Dr. Jerilynn Prior [00:00:00]:

This is the the hopeful message. To me, PCOS is an imbalance, not a disease.

Georgie Kovacs [00:00:08]:

Polycystic ovarian syndrome, otherwise known as PCOS, affects 6 to 12%, which is as many as 5, 000, 000 US women of reproductive age. It also happens to be 1 of the most common causes of female infertility. Additionally, data shows many women take years to get properly diagnosed. A part of this is there are criteria that disagree with each other on what PCOS even is. So today, I interview doctor Jeri Lynn Pryor. She is a previous podcast guest who spoke on the topic of progesterone versus estrogen, and it is 1 of my top episodes. Doctor Pryor is a professor of endocrinology and metabolism at the University of British Columbia in Vancouver, and she has spent her entire career studying menstrual cycles and the effects of the cycles changing estrogen and progesterone hormone levels on women's health. And she also founded Ceemcore, which stands for the Center For Menstrual Cycle and Ovulation Research, which started in 2, 000 and 2.

Georgie Kovacs [00:01:26]:

And she is a force to be reckoned with who really likes to think differently about how we look at women's health. So let's listen to this incredible conversation with doctor Pryor. It is a true honor that she is making so much time to speak with Fempower Health about these important topics she studies so deeply. I know that you've been on the podcast before, but just in case there are folks who hadn't listened to you before, maybe you can tell us a little bit about your background, and then we can talk about PCOS.

Dr. Jerilynn Prior [00:01:59]:

Okay. I grew up in Alaska in fishing villages and have seen lots of life and different, lived with different kinds of people. So I had to fight tooth and nail to get into medical school and to survive in medical school and all of that background helped me to be able to have the courage to see things differently and to say things that I see differently. And I think it was a preparation for being in the right place at the right time so that I could help in women's health.

Georgie Kovacs [00:02:36]:

I'm the 1st generation of, Hungarian immigrant parents, and, there's a lot of dynamics involved with that. And so I feel like they've passed on to me that fighter spirit of thinking differently, so completely get it. It's sometimes a tough place to be, though. Right?

Dr. Jerilynn Prior [00:02:50]:

Oh, it's always a tough place to be.

Georgie Kovacs [00:02:53]:

Yeah. No. It's

Dr. Jerilynn Prior [00:02:54]:

It's never easy to buck the common concepts and challenge the accepted leaders even if you do it nicely and especially if you're a woman.

Georgie Kovacs [00:03:07]:

Yeah.

Dr. Jerilynn Prior [00:03:08]:

Basically, if it isn't fraudulent and if it isn't exorbitant, you know, making a profit off of gullibility, then ideas need to be shared.

Georgie Kovacs [00:03:22]:

Yeah. Why don't we first start out by defining PCOS? And the important piece here is to differentiate it between ovarian cysts because I do understand that this is still a common, thing gap in in knowledge and information. So let's let's start out by that foundation.

Dr. Jerilynn Prior [00:03:42]:

A little story, if I may. Years ago, a mother call me about her her teenager who'd had a catastrophe, which is a an ovary that twisted and then was causing pain and dying, and she had to have that that ovary removed. And she was afraid that 1, her daughter would not have a a future fertility. And she was also afraid that she had PCOS because the pathology of both ovaries showed multiple cysts and, and both ovaries were enlarged. And so when I got the pathology, I began to ask because this, this young woman had not had her first period yet. So how come she had cysts in her ovaries and enlarged ovaries that looked like PCOS? So I learned from very old data that that was normal. That that around the time of puberty, the ovaries get bigger, they get lots of cysts, and they can look like the typical PCOS ovaries. So I learned then that that the ovaries can make cysts for other reason than PCOS.

Dr. Jerilynn Prior [00:05:03]:

And the common reason in non teenagers or pubertal girls is because the coordination of ovulation hasn't occurred, an egg has not been released. So there's a cyst, which simply means a fluid filled bubble or sack left in the ovary.

Georgie Kovacs [00:05:24]:

So perhaps you can, within the definition of it, give some perspective on why it is there is this, lack of clarity, because as you know, when there is lack of clarity and alignment, that's going to impact people getting properly diagnosed.

