Émancipées, le podcast
Le podcast qui émancipe les femmes (et les hommes !) en leur donnant des clés pour comprendre leur corps et leur cycle, pour leur permettre de maitriser leur fertilité, leur contraception et leurs hormones avec autonomie et confiance !
Le savoir, c’est le pouvoir, et Laurène est bien décidée à vous apporter un max, en répondant à des questions qu’on se pose tous, ou pas, seule ou avec des experts passionnés, pour que votre intimité n’ait plus de secret pour vous !
Émancipées, le podcast
#30 (ENG) La progestérone, meilleure alliée de la périménopause
La périménopause, on en parle peu en France, et elle a tendance à être mal comprise ou associé à la “péremption” des femmes, après 50 ans. Alors qu’en réalité, cette phase de transition peut démarrer jusqu’à 10 ans avant l’arrêt des cycles, dès la fin de la trentaine, et cette période peut être vertigineuse pour les femmes, sans qu’elles en comprennent forcément l’origine.
Alors qui de mieux pour nous parler de cette phase si mystérieuse que celle qui l’étudie depuis des années, de l’autre côté de l’Atlantique ?
Je suis très heureuse d’avoir pu interroger le Dr. Jerilynn Prior, endocrinologue spécialiste de du cycle féminin, avec qui on a évoqué en profondeur le rôle méconnu de la progestérone dans la périménopause.
Vous découvrirez pourquoi cette hormone est cruciale pour réguler les cycles, améliorer le sommeil, réduire les sueurs nocturnes et préserver la santé mentale.
Avec elle, on creuse aussi les idées reçues sur les traitements hormonaux, avec des explications claires et des solutions adaptées.
J’espère que cet échange vous plaira, il s’adresse vraiment à toutes les femmes qui souhaitent en savoir plus sur cette période de leur vie !
P.S : Soyez indulgents avec la traduction, nous avions à coeur de vous proposer un épisode traduit, et cela a été fait en partie avec une IA.
Site mentionné au cours de l'épisode : https://www.cemcor.ca/
Bibliographie :
Estrogen's Storm Season: Stories of Perimenopause (2017)
The Estrogen Errors: Why Progesterone is Better for Women's Health (2009)
Transitions Through the Perimenopausal Years: Demystifying Your Journey (2006)
Nos Clubs :
👶 Vous êtes en projet bébé et/ou souhaitez reprendre en main votre fertilité naturellement ? Le Fertility Club est fait pour vous !
🧘♀️ Vous souhaitez adopter une contraception sans hormones ? Go Serenity Club !
🤰🏼 Vous venez d'apprendre que vous attendez un bébé ? Le Mama Club vous accompagne pendant votre premier trimestre 💪
Pour celles qui vivent une grossesse arrêtée, le Club d'Après est là pour vous ❤️
Nos mini-programmes :
🆙 Pour booster sa progestérone en phase post-ovulatoire, c'est par ici !
💦 Et pour une glaire cervicale de folie, c'est par là 😇
👱♂️ Votre amoureux est largué quand on lui parle de cycle menstruel ? Le mini-programme Mon cycle expliqué à mon mec devrait l'ai
that if you put your hand, the palm of your hand over your nipple and push on your breast toward your back, if it's sore at all, it means your estrogen is high. So any breast tenderness means high estrogen. it's a hormonal imbalance that you're dealing with.
