Charting as a Clinical Vital Sign (Episode 351)

Full Transcript: Episode 351

This is the Fertility Friday Podcast, episode number 351.

Lisa Hendrickson-Jack: Welcome to the Fertility Friday podcast, your source for information about the Fertility Awareness Method and All Things Fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of the fifth vital sign and the Fertility Awareness Mastery charting journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health. And I’m so excited that you’re here with us today.

Lisa Hendrickson-Jack: Today I’m sharing a brand new episode with you with my guest Nora Pope, who was a previous guest on the podcast back in episode 106, and today we are talking about using the menstrual cycle as a vital sign and some of the implications for testing and just all the different things that can happen and can really hone women’s healthcare when we combine the menstrual cycle chart with normal healthcare practices. And I’m excited to have Nora on the show to share a little bit about her experience doing this in practice. And also Nora is one of our guest speakers, along with Dr. Jessica Liu, in the upcoming Fertility Awareness Mastery Mentorship Program. And so before we jump into today’s interview, I just want to share a little bit of background about Nora, so I’m going to go ahead and read her bio.

Lisa Hendrickson-Jack: In 2020, Nora co-founded Fertility Continuing Education, an organization that creates accredited postgraduate courses in the fields of fertility awareness, restorative fertility treatment, and perinatal care for healthcare professionals. She is a creator of Cycle Charting, The Key To Fertility, which are continuing education seminars for NDs, naturopathic doctors, along with Dr. Jessica Liu. She is co-creating the 2021 Continuing Education Webinar Chart Your Cycle, Progesterone HRT, and Fertility Optimization for Healthcare Professionals, and her publications include naturopathic treatments for epilepsy, neurology, perinatal care, how to collaborate with other healthcare professionals, and cycle charting for several naturopathic and midwifery publications. So without further ado, let’s jump into today’s interview with Nora Pope.

Lisa Hendrickson-Jack: And I’m excited to be here again today with Nora Pope. So for those of you who might be newer to the podcast, I interviewed Nora a few years ago, I don’t remember how many years ago, but I think it was episode 106 or something like that, so it was a couple years ago. And that interview was really fun because it was incredibly informative, but also because we had done it in person, and you were the first guest that I had on the show that I interviewed in person, so we actually did it in my house. So I will link that episode to today’s episode. But today we are, we’re going to be talking about using the menstrual cycle essentially as a vital sign and the implications for charting in your professional practice. And so welcome to the show, Nora.

Nora Pope: Thank you, Lisa, always a pleasure. Thank you for having me back.

Lisa Hendrickson-Jack: Of course. And so you have recently, well, you have been doing training for professionals for a long time, but you’ve recently developed and enhanced one of your training programs, and so maybe we can start there. Maybe share with us a little bit about what you’re doing now and what brought you to focus on essentially combining charting with clinical practice and supporting professionals to do that.

Nora Pope: My pleasure. I love teaching healthcare professionals. My very first talk was back in 2003 at North York General Hospital, and I was talking about drug herb interactions, and particularly how with blood thinners, what herbs you should or should not take and what supplements you should or should not take. And I mentioned drug herb interactions because I was a little naive when I was trained to become a naturopathic doctor in the 1990s. I just assumed my patients would want to come to me for natural healing and natural care, and 90 percent of my patients were on prescription medication. So we are the experts at drug herb interactions, that was our training. I closed my practice in 2019, and I’m now focusing on teaching healthcare professionals. And I got interested in cycle charting in my practice when I was seeing a lot of patients with epilepsy, and I’ve been familiar with the work of the Creighton model. I was a user and advocate of cycle charting myself in the 90s. And I remember at school at the Canadian College of Naturopathic Medicine, in 1998, no one knew about cycle charting in my class. And so I wrote about this in the Ontario Naturopathic Doctors’ Newsletter. I said, if you walked into a room of a hundred women, how many would know when they’re fertile, when they’re not fertile? And in 1998 I was the only one, it was one percent. So I look forward to the day when it’s a hundred percent. So I really believe in cycle charting as a good for society, it’s body literacy, and this is a term I really like, it was coined by Laura Wershler, who worked at Planned Parenthood. And my understanding is that back in the 70s, Planned Parenthood was very interested in cycle charting and body literacy, but I just think it’s because it’s labor intensive and maybe for some people it just wasn’t profitable enough, I think it just fell by the wayside. But thankfully people like you, Lisa, are keeping the art alive. I did additional training at Creighton University to become a medical consultant auditor, and I graduated in the NaPro Technology Auditor Program, and it just opened my eyes at the power of progesterone, the power of the chart, and how progesterone can save lives, and how little it’s used. And this was back in 2009 when I took this course. I don’t know why, but if you went on CNN and you wanted to hear people fighting, it wasn’t about Donald Trump, it wasn’t about Clinton, it wasn’t about Obama, it was about progesterone. The most violent episode I’ve seen on Larry King Live was with Suzanne Somers advocating for progesterone. She had an integrative doctor there from California and he was defending her, and then you had these other doctors screaming at her, telling her to go home and how progesterone is very dangerous. And I’m thinking, what is going on? So that was a long time ago, even so progesterone knowledge is so limited.

