Exploring the Power Of Progesterone: Bioidentical Hormone Replacement Therapy For Women's Health With Carol Peterson Part 1

Lisa: Well, hey everyone, and welcome into Pushing the Limits. Today I am super honoured to have Dr Carol Petersen with me. Carol is, I think, the world's most foremost thought leader on progesterone and hormones in general, really, and an absolutely incredible mind of information. So welcome to the show, Carol. It's absolutely wonderful to have you here. Thanks for taking some time for us.

Carol Petersen: Thank you. The "doctor" might be honorary — I'm a pharmacist.

Lisa: You're definitely "doctor" in my book.

Carol Petersen: I would propose that I probably have done the equivalent of some PhDs.

Lisa: Exactly.

Carol Petersen: I have a lot of medical stuff. I had wanted to go to medical school, but it didn't seem quite right — the timing or what was available — and in retrospect I'm very happy, because I avoided the propaganda that every medical student, and actually pharmacy too... when I went to pharmacy school some of that was in its infancy. It's horrendous now. You go into a professional school and you are encouraged to forget everything you learned in biochemistry and physiology. In fact, I've had women say things to me about what their doctor said about hormones and I said, "Will you ask him if he passed his biochemistry test?"

Lisa: Yeah, exactly. Exactly. Was he at the bottom of the class? It's just nonsense some of the time. It's incredible. But it does speak to this being an area that is very much ignored in the educational system for medical professionals.

Carol Petersen: And women — and I will submit to you, men too — suffer as much from hormone imbalances and a failure for those to be recognised and fixed, very easily. For the first time in our history we have the ability to top off our hormones with the same hormone. That gives us some powerful tools. We know from basic physiology research what each hormone is supposed to be doing and how it's supposed to be doing it, so you can clinically identify shortages and excesses. We have laboratory testing now — there are limits to the laboratory testing, but it's a tool, a secondary tool. I would say what's happening in the person's body is the primary diagnostic clue as to what's going on. It's a big failure to recognise hormones can be easily in disarray, and it can be all the way through your lifetime. You can have shortages in hormones as an infant. It should be part of every workup. You get a blood chemistry, but you don't get a hormone panel. Why is that?

Lisa: Yeah, yeah. I mean, I just totally agree. And as someone who's been to hell and back with my hormones personally — starting off as a young girl at 12, 13 when I first got my periods, having months of bleeding and not knowing why, huge pain — and the doctors, what they did, they put me on the oral contraceptive pill at 13 years old, and I stayed on that for decades, because yeah, it balanced everything out, because it's a complete endocrine disruptor and takes away all of your own hormones. They put a Band-Aid on a festering wound, in other words. And then later on, infertility, fibroids, estrogen dominance — none of which I knew. And of course I was an ultra-endurance athlete too, so I completely stuffed myself as well, because I did extreme amounts of exercise, threw my own cycle out of whack, of course, which made the progesterone no doubt even lower.

Lisa: So I've been to hell and back in regards to my hormones, and I see so many other ladies going through this now in the perimenopause, menopausal time, and myself, going through menopause as well. And we're not... the talk is always about estrogen, estrogen. "Oh, you've got hot flushes, you've got vaginal dryness, or you're not sleeping well — well, let's give you some estrogen." What's wrong with that picture, and why is that not the full story?

Carol Petersen: Okay. Some of this comes from the work of Dr Jerilynn Prior. She's at the University of British Columbia and she has a lovely website I'd refer you to, called CeMCOR — cemcor.ca. And you'll be interested to know that a lot of her research initially was done with very athletic young women blowing through their hormones and being unrecognised. They would lose their cycles, they'd lose progesterone, ultimately lose estrogen too.

Carol Petersen: She has another thing that she published, and she had great difficulty in getting this published: women in their perimenopausal years — and of course there are exceptions — will have the highest levels of estrogen in their whole lifespan during those years. And couple that with losing ovulations. You can still bleed if you haven't ovulated, and so even that little bit is a mystery too. I've just seen a client I talked to just now who had a test result, and she was postpartum, but she had her cycles already — no progesterone happening, no ovulation.

