The Progesterone & PCOS Connection [Podcast]

Women with PCOS typically have low progesterone. Symptoms include absent, irregular or very heavy or long periods. Unfortunately, it also increases the risk of miscarriage. Whether you are TTC or not, it is important to get your progesterone balanced. Dr. Poppy joins the podcast today to explain why women with PCOS have low progesterone and what we can do about it. Listen in to this important conversation as we discuss:

• Why the pill is not a good long term choice for women with PCOS
• Progestin v. progesterone v. Provera
• Her pregnancy protocol for progesterone treatment
• What test you should ask for and when you should take it
• The connection between progesterone, your thyroid and adrenal glands

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Dr. Poppy Daniels was born in Boston and raised in Missouri. She attended undergraduate and medical school at the University of Missouri-Columbia.  She completed a residency in Obstetrics and Gynecology at Drexel University in Philadelphia, PA.  She worked for a short time for Drexel University Division of Infectious Diseases & HIV Medicine, on a project to institute rapid HIV testing for women presenting in labor with poor prenatal care. She and her husband, Dr. Dennis Daniels who is a Pulmonary/Critical Care/Sleep Medicine specialist, moved to Missouri where she has been in private practice since 2003.  They have 5 sons and one daughter, enjoying football, family time, gardening and raising chickens.  Dr. Poppy, as she is known to her patients and social media followers, has a wide variety of special interests including: Physician-Midwifery Collaboration, Functional Obstetrics, Bioidentical Hormone Therapy, Progesterone Support in Pregnancy, Recurrent Pregnancy Loss, Infertility, Polycystic Ovarian Syndrome, Clotting Disorders, and Vaginal Birth After Cesarean (VBAC).

Full Transcript:

Amy Medling:                    Hello, and welcome to the PCOS Diva Podcast. My name is Amy Meddling, and I am a certified health coach and founder of PCOS Diva. My mission is to help women with PCOS find the tools and knowledge they need to take control of their PCOS so they can regain their fertility, femininity, health and happiness.

If you haven’t already, make sure you check out PCOSDiva.com, because there I offer tons of great, free information about PCOS, and how to develop your PCOS diet and lifestyle plan so you can begin to thrive like a Diva. Look for me on iTunes, Facebook and Instagram, as well.

Today, I have the privilege of talking to Dr. Poppy Daniels. Dr. Poppy Daniels attended the undergraduate and medical school at the University of Missouri Columbia. She completed a residency in obstetrics and gynecology at Drexel University in Philadelphia, and she’s known as Dr. Poppy to her patients and social media followers. She has a wide variety of special interests, including physician midwifery collaboration, functional obstetrics, bioidentical hormone therapy and Polycystic Ovarian Syndrome and infertility, just to name a few. I’m just really thrilled to have you on the PCOS Diva podcast, Dr. Poppy.

Poppy Daniels:                  Thank for having me.

Amy Medling:                    So I found you through your social media Facebook page at Facebook at Dr. Poppy, and you post some really fantastic information and links and your own blog posts, and I really encourage everyone listening to follow you. I really reached out to you because you posted a great article about the importance of progesterone in early pregnancy and to avoid miscarriage. I think that this is a really valuable topic for women with PCOS, because women with PCOS tend to be low progesterone anyway. So, I thought we could talk a little bit about progesterone and kind of the PCOS connection. Why women with PCOS are low, and what we can do about it. So, you know, I’m gonna kind of give you the stage, and we can get started on the topic.

Poppy Daniels:                  Okay, great. Well, this is a very important topic for PCOS patients, and it sort of points to one of the major problems hormonally with PCOS, but unfortunately, at least in mainstream treatment of PCOS, it’s hardly addressed which is a problem because progesterone is the cornerstone of PCOS therapy, in my opinion, whether a woman is trying to get pregnant or not. So it’s important in either situation. That’s because most women who have PCOS have ovulatory dysfunction. As you know, that can manifest in a lot of different ways. Some women, they don’t have periods at all. Sometimes, they’ll have very irregular periods. Sometimes, they’ll actually have fairly regular periods, but they’re very, very heavy, or long or painful.