Laurène:Bonjour et bienvenue dans ce nouvel épisode du podcast émancipé. C'est un épisode particulier. C'est une grande première puisque je reçois une invitée qui est anglophone et du coup, vous allez voir, il y aura deux versions de cet épisode, une version originale avec notre échange en anglais et une version traduite en français. Donc c'est un outil qu'on a utilisé pour traduire la voix du docteur Prior. Pour que les non anglophones parmi vous puissent l'écouter. Pourquoi je suis allé me mettre dans un tel dossier, de vous faire un épisode en anglais à traduire parce qu'en fait le docteur prieur, c'est la personne que je rêvais d'avoir à ce micro. Il y en a quelques autres aussi. Je vais essayer maintenant que. J'ai vu qu'il était possible de faire comme ça, d'inviter des personnes anglophones. J'en ai d'autres en tête, mais elles, pour moi, c'est, c'est quelqu'un très spécial puisque vous allez voir, elle va se présenter. C'est une une professeure en en endocrinology, quelqu'un qui est très réputée sur tous les sujets d'hormones féminines. Et c'est la première personne que j'ai lu sur le sujet de la péri ménopause et qui expliquait qu'en fait, les femmes commençaient à avoir des symptômes de péri. Ménopause bien avant. La ménopause proprement dite, les fameux 51 ans en moyenne. Et qu'en fait, dès la fin de la trentaine, au début de la quarantaine, les femmes pouvaient commencer à avoir des cycles qui dégénéraient un petit peu avec des symptômes, etc. Moi, ça me parle beaucoup puisque c'est un sujet qui me concerne, puisque moi à l'heure ou j'enregistre ce podcast, j'ai 39 ans et des cycles qui commence. Clairement à se raccourcir. C'est pour ça que j'ai commencé à faire des recherches et que je suis tombé sur elle. Et donc c'est quelqu'un qui en fait vraiment fait référence sur ces sujets là qui est assez avant gardiste qui explique des choses qu'on n'abordait pas jusqu'à présent sur la santé des femmes qui étaient un peu délaissée, mais spae le pas puisque ça parce que vous allez voir vous expliquer plein de choses. Mais vraiment, c'est une référence pour moi et je suis extrêmement fier et extrêmement honoré qu'on l'est dans ce podcast français. Parce que vraiment, je pense qu'on n'a jamais abordé ces sujets là en France. Ça, c'est le sujet de la péri, ménopause et son autre sujet de cœur qui est très lié. C'est tout ce qui touche à la progestérone. Et moi, je vous ai partagé il n'y a pas longtemps pour ceux qui me suivent, notamment sur Instagram ou dans la newsletter, une étude qui est sortie au mois de novembre. Sur justement la progestérone en phase post-ovulatoire la durée de la phase postulatoire, pourquoi elle dure pas toujours 14 jours comme on le lit encore, malheureusement beaucoup trop. Et donc elle a mené une énorme étude là dessus qui a démontré que les phases postulatoire pouvaient varier, qu'elles pouvaient durer moins que pouvait avoir des cycles à nov obligatoires, etc. Je vous remettrai le lien de cette étude en dessous. Et là aussi, c'est une étude qui a eu un impact important et qui nous, dans notre métier, en tout cas, moi dans mon quotidien, est très utile. Et avancer énormément les choses. Bref, c'était encore une fois pour moi, génial de la recevoir. Elle a énormément de choses à nous apprendre. Du coup, je ne vous en dit pas plus. Je vous laisse avec cet épisode ou vous l'avez compris pour celles et ceux qui écouteront en version française. C'est une voix off par dessus, sa voix, sa voix véritable. Et l'idée, c'est que vous puissiez avoir accès à son savoir. Et croyez moi, ça vaut de l'or. Voilà. Je vous laisse avec elle. Place à l'épisode. Dr. Prior, thank you so much for joining us today. the first time for me, for us to have an English speaking guest. So I'm a bit, uh, shy, but let's go. You are to me. The reference, the leading advocate in women's health and everything around progesterone, perimenopause, and many subjects like that, that we are going to talk today. Uh, so I'm very honored to have you really a lot. And can we please start by introducing yourself? I can ask you to do that. You will be better than me, I guess. And then we will jump into this, uh, subject of, uh, perimenopause and progesterone, if you're okay with that.
Dr Prior:I'm very happy with that.
Laurène:Yeah,
Dr Prior:I, I'm Jerilynn Prior. I'm a professor of endocrinology at the University of British Columbia. and I focused during my entire career on trying to understand women's menstrual cycle, in particular, to see how it relates to our lives, because that seems to be the missing
Laurène:of course.
Dr Prior:And often the changes that occur are considered diseases when that isn't correct and it leads to mistreatment.
Laurène:Thank you for that. So I'm going to ask you my ritual question. Very easy for you, I guess. But which is, how do you in women's, women emancipation?
Dr Prior:I'm delighted to participate in Women's Emancipation. One of the weird things today is that we supposedly have equality and yet we cannot if our basic physiology is not
Laurène:Yeah. So you work in, Letting women know how their physiology works and trying to, Make it better for a better living for women.
