PCOS Relief: Learn About Cyclic Progesterone Therapy

Lara Briden, ND

Thanks, Dr. Felice. It is so nice to get a chance to chat with you again. I hope we can meet in person one day because we have so much in common. With our shared love of female hormones, I came to this work. I was a biologist before I became a naturopathic doctor. I thought it was funny because I was looking back at the scientific paper or a couple of scientific papers I wrote 30 years ago about sex differences in animal behavior. I realized way back then that I was already very interested in female physiology and what that meant. That has been my journey. 

Then I became a naturopathic doctor, and I worked with patients, as you did through the years. That is how you learn about female hormones, isn’t it, seeing what happens on the ground with women? Yes, I am very passionate about female hormones and the menstrual cycle because that is how we make female hormones. I guess that would be my starting point; a menstrual cycle is not an add-on. It is not a separate optional part of histology; I would say it is an integral part of how during our reproductive years we make both estrogen, which is a very important and wonderful hormone, and progesterone, which we are going to be talking about today, which is the Cinderella of hormones and is sometimes forgotten. It plays a very important role in PCOS.

Felice Gersh, MD

Well, absolutely. We both agree that the menstrual cycle is not an add-on. It is intrinsic to what a woman’s body is doing and her overall health. As I have said, I guess a million times by now, whether we like it or not, this is what it is: fertility and reproduction. These are intrinsic parts of what a female body is designed to have and do, and that involves a healthy, functional set of ovaries and a menstrual cycle. 

I was hoping for people out there who, as we talk about with women with PCOS, one of the cardinal findings is irregular cycles. what is, just from the basics. What is a menstrual cycle? What hormones are being produced? How is this happening? Then we will talk about why it is important and what is happening in women with PCOS.

Lara Briden, ND

Yes, great question. I will just clarify, and I am sure you agree, that the menstrual cycle and our reproductive system are important. Even if we never have a baby, even if we do not want to have one or never do, It is not, I think the narrative has been, Until you are ready for a baby, none of this matters. But my message would be that it very much matters. An answer to your question: What are the basic mechanics of a menstrual cycle? It has to start with ovulation because, as you say, one of the key features of PCOS is that it is not ovulating regularly. Of course, people know ovulation is the release of an egg, which means if you want to make a baby, that is important. But it is not only that; it is also the key event in a menstrual cycle. It is the key hormonal event. It is what defines a menstrual cycle. 

It is possible to have bleeds, even somewhat regular bleeds, without having ovulated, and those are called Anovulatory cycles. I know that is a technical sounding word, but I always encourage my followers to learn the word Anovulatory, which means without ovulation, because that is not just for PCOS, but for PCOS, that is an important part of what is going on. In a healthy ovulatory menstrual cycle, where ovulation does occur,  we have during the bleeding is the first part of the menstrual cycle is day one of the bleeding and day one of the menstrual cycle. That is the big reset when everything starts over and we have very low hormone levels at that point, very low both estrogen and progesterone. That is entirely normal; levels are as low as menopausal levels at that time, which I think sometimes if patients see a blood result when they see very low estrogen, they can be quite scared by that. But that is normal if you are early in the cycle. 

Then communication between the brain and the ovaries starts, and these hormones come essentially from the part of the brain called the hypothalamus and then through the pituitary. You do not have to remember those terms at all. But there are a couple of hormones called FSH and LH, and they start talking to the ovaries, and that process takes a couple of weeks. It depends on your age when you are young; that can take quite a long time. It can take three or four weeks to achieve ovulation. When you are older, typically in your forties, it is a lot quicker. That is why our cycle shortened because the brain was a lot louder at that point talking to the ovaries. But yes, the conversation begins, and if all is going well, ovulation will occur in response to that. In the buildup to ovulation, we make lots of estrogen. That is good for us, as we get our peak estrogen just a few days before ovulation. That is all coming from the ovaries. Then, if all goes well and we do ovulate, we make a huge amount of progesterone. 