As you know, PCOS is associated with infertility, and that is stemming from the ovulatory dysfunction. So whether or not you’re trying to get pregnant, you need progesterone, and progesterone comes from the ovulated egg or the corpus luteum so if you’re not consistently ovulating, which most women with PCOS are not, then you are going to be progesterone deficient. Progesterone is an often overlooked hormone. Most women think about estrogen when they think about female hormones and, for whatever reason, progesterone has not been given the same attention as estrogen, but progesterone is just as important as estrogen, and even more so in pregnancy because progesterone is the pro gestational hormone. You need it to get pregnant, you need it to stay pregnant, you need it to have a full term birth.

So if we know that women who have PCOS have progesterone issues, because they’re not ovulating consistently, then that increases the likelihood that their progesterone may not be optimal when they are pregnant. That’s very concerning, of course, in terms of risk for miscarriage, and that’s something that women with PCOS are at higher risk for. So if you look at traditional mainstream treatment for PCOS, you usually have, they sort of lump you into two categories. Either trying to get pregnant, or not trying to get pregnant.

Amy Medling:                    Right.

Poppy Daniels:                  If you’re not trying to get pregnant, a lot of times you’re offered birth control. There’s sort of two different traditional camps when it comes to that approach. The first camp says, “Well, these patients are not having a period regularly, so they need to shed their lining of their womb so that they’re not at risk for uterine cancer.” So obviously birth control is sort of gonna force you to have a withdrawal bleed every month, and so that sort of takes care of that problem. Then the second thing that happens with birth control is that in general women with PCOS over produce male hormone, and that can be DHEA, testosterone, androstenedione, all of the male hormones that can cause excess hair growth or acne, oily skin, oily hair, thinning of the hair on top of the head. The elevated androgens is what we call that.

Well, when you’re on birth control, birth control makes you produce a protein called sex hormone binding globulin. This protein can increase or sort of suck up some of that extra male hormone that women are producing with PCOS, so some of those women do better on birth control with their acne or hair growth on their face. So that sort of, in one line of thinking, is helping the symptoms of PCOS.

The problem with that, and this is sort of the other camp of clinicians or people who treat a lot of PCOS, is that birth control of course is not, there’s no natural birth control pills or any of the options that are medical options for birth control are not natural hormones. They’re all synthetic hormones, and so when it comes to progesterone, you’re not getting natural progesterone in birth control. It’s not gonna give you the progesterone you’re not making, so it doesn’t really help that problem. Then birth control, of course, has different problems that it can affect you metabolically. The birth control pills can increase insulin resistance, which most PCOS patients are dealing with in one form or another. Of course, it has cardiovascular risk factors … heart attack, blood clot, stroke. Again, PCOS patients tend to be at higher risk for these things anyway.

So it’s somewhat problematic, and I think that I view birth control, if it is used in PCOS, as maybe a temporary, short term solution for some women. It certainly doesn’t fix PCOS. I think that’s important for women to know.

Amy Medling:                    Yeah, I’m so glad you brought that up. I mean, I kind of view it more as a band aid. It’s not really getting to the root cause, the root issue, and it also … I just recorded a podcast with Dr. Keesha Ewers about libido, and that’s another thing that birth control can really rob us of is our libido.

Poppy Daniels:                  Yeah.

Amy Medling:                    You did mention blood clots, and I can’t tell you how many women that I hear from when I post my articles kind of about the risks of the pill, and I mention that women with PCOS are two times more likely to experience blood clots while on the pill. Women are posting that that, you know, they’re in their 20s, their 30s, and they’ve had a life threatening blood clot while on the pill with PCOS.

Poppy Daniels:                  Yeah.

Amy Medling:                    So these are real risk factors, and I’m so glad that you brought that to our attention. The other thing …

Poppy Daniels:                  Well, and I want to mention. Well, I want to mention …

Amy Medling:                    Oh, go ahead.