Dr Prior:Yes, to educate about what's really going on to help women to understand for themselves, because each woman is different, each woman's world is different, and therefore she has to learn for herself. What things affect her menstrual cycle and ovulation.
Laurène:Yeah. And you do a lot of research. I just read, I don't know if it's your last one, but a few weeks ago on, uh, anovulatory cycles and, uh, uh, the length of, uh, the luteal phase. Am I wrong?
Dr Prior:Mm-Hmm, Right. That's correct. So we looked at the variability of the luteal phase and the, the common understanding is the luteal phase is fixed at 13 or 14 days. And that's just not true. It's variable. It isn't as variable as the follicular phase, which is the early part of the cycle. but it's highly variable.
Laurène:And what I think is crazy is that in France, more um, um, um, um, um, um, um, gynecologists say that, okay, ovulation is not the day 14, a menstrual cycle is not 28 days, but they still say all the time that the luteal phase is always 14 days and they never look at progesterone, never test it. So that's one of your, leading work is to explain that, no, it's not wrong. A woman can have not enough progesterone.
Dr Prior:Yes, you can, you can ovulate, you can release an egg, but the timing is important. It takes at least 10 days of high progesterone Mm hmm. for the lining of the uterus to be protected from endometrial cancer and to be able to, um, nurture a, uh, a fertilized egg and lead to pregnancy. So the short luteal phase is important. It's the most common disturbance of menstrual cycles.
Laurène:Yeah. But women need to track their cycle to be able to see this because otherwise you never know that you have a short little face.
Dr Prior:That's correct. And one of the things that allowed me to see what was going on was a long time ago we figured out a way to make the basal temperature, monitoring your first morning oral temperature, make it into a scientific objective tool. And that tool is free, unfortunately only in English, but on the Center for Menstrual Cycle and Ovulation Research
Laurène:Yeah.
Dr Prior:website.
Laurène:Okay. So I could link it for our French listeners.
Dr Prior:Please do.
Laurène:Yeah, of course. So talking about this, I would like you if you're okay, to explain to us what's the role of progesterone. You said a few already, but we only think about it as the hormone which helps to a baby to go into inside it. But what you explain, I think, is that there are many other roles and that women don't, uh, are not aware of this other role and are a bit like, um, Okay. Not taking it too seriously, uh, it's a bit underestimated, this omen.
Dr Prior:It isn't just women, it's doctors as well. so the medical profession itself basically assumes progesterone is present and normal in a approximately month apart cycle, and also assumes that progesterone is only needed for pregnancy or for preventing endometrial cancer. And those ideas are not correct. So let me, let me give you the way I understand it. Estrogen is an extremely important and powerful hormone. It, it's in our bodies is to make things grow. And it does that continuously. So growth and growth and proliferation all the time. Progesterone is, needs to be produced in very large amounts because its job is to control that overgrowth of But it also has a job of making the cells more differentiated, more grown up, if you will. And so the two are part of a system. They work together. They're absolutely essential and everywhere that estrogen works, progesterone also works. So one of the first things I discovered was that women with perfectly normal month apart cycles could be losing bone density if they weren't ovulating with a long enough luteal phase So why does that happen? Well, because Estrogen, when it's at a steady level, prevents bone loss, but when estrogen is dropping, it stimulates bone loss. So in the normal menstrual cycle, estrogen rises to a peak at about the middle, and then it's gradually dropping until the next flow when it's low. That produces a little bit of bone loss that we need progesterone to stimulate bone formation in order to bone in balance. Yeah,
Laurène:Okay. I
Dr Prior:that's one place we know for sure that progesterone is absolutely essential and that's in bone formation. Another, uh, part of our system in which we have some evidence, not enough by any means, but there's evidence that if women have disturbances of ovulation, either they didn't ovulate or they ovulated with too low of a progesterone level. production, Then, those women are at increased risk of a heart attack. even early, even in their early fifties. okay, And there's a lot of evidence that in the cardiovascular system, like in bone, the two are in, hormones are in balance. So for example, the the electrical system of our heart, estrogen produces a long, what's called a QT interval, which can lead to an arrhythmia. Progesterone shortens it, or the, the blood flow in our blood vessels is controlled by something, we call it endothelial function, and both estrogen and progesterone produce increased blood flow, control and So we know that as well. The third thing we know for sure is that if you have a regular cycle and you don't ovulate regularly. You're at risk for endometrial cancer. This is lining of the uterus cancer. This is increased in women with what's called polycystic ovary syndrome, where they also, they have enough estrogen, but they don't get regular periods, and they have too much testosterone that kind of prevents ovulation from occurring.