Dr. Jerilynn Prior [00:05:39]:

Absolutely. So I think the problem, the the heart of the problem is that, like I said, the polycystic ovary and not ovulating occur in other circumstances than the androgen excess syndrome which is what I believe is the only true PCOS. So it can be a transitional period between hypothalamic amenorrhea meaning stress related not getting periods and the development of normal cycles again for example. So in 2018 an international group said that you only need far apart periods and, androgen excess either clinical evidence like unwanted facial hair, acne, you know male pattern balding, or clinical evidence of high male type hormones in order to make the diagnosis. You did not need to have cysts on your ovaries. And and as far as I'm concerned, that's the correct diagnosis. And the categories of the Rotterdam, which is the previous criteria in which there are no high male hormones are simply not PCOS. Okay.

Dr. Jerilynn Prior [00:07:14]:

In fact, I hate the name PCOS because it implies that the only reason for cysts in the ovary or multiple cysts in the ovary, which is what it means, is the syndrome of androgen excess not having periods, etcetera. So III previously called it anovulatory, meaning women weren't releasing an egg, androgen excess. The treatment, I think, would be quite different in in those who have hypothalamic. I know it would be amenorrhea even if they have multiple cysts than in those who have androgen access. It's it's simply a different condition.

Georgie Kovacs [00:08:00]:

How clear are physicians and how aligned are they on that criteria? Because I read it and it was so thoroughly done. They had experts all around the world talking about it, and it it seemed I I looked at them, like, well, finally, everyone in the world has aligned, but then it seemed like not everyone was, like, invited to the party, so to speak. So where are we today?

Dr. Jerilynn Prior [00:08:24]:

All I can say is that Helena Teague, who is the the leader and the coordinator and the person who brought the view Defer's voices together and and give her a lot of credit for including lots of women Mhmm. Women's voices, women with the lived experience of PCOS in that discussion. I think it's because she's not a gynecologist, and she's a woman. And so there are competing voices, but I think hers hers and that international collaborative group is the definitive voice for anyone who wants to be scientific.

Georgie Kovacs [00:09:10]:

Interesting. So so am I hearing you right that there are still doctors who still use, like, the Rotterdam criteria and others? Oh, yeah. Okay.

Dr. Jerilynn Prior [00:09:17]:

Well, actually, if you read the fine print, so did they. They said you don't need to do, an ultrasound, but they ended up agreeing with the Rotterdam criteria because the there is incredible support for that. There's a particular, person in England who's a zealot about it, and I I connected with him years ago. And, yeah, all that's all you can say is that he you know, he's right and everybody else is wrong. Okay.

Georgie Kovacs [00:09:51]:

How would this manifest? A woman is struggling with weight, you know, the, male pattern baldness, and they go to their doctor. They're trying to figure out what to do. Do you find that if it's those types of symptoms, doctors pretty much assume that it's PCOS? Like, where where is that misdiagnosis, that gap?

Dr. Jerilynn Prior [00:10:10]:

The the important the important thing is that all of the criteria for diagnosis say you have to rule out other things.

Georgie Kovacs [00:10:20]:

Okay.

Dr. Jerilynn Prior [00:10:20]:

So I remember 1 time seeing a young woman who'd had no periods for years and who had clear androgen excess, And she turned out to have a pituitary tumor making, increased hormones that drove her her male pattern hormones. So you need to exclude other things. There's a there's an inherited congenital adrenal hyperplasia which can present with male hormone type pattern and also in frequent periods. So so it is a diagnosis that really needs an endocrinologist, and and there needs to be care in making sure that there isn't something else going on.

Georgie Kovacs [00:11:12]:

Are we finding that OBGYNs I mean, because you're alluding to going to a specialist. But I guess what is this gap in delayed diagnosis? I guess that's the part I'm struggling with. Are we getting better about it now that this criteria was established in 2018 around androgen excess? What is still that gap? Because I think it's important for women to understand the dynamics so that if they're at their doctor and they're like, why aren't they listening to me? Like, they better understand what they can do.