Nora Pope: So back to the chart. What does the chart teach you? It teaches you the woman’s days of fertility, which is, I guess, estrogen-driven, and it produces that cervical fluid, which is white flow. Those are your fertile days, and those are your estrogen-driven days. And then estrogen peaks, and then boom, the next day it’s dry, and that’s peak plus one. The day before was estrogen peak. Your estrogen peak day is that last day of slippery, or lubricative, or clear, stretchy cervical fluid. In my course I call it white flow. I’m teaching a course with Dr. Jessica Liu on it, it’s for healthcare professionals, it’s being recorded on February 26th. So you can attend it live on the 26th, but it’s recorded and people have access to the recording for a full year. And we’re trying, I’m trying to find a way to make cycle charting media friendly. You can’t say cervical mucus on TV, you can’t say cervical fluid, and you can’t say seminal fluid, which is the same thing. So I call cervical fluid and seminal fluid white flow, and our number one slogan was white flow makes babies. So that’s a big challenge, let’s make it common knowledge, media friendly. And then the beauty of it is that it’s so powerful for clinicians. Any clinician can really, really help women if they know about cycle charting and fertility awareness. So that’s why I keep doing what I do.

Nora Pope: I’ll give you an example. On my Twitter feed I just put cervical fluid equals seminal fluid equals white flow, and it got taken down for 45 minutes, and I thought, okay, here we go, and it went back up, and I’m sure they were very nervous and jittery, like, what’s she doing? And I think when you say seminal fluid, I think some producers or some individuals think it’s too graphic and they think of ejaculation and they think, oh no, that’s pornographic, we can’t go there. So I think that’s part of it, I think it’s a trigger. And then cervical mucus, it has an ick factor. So that’s why I use the term white flow, and there we go.

Lisa Hendrickson-Jack: Okay, well, that’s, I mean, I’m not going to go down that path because there’s a thousand things I could say, there’s plenty of information out there that is obviously not appropriate, so, but anyways, that’s its own thing, I just found that to be interesting. And I know we’ve talked about white flow before, and I think you mentioned something about white flow and potentially if you were to write a book one day that would probably be the title type of thing. But anyways, so one of the things that you mentioned was that in 1998, I think you said ’98, when you were basically in a room full of naturopathic doctors, you found yourself being the only one who fully understood this whole cycle thing from the charting perspective.

Nora Pope: Students. It was my first year at the Canadian College of Naturopathic Medicine, and I was the only woman in the room who knew about cycle charting, and the only woman in the room who could say with clarity and confidence, no this is not a day of fertility for me, oh yes this is a day of fertility for me. I just knew about my white flow, I knew about my red flow, and I knew about my dry days, and I knew about what the estrogen in my body was doing, what progesterone my body was doing, because I worked with someone like you, someone who was trained in cycle charting, and it took, it can take three months, it took me about six months to learn, but I’m glad I did, it was the best investment of my time, and I loved it, and I’m now spreading the love.

Lisa Hendrickson-Jack: Well, so I mean that’s really interesting, and I think that there may be, I would imagine that there would be some listeners that would be surprised to hear that, because today, so 22, 23 years later, if you were in a room full of naturopathic students, likely there would be a higher percentage, it wouldn’t certainly be 100, but it certainly wouldn’t be like one out of the entire group of people, I would imagine. And so with that in mind, though, I think because fertility awareness, it’s getting more attention, a lot more people know about it, a lot of women are really passionate about it, but maybe talk a little bit to the challenges. So one of the questions that I’ve had from professionals is kind of like, well, I went to naturopathic school, I obviously understand anatomy, why wouldn’t I be able to just teach my clients to chart? And I think one of the challenges with professionals as this knowledge becomes more available is that I feel that we tend to underestimate the notion that fertility awareness is its own silo. So being a naturopathic practitioner or medical doctor doesn’t make you a fertility awareness practitioner. So maybe share with us, you were a naturopathic doctor, you did go and learn the Creighton method for medical practitioners in addition to your naturopathic skills, maybe talk us through that and why you did that, and why, even though you were tracking your own cycles, it still wasn’t necessarily enough to support your clients.