Laurène:So, progesterone to be produced.
Dr Prior:Yeah, so progesterone isn't produced, therefore they're at increased risk for cancer of the lining of the uterus. And, and the pattern that we see in the things we know suggests this pattern goes on throughout the body. In the skin, in the muscle, in the joints, you know,
Laurène:Yeah. not just fertility, but the whole, um, health of a woman. And what about mental health? There is a link as well with progesterone.
Dr Prior:Okay. So when we are under stress of any sort, it can be arguments with our partner, it can be problems at work, it can be, you know, issues with our children. It can be financial worries, it can be under eating or over eating. The first change that happens is that there's less progesterone made and, and, and eventually if that carries on then there's still regular cycles but no egg release at all, no progesterone at If it, if it's many, many stressors and often that happens. These things bother you, then you don't sleep, then you don't eat properly, then you don't exercise properly, etc. Then you start skipping periods, and that becomes obvious. So we only think about amenorrhea, no periods, or far apart periods, and we totally ignore all the signals before that are happening that we can't see very well. So I liken it to an iceberg, you know, the iceberg A little bit sticks above the water. That's the amenorrhea and the oligomenorrhea. But majority of the iceberg is under the water. We simply don't see anovulation and short luteal
Laurène:If you don't track your cycle.
Dr Prior:you don't have some reliable way of monitoring
Laurène:Yeah, of That's very interesting. And what you explain a lot. is the link between this low progesterone and the symptoms that woman can feel. And mostly at the beginning of perimenopause, and you are the first person that I read, we explained that menopause is just not a 50 year old subject. It can start 10 years before and this is very linked to progesterone because it's the moment when progesterone starts to Get down and the symptoms start to increase. If if I'm correct Can you explain this with your words? Because you, you searched, uh, many things on this subject.
Dr Prior:happy to. So, there's a long necessary transition between a regular cycle in which we could get pregnant. With egg release and everything. And a time of our lives, menopause, when we've been a year without a period. And hopefully don't have any more periods. So, in the transition, the body is trying to get rid of all the extra egg follicles that are stored in our ovaries. And as it does that, each stimulated follicle can make a little bit of estrogen. And our estrogen goes higher and starts swinging. forward. And we don't know quite why, but progesterone, even though estrogen is high, progesterone starts decreasing. And I think that's why night sweats, sleep problems, increased cramps, bloating, mood changes, all of those.
Laurène:changes. A lot.
Dr Prior:And what's interesting is we, we've tended as a culture to blame low estrogen for the symptoms. But in fact, it's dropping estrogen. It is a change from a high to a normal, or even from normal to low. The drop in estrogen produces increased bone loss, produces night sweats and hot flushes, and produces depression.
Laurène:But what you say that before estrogen starts to get down, there is a moment you have too much estrogen and
Dr Prior:I call it,
Laurène:can be complicated for women as well.
Dr Prior:I call it estrogen storm season.
Laurène:Yeah. And estrogen stumps, Tom season can start in the late thirties. early 40s. That's what you explained. And I think it's very important because from my point of view, many women in this stage of their life start to feel a bigger premenstrual uh, premenstrual syndrome to be more, uh, to have more anxiety, more swings, many things, uh, sleep disturbance, and don't do the link. With perimenopause and maybe think that it's midlife crisis. So I don't know they have to divorce. So many things are burned out, I think, at work. And if we did the link earlier with these hormones and okay, that's just my hormones, which are starting this storm. Uh, pretty early, pretty early. Okay, but why not? I am 39 and I start to feel it. Uh, I think we would. live much better this stage of our life because we would know that it's not us, it's not our work, it's not our husband, it's just our hormones and maybe we can help them to be more balanced as well.
Dr Prior:That's right. I think education about what. What may change? And it, it, it's not, not simple. The, the cycles tend to get shorter. That's one clue. And that's the kind of clue that doctors will pay attention They often will not pay attention when a woman says, I'm feeling anxious for no reason.