Dr. Jerilynn Prior [00:11:41]:

I think the problem is that doctors don't listen very carefully to women. They assume if a woman is overweight that she's overeating and not exercising. They assume that, she's making it up when she says well, you know, typically women will remove facial hair before they go to see the doctor, and they will make themselves up. And therefore, when they present, unless the doctor is very clever and asks specifically, they may not show clinical signs of androgen excess. Right? So that's human nature on both sides.

Georgie Kovacs [00:12:22]:

Yep.

Dr. Jerilynn Prior [00:12:22]:

So and and doctors don't tend to listen to women period.

Georgie Kovacs [00:12:27]:

Yep. Okay. That makes sense. That makes sense. So it so it sounds like just to break it up here, androgen excess definitely is the theme here, but we need to understand why someone has it. And for those of us ladies who get nervous, like, even actually my sexual health doctors, they're like, women will apologize because they think they smell bad, and they're like, you can't, like, prepare for us because then we can't help you. So, like, just come in as you are. We truly care and wanna help you.

Georgie Kovacs [00:12:53]:

So no fucking facial hair, it sounds like as well. So, what about the treatments? So and and by the way, for for testing androgen excess, is it as simple as a blood test?

Dr. Jerilynn Prior [00:13:05]:

I think we're oversimplifying it because there are several different androgens that could be tested. And there's disagreement about which ones belong in that bin, etcetera. I mean, but the combination of any clinical signs and just 1 of the ones that, that I learned long ago is and a question I always ask is how frequently do you need to wash your hair? And if a woman says more than once a week, you know, that suggests to me oily scalp, oily hair, and that is part of the same androgen excess thing.

Georgie Kovacs [00:13:53]:

So you mentioned, I know we've there's been many different, thoughts around birth control, and I I believe you'd also mentioned concern over the birth control and PCOS. Tell us tell us more about this.

Dr. Jerilynn Prior [00:14:07]:

Okay. At its base is the fact that the birth control pill has been the go to therapy without further thought evaluation anything for 50 years. And it's a band aid. It gives regular periods. It makes the woman feel comfortable because it's a common, medication or, you know, it's common in among their peers, but it doesn't solve the problems. It doesn't address the problems. Yeah.

Georgie Kovacs [00:14:45]:

No. I don't disagree. And and I guess I'd love you to comment on, the pill bleed. I know that there are strong opinions, amongst various experts on the term pill bleed and that it's not a real bleed, and I think, I'm not sure if there's misinterpretation of the intent or if it's not necessarily correctly stated, so I'd love that nuance as well, is, that you can have pill induced PCOS.

Dr. Jerilynn Prior [00:15:18]:

I mean, yes. When you're on the pill, you don't ovulate, and therefore, your ovaries get more cysts. But, that's a really an aside because I'm not relying on the ultrasound at all. And and it it is I think it's wrong to make women have to have an ultrasound when you can make the diagnosis without it. And there you know, it's an expensive test. In the old days, you had to have a full bladder and and hold that full bladder agonizingly long to get the scan. Nowadays, someone has to stick a probe in your vagina in order to get the probe big to get the scan. And those are invasive.

Dr. Jerilynn Prior [00:16:03]:

It's expensive, and it's not necessary. So someone is making money when they ask for it.

Georgie Kovacs [00:16:09]:

Help us understand this thought that's out there around pill induced PCOS. Because what I keep hearing is that you sometimes it takes a little bit of time after you've been on the pill for your period to get regular again. So it's not necessarily that you have PCOS. So can you is that right. More what it is? Okay.

Dr. Jerilynn Prior [00:16:32]:

That's right. It's a transition to normal ovulatory cycles.

Georgie Kovacs [00:16:37]:

Okay.

Dr. Jerilynn Prior [00:16:38]:

And the transition goes through a period when there's imbalance and there may be androgen excess.

Georgie Kovacs [00:16:45]:

But it's a transition. Yep. And the is the concern more if through a certain time period? I don't know if you know the magic number. Once you've gotten through that period, then you're okay? Yeah. Okay. And how long should a woman be waiting after they get off the pill to say, maybe I need to get this checked out?

Dr. Jerilynn Prior [00:17:05]:

That's a question because it depends on how old they are, whether they ever had regular periods

Georgie Kovacs [00:17:12]:

before. Okay.

Dr. Jerilynn Prior [00:17:12]:

But, you you know, the pill is used as a therapy for things it doesn't treat.