Poppy Daniels:                  … One quick thing about birth control. For many years, probably less so now, but maybe eight to 10 years ago, a lot of PCOS women were being put on a birth control called Yaz, which you may be familiar with that birth control pill. It was felt to be a better birth control pill for women who had PCOS because it has less androgenic properties than some birth control pills, and it also had some similarities with another drug that’s used for PCOS called spironolactone. Spironolactone is a male hormone blocker, and a lot of women with PCOS are put on spironolactone for that reason. So this particular birth control actually had similar properties to spironolactone. The only problem is, and now, of course now, we find this out, after medications have been on the market for long enough for us to see the problems with them, that Yaz actually had an even higher risk for blood clots than some of the older first and second generation progestins that were in birth control pills.

So the particular progestin in Yaz was a fourth generation progestin that had … it depends on which studies you look at, but 100 to 300 times higher risk of blood clots than traditional birth control pills. So you have women, as you said, who already could be at higher risk, them taking the pill that puts them in the even highest risk category, and it’s really become an issue. Especially if doctors really are not keeping up with these things, and just sort of prescribing birth control sort of without knowing some of this newer information about the increased risk with the newer generation progestins. So you have a lot of PCOS women who were put on Yaz or Beyaz or Ocella, that’s a generic version of that pill, and they are actually at much higher cardiovascular risk with that particular type of pill.

Amy Medling:                    That’s why I really advocate digging into the information yourself, and knowledge is power, and listening to experts like yourself, Dr. Poppy, and other podcast recordings. Getting on PubNet, and kind of looking and researching yourself, and arming yourself with this information because sometimes you just can’t rely on, like you said, your doctor to be up to date with all of the latest information. There was something else that I wanted you to clarify.

So, a lot of women write in and say that their doctor has given them Provera so that they can get a period, and I think there’s a misconception again that Provera is progesterone.

Poppy Daniels:                  Right, very good point. This is a long standing problem, and that is that a lot of doctors sort of interchange the term progestin and progesterone so that a lot of people think that they are the same thing. They’re not. Natural progesterone is a different hormone than any of the synthetic progestins that are in birth control, so Provera is medroxyprogesterone acetate. That is the hormone that’s in Provera and Depo Provera, which is the birth control shot, and it’s also in the HRT drug Prempro and Premphase, there’s actually two HRT drugs that have Provera in them. Medroxyprogesterone acetate is certainly not real progesterone, and it always surprises me when I see people say that that’s progesterone, because it’s very clearly not. Completely different chemical structure, and has different side effects than natural progesterone.

However, it’s been used for years and years and years to induce periods. So basically, your typical scenario is someone hasn’t had a period for two or three months or longer, so they get put on 10 days of Provera to induce a period. The issue is that we do have natural progesterone available on the retail market as a pill. It’s called Prometrium, and so to me, why would you want to use a synthetic hormone that has other side effects, instead of the real hormone that your body isn’t making, which is progesterone? So Prometrium is generic, real progesterone, or bio identical progesterone, and I think a lot of older doctors just sort of grew up using Provera, and that’s just what they’re used to. The younger doctors I think are more open to using Prometrium, rather than Provera, but it’s still very commonly used to induce periods.

What’s disturbing, and what I like to point out to patients, especially if they’re also trying to get pregnant, is that Provera is pregnancy category X. That means it’s contraindicated in pregnancy, whereas natural progesterone, you have to have it or else you’re not gonna have a successful pregnancy. So that’s a very good way of contrasting the differences between synthetic hormones and natural hormones. So in my opinion, you know, why would we need to … Why would we need to use a synthetic hormone when we have the real one?

Amy Medling:                    So again if, you know, those listening, sometimes you have to be a Diva. If your doctor is prescribing Provera, certainly bring up Prometrium and ask your doctor about that as an alternative. So I wanted to ask you, Dr. Poppy, for women listening who are trying to conceive, or may be early in their … very early in their pregnancy, what do you usually, what is the protocol for your PCOS patients in regards to progesterone in trying to conceive or early in pregnancy?

Poppy Daniels:                  Well, my practice is different probably than your traditional practice. All of my patients get tested for progesterone in early pregnancy. The vast majority of PCOS patients, they need support. They need that hormonal support. Is that something that other doctors are talking about, do you know, to their patients? Have you heard of that before?

Amy Medling:                    Well, I can tell you when I hear, when women share that they’ve worked so, you know, tried, struggled so hard to get pregnant. They’re finally pregnant. I will say to them, “Please ask your doctor to test your progesterone, and make sure it’s rising as it should and, if not, ask for supplementation,” and a lot of doctors are not doing that. So maybe you could explain what test that you should ask for, and at what like … Like as early as like five, six weeks? You know, at what point are you testing?