Laurène:Yeah.
Dr Prior:Right? So,
Laurène:No, they don't.
Dr Prior:get shorter. Cramps may start to be problematic again. Menstrual cramps. Women who had a migraine when they were in their teen years may start having migraines again. Um, the,
Laurène:tenderness as well now.
Dr Prior:yes, breast tenderness is one that's, that I experienced. That was horrifying. I had sore breasts for 10 years.
Laurène:Really? Oh,
Dr Prior:And you know, I, it was part of my clue that this was not low estrogen. The other clue that
Laurène:high oestrogen to
Dr Prior:that, yes, I knew that, that. I knew, okay. The other clue, and this is a very strange one, is some women in perimenopause, early perimenopause. May dream that they're pregnant. I had that dream that it was reported by a woman sociologist in, in Ria, and it was also reported by a kung woman of the Kalahari Desert. So it's a archetypal experience and
Laurène:Wow.
Dr Prior:our subconscious, our dream world, is telling us something that our culture still doesn't believe, and that's estrogen is high.
Laurène:Okay. Did you review it? Do like a research on that yet?
Dr Prior:I looked. Yes, Yes,
Laurène:Yeah.
Dr Prior:Mm
Laurène:That's amazing. So yeah, if you want to go to your gynecologist and try to speak about perimenopause, which is not always easy, but why not? What would you advise women to say to explain? So the symptoms. The cycle,
Dr Prior:I think it's helpful if a woman suspects that in perimenopause, for her to keep a daily record for a while. And the daily record that we've used in research studies and I used clinically is on the Center Menstrual Cycle and Ovulation Research website and it's free for use. Daily Perimenopause Diary. So it includes night trouble with sleeping, includes night sweats, includes daytime hot hot And it also can show things like breast tenderness and mood swings before the period starts.
Laurène:But, you know, I think that women are not taken seriously when they, if I go, well I look younger than my age, so that doesn't help neither. But if I go my gynecologist and explain that, I think that maybe I'm starting slowly the perimenopause because I have a huge PMS, I have sleep disturbance, I have everything that you said. I, I have, I can tick everything. They, I won't be taken seriously. You know, that's the point. I think the problem with women, because we consider that menopause is the end, the years before are not taken into consideration, I guess.
Dr Prior:The problem of doctors not listening to women is fundamental and it crosses all cultures. It crosses all languages. What I think is important is that you work with one doctor who gets to know you a person and, and you develop a relationship of trust. I, in Canada, we try to make that the family doctor, a family physician who knows you, your family, your kids, your partner, et cetera. And because the family doctor is trained to listen, whereas the gynecologist is trained to be a surgeon.
Laurène:Yeah. To cure, So maybe you have to choose the best person to talk about it
Dr Prior:That's right. Yes.
Laurène:but that's what I wanted to speak after about menopause. Uh, treatments, hormonal replacement therapy and everything. Not everybody can, uh, produce, propose this. Um, can you explain to us what's your point of view regarding this? Because yesterday, again, I had like, um, talk with a, uh, cancerologist and we said that this increases the uh, breast, uh, risk of breast cancer. So I said, are you sure you're talking about new treatments with a bio identical hormones? And we had an interesting talk about it, but I would like you to explain what's the thing today in 2024, um, regarding hormone replacement therapy for women. When, what's the risk, what's the, uh, benefits.
Dr Prior:Okay. So, first of all, the, the term hormone replacement therapy is a marketing term. It was created by those who wanted to sell So we should change our, our language to hormone treatment. And, and the treatment, we've already said that estrogen is too high and swinging in perimenopause. So it doesn't make sense to an estrogen dominant treatment, which is what menopausal hormone therapy is in that situation. So I think estrogen should not be taken at all until a woman has been one year beyond her last period. Okay. So, until. Last June, we had no therapy that had been proven to help perimenopausal women who were symptomatic, who were having a difficult time. But we finally got a randomized controlled trial, placebo controlled trial of oral micronized progesterone. progesterone, the, the one that's same as our bodies, our ovaries would make if they could, and showed that oral micronized progesterone, 300 milligrams, three little round balls at bedtime, decreased night sweats, decreased the intensity of daytime hot flushes, improved sleep, and most important of all, they decreased the interference of perimenopause with our daily lives. All of those are compared with placebo.