In a healthy menstrual cycle, we make 100 times more progesterone than estrogen, or peak progesterone, which is quite astronomical. We do not see that in the typical representations of the menstrual cycle because they always scale them to look roughly equivalent. But we make just a giant amount of progesterone, and we only make that for two weeks unless we are pregnant, of course. Then the whole system is rescued, changed, and carried on. 

We have high progesterone levels throughout the pregnancy, but if you do not conceive, then that progesterone can only last two weeks because the little temporary gland in the ovary that makes progesterone has what I call in my book, the lifespan of a  butterfly. It is only with you for a short time, and then progesterone drops away, and that is partly what signals the next bleed. But I do want to emphasize this because so many of my followers have said they know, they know, they have learned that the drop in progesterone triggers the period. Then they are confused about how you can have a period. Without that, you can still have a bleed without the ups and downs of progesterone. That is important to know.

Felice Gersh, MD

One of the things that you said that is very important, I think, to emphasize is that whether or not you want to become pregnant, the menstrual cycle is key to female health and well-being. Humans make determinations about what they want to do and when they want to have families, and that is what we are all about making personal decisions. But it is so important to understand that the menstrual cycle, whether or not you want to become pregnant, is intrinsic to our well-being during these reproductive years because the menstrual cycle and these vital life hormones have, I changed their names from sex hormones to life hormones because they do so much more than just a reproductive function. 

They have these hormones that receptors, and function all over the body, and the rhythm of the menstrual cycle is key to so many different things happening in the body. One of the things that is so important that I had you touch on is how these rhythms of hormones matter, because so often women with PCOS are treated with oral contraceptives, which get rid of the rhythms, and of course, they are not human hormones. Maybe you could just touch on the interplay, as you mentioned, between high progesterone and then changes in estrogen. These rhythms are important to how the whole body functions and the key to having ovulation even occur is that you cannot have a static level and then end up with an egg coming out.

Lara Briden, ND

Absolutely. Yes. I could not agree more about the life hormones. It is a lovely phrase release. Yes, that is nice. Well, I guess one thing to consider is that we are cyclic beings, as we have said. Establishing regular ovulation and ovulatory cycles is an important part of the maturation of the hormonal system. The problem was shutting it down with oral contraceptives, which is what it does: essentially, it temporarily and reversibly switches off that viability process that I have just described and flatlines both estrogen and progesterone. 

One of the problems with that is that it does not allow the maturation of the communication between the brain and the ovaries, which, according to some research and I have the citation for that in my book, takes 12 years to mature. Which is pretty interesting. If you get your first, you start getting periods at, say, 13. I know it is a little bit younger these days, but let us say 13 years old, then you will not have fully matured robust ovulation, fertility, or progesterone levels until you are 25, which fits. That is about the peak fertility, which would be around the early to mid-20s. 

Unfortunately, if you switch it off, it can take some time to get it all going. I have had, and I am sure you have had, the same. I have had many patients who might have been on the pill since they were 13, possibly. It is not unusual to put young girls on the pill now, and then if they stop the pill at 31, hoping everything is just going to snap into place, that is often the case. Yes, that is not going to be the case. That is one reason, and at least one of my main concerns with the pill is the way it flatlines hormones and robs women’s bodies of their hormones. 

But to acknowledge, just to give a nod to why the pill is prescribed, of course, is that it does pretty reliably suppress testosterone or androgens, which is one of our obsessions when we are talking about PCOS. That has to be one of the clinical goals, which is to suppress testosterone, and the pill can do that. But one thing I want to mention at this point in our interview is that progesterone also does that. 

Progesterone, which has both estrogen and progesterone, has natural anti-testosterone effects. Progesterone does so via several mechanisms. It has even been proposed. It is quite interesting because I am an evolutionary biologist, so I always see things through the lens of how systems develop. But in the teenage years, most teenagers, Would you agree, Dr. Felice, that in our teenage years, most girls are in a temporary state of PCOS anyway? An androgen or testosterone dominance is happening before ovulation kicks in. They might have mild insulin resistance around those early puberty years. That is pretty common. 