Poppy Daniels:                  Sure. So I think that there’s such a disconnect between doctors sort of going back to physiology and thinking about normal pregnancy and normal hormone levels in pregnancy, because progesterone, as you know, after you ovulate you produce the corpus luteum. That is what produces the progesterone. If the corpus luteum is removed in the first trimester, so if the woman were to have surgery and have her corpus luteum removed, she would immediately lose the pregnancy. So that’s been … You know, we’ve known that for a long time. That’s just sort of basic hormone physiology. What I think most doctors do not understand is that number one, testing for progesterone levels, we do know that the majority of successful pregnancies in the first trimester need to have a progesterone above 20 by six to seven weeks.

So what I see a lot of times what happens is that a doctor will either go by whatever range is listed as normal by the lab test, you know. Different labs have different ranges of normal, so I’ve heard everything from, “Oh, as long as it’s in that range, it’s fine” or “As long as it’s above 10, it’s fine” or “As long as you’re not bleeding, it’s fine.” What it reveals to me is sort of an ignorance of what it should be, and that is that it should be above 20 by about seven weeks, it should be above 20. So what we have is a lot of doctors who will not give progesterone unless a patient has either had a miscarriage before, or is bleeding or cramping in early pregnancy. Even then, you have a whole contention of doctors who think that progesterone support in pregnancy is voodoo. I mean, I’ve literally had doctors say that to patients. That is voodoo, it’s not supported in literature, we only do it to make women feel better. Sort of all these very incorrect and sort of derogatory things that are said, basically like you know, “Yeah, women ask for it and we put up with it, and it doesn’t really do anything.”

Well, number one, again, I point back to normal physiology. Progesterone is the cornerstone of hormonal production and support in early pregnancy, so what the corpus luteum does is the progesterone that it produces, it actually prepares the womb, or the lining of the womb, the endometrium, for the arrival of the embryo. It actually secretes what we call uterine milk, so those are proteins and nutrients that help the developing baby to grow. We also know from lots of studies in women who are not pregnant that the main issue of having progesterone in the second half of the cycle is that those secretory proteins that they produce help to balance and stabilize the lining of the womb. That’s why so many women, when they do have periods with PCOS, have very long, heavy periods, because they’re getting all of this estrogen effect. Estrogen is the growth hormone, so it grows the lining of the womb, and then the point of progesterone is to stabilize that lining so it doesn’t bleed abnormally.

Well, we know most of the women with PCOS don’t have adequate progesterone, so when they do bleed it tends to be very heavy, long, irregular, breakthrough bleeding. Spotting that goes on for days, even after the period’s over, and these are all reflective of the hormonal imbalance. So then when you’re pregnant, you even more need those secretory nutrients that are produced by progesterone. So I think it just really lacks a general understanding and appreciation of how important progesterone is in early pregnancy, and an understanding that most women with PCOS are going to be going into the pregnancy with inadequate progesterone.

Then you also have common misconception number two, which is that magically at 12 weeks, the corpus luteum is not making the progesterone anymore. That the placenta is now making progesterone, and there’s suddenly no more need for progesterone. Sometimes, that is correct, but many times, women still are not making adequate progesterone, even after the first trimester. So what you have is a lot of women whose placentas are not doing that great of a job of making progesterone, and so some women are still having issues. If you just sort of randomly stop at that stage, you’re gonna have a lot of women who number one, can be symptomatic at that point. So we have a lot of women who say, “Yeah, they took me off at 12 weeks, and then I started spotting,” or “I started cramping,” or “I just didn’t feel good,” or “I felt like something wasn’t right,” and then they said, “No, you don’t need it anymore.” Or they are asymptomatic, but their levels drop. What’s the only way to know if your level is dropping is to test it, and unfortunately, most doctors are not testing the progesterone levels.