Lisa: Yeah, and we're always given estrogen as the first call.

Carol Petersen: Yeah. Okay, let me address hot flashes, because hot flashes is a big thing that women think they need estrogen for, and they sometimes even get some relief. But I think we have to look at it a little differently. Why are you getting hot flashes when you have the highest amount of estrogen in your body? Jerilynn Prior just recently, in the last few months, published a study that showed 300 milligrams of oral progesterone took care of the hot flashes. And that's my experience too, that progesterone will help that.

Carol Petersen: This is how I think hot flashes occur. A colleague of mine mentioned that some of her clients had continuous glucose monitors, and when they had a hot flash or a night sweat, their blood glucose dropped to 40, 30 — extremely low levels. And this causes adrenaline to shoot up to bring back your blood glucose. And I think it's this combination — progesterone's a moderator of adrenaline, it will put the brakes on excesses. So you have not enough progesterone, shoots of adrenaline, with insulin-glucose dysregulation. I recently heard that the incidence, at least in the US, of insulin resistance is nine out of 10 people show signs of insulin resistance. So this is all tied up into our diet, our stress. And recently I've been investigating how alkaline you are, which also ties into early problems with the pancreas and the kidneys, and so I think that might be a little tiny piece of it.

Carol Petersen: So when I'm working with clients, I have to take a multifaceted look. It's not just, "Okay, you're getting menopausal, we'll give you progesterone, we'll give you estrogen, hello, we'll see you next year," and that's the story. No. In fact, many women are getting worse because of their doctor's treatment.

Carol Petersen: I was working for Women's International Pharmacy till 2020. I got laid off with the Covid stuff, so I went to Facebook and I found hormone-related groups, and I loved it because they had exactly what I wanted: how are we failing women and men? And we are. There are so many women there, having gone to multiple, multiple practitioners, still suffering. And I started staying up to two or three o'clock in the morning answering questions. I was just so taken up with how many women out there were having some real problems that I saw there were pretty straightforward solutions for. And I had to quit that because I was losing a lot of sleep.

Lisa: Yeah, you'd get yourself sick.

Carol Petersen: I know, but I still try to pop over now and then. It sort of started getting me doing more podcasts and things, because the Facebook admins reached out to me and I started doing more and more things.

Carol Petersen: The one thing that really threw me for a loop — and I'll say those women who are told that they have PMDD, premenstrual dysphoric disorder, that's really the emotional side of PMS. Katharina Dalton in the 1950s had already described it. It wasn't until the late 1990s that the drug companies in the US wanted to find a new approval for the SSRI antidepressant drugs, and they railroaded this diagnosis through the FDA. They had some study that showed like 50% of women had mood improvement with these. But it's worse, because at the time I was working with the compounding pharmacy, all those symptoms disappear with progesterone, and I said, "Well, this one will never fly." I was so mistaken.

Carol Petersen: One of these groups from the UK about PMDD reached out to me and said they started using more generous amounts of progesterone and their lives were transformed. And women with these symptoms, where first line were these antidepressants — don't work — even worse, gonadotropin-blocking drugs, which shuts off your pituitary signalling to your adrenal glands and your ovaries, and then you put estrogen back and you make the poor woman worse. And when all that fails, birth control pills sometimes tossed in there too. When all that fails, you're encouraged to get an oophorectomy, because you should not use progesterone — you're sensitive to it, it's your enemy — and it's the very thing you need.

Carol Petersen: And what's horrifying is I now find this philosophy is entrenched. They entrenched this in medical practice. So women in this — I would call them the canaries of this whole kind of situation that we find ourselves in with perimenopause and PMS, infertility — where we don't have the right answers, we have contrived protocols being taught in medical school and entirely without good results.