Nora Pope: Yeah, no, I mean there’s, it’s one thing being an advocate and user, so I was taught well, and then so that was my first step. My second step was to take the Medical Consultant Auditor course for NaProTechnology, because I was getting more referrals from NaPro doctors and fertility care practitioners, and my new patients, whether they had epilepsy or infertility, were bringing in these charts, and they weren’t the textbook example. I had a textbook chart in the 90s, I think everyone was healthier in the 90s, I think the planet was healthier, who knows. But I had a very standard chart, and then I was seeing a lot of interesting charts that showed a lot of hormonal disruption, and probably it was, they’re very, very challenging shall we say. And so for me to understand why these medical doctors were prescribing certain drugs, and some of them were quite creative and off label, and to learn the rationale, I thought it would be a really good investment to learn about the medical applications of cycle charting. I’m really glad I did, and so it just brought my level of women’s health up to another level, and it gave me a very profound respect and knowledge for obstetrics and gynecology, and also a restorative philosophy. I love drugs actually, I love pharmaceuticals, and when used wisely and prudently and in a very low dose, you can restore health, it’s one of the pieces in the puzzle. And then a lot of my clients are saying, Nora, I have to go to a fertility care practitioner to do charting, then I have to see you, can you become a fertility care practitioner? So I became one, I took more training, and that way I was able to teach clients about cycle charting in sync with naturopathic medicine. So I would do a long intake and then do the cycle charting, do intro sessions, and we were hitting the ground running, and they could immediately, I could hear and see that this person could be low in estrogen, low in progesterone, these are the reasons why this could be triggering a seizure, this could be triggering their MS symptoms, this could be triggering a rheumatoid arthritis flare-up, because the beauty of cycle charting is that yes, of course it’s very powerful for making babies or not making babies, but it’s women’s health, and hormonal health is women’s health, and body literacy will help you better treat your patients. So it was a wonderful, wonderful experience. And now I find that there’s still not enough body literacy, so that’s why I want to teach healthcare professionals. So in my upcoming course I have a growing number of healthcare professionals from different modalities, some pharmacists are enrolled, a nurse is enrolled, midwives are enrolled, naturopathic doctors, and my dream is to have ER doctors and ER nurses know about the power of progesterone to prevent a miscarriage. And a study out of the UK said that if every doctor and nurse knew about progesterone in the ER, they could save or prevent up to 8,000 miscarriages a year in the UK. So the UK has a bigger population than Canada, but if you sort of do a ratio, that can mean up to four or five thousand Canadians, or mothers, not having a miscarriage, and in the States even more, forty thousand. So the numbers are quite staggering, and progesterone is not used in the ER regularly. It’s tragic, a woman’s bleeding, she’ll go to the ER, she’ll get her HCG tested and get an ultrasound, and it’s like, wait and see, and I’m thinking, no, no, no, you can give her progesterone and stop the miscarriage. So I still think there’s so much work to be done, so that’s the fire in my belly.

Lisa Hendrickson-Jack: Well, let’s talk about progesterone and hormones in general in the cycle. So a question that came to mind when you were sharing your experience, so you were already a practicing naturopathic physician, that means that you have the opportunity to work with clients, detailed intakes that take all kinds of information, so share a little bit about how the chart specifically, so I think this is a key point as well, just for the kind of general audience listening, is that there’s a difference between having someone come into your office and showing you their chart that they’re doing in whatever manner they’re doing it, versus having someone who’s trained in a specific way. When you’re wanting to use the cycle as a diagnostic tool, it’s not just like anything and everything goes, there’s certain things that you’re looking for in certain ways. So maybe share with us how that additional part of your practice changed, like you would think you had already had all the tools that you needed to assess these situations.

Nora Pope: I think what the training of becoming a fertility care practitioner gave me was a visual reminder that every woman is unique, and it demystifies the individuality of each woman. So we’re raised to learn that a typical cycle is 28 days, but what if it’s 26 days or 40, 28 days, we were taught that it’s roughly 14 days before ovulation, roughly 14 days after ovulation, but what about the variability? And one of the tenets of naturopathic care is you treat the individual and get to the root cause, and everyone is unique, which is wonderful. So when you’re cycle charting, especially when you’ve charted for about three or four or five months, what happens is patterns emerge, and even though it’s not 28 days month in month out, if it’s 29 one month or 27 the next or 31 the next, a little bit of variability can still teach you body literacy. So typically if the cycle is a little bit variable before ovulation, that’s healthy and normal, and nothing alarming about that, and if the days are stable in number after ovulation, that is a wonderful biomarker. Your book, the fifth vital sign, is a wonderful description of how the menstrual cycle shows what your hormones are doing and what your health is doing. So the variability before ovulation, no big deal, because estrogen can rise and fall a little bit before ovulation, and that means the length of the cycle may rise and fall before ovulation, and that is common and nothing wrong with that, and you’ll know you have estrogen rising in your body because of white flow, your body produces white flow from the cervical crypts, and may I add, cervical crypts are never included in anatomy textbooks, I look forward to the day when they are, so another reason why I’m doing this course with Dr. Jessica Liu. But anyway, the cervical crypts produce that estrogen-driven white flow, and then after ovulation that follicle that produces the estrogen shrinks into a corpus luteum, and you want it pumping out progesterone, anywhere, it doesn’t have to be 14 days, but anywhere from 10 to 16 days is healthy and normal. So right there, what cycle charting taught me is that variability is healthy and normal, variability will not throw you off in terms of trying to identify days of fertility and days of infertility, variability is part of the unique woman that you’re dealing with, and I get this visual charting in front of me, so people are charting with their red stickers and their green stickers and their white stickers to identify what their body is doing, patterns emerge, and you can see, okay, the fifth vital sign is alive and well in the menstrual cycle when you have about five days of bleed, red flow, no one wants to talk about blood, especially not on tampon commercials, you never talk about blood, so my company, we call it red flow, fertility CE, we call it red flow, and that’s sort of the nomenclature we’re using. And then the white flow will happen, and ideally five days of white flow is very, very healthy, and what five days of red flow, what five days of white flow means, is that your previous cycle had enough estrogen and progesterone to recreate that in the following cycle, and then after your white flow, you want 10 to 16 days before your next period, and numbers are good, numbers are good. And what I teach in my course with Dr. Jessica Liu is that you want those biomarkers pointing to a fifth vital sign, like healthy blood pressure, like healthy heart rate, you want five days of red flow, five days of white flow, and a stable post-peak phase of 10 to 16 days, and I keep drumming in those numbers. So if someone has a very long cycle or a very short cycle, look for the biomarkers, look for those biomarkers that point to your fifth vital sign. For me that is a huge teaching goal in the first part of the course I’m giving for healthcare professionals.