So I follow a progesterone support protocol in pregnancy that was established by Dr. Thomas Hilgers. He is the doctor at the Pope Paul Institute for Reproduction in Omaha, Nebraska at Creighton University. This is a Catholic institution, and they don’t use birth control, so they have for a long time worked on supporting pregnancy, supporting women trying to get pregnant and women with a history of miscarriage. They have always used natural progesterone, because they don’t use anything synthetic like birth control. So what Dr. Hilgers did is he took a whole bunch of normal, pregnant women who had normal, full-term births and he tested them all the way through their pregnancies with progesterone levels every week, and then he compared those to women who had pregnancy problems such as miscarriages, or preterm birth, or bleeding during pregnancy, or preeclampsia, or sort of any sort of obstetric complication. Out of that, he created a curve for what the normal progesterone levels should be for each gestational week of pregnancy.

So he established his protocol based on normalizing a woman’s progesterone level based on that curve, so that’s the protocol that we go by. So we don’t go by how far along you are, or even if you’re having symptoms or not. Now, in my practice, symptoms always trump lab levels, so if someone’s cramping or bleeding, they’re always going to get progesterone, even if their level looks okay. If they’re not having symptoms, so if they’re asymptomatic, then we try to normalize their progesterone level for where it should be for their gestational age. On top of that, what we do is if we take someone off, if we wean someone off of progesterone, then we always go back and test them after they’re off to make sure they don’t drop back down. That’s a much more objective way of doing progesterone therapy in pregnancy.

Amy Medling:                    So are you using suppositories or cream, or are you using Prometrium as a supplement?

Poppy Daniels:                  I use a lot of different kinds of progesterone. I use oral, so I do use Prometrium. And you can actually use Prometrium orally, or you can insert it vaginally. I do use compounded progesterone vaginal suppositories very commonly, then I do progesterone injections, progesterone in oil injections, and I’ll be honest with you. I have several patients that have had to be on multiple forms of progesterone in order to maintain their progesterone levels, and so every individual patient gets an individual care plan based on what’s going on with them. I just had a patient who came in with her baby last week. She just had her baby, and she has PCOS. She had had several miscarriages, and in this pregnancy she was on shots and oral, I believe.

She actually had to be on shots all the way up until the end. I usually wean people off by about 38 weeks, and she was telling me, she said, “The minute I stopped progesterone shots, I started having more Braxton Hicks contractions, and went into labor shortly after that.” So there are some women that, they just need a boat load of progesterone in order not to contract because we know that progesterone is what sort of causes the uterus to be quiet, and to not contract, and so it makes sense that if you don’t have enough, then your uterus is going to be more irritable and more likely to contact. Now obviously, there’s other things besides progesterone that can make your uterus contract. You can have infections, and you can have twins, and you can have other issues going on that is not hormonal, but since progesterone is the pregnancy hormone, and since it’s so vital, it is the problem for a large number of women.

Amy Medling:                    Yeah, and a large number of women with PCOS, because …

Poppy Daniels:                  Absolutely.

Amy Medling:                    … They tend towards low progesterone, and the other thing. I know this is kind of off topic, but the other thing that I tell women when you found out that you’re newly pregnant also to get your thyroid tested, because low thyroid can also be a problem in pregnancy. I think a lot of women with PCOS are hypothyroid, and they don’t know they are.

Poppy Daniels:                  Yeah.

Amy Medling:                    They’re not getting the proper testing, or the doctors aren’t using the right metrics, I think, to compare those tests, as well.

Poppy Daniels:                  Absolutely, and you know that’s another area that I think is not done well. I test everyone for thyroid, of course, but especially someone who’s had a miscarriage should absolutely have their thyroid tested, hopefully before they get pregnant again. We don’t want to … you know, it’s sort of one of my pet peeves that we don’t have universal thyroid testing in pregnancy. This is a big, controversial topic with ACOG. They refuse to kind of advocate for that. They still are of the position that only women who have a family history, or have risk factors for thyroid disease should be tested when the truth of the matter is that the majority of women who have thyroid issues don’t have any other indications that they would have that.