Lisa: Yep. And aimed at selling more SSRIs, which they've successfully done, is huge, when progesterone should have been the first port of call for a lot of these ladies. And what I'm saying — I do a lot of testing. I do DUTCH testing, which I know now has its limitations in some ways, and then serum testing has its limitations in some ways. But what you're seeing very, very often is low progesterone levels across the board. So that seems to be younger and younger women — it seems to be even in their 30s that they're starting to have a drop-off of progesterone.

Lisa: And we tend to have estrogen, sort of in the perimenopausal years, going up and down, and it's all over the place and it can be very high. Then we've also got xenoestrogens in the environment, the glyphosate, all these xenoestrogens, so they act like — we can't measure those, really, can we? And then we've got a drop-off of progesterone happening at the same time. So progesterone's going steadily down or dropping off a cliff, estrogen's going all over the show, plus we've got these xenoestrogens, and what we get is a net effect of estrogen toxicity or estrogen dominance. And then you're getting fibroids, you're getting endometriosis, you've got infertility, you've got all of these problems that could be addressed with progesterone at higher levels than what we're currently doing.

Lisa: Generally most women, when they get estrogen, they might get 100 milligrams to protect the uterus — that's the sort of normal dose, right? 100, if you're lucky. You might get a 200 milligram dose to help with sleep or something like that, which seems to be the effect. When I started to study your work and your lectures and things, I was just like, holy crap, this isn't touching the sides for a lot of ladies. And it certainly wasn't for me.

Lisa: I've been experiencing all sorts of swings and roundabouts with my hormones, as I said, for many, many years. When I was 48 I had massive fibroid problems. I had one huge fibroid that was the size of a grapefruit that had fallen into the cervix, so I was having incredible pains and bleeding — too much information, people — but I bled for an entire year without a day off, and I had to have blood transfusion after blood transfusion. And they said to me, "You have to have a hysterectomy."

Lisa: I was going through IVF at the time. I was like, "I am not losing my uterus. I don't give a damn what you tell me, I'm not letting you take it." And they said to me, "Well, you're going to die if you don't have a hysterectomy." And I stood my ground, and I didn't have a hysterectomy, and I didn't die. I worked out which of the fibroids had to be taken out, and I convinced a surgeon to take just this one particular pedunculated fibroid that had collapsed into the cervix. Took that out — ten-minute operation, Bob's your uncle — didn't have any more problems after that.

Lisa: What I see is hysterectomy after hysterectomy. I recently had a friend who nearly died after having an operation, and they don't know what happened to her. It's an unusual situation, but this is not an operation without its risks. And then the consequences of having a hysterectomy — you're instantly going to go through menopause. They say, "Well, if we leave you your ovaries, you're still going to have your ovaries." It's like, most of the time they're not going to work. If you watch an operation of what they do with your ovaries while they're taking out your uterus — which I did, I went and watched operations online. I wanted to see, if I'm going to go through this, I want to know exactly what they're doing, because I like looking things in the face and facing up to them. And I'm like, hell no, that's not happening in my body.

Lisa: But we do hysterectomy as sort of almost a standard. "Oh, you've got heavy bleeding. Oh, you've got fibroids. Oh, you've got this, oh, you've got that — let's just take it all out." That is a disaster, a health disaster, for the woman. It instantly puts you into menopause most of the time, even if you've got your ovaries, and it hasn't dealt with the actual problem. And how many of these people could have avoided hysterectomy if they'd been given progesterone?

Carol Peterson: I think nearly all. Exactly. I used to say maybe except cancer, but now I'm going to say progesterone is going to be helpful for that too. Endometrial cancer — I came across an article, University of California, I believe San Diego, and they were working on a project to introduce a test for endometrial cancer severity. The test involved evaluating the number of progesterone receptors, and they observed that as endometrial cancer got progressively worse, the body had less and less receptors for the progesterone. And in the discussion, in the preamble, it said, "Oh, we used to reverse endometrial cancer for about 50% of women with progesterone." Hello! Hello! That would have been good to know. And now that's not even offered. You go right to hysterectomy, no choice. "You have cancer. Oh, this is a very treatable cancer, we'll just take out your uterus." And then, worse on worse, you're sold the idea that after that you're going to need oestrogen.