Georgie Kovacs [00:17:18]:

Right.

Dr. Jerilynn Prior [00:17:18]:

So I wanna I wanna share with your listeners that in a in a follow-up study of women who are treated in a particular medical for loss of period amenorrhea. They looked at what therapy the, the women had had. Some of the women were given the pill. Some of the women were given menopausal type hormone therapy, and some of the women refused therapy. And of those women, the quickest to recover were those who refused therapy. The next quickest to recover were those who were on the menopausal hormone therapy, which has lower dose estrogen. And the pill took years for those women to recover. And in fact, fewer women actually totally recovered either regular cycles or fertility.

Dr. Jerilynn Prior [00:18:17]:

So in other words, it it's not a good therapy for amenorrhea, it should not be used as a therapy for amenorrhea, and it doesn't protect bones in young women. In fact, it's detrimental for normal healthy girls to be on the pill in terms they just don't gain the bone growth they should be gaining. And there's also evidence that you take it in your adolescence, you have an increased risk for depression not only when you're a teenager, but lifelong. So there's some really serious concerns about the way we're currently using the birth control pill. Yes. The real problem with the pill is that it doesn't address the root cause

Georgie Kovacs [00:19:06]:

Right.

Dr. Jerilynn Prior [00:19:06]:

Of PCOS. So we have to talk about the the multiple theories of the cause of PCOS. So there's a group of doctors who believe it's entirely genetic, and there is definitely a genetic component. And it can affect men as well as women. So men get early balding, for example, and obesity and diabetes, more commonly. But in women, they may know that their aunt had trouble getting pregnant and never was able to have a kid, for example, or had irregular periods when, you know, for most of their life, etcetera, etcetera. So there's a hereditary component for sure. There's a group of people who says it's because for whatever reason that baby when that girl baby when in utero was exposed to higher male hormone.

Dr. Jerilynn Prior [00:20:06]:

And that is clearly an ideology in things like primates, monkeys, for example. And but it's unclear how that happens in humans Mhmm. And how often it is, etcetera, etcetera. There's another group that says it's all has to do with insulin resistance and some genetic thing related to insulin mishandling or lack of lack of appropriate insulin action. And then there's a another final group that says it's all because of inflammation. Now none of those answer or explain all of the spectrum of of physiologic changes that occur in PCOS. And so the the root cause that makes sense to me is genetic and other influences on the signals from the hypothalamus going to the pituitary and the ovaries. And the basic thing is that gonadotropin releasing hormone, the hypothalamic hormone, is pulsing.

Dr. Jerilynn Prior [00:21:22]:

Normally it pulses but too rapidly. So the rate of pulse has to do with whether the stimulation of the pituitary is to make lh or whether it's to make FSH. And that balance changes obviously across the menstrual cycle because you need FSH in order to ovulate. But what LH does is pulse rapidly also. The level is increased, And that stimulates particular cells called theca cells in the ovary and in the follicle itself to make male hormones. And when LH is rapidly pulsing, FSH is suppressed. The system perpetuates increased androgen and decreased progesterone. And along with androgen goes increased estrogen.

Dr. Jerilynn Prior [00:22:23]:

This is the the hopeful message. To me, PCOS is an imbalance, not a disease. And the imbalance can be corrected, and everything about it can go away.

Georgie Kovacs [00:22:38]:

Oh, so given that, then what and it's funny. This past week, I launched a a episode on hormonal imbalances, and it's really interesting because it's, doctor Sean Tassone, and he really, has this interesting way of looking at hormone imbalances where he talks about he wrote this book and he put them into archetypes where it's like, if these are the dynamics that are happening with happening with you, it's probably this combination of hormones that are off and here are different things that you can do. And so, like, the way you're describing it, it's almost like there's this PCOS archetype. And so if it is this way of this complexity of, how the hypothalamus is is, initiating, the way the hormones are working in the body, then if we look at it that way, what would be the change in potential treatment then?