So, but I do think this goes back into your point about Dr. Briden’s statement about stress, because all of the hormonal systems talk to each other, right? So all of your hormonal production starts with your hypothalamus. Your hypothalamus talks to your pituitary, your pituitary talks to your thyroid, talks to your ovaries and talks to your adrenal glands. So this is a very big, important hormonal circuit, and what happens when women are under stress is they’re over producing cortisol which is a stress hormone. If that goes on too long, that can eventually burn out their adrenals, or have decreased adrenal function, so they’re not producing adequate cortisol. Then they will try to go over to the ovaries to get some progesterone, because these hormones all have the same backbone, and that is cholesterol. So the sex hormones are made from cholesterol, so they are interchangeable somewhat.

So the adrenals what, they’re under stress, they want to see if they can get some progesterone and make more cortisol. Well, if you don’t have adequate progesterone, then that’s not going to help that problem. So her point that the older you get, the less you’re ovulating consistently, the less progesterone you make, that’s gonna undermine your adrenal function, but that also undermines your thyroid function in a lot of different ways. So absolutely, every PCOS should automatically be tested for thyroid.

An interesting thing that you’ll see in women who have PCOS and hypothyroidism, sometimes those kinds of symptoms kind of cancel each other out. So if you have a woman with PCOS who has, you know, elevated male hormones, she may not actually be exhibiting the oily skin, the oily hair or acne, all of that, because if she has thyroid disease, then that’s sort of drying her out. So I will see a lot of women who are not clinically exhibiting your typical PCOS symptoms, but they still have elevated male hormones when you test their hormones, and the thyroid is kind of mitigating some of that, so you don’t see it as much. Yeah, I mean, and then thyroid function is incredibly important for fertility and reproduction, and so I know that you wanted to mention this paper that just came out because this is, again, evidence based medicine to present to your doctor.

This is the paper that was published in Fertility and Sterility, which is a mainstream peer reviewed journal put out by the American Society for Reproductive Medicine. This study is entitled, Luteal Start Vaginal Micronized Progesterone Improves Pregnancy Success in Women With Recurrent Pregnancy Loss.” I won’t go into the details on this paper, but I will tell you that it actually, progesterone support, and in in this case it was vaginal Prometrium, and at a dosage of 100 to 200 milligrams actually improved pregnancy in women who had recurrent pregnancy loss, and they didn’t have any other obvious reasons why they were losing the pregnancies.

It actually improved, compared to controls, 68% of women who took Prometrium had a successful pregnancy after pregnancy loss compared to 51% who did not take progesterone. So that was statistically significant, and given that women who have PCOS are at risk for pregnancy loss, one of my main statements is why would I want a woman to have to go through a miscarriage before I would give her progesterone?

Amy Medling:                    Oh, I know, and you’re saving lives.

I mean, what you just did for the patient that you described, you were able to help her have that baby because of the progesterone, so that’s wonderful. Couple things that I just wanted to … resources that I thought of, first of all we were talking offline about Dr. Lara Briden’s article about women in their 40s and decreasing progesterone and stress. You could find that on her blog, or I’ll try to put a link to it under the podcast article, under resources. Also, you had mentioned Dr. Hilgers and Creighton, the Creighton model and you know if … I know that I actually went to a NaPro doctor, which is trained in Dr. Hilger’s method. So that’s one thing that, if you’re listening and you’re concerned about progesterone, you could look for a NaPro trained doctor, and they would be familiar with the protocol that Dr. Poppy’s describing.

Then finally Hypothyroid Mom, she’s a blogger and she’s a real advocate in thyroid testing in pregnancy to avoid miscarriage, and she would be another great resource if you’re interested in more information there. Gosh, Dr. Poppy, there was so many other things that I wanted to ask you about, about thyroid beyond pregnancy, so I’m gonna have to invite you back on the podcast so that we can talk more about progesterone and stress. We kind of sort of touched the surface of that, but I would, I really want you to tell our listeners how they can find out more about your work, and connect with you on social media. If they’re in your area, even see you in your practice.

Poppy Daniels:                  Sure. So, on Facebook, my professional Facebook page is Dr. Poppy, and I do try to put up a lot of articles such as this progesterone paper, which got lots and lots of shares when I put it up. I put up information about a wide variety of subjects, but I do regularly post on PCOS. Post about progesterone a lot. You can follow me on Twitter, and that’s at Dr. Poppy B-H-R-T on Twitter. My website is DrPoppy.com, so I have information on there. I do want to say a couple of things for your listeners who are trying to sort of access some of these things, sort of running into road blocks.