The maturation of the menstrual cycle and the arrival of progesterone are what help push down testosterone and essentially mature the menstrual cycle. If you do not allow progesterone to come on, come online, and come on board, then that is going to contribute. To be fair, there are lots of factors contributing to the reason women develop androgen excess, PCOS, or testosterone. There are lots of prenatal, genetic, and epigenetic reasons why this happens. But in the natural system, progesterone is part of our natural anti-androgen maturation process.

Felice Gersh, MD

Well, absolutely. Some of the key things that you touched on are what would be called a feedback system. A lot of people do not know that hormones have receptors and that these receptors are not a lock in a door. They are not fixed. Sometimes people use the analogy that the hormone is the key and then the receptor is a lock. But that is not the way it works because receptors are very dynamic, and they are shapeshifters. They can change their receptivity, and they can change how well they work, like a mouse, which is a receptor for food. It could be open. It could be open a lot. It could be closed. The receptor for hormones can have different capabilities for receiving the hormone, which ultimately leads to the effect of the hormone going into the receptor. These different hormones, progesterone, testosterone, and estradiol, the form of estrogen made by the ovaries, have different effects at different amounts and in different parts of the cycle depending on how the receptors receive them and how they work. 

There is this incredible dynamic of up-and-down regulation in the words that we use for the receptors. When you talk about, well, progesterone can downregulate testosterone production and receptor function, and all of that is fascinating. These are some of the cutting-edge ways that we are evolving in our understanding of PCOS and the fundamentals of how hormones work and the menstrual cycle. You touched on testosterone excess, and of course, that is one of the key reasons why they try to do birth control pills and excessively just shut down the ovaries. Of course, we always prefer, if we can, to fix it rather than just turn it off. Just shut it down because it is not working. But maybe you could explain because a lot of people may not know where testosterone is coming from.

Lara Briden, ND

Yes.

Felice Gersh, MD

What is going on is that there is excessive testosterone production. Where is it coming from, and why do women have testosterone? I thought that was a man’s hormone.

Lara Briden, ND

Well, great question. Yes, so well. Of course, in PCOS, a lot of it comes from the ovaries. Of course, not all of it is; we make testosterone in the adrenal glands as well. Testosterone is important for health. There is a sweet spot with every hormone; there is a sweet spot with testosterone. We certainly need some testosterone for lots of things, including bone health and mood. We have more testosterone, typically when we are younger. That is partly why, as I mentioned earlier, in teenagers at around the time of puberty, testosterone is relatively high for women, but still way lower than for men. Men have ten times more testosterone. That is another different topic. 

But then also we get this lovely little, quite interesting, little testosterone surge just before ovulation, which a lot of us will remember from the day when I was having menstrual cycles. I am menopausal now, but that little pre-ovulatory testosterone surge can feel amazing. Testosterone can have quite several benefits. But of course, in the problem with PCOS, almost by definition, I would say that testosterone is upregulated primarily in the ovaries, but depending on the woman, of it, a lot of it might be coming from the adrenal glands. In some of my work, I differentiate and categorize PCOS into different types, depending on what is driving the androgen excess and where that is coming from. There is, for what it is worth, and you see that in the scientific literature, there is an adrenal gland-essentially type of PCOS, which is quite different than ovarian PCOS, which has a lot to do with testosterone from the ovaries, though not exclusively from the ovaries. These are things you want to add about testosterone.

Felice Gersh, MD

Well, when we are talking about PCOS, we are usually talking about the ovarian variety, which involves high testosterone, predominantly from the ovaries. But you are right. It is important, for people to understand that, when we talk about PCOS, the S stands for syndrome, which just means it is a constellation of physical symptoms, presentation, and findings with an ultrasound. It is not talking about etiologies at all; it is just talking about presentation. Yes, the adrenal gland is a major producer of androgens and a big producer of DHEA which is one of the lab tests that we measure when we are trying to figure out, well, where is this excess of androgen coming from. Is it from the ovaries? Is it from the predominantly adrenal gland? But they are different entities, and we have to. 

That is why for PCOS, it is important to emphasize that it is always a diagnosis of exclusions. In other words, you need to do testing to make sure that it is not something else. There is a whole array of things we are not going to deal with, including acquired adrenal hyperplasia. Yes. So we have to make sure that anyone out there who thinks they have PCOS sees a healthcare professional who makes sure what is going on and what is causing their symptoms, not just accept the symptoms as well. You have PCOS, and therefore, we are just going to put you on birth control pills; end of the story, because it could be an adrenal issue. 