Lisa Hendrickson-Jack: So well, as you’re talking about it, I mean, so, you know what I do, because I teach charting, so the charting is what I do, and because I’m not a naturopathic physician or a medical doctor, I can’t imagine working with women without it, so I’m in a totally different perspective, because our perspectives are all coloured by what we do for a living, right, so you could hardly tell an acupuncturist to imagine what it would be like to try to work with a client without applying acupuncture. So I guess what I’m saying is, from my perspective, if I had a woman in front of me that was saying that she had certain challenges, in my mind I need to know what’s happening in the chart, and that’s why every single client that I’ve ever had that has gone through one of my programs, we spend several sessions getting the charting sorted out before we even can go into some of those types of questions. So maybe share with us, because I know you mentioned progesterone, and that’s a big topic, I think anyone who’s aware of, or who has charted their own cycles, or is in a group, or whatever the case is, has lots and lots of questions about low progesterone. How does the charting help to identify it, what you can do about it? And I know you mentioned giving progesterone, and so from my perspective there’s different ways of handling it. From a NaProTechnology perspective, so for those of the listeners who aren’t familiar with that, I’ll link in the podcast previous episodes that I’ve done, but briefly I’ll say that NaProTechnology, it’s essentially charting meets allopathic medicine, where the chart is quite literally used as a vital sign to inform medical testing and medical treatment, and so it’s literally done alongside the chart in a very scientific and medical way. So from that perspective, if a woman has issues with progesterone, the allopathic treatment is to give her progesterone, and there could be an argument made in some cases, when it’s not so dire, to maybe try to do other lifestyle factors and improvements to improve progesterone. Maybe you can speak to that, and how the chart helps you to figure out if there’s hormonal imbalances, and then how to kind of go about rectifying them.