If you go to fertilitycare.org, fertilitycare.org, they have the NaPro doctors listed on there by region, so those are doctors that usually follow Dr. Hilger’s progesterone support protocol. Unfortunately, if you’re more, in a more rural area, you may not have as much access to a NaPro doctor. I’m actually not a NaPro doctor. I just follow his protocol because I’ve always, progesterone has always been very important, and it made sense to have more of a structured guide to go by. I think that if patients can sort of talk to their doctors and sort of say some of these things in a very kind of non-confrontational way, I think that there are some doctors that will listen and will say, “Yeah, I’m willing to do that.” Especially if you sort of say, “Have you seen this paper? It really shows that women had good pregnancy success with using progesterone.” You’re always gonna have those docs that are not open minded, and so I always tell my patients, you know, talk with your feet.

You are a health care consumer. You have a right to engage with a provider who will respect you, and these are all very reasonable things that we’re talking about. Getting your thyroid checked, considering progesterone support when you have PCOS. These are not sort of unreasonable requests. So I do think it’s important for patients to try to identify those practitioners that are near them that would be more supportive, and that’s where social media has been greatly beneficial. So people can sort of crowd source and get on forums and get on Facebook and Twitter and listen to podcasts, and try to find doctors that are more supportive to the hormonal aspect of these things.

You know, I’ve had some women who just weren’t able to get anybody to listen to them, and they just went to the health food store and got progesterone cream over the counter, and just used that because that was the only thing that they had access to. It’s not my optimal way of using progesterone in pregnancy, cause it’s hard to monitor topically applied progesterone cream, but some women are desperate and they don’t want to lose their babies. I feel very sad that so many women have not been able to get the support they needed. As far as seeing me in person, I’m in Missouri, and so if you’re in Missouri and you wanted to come see me, you could do that. I also have a license in Pennsylvania, and I’m available to do Skype consults in Pennsylvania. If you are in any other state, I can do a Skype consult with you, but I cannot prescribe medication across state lines in the state that I don’t have a medical license in.

So I’ve had some patients who said, “If you’ll just sort of tell me what to do, I will share it with my local doctor, and my local doctor can prescribe this for me,” and that’s fine. If you have a nurse practitioner or a midwife or someone else who would be willing to prescribe what I recommend, that’s one option. Then, of course, I’ve had people that just decided to travel to see me because they wanted to work with me, and that’s an option, too, but I would suggest reaching out to see if there’s any fertility care or NaPro doctors close by if you have PCOS and you are interested in progesterone support in pregnancy.

Amy Medling:                    Well, really, that’s great resources, and it’s great that women can avail themselves of your help, and thank you so much for coming on the podcast and talking about this really important topic.

Poppy Daniels:                  Well, it is one of my favorite topics, and I always tell patients … I probably see 10 PCOS patients a week, on average … You know, this used to be a very rare condition, that some doctors would never see a case of it in their whole careers. Now we are seeing tons and tons and tons of PCOS, which does point to the food supply and the environment as big factors. Big factors for why we see so much of this, but the good news is PCOS is very treatable, very treatable, and especially if you have more of a holistic approach like what you recommend with dietary changes and more of a holistic approach. You can actually really have good results with PCOS.

Amy Medling:                    Yeah, well that’s what we teach here on PCOS Diva, and I hope that you’ll come back on to talk about another important topic sometime soon.

Poppy Daniels:                  Absolutely, I’d love to.

Amy Medling:                    Well, that wraps up our podcast today. Thank you all so much for joining us on the podcast. I hope you enjoyed it, and if you like this episode, please don’t forget to subscribe to PCOS Diva on iTunes, the app or wherever you might be listening to the show. If you have a minute, please leave me a quick review on iTunes. I’d love to hear from you, and if you think of someone else that might benefit from this podcast, please take a minute to share it with a friend or family member so she can benefit from it, too. Don’t forget to sign up for my free newsletter. Just enter your email on PCOS Diva, and you get instant access and make sure you never miss a future podcast or posting.

This is Amy Medling wishing you good health. Look forward to being with you again soon. Bye-bye.