Dr. Jerilynn Prior [00:23:30]:

You know, it would be clever of me if I said, yes, I figured this out. And I tried this therapy, and this therapy works in my hands and in my for my patients. But the reality is that when I first began to practice in Vancouver, I was a new endocrinologist. I had very little clinical experience. And because I was a woman and there were none in endocrinology, I got overloaded immediately with women with androgen excess, hirsutism, acne, etcetera. And and I had almost no experience with it. So I was reading like crazy. And 1 of the things I read is that women with PCOS are at increased risk for cancer of the lining of the uterus, endometrial cancer.

Dr. Jerilynn Prior [00:24:27]:

And I knew that that meant too high estrogen and androgen and not enough progesterone. I also knew, of course, that they didn't have regular cycles. So I said, what if I gave them back? And in those days, we didn't have progesterone. We had a cousin synthetic medroxyprogesterone. So I gave initially 10 days and later 14 days of medroxyprogesterone. And it was remarkable. They began to be better. And some of them had very heavy beards, you know, going all the way down their neck and everything.

Dr. Jerilynn Prior [00:25:09]:

Oh. And and so I said, well, maybe I can add to that cyclic progesterone something that blocks the male hormone action. Okay. So it turned out that in my research endocrine training, I had worked with spironolactone which was initially trialed as a blood pressure pill. But we learned very quickly that in the men, they their breasts got swollen, their libido went away, their testosterone went down. So it was not an appropriate therapy in the in the necessary doses for blood pressure. But if it blocks the androgen action, it should help along with the cyclic progesterone. So I started giving that treatment, and women began to cycle regularly.

Dr. Jerilynn Prior [00:26:04]:

Their androgen excess decreased. Eventually, they could stop those medicines, and they were ovulating on their own. And, I probably followed 200 women during my clinical career and followed them for years. Some of them 10, 15, 20 years. And and they when they got to perimenopause, they didn't have intractable bleeding that led to a providing the donations that started Semcor was such a woman. She said, I don't want hysterectomy. What can I do otherwise to stop this heavy bleeding? And in her, I gave her progestin you know a strong dose of progesterone for a long time and it was better. And so I was able to prevent hysterectomy for her.

Dr. Jerilynn Prior [00:27:06]:

Wow. Yeah. So that's that's a interesting story. And I I should have tweaked because I had read the papers but I didn't for a while until there was a review by a group by, John Marshall's group. He's a British trained man who's still working in Virginia in the states. And his review said, this is the etiology of PCOS, this rapid pulsing. And when you give progesterone, the pulse slows. However, what he his testing only tested progesterone with estrogen.

Dr. Jerilynn Prior [00:27:50]:

And I didn't wanna give estrogen because estrogen suppresses the whole system. I wanted the system to recover.

Georgie Kovacs [00:27:58]:

So the spironolactone, I have read in many documents that it is used for PCOS. So it sounds like the gap is the progesterone.

Dr. Jerilynn Prior [00:28:09]:

That's right.

Georgie Kovacs [00:28:10]:

So let me ask you this, because progestin is in birth control.

Dr. Jerilynn Prior [00:28:15]:

Mhmm. Okay. But the birth control pill is the archetypal example of hormone imbalance. The estrogen dose even in the low dose pills today, you know, 20 micrograms say, is still 4 times physiological. At best, the progestin is close to physiological.

Georgie Kovacs [00:28:40]:

So the issue is the estrogen that's in the birth control, not that it's progestin.

Dr. Jerilynn Prior [00:28:44]:

Yes. That's the issue. And most most progestins are derived from testosterone. So they have some androgenic actions as well as progestogenic actions.

Georgie Kovacs [00:29:00]:

Is there anything so what I'm hearing then is the ideal treatment would be progesterone. There's concern about the birth control for everything that you just mentioned, and then also, the spironolactone, and that should be sufficient.

Dr. Jerilynn Prior [00:29:15]:

It will be unless a person is very overweight or has reasons they can't exercise or have trouble losing weight, then metformin is quite helpful. Metformin is a medicine that makes the insulin more effective.

Georgie Kovacs [00:29:32]:

I'm hearing a lot of people talking about, myo inositol as being another medication that people can take if they can't take met formin. Can you comment on that?

Dr. Jerilynn Prior [00:29:43]:

Okay. So first of all, metformin needs to be started very slowly. So if you start extremely slowly give the first dose at bedtime say. And, and about a quarter of what would be an an optimal dose and work it up gradually. There's very few women that can't tolerate it in my experience.