Nora Pope: No, the charting is just such a powerful tool, I call it a road map for identifying your hormones, or identifying your physiology if you wish, and then identifying days to test your hormones, and then when you have those test results, identifying days when to prescribe a potential treatment, and then it’s a roadmap to monitor your progress and your prognosis. I mean it’s so multifaceted, so for instance, let’s take naturopathic medicine, so you asked about what would low progesterone look like, so there are many, many scenarios. Ideally, as I mentioned before, one of the biomarkers for the fifth vital sign of a healthy cycle is 10 to 16 days after ovulation you have that quite consistently month in, month out, and the variability should be no more than two or three days. So if cycle in and cycle out, if your number of days after ovulation is 10 days, 10 days, 10 days, 10 days, 11, 12, that’s healthy and normal. Where it gets problematic is if there’s a range, more, if it’s a difference of more than four days, so let’s say one cycle it’s 10 days, the next it’s 14, the next is six, that’s not good, that means you have irregular progesterone levels, so you want to look at that, what is your body doing. And then another thing that’s a sign of low progesterone is that you’re spotting, spotting, spotting, a few drops a day, spotting, spotting, spotting more than three days before your next period, because what that’s showing is that the lining of your endometrium is breaking down prematurely, because there hasn’t been enough progesterone to maybe maintain the architecture of that growing lining prior to your period, so that’s another biomarker, that you have spotting, spotting, spotting. Another one is a very short number of days after ovulation, so instead of 10 days, it’s six or five or seven. Another marker is that you have limited white flow, because if you have limited white flow, that means the follicle was small, it wasn’t growing to the ideal of two centimeters, 2.2 centimeters, and so you only had a limited number of white flow days. So if you had a smaller follicle, after it ruptures you can have a smaller corpus luteum, and so you start reading more and more physiology just by looking at someone’s chart. What becomes a little more robust is that you do blood tests, so when you’ve been charting for about three or four cycles, and you can confidently identify your peak estrogen day, the ideal time to test progesterone is peak plus seven, that is called mid-luteal, and it’s not day 21. I wrote an article called Day 21 No More, because I was trying to get people away from thinking of the 28-day model and the day 21 testing, so we like to call peak plus 7 in the cycle charting world. And if you’re really interested in the corpus luteum function, you want to really test peak plus one, peak plus three, peak plus five, peak plus seven, peak plus nine, peak plus eleven, and there you want to see a good healthy rise and fall, or crescendo decrescendo of progesterone, and estrogen too, you test the two hormones because they work in concert post peak. And then when you really know about your cycle, and you’re becoming very predictive, and you have a good predictive analysis of when that white flow is going to come, you want to start testing your estrogen function, or your follicular function, with peak minus 5, peak minus 3, peak minus 1, and look for the crescendo decrescendo of estrogen only before the peak. So right there, your cycle chart becomes a road map for blood testing. What I get very excited about is also that it becomes a road map for using ultrasounds. A lot of the time you’re told to get an ultrasound, a vaginal ultrasound series, to test your follicular function, to see if you are ovulating, and they usually grab cycle day nine. What if your white flow starts early, let’s say it’s cycle day six or seven, so I used to instruct my patients to go in earlier, go in earlier, and keep going in on your white flow days until you’ve had the follicular rupture, and then go in again the next day, because you want that follicle to shrink from 2.2 centimeters to 1.4 centimeters, and then you know you’ve had a healthy follicular growth and a healthy follicular rupture, and that will lead to a healthy corpus luteum. With those numbers, sadly these numbers are changing more and more, it’s very common now to see follicles grow to 1.8 centimeters before they rupture, and they’ll shrink by maybe 20 percent, so there’s been a definite change since I started cycle charting back in the 90s. So cycle charting, you learn, you see the physiology before your eyes, you start doing blood tests, you start doing ultrasounds, and then you’re getting this hard data, and whether or not, like which prescription medication you want to use, is basically based on your experience. But the very linear model is that you do progesterone HRT, and you introduce it on peak plus three to peak plus twelve, so it’s in sync with the crescendo decrescendo of the body, so that’s one strategy. Another strategy is HCG, HCG the pregnancy hormone also mimics FSH and LH function in the body, so by getting HCG injections, you can trigger the next cycle to produce a growing follicle and then a growing corpus luteum, so that’s another angle. Another angle, which I talk about in my course, is amphetamines, and this is unbelievable, who knew, but there are nerve endings in the ovary for dopamine, and amphetamines can help with dopamine function and restore fertility. Another one is low-dose naltrexone, because low-dose naltrexone works on endorphin receptors, there are endorphin receptors in the ovary, so all this to say is that there are many, many ways to restore fertility. I think why acupuncture is so interesting is that acupuncture can also work on endorphin levels like low-dose naltrexone, so there are natural therapies that can mimic the pharmaceutical therapies out there, and they can work in concert safely as well, so it’s very, very exhilarating.

Lisa Hendrickson-Jack: So can I ask a question for a moment, you’re on a roll, so I’m interrupting, but I’ve got a couple questions. So what you were talking about, the different medications, I think even before that, just to kind of go into that, so what you’re describing is a very informed medical approach, so most women who are seeking fertility treatments don’t, you know, they may be getting an ultrasound for something, but I would say is it safe to say that most women aren’t necessarily working with a practitioner who’s organizing ultrasounds around her cycle, and not just doing one ultrasound, but actually timing it and doing it in such a way that provides an arc. And so this is again kind of like the unicorn, magical, you know, NaProTechnology, where there’s this marriage of cycle charting with allopathic medicine, such that the testing is actually looking and mirroring what’s happening in your cycle, so we can determine if everything is happening normally, because one of the amazing things about charting is it gives you the arc, but the challenge is that it doesn’t give you an ultrasound, so you can tell what’s happening, but you can’t necessarily tell if it’s happening normally at a follicular level. And what you were describing were using certain medical treatments, so whether it’s progesterone or the different medications that you described, and it sounded like in the pre-ovulatory phase these treatments would potentially then be encouraging a more healthy, or encouraging healthy follicular development, such that the follicle is fully developing normally, am I on the right track there?

Nora Pope: Yeah, that’s the goal of the medication, you want, if progesterone is not enough and the couple aren’t conceiving a child, you look at other avenues, and these other avenues also timed in cooperation with the cycle include low-dose naltrexone and HCG and amphetamines, and they can restore fertility.

Lisa Hendrickson-Jack: So you did, and I have a follow-up question. So you know I’ve worked with a number of women over the years, and one of the approaches, so outside of the context of a doctor who is trained in the cycle, one of the common approaches when women are trying to conceive and it’s not working is to simply prescribe something like Clomid, or something like that, but with the idea that it’s going to produce a stronger ovulation. Do you have comments on that, is that a thing, that trigger drugs, that the fertility treatments are causing a stronger ovulation? Because I’ve often had the question, as a fertility awareness educator, when you can see a woman is ovulating every single time based on her cycle, do we need to have this, does it really cause a stronger ovulation, is there credence to this?