Lara Briden, ND

That is correct. 

Felice Gersh, MD

I am glad that you brought that up. I think it is important for everyone to know. Then I want you to know we are going to talk about progesterone. Is it true that all estradiol that is produced in the ovary is derived from one hormone, and that is testosterone?

Lara Briden, ND

True.

Felice Gersh, MD

Half of that comes from testosterone, and half of it comes from something else. 100% of the estrogen produced in the ovary, which is a type of estrogen called estradiol, comes from testosterone. The ovary has specialized cells that make testosterone. They are made by these special cells when they are stimulated and told to do so by the pituitary, which you talk about. then the pituitary is then told what to do by the portion of the brain called the hypothalamus. The pituitary puts out that little hormone that you mentioned, the luteinizing hormone, LH. Then there is an enzyme in the ovary aromatase that is in a different set of cells that then converts the testosterone into the estradiol under a different pituitary hormone direction, the FSH,  follicle-stimulating hormone. 

I would like you to talk about, and I always defend what I call the defenseless, poor estrogen. because it has been so long, but you are 100%. Progesterone is super important to me. You can have a functioning, healthy female with just one and not the other. Progesterone is so often forgotten. The role that it plays in so many aspects of female health, the menstrual cycle, and so on. Of course, women who don’t ovulate cannot make progesterone in their ovaries. That is just absolute. You can make some estrogen, but you cannot make progesterone without having that ovulation. I would love you to introduce this audience to that amazing, forgotten, underappreciated hormone, progesterone.

Lara Briden, ND

Absolutely. I want to pick up on a couple of things you said there. I am a huge fan of estradiol as well. The other thing is that if you do not ovulate, you not only do not make progesterone, but you also do not make peak estradiol. The ovaries, it is pretty easy for the ovaries to add a little bit of estradiol, but that is not enough for this whole sequence of events that has to happen. There has to be a spike and, essentially, a peak of estradiol to be able to ovulate. Estrodiol is also very important for estrogen and not to get too technical for everyone. Do not worry, it is not going to be technical. But two things you said there; that two parts are going wrong with PCOS if you will. 

There are many parts to this, but two parts of what you said. There is the LH signaling from the brain, which is essentially stimulating testosterone. Then there is the aromatase, which converts testosterone to estrogen. Both of those systems are not functioning perfectly or well, with PCOS, I think that is safe to say. There is research into both of those systems. 

You want, we need to be trying to support both of those systems, and that is where progesterone comes in. Because it is a superpower, it feeds back to the brain as progesterone receptors in the brain. As you say, there are receptors everywhere. When the hypothalamus part of the brain receives that huge, as I said, just an enormous amount of progesterone that is made after ovulation, it downregulates LH. Progesterone pushes down on LH after ovulation. That is, as we can imagine, very important for PCOS. As we just said LH is part of what stimulates testosterone production, LH is a very dynamic hormone in that it is supposed to be relatively low and then undergo this huge spike just before ovulation and then goes back down, and with PCOS it tends to be just generally elevated baseline elevated, and that is not a good situation. 

Anything that can push down on LH can help the hormonal system find its rhythm again. That is what progesterone does. I might introduce the topic, if that is okay, Dr. Felice. 

Cyclic progesterone therapy is a new treatment approach that was developed by my colleague, who is in Endocrinology Professor Dr. Jerilynn Prior, in Vancouver, Canada. They have just, I think, completed it. They have not published it yet. We are all excited to see the results. They have done a clinical trial of cyclic progesterone for PCOS, and this is going to be quite a different approach. It mimics the luteal phase production of progesterone for a while with the understanding that it might not need to be permanent because once progesterone comes on board and exerts its negative feedback, its regulatory effect on the brain, and pushes down on LH, then that can allow the ovulatory cycle or regular ovulation to establish essentially for the cycle to mature and for women to start to make their progesterone, which is what is so great about it as a treatment that it is not, you do not have to go on it and stay on it you would the pill. 