Georgie Kovacs [00:30:08]:

Here's how I have simply understood PCOS. And, again, I dive into so many different women's health topics. This is why I rely on the experts here. But the theme I tend to see when I hear people talking is, you know, it is a complex condition. Like, I know at UCSF, they actually have a PCOS center and I've spoken to a couple of their doctors on a few occasions, and they're really working on having like mental health specialists and nutritionists, etcetera. And so I guess I just wanted to speak to you about the team that would need to obviously, endocrinologist as well, because I don't want people to walk away saying, okay. Doctor Pryor says take progesterone and spironolactone, and you'll be cured. Everything is great.

Georgie Kovacs [00:30:50]:

So can you can you just talk about the whole

Dr. Jerilynn Prior [00:30:53]:

Sure. Sure.

Georgie Kovacs [00:30:54]:

Dynamic that people need to consider so they don't say, why am I not healed by taking these 2 meds?

Dr. Jerilynn Prior [00:31:01]:

Yeah. And and and people ask me how long do I need to take them. And and that depends on a person's weight, how they feel about themselves, whether they're, you know, have the energy and the self respect to be able to change their diet from what makes them comfort you know, comforts them. And we all I mean, most of us eat for comfort. And to do the exercise, that's hard to do for some people. So but but definitely, mood and negative body image are an important part of this. And, and it's a consequence of these abnormal hormones and society. Because I think PCOS makes women feel not like women anymore.

Dr. Jerilynn Prior [00:32:01]:

And that's devastating.

Georgie Kovacs [00:32:03]:

I'm I'm sitting here thinking about a couple of women who had reached out to me, and both of them had really extreme PCOS cases. And I'll have to see if I still have their contact information because I wanna send this to them because they were truly at their wits end. And at the time, I only knew the things I had just identified, and I clearly didn't know about your research at the time. But they were, like, really, like, had run out of hope. Yeah. So I hope they're doing okay now.

Dr. Jerilynn Prior [00:32:31]:

It's very difficult. It's a terribly difficult disease, or condition. It's not a disease. Right. Let me explain a little bit more about how progesterone works.

Georgie Kovacs [00:32:44]:

Please.

Dr. Jerilynn Prior [00:32:44]:

Okay. And and this is why I sort of feel bad that I didn't figure out the physiology before I did. But basically, in the normal menstrual cycle, the pulse of, GnRH, the the brain hormone is increasing toward the mid cycle to make the LH peak, which is what comes before ovulation. And we know that in the normal menstrual cycle as progesterone rises, that pulsatility slows. And it doesn't slow if ovulation doesn't occur. So in other words, specifically addresses the issue that the pulsatility is too fast. And it probably feeds back to the brain. In fact, I'm sure it does, not just to the pituitary.

Dr. Jerilynn Prior [00:33:45]:

So it's solving that basic problem.

Georgie Kovacs [00:33:49]:

Is this something where like, I'm thinking where they've gotten to now in their life where they've probably been struggling for years, probably depression leading to eating more to hear, like, it's a bad cycle. Right? So, you know, would this also be fair to say that it's a call to action for making sure that as soon as we're starting to see that it's a an issue to really making sure you're addressing it early on? Because it seems like if we get the right treatment, it it's quicker to getting back to what normal is for them.

Dr. Jerilynn Prior [00:34:20]:

Yeah. Usually, it starts in adolescence.

Georgie Kovacs [00:34:23]:

Okay.

Dr. Jerilynn Prior [00:34:24]:

And it starts with cycles that remain irregular, you know 2 3 years after the first period. That's the clue and that's a clue that comes from a very good population based study that followed adolescents in in the part of the Netherlands south of Amsterdam. So so if a woman, young woman has persistent irregular periods, you know, 2 more than 2 years beyond her first period, then cyclic progesterone is the right therapy, not birth control pills.

Georgie Kovacs [00:35:03]:

So let me ask you this just to be very clear here. 1, I have heard that it takes a while once you start menstruating for your cycle to be normal. Mhmm. So if that's the case and if it's the first period and it's irregular for 2 years, how do we know what's normal adolescent body trying to figure itself out versus initial signs of PCOS?