Nora Pope: Well sure, I think Clomid is being used, I just from what I’m observing, is being used less and less in fertility clinics, but it’s all about the dosage. I think 10, 15, 20 years ago, too much Clomid was given, and creating and stimulating too many follicles, which was endangering the health of the mother. So in the natural world they’ll use a lower dose Clomid, much, much lower dose, like sometimes as low as 10 percent, and the goal is to have a mild jolt in the ovulation, and now more and more clinics are using other medications like letrozole to help trigger ovulation as well. So yes, more Clomid, more follicles developing, more ovulations, more danger, less Clomid, less danger, and you want to have ideally one follicle in a perfect world, so I think that’s why I like the natural way, is that they use low doses, and the goal is to restore fertility. So I think that’s important.

Nora Pope: Well, and then you mentioned that in acupuncture there’s a different mode of treatment, in some cases you’re able to get similar results, so from a naturopathic perspective, are there ways to support the body to produce stronger, healthier follicles on its own? Sure, I mean, when I’m talking to my peers, they have a mixture, their patient population is either going through IVF or can get pregnant naturally, and so there’s a real mixture, so there’s all kinds of ways to restore health in the body, and I want to talk about acupuncture, I’ll tell you why, because it’s bugging me that the acupuncture textbooks use a 28-day model, but you can tailor the acupuncture, and more importantly the herbal medicine and the diet recommendations, you can time that with the cycle. And if I may, I just want to touch briefly on that, that in TCM they divide up the cycle in a 28-day model in four phases, so phase one is the period, and then phase two is day seven, phase three is ovulation, like day 14, and phase four is day 21. And we tweak that in our course at fertilityce.com, we tweak that basically we use a pre-peak phase one and two strategy, and then we use a peak or phase three strategy, and then we use a post-peak phase four strategy, and you tailor that to the woman. And so acupuncture is not really enough in itself, I think you need to support the woman with the proper diet to support her yin organs if you wish, and you need to time the herbs with what the cycle is doing. So in phase one you want to help with a good period, a good red flow, to make sure that the lining of the uterus is getting a fresh start, and then in phase two you want to help follicular function with certain herbs and diets as well, and just very generally in kidney and very broad strokes, but there’s also a spleen picture, a liver picture, a lung picture, a heart picture that you want to address as well in Chinese medicine, which is also supported with diet and botanical medicine. And then peak, or ovulation, is another phase, and the woman can use her chart to time the diet and the herbs as well, and then phase four, post peak, you use the chart again to time the diet and the herbs. So even though I’m talking about Chinese medicine and acupuncture, it’s really world medicine, because you’re using botanicals, herbs, foods that have been around for millennia, but I’m tailoring it to the woman’s individual cycle, and the goal is to restore health, and to really ensure a healthy follicular function, healthy follicular rupture, healthy conception, and healthy implantation.

Lisa Hendrickson-Jack: Well, and when you break it down in this way, so for all of you who have been listening this whole time, and I’ve been kind of following along in our conversation, you really get the picture. So the cycle is an integral part of what’s happening with women, so if you’re working with women and with hormones and you don’t have the cycle as a picture, from my perspective, and this is my perspective because of what I do, I couldn’t imagine trying to understand what’s happening hormonally with a woman if you don’t have this information, because the only way to really see that picture is through charting. That’s pretty much it. And along those lines, if you wouldn’t mind touching a little bit, you mentioned earlier about arthritis and epilepsy and how that was kind of one of the things that drew you to it, and how it relates to the cycle. And I’m sure that there are plenty of listeners who are kind of like, what do you mean epilepsy is related to the cycle, could you share a little bit how the cycle and the chart, like what does that have to do with those illnesses?