Lisa: You need oestrogen, you don't need progesterone.

Carol Peterson: You don't need progesterone. You ignore the whole rest of the body. Tell me how the Endocrine Society and the Menopause Society and the American Association of Obstetrics and Gynecology — how dare they sit in a committee and ignore how a hormone works throughout your body.

Lisa: It's shocking. It's shocking. Progesterone does not just work in your uterus, does it? Tell people what it does.

Carol Peterson: No, it's all over. We have a little misconception, and if John Lee were still alive, I'd have a little bone to pick with him. He wrote a great book on progesterone, for a basic first look at what progesterone does — What Your Doctor May Not Tell You, the multiple roles of a remarkable hormone. Lovely book, lovely book. But John Lee said, "Oh, we only need 20 milligrams." Let's make 20 milligrams wrong. The interesting thing that happened with that is, right about this time I'm working in the compounding pharmacy. We're using large doses of progesterone to treat PMS à la Katharina Dalton, and we started at 100 milligrams four times a day with a progesterone-in-oil capsule. When that wasn't enough, we went higher. When a woman was doing pretty well on a particular dose, she stayed there, but she might have breakthrough, we called it, and she might need a rescue dose of progesterone. We were doing lozenges and vaginal inserts, rectal solutions, all sorts of things. And I added up the milligrams at the time — the most I saw a woman use in one day to control all the symptoms was like 2,400 milligrams.

Lisa: Wow.

Carol Peterson: And I've seen more since. But we called it a breakthrough. So there was a health newsletter. Dr Julian Whitaker published that Pro-Gest had come on the market — this is the brand that John Lee recommended — and it had 16 milligrams of progesterone.

Lisa: Which is a tiny amount.

Carol Peterson: A tiny amount, yes, in about a quarter teaspoon dose. And he recommended that's all you needed, one dose of that, because that's all your body made, that's all you should put on — ignoring the fact that maybe you didn't absorb it in the first place. But there it was. And because this came on the market, Dr Whitaker was talking about Women's International Pharmacy compounding with hormones, and he directed people to buy Pro-Gest from us. We didn't even stock Pro-Gest. We hadn't even heard of the product. And of course, we got it, because we're getting all these women calling for it. And then after a while, of course, they're calling back. They're not doing so well. Their symptoms are actually worse with that little dose. And of course, we knew what to do. We knew progesterone works, and we would kind of guide them and give them our literature for Katharina Dalton's protocols, like using plenty of progesterone. We know it works.

Carol Peterson: Later I heard John Lee give a lecture, and he spoke about this complaint where women weren't doing so well on that low dose. And he goes, "Oh, just keep up with it, and in about nine months it'll be fine."

Lisa: Nine months!

Carol Peterson: Nine months, when I know it can be an hour or so.

Lisa: Wow. So you get instant relief when you do these higher doses, and then with these tiny little doses — these little doses can actually have, I think you called it kickback, or one of the Facebook groups called it oestrogen kickback, where you're actually potentiating the oestrogen and actually making it worse, because you have a tiny dose and you're not balancing it.

Carol Peterson: Yeah. And I think some of that may have some adrenaline effects too. At first I was thinking my heart palpitations and panic attacks are oestrogen-related, but those really sound more and more like adrenaline, which progesterone balances too. The oestrogen things that come up all the time are headaches, even new onset of headaches, terrible breast pain, fluid retention, and anxiety is a big one — and that could be more adrenaline or oestrogen, I don't know which. But these low doses can do that, and I think it's a horror show if you leave a woman in that situation. What if your doctor's given you a prescription for 20 milligrams of progesterone, "See you in three months," and she's desperately trying to use this because it's supposed to help her, but she is terribly underdosed? I think this is kind of a dead zone or a dangerous zone, if you're magnifying your effect of oestrogen and not balancing it.