Dr. Jerilynn Prior [00:35:28]:

Because there are also other androgen excess symptoms.

Georgie Kovacs [00:35:33]:

Okay.

Dr. Jerilynn Prior [00:35:34]:

So acne is bad. You know, oily hair starting to get hair on the chin. It's, it's not common in adolescents to get much hair because it takes a while for the the follicles to change from making the fine hair that's normal to making the darker, thicker hair that's not normal. Okay. And it's not gonna hurt anyone. Anyway, I'm not I mean, the first 2 years are fine. And in fact, you're quite right that it takes about 10 years before ovulation is consistently and securely present for the majority, 95 percent of us. Let me be clear.

Dr. Jerilynn Prior [00:36:20]:

Okay. We've published now 1 person who took cyclic progesterone with androgenic DCOS.

Georgie Kovacs [00:36:27]:

Okay.

Dr. Jerilynn Prior [00:36:27]:

Who took cyclic progesterone for 6 months and recorded her experience in the daily menstrual cycle diary. And what we observed with that person over 6 months was a marked decrease in breast tenderness, in the in fluid retention and in mid cycle mucus secretion. So in other words, it looks like it was decreasing the high estrogen plus giving her a regular regular period.

Georgie Kovacs [00:37:00]:

Wow. So we know really is amazing. Right?

Dr. Jerilynn Prior [00:37:02]:

Yeah. So we know that and we're currently doing a prospective study in 40 women.

Georgie Kovacs [00:37:10]:

Okay.

Dr. Jerilynn Prior [00:37:11]:

In whom we're giving progesterone cyclically and spironolactone and each woman is her own control. So we've recorded hormones and experiences and things at the beginning. Okay. We're recording experiences throughout cycles throughout and then we compare the change over time. In fact, the the main outcome of the study is, what's called PCOS specific quest quality of life questionnaire. So that that includes domains of androgen excess cycling, fertility, emotions, etcetera.

Georgie Kovacs [00:37:55]:

Wow. When is that, when do you expect the trial to be complete?

Dr. Jerilynn Prior [00:38:00]:

It depends. We have 18 women currently enrolled. We need 40. So we're Okay. We're having a bit of trouble. If anyone knows anyone in the Greater Vancouver, Canada area who has PCOS, please ask them to get in touch.

Georgie Kovacs [00:38:18]:

You already did this in your clinical work and saw that spironolactone and progesterone worked. Why do you need to do this study?

Dr. Jerilynn Prior [00:38:27]:

Because it wasn't documented in my clinical work. It it wasn't controlled adequately. I didn't have a consistent hormonal and and appropriate questionnaire data. Yeah. It I tried actually very, very hard to do a, randomized controlled trial of this therapy versus the birth control pill. And each time I applied, I got a lower score. Nobody was gonna buy that. It was an appropriate comparison.

Dr. Jerilynn Prior [00:39:04]:

So hopefully, when we finish this trial, it we will have evidence that that a comparison with the standard of care is needed.

Georgie Kovacs [00:39:13]:

Very exciting. I'm definitely staying tuned. Anything else that you wanna share about your research or anything, we can do to support the the efforts of, your wonderful organization?

Dr. Jerilynn Prior [00:39:26]:

Well, I'm I'm, facing the reality that the center that I founded and I've been supporting for almost 20 years, we'll have our 20 year celebration in May, is not going to survive when I no longer am working. So we need both a professorship in women's health in endocrinology to to examine the women's reproduction from the perspective of a nonsurgeon, and we need the funding and Semcore doesn't take a lot of funding to keep going. We're managing to do what we do on about a 100, 000 a year.

Georgie Kovacs [00:40:12]:

Wow. Yeah. Wow. Okay. Good to know. Thank you so much for talking to us today about PCOS. Every conversation we have always blows me away, And, thank you truly for for this information and your dedication to women's health and really advocating and working so hard against, you know, just the big health care system.

Dr. Jerilynn Prior [00:40:40]:

Well, I'm very, very grateful to you for giving me the voice to speak to more women.

Georgie Kovacs [00:40:47]:

Yeah. No. I'm more than happy to do it. So we will make sure we get as many people out there as possible to to listen to this.