Laurène:That you run this research. You run it? Yeah.
Dr Prior:yes, I, it was my idea.
Laurène:So thank you so much for that. And I hope it will grow, it will go all around the world because I think it's not yet, um,
Dr Prior:it, it's, it's actively opposed by those who say that perimenopausal symptoms are basically the same as, as menopausal ones, and therefore you should use menopausal hormone therapy, which is predominantly estrogen.
Laurène:So as long as it's your progesterone, which is low and your oestrogen pretty high, you should take progesterone because that's what creates the unbalance. And only when you don't have any periods, you are like menopause free. For sure. You can start estrogen and no more progesterone or you should
Dr Prior:No, no, no, no, no, you have to continue the progesterone.
Laurène:You take both. Yeah.
Dr Prior:Never, ever take estrogen without
Laurène:yeah, okay,
Dr Prior:But the other way around works. You can take progesterone alone. You don't have to take estrogen.
Laurène:yeah, So you can take progesterone alone, not estrogen a lot, uh, alone. Sorry. And then you can take both.
Dr Prior:Mm hmm.
Laurène:For how long? Uh, forever? Uh,
Dr Prior:Wait, okay. Let's, let's talk now about menopause a a
Laurène:yeah, sure.
Dr Prior:So, the notion still exists that there's something the matter with menopausal women. Okay? That we're deficient. That we we need fixing. I mean, I've never taken estrogen. Ever.
Laurène:okay, interesting.
Dr Prior:yeah, and there's, there's proof now. That estrogen treatment doesn't keep your skin better. It doesn't make you sexier. it's not
Laurène:a shame.
Dr Prior:it's not gonna keep you young. Well, what makes you sexier is feeling good about yourself and having energy.
Laurène:Yeah, that's true.
Dr Prior:Yeah, it's not and
Laurène:not estrogen, yeah.
Dr Prior:And it's not progesterone either.
Laurène:Yeah,
Dr Prior:It's, it's, it's feeling good about yourself. At any rate, so, so, uh, now, menopause Yes, given that it's normal, if you have very severe night sweats, hot flushes, sleep problem, then you need a treatment. And that's fine. Treatment with estrogen and progesterone for as long as you need it is, is important. But if you don't have
Laurène:Any
Dr Prior:problematic symptoms, you don't need treatment.
Laurène:Yeah, because women are made like that, you know. We are made to stop menstruating at some point, so we are supposed to be able to live without like a
Dr Prior:Yeah, it's, it's um, it's a gift to no longer have the demands. of estrogen and
Laurène:Yeah. I read that it's only women and whales who have menopause, you know, we are the two mammiphores that uh, stop menstruating.
Dr Prior:A few of the uh, old world apes also. Monkeys
Laurène:okay. Ah, yeah, true that, okay. But yeah, what's very important, I think, and I link it a lot with PMS, because I think that the perimenopause symptoms are really put in the same, you know, thing that, than PMS, because it's many symptoms that come more before period. So, um, what women Need to know is that it's not like, um, something that they have to endure, uh, during years. They can do something, they can treat themselves because you call it treatment, uh, and, and not replacement. Exactly. If you have symptoms, you can try this.
Dr Prior:So I think it's really helpful to know that if you put your hand, the palm of your hand over your nipple and push on your breast toward your back, if it's sore at all, it means your estrogen is high. So any breast tenderness means high estrogen.
Laurène:Yeah.
Dr Prior:then, then, you're feeling,
Laurène:High or too high?
Dr Prior:too high.
Laurène:Okay.
Dr Prior:So you're, you're feeling moody, you're feeling blue, you're feeling angry. Test your breast. It's sore. It's a, it's a hormonal imbalance that you're dealing with.
Laurène:Interesting. Any time of the cycle? Oh.
Dr Prior:Anytime.
Laurène:okay, Okay. I'm going to use it. A lot. And that makes the link a very interesting transition because What I wanted to ask is this link with the risk of, um, breast cancer that we read sometimes with hormone replacement therapy. Can you explain the difference between what you say
Dr Prior:So, what's really important to know is that the hormones that were made to act like progesterone in the uterus Act differently in different tissues. So, for example, the progestins, medroxyprogesterone, levonorgestrel, those progestins that are knock offs of progesterone
Laurène:that you have in the pill?
