and progesterone. They um Now, uh we have to be much more 13:59 Now, uh we have to be much more 13:59 Now, uh we have to be much more concerned as a whole another topic. We 14:00 concerned as a whole another topic. We 14:00 concerned as a whole another topic. We have to be much more concerned about 14:02 have to be much more concerned about 14:02 have to be much more concerned about men's testosterone getting on the women 14:04 men's testosterone getting on the women 14:04 men's testosterone getting on the women if they're using a transdermal cream. 14:06 if they're using a transdermal cream. 14:06 if they're using a transdermal cream. That's a much bigger deal. Women, kids, 14:08 That's a much bigger deal. Women, kids, 14:08 That's a much bigger deal. Women, kids, and pets are the ones you have to be 14:09 and pets are the ones you have to be 14:09 and pets are the ones you have to be careful with. Um but, it going the other 14:12 careful with. Um but, it going the other 14:12 careful with. Um but, it going the other way, the hormones for men 14:14 way, the hormones for men 14:14 way, the hormones for men uh uh from women getting on men is not 14:16 uh uh from women getting on men is not 14:16 uh uh from women getting on men is not that big of a deal. 14:17 that big of a deal. 14:17 that big of a deal. >> No, it it'll be it'll be okay. 14:18 >> No, it it'll be it'll be okay. 14:18 >> No, it it'll be it'll be okay. >> Yeah, yeah, yeah. 14:19 >> Yeah, yeah, yeah. 14:19 >> Yeah, yeah, yeah. >> Like I said. 14:19 >> Like I said. 14:19 >> Like I said. >> It's funny. 14:20 >> It's funny. 14:20 >> It's funny. >> This is for education. 14:21 >> This is for education. 14:21 >> This is for education. >> Sure, sure. Uh all right. So, we'll wrap 14:23 >> Sure, sure. Uh all right. So, we'll wrap 14:23 >> Sure, sure. Uh all right. So, we'll wrap this one up. 14:24 this one up. 14:24 this one up. Oral progesterone, uh using it using it 14:27 Oral progesterone, uh using it using it 14:27 Oral progesterone, uh using it using it vaginally is a perfectly good uh 14:30 vaginally is a perfectly good uh 14:30 vaginally is a perfectly good uh perfectly good option for some. Uh so, 14:32 perfectly good option for some. Uh so, 14:32 perfectly good option for some. Uh so, if you have any comments, you can just 14:34 if you have any comments, you can just 14:34 if you have any comments, you can just write them down below if you feel 14:35 write them down below if you feel 14:35 write them down below if you feel comfortable. Uh 14:36 comfortable. Uh 14:36 comfortable. Uh otherwise, uh you and I will uh you 14:39 otherwise, uh you and I will uh you 14:39 otherwise, uh you and I will uh you know, 14:39 know, 14:39 know, >> See you next time. 14:40 >> See you next time. 14:40 >> See you next time. >> Yeah, we'll see you next time on the 14:41 >> Yeah, we'll see you next time on the 14:41 >> Yeah, we'll see you next time on the next episode. So, uh till next time I'm 14:43 next episode. So, uh till next time I'm 14:43 next episode. So, uh till next time I'm Dr. Mack. 14:43 Dr. Mack. 14:43 Dr. Mack. >> I'm Dr. Valerie. Take care. 14:45 >> I'm Dr. Valerie. Take care. 14:45 >> I'm Dr. Valerie. Take care. >> Bye-bye.
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