Nora Pope: Sure, in some scenarios, not all, but for some women, if they have low progesterone, it can bring on a seizure, and so by cycle charting you can see quickly if the woman could be low in progesterone, so does she have spotting before the period, is the post-peak or post-ovulation phase shorter, does she have PMS, and all these can point to low progesterone. And of course you want to do the cycle charting with a trainer like yourself, or a fertility care practitioner, or a Sympto-thermal method practitioner, and then you want to time the blood test, and then you want to evaluate the levels and see if HRT progesterone is warranted, or what are some of the other modalities that can help, like for instance stress, when you’re making a stress hormone in the body, or cortisol, to modulate stress, it’s going to rob some of the raw materials to make progesterone, for instance. Or if you have very dry cycles, if you have limited white flow, your body not only is not making enough estrogen, but it’s not going to make enough progesterone in the next cycle. So in the past I had many patients with MS who would get miscarriages because they just didn’t have enough white flow, didn’t have enough progesterone, and would miscarry, and in some cases if you give progesterone to women with MS, they have fewer flare-ups, for instance. And the same correlations happen, or I’ve seen with women with autoimmune conditions like rheumatoid arthritis and lupus, they’re low in progesterone, and progesterone has wonderful immune balancing properties, so it’s not surprising that someone with an immune or autoimmune condition would benefit from and get symptom relief with progesterone. And there are of course natural ways to restore progesterone too, so again, managing stress, taking anti-stress herbs, protein at each meal, balance your blood sugar, support your adrenals and your thyroid, because they all work in concert, the ovary, the thyroid, the adrenal glands all work together, and you want to support all the organs in the body. Of course let’s talk about the liver, the liver makes the hormones, you want to support the liver, you want to support good digestion, because digestion is very important for the immune system, TH1, TH2, so I could go on and on and on. I think when you take a whole-person world view, when you look at your patient, you’re going to look at, it’s not just the ovary, it’s not just the hormones, it’s all the body working together. So autoimmune conditions, epilepsy, MS, very interesting correlations between low progesterone and worsening of symptoms, so absolutely progesterone in the brain is very, very important. And so that’s why, I mean, I have no children, I have never been pregnant, but I loved cycle charting, I just knew I loved knowing what my body was doing, so even though I do a lot of fertility work, or I have in the past, I don’t have a reproductive agenda, I have a health restoration agenda, that is my agenda, I want to restore your health with cycle charting, I want to really present the idea, like you do, Lisa, that it’s the fifth vital sign, like your blood pressure, like your heart rate, and your respiration, it’s your menstrual cycle. And by learning body literacy and hormone literacy, you can take charge of your health and use your cycle chart as a road map to time your blood test, time your ultrasounds, time your treatments, and then monitor your progress.

Lisa Hendrickson-Jack: So I feel like to women and everyone listening who has never done this in practice, or who hasn’t thought of it this way, it seems very novel, so when we’re talking about it, it feels like this novel thing, but if doctors didn’t take blood pressure readings, and you and I were talking about blood pressure and no one had heard about it, it would seem very novel as well. And what’s interesting and ironic is that you mentioned that you have your hopes for someday everyone understanding all of this, and teaching doctors and all those types of things, and it would just be a different world if this was just a standard part of how it was done, and it wasn’t novel, if everyone just knew about it and it was just how things were done, because we understood how the female body works, and we just did it. And that’s essentially what you’re talking about, so it’s only novel because they don’t do it, but it really should just be, hopefully it’s clear from our conversation today, Nora, but it should just be a part of standard practice.

Nora Pope: I agree, I agree, no, I gave a talk at the Toronto French School, and the science teacher, I did a career day, I was talking about working as a naturopathic doctor at the time, and working as a fertility care practitioner, and yay, I was able to teach human reproduction with cycle charting to their biology class, and that’s when the white flow hit me, because the first class I had was I think 10 girls, so I was talking about cervical mucus, cervical mucus, cervical mucus, and then the next class it was 10 boys and two girls, I go, hmm, so there was a slide on just seminal fluid, bing, and that’s when it hit me, white flow, boys make white flow, girls make white flow, isn’t that beautiful and special, and that’s how I was able to unite the whole concept of combined fertility between boys and girls, or men and women, and I love teaching that class, and by teaching I become a better speaker, a better educator, and so that’s why I love teaching, and I’m so glad I did that. But it’s not taught in high schools, it’s not taught in grade school, and it’s the cervical crypts that make the cervical fluid and the white flow, it’s not in an anatomy textbook, so we have our work cut out for us. But I just want to shout out Dr. Margaret Duane, she has a program on fertility awareness at Georgetown University, so it’s happening slowly, it’s happening slowly, but I wish it was more well known, so that’s why I’m teaching healthcare professionals at fertilityce.com.

Lisa Hendrickson-Jack: Yes, well, I am, when you said that the cervical crypts are not in any anatomy textbook, it’s interesting because, as you know, the third chapter of the fifth vital sign is the cervical mucus chapter, and what I hear most from professionals is like, what is this, I never heard about this, I never knew about that, and it’s completely ridiculous, and I often think that if I had gone to medical school, and depending on where, paying tens of thousands of dollars, I feel really frustrated to discover that there’s this incredible part of anatomy that isn’t even talked about. So, Nora, you have a program coming up, and you mentioned that it is recorded, can you tell us a little bit about the program? We talked about obviously some of the topics that you cover, who it’s for, talk a little bit about the CE credits for professionals, and the website, and all the things.