Carol Peterson: So what's the problem here? The problem is the oestrogen is potentiated, maybe even the adrenaline is too, and you have this small dose of progesterone. So let's go back to John Lee and the ovaries. Yeah, they make about 20 milligrams, maybe a little more, the ovaries do. But your adrenal glands make it. Your Schwann cells, that make the myelin sheath around each and every nerve in your body — they make it right there and use it right there. We never measure it in any type of test. Nothing. You can't measure that. The brain makes it independently. The mast cells make all the hormones independently.

Lisa: If you're off balance there too, with not enough progesterone inside your mast cells, you're going to get histamine release, allergies and all of that sort of carry-on, itching and all of that.

Carol Peterson: Yep.

Lisa: So that could be oestrogen dominance as well.

Carol Peterson: Yeah, exactly. And then there's all the corticosteroids. There's a great debate whether progesterone actually converts to cortisol, or if the presence of extra progesterone allows pregnenolone to go that way and replenish the corticosteroid pathway.

Lisa: But we can measure that. We measure that in some of the urine tests. You see the metabolites, you see women not only low in cortisol but cortisone, the major storage, and then like three or four metabolites, they're all getting zeroed out. And you've got chronic fatigue, you can't do anything. So you're asking that little bit of progesterone to do all that work, and it's just not going to make it. It's just backing up there.

Lisa: So what is the relationship from progesterone and pregnenolone to cortisol, and what does cortisol do in the body, and how do you feel when you have low cortisol, and how does that manifest? Tell us that picture.

Carol Peterson: Oh, I love that question, because I frequently give this advice. When you have low cortisol, you have fatigue so debilitating you can hardly get out of bed. You have muscles ache, every muscle aches, every joint aches. What's that sound like? It sounds like the flu, right?

Lisa: Mm-hmm.

Carol Peterson: Right. And I'll submit, if you do have this and you do have the flu — what's happened? Dr William Jefferies did one study on this and showed that the stimulus to make more cortisol from the pituitary is blocked when you're sick like that. You put in hydrocortisone, you can get rid of that in half an hour, an hour. Hydrocortisone cream 1%, available in the US everywhere — you can simply use that hydrocortisone and relieve that fatigue.

Lisa: So in the short term, because you don't want to do that for long, do you, because you get dependent on hydrocortisone?

Carol Peterson: Well, there are people that have used it for great lengths of time. There's congenital adrenal hyperplasia, which you can't use progesterone for, you've got to use hydrocortisone, and it's going to be a lifelong thing, and you have to be exactly balanced. Dr Jefferies probably was this kind of person. He used hydrocortisone 5 to 10 milligrams every six hours — he was very keen on the every six hours — and he himself used it over 30 years in that manner, and sometimes increased his hydrocortisone according to stressors in his life where he identified his minimum wasn't helping him. I talked to him personally one time. He had an outbreak of shingles. He went up to 300 milligrams of hydrocortisone and went golfing and had an uneventful weekend, and after three days of that, the shingles were healing up nicely.

Lisa: Wow. Wish I'd known that when I had shingles.

Carol Peterson: So he had absolutely no problem with pain or quality of life. He just went up. And he explained to me, this is exactly how your body is supposed to work — to address an onslaught like that, you would naturally have a big flood of hydrocortisone, and then as it passed, you could come down, and you can come down fast. Unlike the synthetics like prednisone and methylprednisolone — these actually shut your adrenal glands off, and they've killed people by giving them these and then pulling them off right away, and your adrenals are not doing anything.

Lisa: So hydrocortisone is quite different to prednisone and methylprednisolone and all of those ones. So hydrocortisone is sort of like a more bioidentical form of the cortisol or cortisone?