Dr Prior:that you have in the birth pill and that are sometimes used for menopausal hormone therapy increase the risk of breast cancer. And, in fact, the best study showing that is, is a French study, E3N. You know that study?
Laurène:Uh, I think I, I didn't understand the word that you said, but I read some. Yeah.
Dr Prior:3N is the abbreviation.
Laurène:I, uh, the nurse study.
Dr Prior:It's a teacher's, teacher's union study. And so 80, 000 women, menopausal women, Followed in France for eight years, some of them took estrogen alone, some of them took estrogen with progestin, some of them took estrogen with progesterone, because our oral micronized progesterone began in France. That was where it was
Laurène:That's what we call the French treatment versus the American one.
Dr Prior:At any rate, so what the study showed was compared women who didn't take any hormones at all in menopause, Estrogen increased breast cancer by 29 percent. Estrogen and progestins increased it by 69 percent. Estrogen and progesterone did not increase it at all.
Laurène:Wow.
Dr Prior:Which means, if read the data properly, that it's actually preventing breast cancer. It's overcoming that 29 percent that estrogen alone costs.
Laurène:Yeah.
Dr Prior:But
Laurène:And if you take just progesterone, was it looked at in the study?
Dr Prior:we do not have adequate study
Laurène:Okay.
Dr Prior:for progesterone, and it's biased usually when we, when we look at it because those people who take progesterone alone have high estrogen symptoms, right? So we just can't measure the estrogen,
Laurène:Okay. Of
Dr Prior:okay? But I, I think that like in the breast, like in other tissues, progesterone prevents a negative effect of estrogen. So if you do get breast cancer, and it's estrogen and progesterone receptor positive, your, your long term survival is better than if it's estrogen only positive.
Laurène:And what is, it's not, maybe you don't know, but not explained in medical schools because I think medical, people still think that it's, you know,
Dr Prior:Causes, causes breast cancer, it's, it's basically a really stupid mix up of progesterone and progestins, thinking that they, they're the same. And they aren't.
Laurène:that.
Dr Prior:Because we don't know how most of them work in other tissues. And in fact, a French scientist colleague of mine, Anne Gompel, um, showed that medroxyprogesterone acts through a cortisol receptor to increase breast proliferation, which is why it increases breast cancer.
Laurène:And progesterone can help as well mental health. That's what we talked earlier.
Dr Prior:It especially helps with sleep. It's a calming hormone. That's a way of thinking it. it. And multiple studies show it prevents sleep disturbance, it improves deep sleep, and those things are so helpful.
Laurène:For mental health.
Dr Prior:Yeah.
Laurène:Of course. Are there thing that we didn't talk about that are very important to you to say.
Dr Prior:One thing I wanted to mention, which is quite peculiar, but helpful, and that is that in very early perimenopause, when cycles are still regular, getting a night's sweat will often predict that your period is going to start. That's a peculiar thing, but it's helpful.
Laurène:Yeah. Well, I track my temperature, so I see the drop, which tells period is starting, but that's another clue.
Dr Prior:Yeah. Are you having any night sweats yet?
Laurène:No, I don't have that. that you talked about my breast, I keep feeling my breast for 10 minutes, but that's the placebo thing, I think?
Dr Prior:Maybe your breast will get sore from touching it too much.
Laurène:As well. well. Oh, I think about them too much. But anyway, no, I have this, but I don't have
Dr Prior:That's good. I ended up having very bad night sweats and I needed to take progesterone for seven years. So I took it in perimenopause and into the early years of, of menopause. What is important is you can stop progesterone suddenly, it's okay, and you can then tell if, if the hot flushes are going to come back again. But they don't ever come back worse. In fact, in a study we did, it took a month, even in a month, the hot flushes weren't as bad as they were at the beginning of a study.
Laurène:And how do you explain that?
Dr Prior:But, because the calming effect of this hormone on the brain. But, if you stop it's that downswing that happens, and then hot flushes get worse than they were before.
Laurène:Oh, yeah. So you are like, uh, a slave of the treatment. You can't stop it.