Nora Pope: Sure, so the course is being presented live on February 26, 2021, and then it’s being recorded, so you can access it any time you want until 12 months after, till February 2022. It’s six hours, it’s been accredited for two hours of obstetrics in Oregon for Oregon naturopathic physicians, it’s been accredited for two hours of pharmacology for North America for naturopathic doctors all over North America, and then another two hours of general naturopathic and TCM practice, so it’s a total of six continuing education credits, it’s co-presented by myself and Dr. Jessica Liu, the website is www.fertilityce.com. And it’s divided into three parts, part one is the obstetrics or cycle charting part, and it’s how you use cycle charting for women’s health and maternal-based care. One aspect I love is calculating due dates, I think that is very, very exciting, the convention is that you calculate a due date from the last menstrual period, but what if you have a really long cycle, or what if you have a really short cycle, then that’s an invaluable metric, so by calculating a precise due date you can really ensure positive birth outcomes, so that’s one nugget that I really love about part one, but we want to really learn about the biomarkers and the fifth vital sign of white flow and red flow, and then how to time those blood tests. Part two we go into ultrasounds, and basically using the white flow, look how the ovary changes, the cervix changes, the lining of the endometrium changes, peak near ovulation, post peak, so you’re gaining real physiological function in a visual medium like ultrasounds, so what looks like blurry gray images, you’ll see this is black, this is white, this is gray, and this is what it means, so I talk a bit about that. And then I talk about the pharmaceutical options that are timed in cooperation with the cycle, like progesterone, that are timed in cooperation, pre-peak and post-peak, some are taken every day if need be, like metformin, metformin can restore fertility in some women, and then I talk about drug herb interactions, about the herbs and the nutraceuticals that you can take safely that will increase the efficacy of these pharmaceuticals, so that’s part two. And then part three I go into a deep dive with Dr. Jessica Liu on traditional Chinese medicine, tailoring the four phases of TCM into the woman’s individual chart, and how botanicals, nutraceuticals timed in cooperation with the woman’s chart can help restore her fertility and help ensure a positive outcome, and we also go into the research, because there’s new research every day about what works and what doesn’t work, sometimes certain nutraceuticals get a lot of good press, and sometimes it’s warranted and sometimes it’s not, so we want to really develop good critical thinking skills. But what’s really at the heart of all six hours is the chart, the chart, the chart, start with the chart, the woman’s chart is her road map to learning about her physiology, giving her body literacy, giving her hormone literacy, and timing those blood tests, those ultrasounds, that medication, that acupuncture, that botanical medicine, that diet therapy, and really it’s a restorative model, and that’s who we are, me and Dr. Jessica Liu at fertilityce.com.

Lisa Hendrickson-Jack: Well, and I’m very excited to have you, you’re coming in as a guest speaker into the upcoming Fertility Awareness Mastery Mentorship Program, you and Jessica, and this just gives kind of a sample of, I mean with the program that you’re doing with Jessica, it’s a six-hour day-long intensive program, and I think that just speaks to the application of fertility awareness as its own kind of silo. And I always talk about, in my perfect world, women would fully understand and be aware of the fact that when you’re dealing with specific health challenges, particularly fertility challenges or whatever the case may be, hormonal issues, that often we need to have different practitioners. If you have an issue with your thyroid, you will benefit from working with someone who specializes in that area, and I think it just speaks to, in many ways charting is quite simple and straightforward, and in many ways it’s complex. What you said at the beginning of the call was that when you were first working in your practice, you saw a few vanilla, regular cycles where everything was normal, but when you’re working with, I mean people come into your office when they are not feeling well, and so when you’re working with women in the real world, the majority of the charts that you likely see are not going to be perfect and optimal, and so the support that you’re providing, and the education that you’re providing, it allows practitioners to understand what to look for, and also what to prepare yourself for what you’re going to see, because I think a lot of women go into this thinking that they’re going to see clients with charts like theirs, and what I can tell you is most of my clients don’t have charts like mine, because it’s kind of like expecting to be a doctor and seeing people that are in the same level of health as you.

Nora Pope: Yeah, no, it just, you need some charts, especially with autoimmune patients, they have constant discharge, and it takes a bit longer, but then eventually you can’t find their peak day, and then by reducing the inflammation you can help restore some of their health too. So yes, there’s some charts that are just very chaotic, but you stick with it, and you see changes, so it’s a good challenge to have.

Lisa Hendrickson-Jack: Well, Nora, it was a pleasure as always to have you on the show, thank you so much for sharing your wisdom and your knowledge and your passion for this topic, and I just know this episode is going to be quite popular with women professionals and otherwise, because of how much information you shared with us, so thank you so much.

Nora Pope: Thank you, Lisa, and thank you for all your work in promoting fertility awareness-based methods, I really appreciate it.

Lisa Hendrickson-Jack: Thank you for listening, if you enjoyed today’s show please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/351. I hope that you enjoyed today’s interview with Nora, it was such a treat to have her on the show and to dive into the practical ways that you can use the menstrual cycle as a vital sign in your professional practice. And of course this is just the tip of the iceberg, because there is so much more to know about this topic. With that said, I hope you have a wonderful week or weekend, whenever you are tuning into today’s episode, and of course, as always, until next time, be well and happy charting.