Carol Peterson: Yeah, it is. It's entirely bioidentical. So I kind of like hydrocortisone now. As I said, progesterone in charts is one metabolic step away from cortisol, but there is an argument that it

Carol Peterson: ...actually is being converted from pregnenolone, not from progesterone, and the normal charts don't actually show that. However, if progesterone is there, one way or another it either helps you make more cortisol, or it shifts, so pregnenolone helps you make more cortisol and fill in all these deficits.

Lisa: So if you've got people — if you've say done a DUTCH test and we're looking at the cortisol and the cortisone levels and you've got someone who's flatlining, they're not making a cortisol awakening response and they're not having that nice rise in the morning like we're meant to, to get our energy going and melatonin down and all that — they could really benefit from progesterone, pregnenolone possibly, and even hydrocortisone, as well as maybe adrenal glandulars and adaptogens like ashwagandha and things like that.

Carol Peterson: And salt. Salt, salt and vitamin C.

Lisa: Salt and vitamin C, yeah. Two other very crucial pieces.

Carol Peterson: Yes, thank you.

Lisa: Just interrupting your show to let you know about our Health Span Hacks course, How Not to Die. This is a comprehensive course created and produced by myself and world-renowned cellular health and regenerative medicine specialist Dr Elizabeth Yurth, founder of the Boulder Longevity Institute. Now this course unlocks the latest on the science of anti-aging, longevity medicine and health, equipping you with the tools and the insights to improve your health span and vitality. Together, Dr Yurth and I have provided evidence-based strategies to optimise your body and mind, empowering you to live a longer, healthier life. So enrol today at lisatamati.com and start transforming your future, or check out the link below in the description.

Lisa: And B5 as well. Okay. What about if it's high? If they've got high cortisol and it's staying high over the day and going up at night — you often see that inverted pattern, low in the morning, high at night.

Carol Peterson: Okay, so cortisol, hydrocortisone, cortisol — it's not stimulating. You could be in a bathtub of it, it's calming. It's the adrenaline. And often the two track each other and sort of balance. The high cortisol is trying to balance a high adrenaline. But you can get in the situation that kind of characterises adrenal fatigue, that the adrenaline stays up and you exhaust all your hydrocortisone. And that becomes more and more depleted. At first it was high, but then it's down.

Carol Peterson: One of the problems that I see in women having multiple, multiple problems is they have detoxification problems with methyl groups. And you need methylation to metabolise estrogens, histamine and adrenaline. It's the primary pathway for adrenaline. So if you are low in methylation factors, you don't simply have them, and you have sluggishness in your liver being able to use these, you have a problem getting rid of this. And I've talked to women, they literally shake, they have so much adrenaline. Their body quivers during the day, they can't get rid of it. And it's horrifying.

Carol Peterson: Then I learned — I just learned this too, a couple of weeks ago, because I was in one of the medical groups and somebody mentioned adrenaline and creatine, and they go, "Oh, what's that about?" And that's a group —

Lisa: Yeah, I love creatine.

Carol Peterson: Well, it's a methyl group sink. If you don't have enough, your body will make more creatine, using up your muscle groups, and then you can detoxify. So why not supplement?

Lisa: Absolutely. I'm a huge fan of supplementing. I think everyone over the age of 40 should be on creatine, from a muscle synthesis perspective, from a brain health perspective, from a methyl donor perspective. I think five grams of creatine would be good for everybody, to support methylation, which is such a huge thing. And if you've got snips in your methylation genes, of which there are a number, quite a few — not just MTHFR, by the way — then this is even more important, because that's part of the detoxing, those processes to get your hormones back out of the body once they've done their job. We want that.

Lisa: And then you've got also beta-glucuronidase. So if you've got a gut issue and you've got some dysbiosis in the gut and you've got too high levels of beta-glucuronidase, you might have detoxed your estrogens out and then beta-glucuronidase comes along and goes, "Oh, what's in here? Oh, estrogen, oh, we're going to put that back out into circulation." And so if you have gut problems and gut dysbiosis and beta-glucuronidase is too high, then maybe you're going to have to even double down on lowering the estrogen, getting the progesterone level up, because it seems like progesterone is the balancing act. And if your estrogen is too high because of environmental, the time of life, menopause, up and down, then progesterone is the answer to pretty much everything.