Also, you can take it when you are trying for pregnancy because it is safe during pregnancy and it permits ovulation, which is a big plus. The progesterone, with cyclic progesterone therapy, is real progesterone, or what is called body-identical, bioidentical, or natural progesterone, depending on how you want to phrase it. It is not the progestin in the pill. We have not talked about that yet, but I will just say, as a simple statement, that there is no progesterone in any type of hormonal birth control, which is very confusing because it is often called progesterone, but it is not. The progestins, the various synthetic versions of progesterone that they use in hormonal birth control, do not have that same effect on the brain; they just flat out do not do that. They cannot be used in the same way that progesterone can be used. Well, have you?

Felice Gersh, MD

Well, we have never discussed this.

Lara Briden, ND

Yes.

Felice Gersh, MD

But I have been doing that as well, with the theory that you cannot heal without the hormones, but until you have the hormones, you cannot heal. It is a temporary thing to try to get back the rhythms of the body, the beautiful spike of estradiol, and progesterone. I am just so excited to hear what you have been doing and, in a different part of the world, that we are, to say great minds think alike. 

We recognize that the hormones that the human body makes, which are not the same as the chemically made mimics, are not the same—progestins versus progesterone or ethanol, estradiol versus 17-beta estradiol—the estrogen made by the ovaries. I just want to hear. I am so excited to hear about this new research using the human body’s identical progesterone because I have been doing that, but we have not talked about it. Let me hear all about what I have been learning.

Lara Briden, ND

Well, it is fun. I think you have intuitively come to the same conclusion. This cyclic progesterone therapy was not my invention. It was by the Endocrinology Professor, Jerilynn Prior. She has been using it clinically for a lot of years, and because she is a scientist, she has finally been able to bring it to a clinical trial. I wrote a paper, a review paper, with her about it a couple of years ago, more of a mechanistic look at all the nuts and bolts of how that works, including a lot of what you just talked about. All the interesting things that happen in the brain at different times of the cycle and in terms of exposure to progesterone. 

What you said, It is imposing, if you will, or hooding the structured cycling, putting the hormonal cycling in it, giving a woman that with external doses of natural hormones, with the expectation and often the result, that that will essentially train the brain in a way that establishes that cycle. Often, what I say to my patients when they are trying to get ovulation going, and I am sure maybe you found the same thing, is that once you get it going, it is like getting a big boulder rolling. It can take a bit to get it moving. But then, once it is going, it will keep going. Often, there is momentum behind that. I think that has been the idea. Also, just as I said earlier, both estrogen and progesterone have an anti-androgen and anti-testosterone effect. That can just push down on the level of testosterone that is interfering with the system, essentially. 

Yes, I think using it for a year is reasonable. Sometimes my patients are on cyclic progesterone for six months and then can come off it. It depends. Honestly, it just depends on how severe that testosterone excess was. I think there are different degrees of it. Some women just have a quite mild amount that they are potentially even just going to outgrow. For some women, it is a much stronger amount. That will tend to determine for how long they will need to continue using natural hormones this way. This can always be done in conjunction with other things. 

I just want to say as well that it does not have to be the only treatment people use because I am also a huge fan of isositol, of which we can be sure. You talk to other guests about that supplement. But yes, this natural hormone approach can work quite well, and you would not want to combine it with the pill, because that would just defeat the purpose, because the pill, as we have said, shuts down the system, and this is a treatment that is trying to get the system going and functioning normally. I do not know what version of progesterone you use. In the US  what is available is Prometrium, or you could get it compounded capsule. What do you tend to use with your patients?

Felice Gersh, MD

Well, depending on the situation, I use the oral version you mentioned. But occasionally, some people cannot tolerate that. So I will occasionally use the creams that have less data, and you have to use large quantities to get it absorbed. But as an alternative for people who do not tolerate it, a small percentage just do not tolerate oral progesterone. But I usually start with oral progesterone. The thing that is so interesting is that I read your paper. That is why I feel it is good. I did, and I enjoyed it very much. Even though you did not invent it, you are promoting it, and you are part of this. 