Dr Prior:Exactly, and I haven't proven this, but it's works I know, and everyone that I've tried it with. If someone wants to stop estrogen and progestin, the best way to do that is to take full dose progesterone instead of the progestin. Take them together until you feel no hot flushes, sleep problem, you're doing fine. And then gradually decrease the estrogen, 10 percent every two weeks,
Laurène:Okay.
Dr Prior:until eventually you can stop it.
Laurène:And you can just continue the progesterone.
Dr Prior:And you, you could probably stop that eventually
Laurène:Oh, as well. And is there a better way to take it, like, orally, vaginally, the cream?
Dr Prior:There's no evidence the cream works.
Laurène:Okay.
Dr Prior:Vaginal is, as far as we know, doesn't help sleep, Which is good. which is a problem. It's, it's often used in, if there's bleeding in pregnancy and it does help to prevent loss of a pregnancy. But, so oral the one that I've studied and proven that it's effective for hot flushes in both perimenopause and menopause.
Laurène:Okay. So 300 milligrams
Dr Prior:300
Laurène:hourly.
Dr Prior:at bedtime, Only at bedtime.
Laurène:Only at bedtime, otherwise you sleep all day Okay. So thank you for adding this. Is there something else because you I worked on so many subjects that maybe there are some which are linked to what we said and that we didn't mention.
Dr Prior:There is a lot of information about perimenopause on the site. Center for Menstrual Cycle and Opulence
Laurène:I will link everything.
Dr Prior:website. Um, unfortunately, it isn't translated. I would love to, so we've translated Estrogen Storm Season into French, and I've been trying to get it published in Canada, so far without success. So, I would love to be able to communicate with a French publisher.
Laurène:of course. Well, with this podcast, You already will be able to get in touch French people. What I told you at the beginning is that we don't talk a lot about perimenopause yet. I read you, I listen to you. There are some American as well, um, uh, gynecologists subject, but in France, it's really the very beginning. And so I hope this podcast will help and
Dr Prior:Also, I guess the, the following, uh, is, is essential for anyone in perimenopause, and that is, if you're symptomatic in perimenopause, you'll get better in menopause.
Laurène:Um, that's the relief. It's like periods, when you have a big PMS, periods are like, uh, the best day of your month. So that is the same with menopause.
Dr Prior:Yes, that's
Laurène:And is the opposite true? If you don't have any symptoms in perimenopause, you can have a worse menopause, um, that's
Dr Prior:I don't think so. I think, I think the most symptomatic people begin to be symptomatic early in perimenopause And it lasts a very long time, and into the early days of menopause, and then gets better.
Laurène:Okay. So we
Dr Prior:If I were to a big overview of the role of progesterone, progesterone, now mostly talking about menstruating I think Ovulation reflects women's well and predicts it. good health, good bone, good heart, no cancer, health as we get older.
Laurène:Yeah. Yeah. We only think about it like something for fertility, but we really need to go higher in the reflection and important But I often explain that to people when I talk about the pill, the birth control pill. And I say, if we told men that we could just keep their testosterone and they would be like, they will have contraception. Nobody will be okay because men know that they need their testosterone. and we don't have the same thing for women because it's the exact mirror. Their testosterone is the same. It's not the same, but we need estrogen and progesterone as much as but we are okay to get it, uh, with birth control and. to not think whereas for men, we have in mind that the almonds are important. And, uh, I think that what we must, that's the reason why we have to talk about it to explain that it's not just a fertility subject, it's a health subject, a well being subject for now, for the forties, for the fifties, for the sixties
Dr Prior:for our whole lives,
Laurène:yeah, exactly.
Dr Prior:And it, and it changes the perspective because there are so many things that, that giving progesterone for 14 days cyclically could do better than the birth control pill does. We're using it as a treatment when we shouldn't should only use the birth control pill for contraception and there are also better, Less disrupting contraception such as IUDs
Laurène:And you said something and I realized that we didn't mention it, is that the progesterone, you just take it after the whole would, uh,
Dr Prior:Who are working on, on fertility, you want to be sure to have that LH peak and then, then start the progesterone.
Laurène:I think we had, uh, great overall of the subject. We don't forget anything.
Dr Prior:I think we covered it pretty well.
Laurène:thank you so much for taking this time with us for speaking to French people. We don't have the chance to read your papers, but, I will link everything that I can link and hopefully we can have French versions soon.
Dr Prior:that would be great. Thank you so much.