Carol Peterson: Okay, now you're going to see some information — Dr Mercola is promoting this in his new book and on his website recently. He's following the writings of Dr Ray Peat, who was one of the original progesterone investigators as a biologist. And Dr Peat said measuring prolactin is a better measure of estrogen status than if you measure any of the estrogens directly. Now, does his status include all those xenoestrogens? Maybe it does, it doesn't, I don't know everything. But in a high estrogen state, prolactin goes up. Accompanying that high estrogen state is low thyroid functioning, which is what can happen when you overexpress estrogen anyway — you depress your thyroid functioning. So you can watch for increasing prolactin. So if you're doing metabolic tests, I would definitely include prolactin.

Carol Peterson: Another clue I would look for for estrogen status would be sex hormone binding globulin.

Lisa: Yeah, the carrier protein made by the liver.

Carol Peterson: And it's stimulated by high estrogen and high cortisol too. And oral contraceptives — if you've been on those bloody things, it can keep that sex hormone binding globulin up for years and years after your last pill. I'm very happy, I had a couple of clients who took birth control pills for a long time. One was post five years and her sex hormone binding globulin had returned to normal. The other one was 10 years after, normal. But we don't really know. They've gone out a couple of years as they've done their studies and seen it persist, and high sex hormone binding globulin interferes with your ability to use hormones. It's not a complete block, your body knows how to use the hormones on it, but it's a limited kind of absorption.

Lisa: Yeah, and we see this high. I mean, I was on oral contraceptives for decades and my sex hormone binding globulin, even a decade after, is still too high. And I take boron intermittently at least, to try and keep that sex hormone binding globulin down, so that the little amounts of hormones that I've got left can be utilised.

Carol Peterson: Yeah, actually boron helps dissociate the hormones from the binding globulin. One technique you can also use for high sex hormone binding globulin is add androgens back. It's the most tightly bound, but potentially if you add some DHEA, add some testosterone as supplementation, you can maybe bring that down a bit. At the same time, you have to make sure that estrogen's under control, because that's persistent, makes you want to make more, and your cortisol's under control.

Lisa: Yeah, this is complicated, right?

Carol Peterson: It is.

Lisa: And then testosterone can aromatise into your estrogens as well. Exactly. What pathway are you putting those estrogens down, the 2-OH or the 4-OH or the 16? Which pathway, and then how are you methylating it? So it's not a simple thing.

Lisa: But I think if we bring it down to people listening who are dealing with symptomology — so if we look at young girls who maybe are in their early years of their cycles and what they might be dealing with. Are you seeing progesterone as being a problem in those very young girls, so 13 to 25 year olds, even with those young ladies?

Carol Peterson: Yes. And that's where I started. And they need a lot of progesterone.

Lisa: Wow.

Carol Peterson: And this is kind of interesting too. Katharina Dalton really tapped into that arena. And you can get violence, rage, anger, suicide, murder. It can be so severe. Interesting enough, in the luteal phase, the second part of the cycle from ovulation to bleeding, progesterone is going up pretty much in a nice big abundant bunch of progesterone. But what happens is this luteal cycle's got two parts. The first half of it is where progesterone supports the estrogen-stimulated endometrial buildup in anticipation of a fertilised egg. When this doesn't occur — and this is mid-cycle, when progesterone should be at its very, very highest — that it becomes a secretory hormone and turns that tissue, changes that tissue so you can shed it.

Lisa: It's progesterone allows you to shed it.

Carol Peterson: Yes. Okay, so you're shedding it. Now some women have these PMS type symptoms one, two, three days into bleeding. It's okay to use the high amounts of progesterone there. Progesterone does not have to drop for you to bleed.

Lisa: Wow.