Because many doctors and other healthcare professionals use progesterone to do what they call, inducing a bleed. They say a period is not a period. It is bleeding, you said. It is not because there is no ovulation in that case. They are just giving progesterone to convert the uterine lining to a secretory state. You are changing it so that it is somewhat similar to what it would be before having a real menstrual period because it changes how the lining looks and how it behaves. Then you withdraw, you stop the progesterone, and then the lining sheds out. It just comes out. But it is not period bleeding; it is blood. We call it withdrawal bleeding, and that is important. 

You do not have what is called unopposed estrogen that is made by the ovaries, a low but chronic amount of estrogen that causes growth or proliferation of the uterine lining in a pro-inflammatory state, which unfortunately for women with PCOS is a pro-inflammatory systemic total body-wide inflammation, and so that can increase the risk for uterine or endometrial cancer. That is why they give progesterone just to get rid of the lining and change it into that secretory format. But you are using progesterone. It also involves retraining the brain, looking at brain receptors, affecting testosterone levels, and so on. It is a different approach. For people who hear that, well, my doctor gave me some progesterone to bring on a bleed, but that is important. We do not want uterine cancer, but it is a different thought process. It is, so it is a different use of it, which has a greater scope of benefits when you are using it in the way that you are discussing it.

Lara Briden, ND

That is a great way. That is a good point to bring in, getting a semi-regular withdrawal bleed, as you say, is important for protecting the uterine lining. A lot of women are aware of that. Their doctor might have mentioned something about preventing cancer. This is what they are talking about preventing the cancer of the inner lining, which, to be fair, is long-term. A lot of women get scared by that, but that would just mean that would be a risk after many years of not having bleeds. Most women are not going to end up in that situation. 

But yes, so progesterone has that benefit, which is level one, if you will. That is great to be able to use a natural hormone to induce the bleed. But then, as you say, there is more. If you do this, in a cyclic manner, which is two weeks on, two weeks off, essentially, then you can also have this brain retraining. I will just reemphasize again how you and I are now talking about natural progesterone, her body, and identical progesterone, from which you can get other types of progestins, which are sometimes called progesterone, which makes it very confusing. Progestins can induce withdrawal, but they cannot retract. They cannot retrain the brain. 

That is where the distinction comes in. The other distinction is that, of course, natural progesterone is safe when you are trying for pregnancy or is compatible with achieving pregnancy and can help to hold the pregnancy. One thing I do not know if you agree, but I would just say one pretty one listening and hoping to maybe go down this strategy if you are using progesterone, progesterone when you are trying for pregnancy, and then if you do become pregnant, I usually say stay on it for the first few months. What do you say about that, Dr. Felice? Just because you want to keep that natural progesterone in place and not withdraw it early in the pregnancy? 

Felice Gersh, MD

Yes. Often, depending on each individual’s situation, it would not be uncommon for me to take it for the first 12 weeks.

Lara Briden, ND

Yes. For the first trimester. Until then, the placenta kicks in and starts to make an even bigger amount of progesterone. At that point, you just do not need it anymore. I want to follow up. I want to ask you a question if that is okay. Because you just mentioned the women who cannot tolerate progesterone. I do want to touch on that because, again, for anyone who is going to go out and try to try this treatment, there are a couple of things to know about oral progesterone. 

One, you should, or at least I think you should take it at bedtime because it is quite normal and quite tranquilizing. It can make you feel very sleepy if it is bedtime, which is a good thing, or very groggy if you try to take it during the day. 

That is what most women experience from it. That is how Professor Prior doses it, as well as a bedtime dose. But I think it is about one in 20 women. You can tell me what you find in your clinical practice. As you say, do not tolerate it. They get a paradoxical anxiety reaction from progesterone, which is usually when you have to switch to either cream or maybe vaginal progesterone to avoid that brain effect. Would you say it is about one in 20 or maybe more frequent? What do you find?

Felice Gersh, MD

Yes, I would say that one in 20 is about right. It is not super common. Yes, and it is always annoying when this happens because it makes it harder for everybody.

Lara Briden, ND

But yes.

Felice Gersh, MD

We just have to recognize it. I00% I only dose oral progesterone at bedtime. Since I love it, they say I have never slept. There is a relationship between progesterone and GABA, but we could just talk forever. All because we think along so many of the same lines because we are looking at the key role of the menstrual cycle and these vital hormones that are produced by the ovary what they mean for the total body, and the different things that go awry in women with PCOS. We are constantly searching for ways to not just cover up symptoms, which I am not going to belittle. 

Covering up symptoms is very valuable, but we are doing and want to do more than that. We want to repair it. Like what you write in your books; repair. If you want to repair the problem, fix it. 

I do not want to use the word cure. That is a little too powerful. Perhaps, but repair so that the body can function in a much more normal fashion rather than just cover up symptoms, and then, unfortunately, I agree with you, about birth control pills. Often I call it kicking the can down the road because they may do fine while they are on it. But eventually, if they go off and eventually you have to go off, they find that things are maybe worse than what they seemed to be when they started. 

You and I are on the same page. We are looking for a deep understanding of how hormones work in the female body, how the ovary functions, the relationship between these different other parts, the pituitary, the brain, the hypothalamus of the brain, and all these different signaling agents. We could talk about both in-depth, we did not even touch on all the different intricacies of the hypothalamic-pituitary-adrenal ovarian axis or how all of this works. It is amazing. For people who want to learn more about what you have written about, maybe you can give them some resources. Where can they go? We have barely just weathered their appetite for this.

Lara Briden, ND

Absolutely. Well, I have a couple of blog posts about progesterone. I have a blog post called Cyclic Progesterone Therapy for PCOS. That links to the paper I wrote with Professor Prior. But also watch this space. I would encourage everyone, if they are not already obviously following you, to maybe follow me and get on my newsletter list because I will, as soon as Professor Jerilynn’s clinical trial. As soon as that is published, peer-reviewed, and published, then I will share that. Of course, it remains to be seen what they find. I am expecting them to find good results. We will find out when the research is published. But then that will be a resource to take to your doctor. 

Just to be clear, the progesterone we have been talking about is a prescription medication. You will need to have a conversation with your doctor about whether this is something you have to try. In my experience, the feedback I have had from a lot of my readers and followers is that a lot of doctors are open to it for the main reason. I will just say that the main selling point of trying cyclic progesterone therapy is its safety. Because of the big picture, I would say natural progesterone is safer than progestins in terms of breast cancer risk. To be fair, the breast cancer risk with progestins is quite low, but it does exist. Progesterone is even safer, I would say, at this point, given the reading of the research. 

What is often quite important for doctors is not just to know; they do not have to be convinced that it is going to work. They just have to be convinced that it is safe to try because I think that is probably fair to say. That is the most important thing for most doctors. They do not want to; they might be a little nervous about it, but then you could just say, Look, here is the research. I will just leave that with you and come back next week for another appointment, and we can talk about maybe getting started on it.

Felice Gersh, MD

Well, I hope everyone will follow you. Read your blogs. We are all awaiting the publication of that article and the research, and I agree that most doctors are already familiar with using progesterone, as we talked about, to create that withdrawal bleed. The idea of using it on a routine basis every month is probably not going to be that big of a stretch for them to adapt. Then and then we will see where it goes from there, and all the different researchers will say that finally, we are getting more interest in PCOS, which excites me when I go to PubMed and Google Search and I find more and more articles published. It warms my heart, and I am so happy.

Lara Briden, ND

Yes.

Felice Gersh, MD

You are in this space with us. After all, it is only the most common endocrine disorder in reproductive-age women. Why should we be caring? It is so amazing. 

I appreciate all that you are doing. the education, the books you are writing, and that you are so active and growing stronger as the years go by in terms of your involvement in all of the basic science research as well as the clinical, which is why I love it when we get to join these two together. Clinical science and clinical practice are so important. 

Thank you so much. I look forward to staying connected, and I hope all of you will follow my wonderful friend here, Dr. Lara Briden. Thank you so much.

Lara Briden, ND

Thanks, Dr. Felice. It was such a delight to chat with you today.