Carol Peterson: And we are all taught this, and it's causing so much confusion when women are dosing with progesterone. For instance, I talked to a poor woman a couple of days ago, her doctor started her on some estradiol and progesterone and she had a big bleed, huge bleed. And so they said stop everything, stop everything and come in here. And they put her through thousands of dollars of tests.

Lisa: Yeah, cancer tests and all sorts.

Carol Peterson: Exactly. And you know what? It's entirely predictable. You start progesterone and you have some endometrium built up, at some point you build up enough progesterone activity to make that layer sheddable, and it's going to shed. You're going to bleed. And good deal, you want it out of there.

Lisa: That's fine, yeah. I've been dealing with that since I've been learning your work. I've increased my progesterone levels, and I'm also on testosterone, a small amount of DHEA, some pregnenolone for the whole picture, and estrogen, a tiny amount of estrogen as well. And I'm having regular bleeds now, probably a little bit too regular, like every couple of weeks regular at the moment. And I'm still trying to play around with the dosing, right, because I think I need more. I'm at 500 milligrams a day, which is considerably more than what I was on — 200, your normal sort of protocols. And I haven't felt like I've reached that breakthrough point yet, but I'm just going up carefully so that I don't throw everything out of whack. But one of the main problems that I've had was mood. Like I could kill people — not literally, but irritability up the wazoo, rage, that type of thing. I'll be honest, that's me at times, right? And very stressful life, very stressful life.

Carol Peterson: So you need enough progesterone, it should whip that away in under an hour.

Lisa: That's happening.

Carol Peterson: This woman said to me, she said, "Nothing my husband says bothers me anymore."

Lisa: What? She's taking that much progesterone and that's what it feels like? Okay, I've got to keep going up then. I think I'm going to keep going up. No downsides to that, sorry?

Carol Peterson: Yeah, well, just think about what that does to relationships.

Lisa: Oh, the amount of people that get divorced at 50 or 45 or 55, because we're not tolerant anymore, we're grumpy, we're agitated, we can't sleep. It is really hard on marriages and it's hard on women, and this is not being talked about enough. And people think you've just changed — well, it's your hormones. And I often say to my husband, "I'm trying to balance my hormones, can you be patient with me?" And he is, he's very good. But it is quite violent, right, especially when you've had such a mucked up history as I've had, and probably years and decades of low to lower progesterone levels. Do you think there is such a thing as stored up deficits, from decades of being progesterone deficient, and then you get to your 50s and you're like, holy...

Carol Peterson: Yes, yes. And I think this is what's calling for some of the bigger doses of progesterone. If you were just aging gently, that 100, 200 milligrams may be just fine for you. Your adrenals aren't stressed, it's producing plenty of progesterone for you, and that little bit of extra progesterone helping you sleep better, have less anxiety, no breast tenderness, all well and good. But there are women who probably from birth even were low in progesterone, and they have a horrible history of the PCOS, infertility and miscarriages.

Lisa: Miscarriages is another major, major thing.

Carol Peterson: Yeah. I've recently been thinking about this — I don't have any good evidence, I'll probably try to look for it — that nausea that you get, particularly the first trimester of pregnancy: if you used extra progesterone then, would it not balance out that estradiol? You have a surge of estradiol happening, and the real big amounts of progesterone don't start till the second trimester when it's coming from the placenta.

Lisa: Wow.

Carol Peterson: And Katharina Dalton — I don't see that she mentioned it — her severe PMS patients who were using large doses of progesterone, she continued on those large doses throughout the pregnancy. And then 10 years later, scientists said she went to check on the kids, and the kids were doing great. They were above their peers in their intelligence and they were more socially adept, but they weren't excelling in sports. They were the same as their peers.

Lisa: Same as. So it didn't make them — they didn't get more testosterone.

Lisa: Thanks so much for watching and we hope you enjoyed this video. Please like, comment, hit the notification bell and subscribe, and of course share it with just one person who you think could really benefit from this content. Click here to watch last week's episode, and click here for my website, and click here to watch a video you may not have seen yet.