Ashley (00:00)

Welcome back to the Hormone Harmony podcast. I'm Ashley Wheeler, nurse practitioner at Thrivelab. And today we're talking about one of the most important and misunderstood chapters in women's health, perimenopause. Joining me is Dr. Mariza Snyder, bestselling author of the Perimenopause Revolution. She's here to help us unpack what's really happening during this stage and how women can feel empowered, not limited by it. Dr. Snyder, welcome. Would you mind introducing yourself?

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Dr. Mariza (00:26)

Yeah, so I'm a women's health and perimenopause and menopause expert. I've been taking care of women for over 17 years in clinical practice, and I am an author of nine books. This is book number nine for me, The Perimenopause Revolution. I am a podcast host and more importantly, I'm a mama like I'm a mom to the most beautiful little four year old. And I am in perimenopause. I think that's important to note.

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Ashley (00:54)

All of those pieces fit together so great. And I love the mom thing, right? Because during motherhood and just struggling through these multiple stages of life, like when the perimenopause kicks in, it's like, now not only are you managing yourself and your feelings and your symptoms, but now you have to be there for your kids and for your spouse and all these things. So that's amazing. I didn't know that you had nine books. So absolutely.

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Dr. Mariza (01:10)

Yeah, nine book babies. I have nine book babies and one real baby. And, you know, I've birthed two baby, two book babies while I've had my son. And so this being number four. And I'll tell you, launching the last book when he was four months old was a whole lot easier than doing it when he was four, because he loves he negotiates with me on all the things, particularly my being away.

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Ashley (01:20)

I love that.

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Dr. Mariza (01:42)

You know, he wants to know how many FaceTimes and how many nights I'm going to be away. And just a lot of, a lot of negotiation in the process. And it's been, it's been interesting to, to have this book out in the world while I'm also trying to show up as the mother that I've always wanted to be and that I strive to be.

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Ashley (01:50)

Sure, yeah, that's a struggle. I think most women can relate to that. It's difficult managing everything, but obviously you're doing a stellar job at it, so yeah. That's awesome.

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Dr. Mariza (02:10)

I'm trying. Yeah, I just got home yesterday. We got him to school and we are taking him to Disneyland tonight. We don't live very far, but so he's excited to do Halloween Disney. This is when we're recording this. so, yeah, just trying to like, you I got podcasts all day today and then I'm packing up the Mickey ears or the Minnie ears and leaving for Disney.

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Ashley (02:33)

I love that we just did that a couple of weeks ago with family. Yeah, it was really fun.

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Dr. Mariza (02:36)

Yeah, it's so fun. It's fun, especially when it's decorated. So, yeah, I'm excited to talk about this and to talk about why we need this revolution, why I'm so grateful that we're having this is having a moment. You know, menopause has been having a moment for a little bit of time. And mind you, I think these should always be a moment. It shouldn't just be like, OK, you know, flash in the pan like this is an inevitability for every woman. At some point, we're going to get there. And it's such a profound transition that it's due its respect, you know?

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Ashley (03:13)

Absolutely, a thousand percent. I couldn't agree with that more. What inspired you to dedicate all of your work to women's hormone health? What was the starting point?

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Dr. Mariza (03:24)

Yeah, I had chronic migraines. Actually, I have a migraine today. I woke up with, well, I had one yesterday. I was interviewing with Gabby Reese. I had flown in from Austin and I hightailed it from San Diego to Malibu. I think I just, you know, like life just adds up and I'm prone to migraines. I started getting them when I was seven years old. And because of that, I missed out on a lot of life as a child. I missed out on sleepovers and I didn't even miss school and I was very astute. I loved school. I just felt like, you know, it was hard. And when I started getting my cycle, when I started getting my period, they became worse. I had menstrual migraines on top of the other migraines. And I remember every neurologist and every doctor that I went to was just like, this is your lot in life. You're going to have migraines and you're going to be on drugs. That is that. It was, I was like, really, this is awful. And so I remember it was really from the through line of how do I ensure that other girls, particularly, like I had done the research even when I was a teenager and in college, I knew that 70 to 80 % of migraine sufferers were women and that they often, know, the onset were during major hormone shifts.

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Whether that was puberty or second puberty, right? Perimenopause. A lot of women who've never had menstrual migraines or migraines before start to have them in perimenopause. I go to, become a doctor. I have a migraine, predominantly migraine and pain-based practice. And what ultimately, as a result of that, majority of my women were in midlife. And they were in perimenopause and menopause. That was a majority. And I had younger women as well, but mostly I would say 85 % of my practice was women in midlife. And what I saw was that many of the women in my practice were being slotted into multiple specialties. They had a cardiologists for those palpitations and the arrhythmias. They had a psychiatrist because their mental health related symptoms of perimenopause were misdiagnosed and they were put on SSRIs. They were seeing endocrinologists because other autoimmunities were popping up. And so I was just like, wow, we are siloing women in so many different directions. We're missing something here. At the same time that this was happening, my mom was 48 years old. I was 30, she was 48. She had me when she was 18 years old and she was going through perimenopause and we're talking late perimenopause at this point. We had come, everyone had misdiagnosed my mother in the beginning, you know, in early peri because she still had a regular cycle. Maybe it was changing, but still this was very much the mind, the mindset and the narrative, um, in, medicine at the time and still is very pervasive today was that, you have a cycle. It's not perimenopause. You're too young. So by the time my mom was 48 years old, she was having crime scene periods. So we knew at this point that this was perimenopause, but she was also having rage and a lot of mental health issues. She was struggling with low mental energy, physical energy, weight resistance. I mean, a lot of the kaleidoscope of symptoms that we see in perimenopause. And by the time she talked to me about it, she really, because she was really concerned at the time, she really did not feel like herself anymore. She had been to multiple doctors and she had been dismissed. Multiple times. And so I got a front row seat to my mom's perimenopause journey and it was disruptive. I watched my mom shift significantly from who she was into a shell of herself. And that was when I was like, we have to do better. And so I think at the time I had so many women in my practice in peri, my mom was in peri, but I just knew it was hormones. I knew we were missing the boat in so many ways. Well even before perimenopause. And that was when I decided that I was going to dedicate the rest of my life to supporting women, not only in perimenopause, but with, our hormones. It just happened to be that majority of my women have come to me when hormones are declining.

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Ashley (07:49)

Yeah, and you know, it's like those personal situations that really just grasp your heart and really show you what you're meant to do in life, right? I have so many patients that see me every day and they say, you know, I've had these symptoms for so long and I've been either dismissed or I've been sent to all of these different providers in different specialty areas to try to rule out other causative factors and or they've been to their gynecologist and the gynecologist says, well, you know, this is perimenopause but, you know, you'll get through it, you'll get over it, it'll be fine. Maybe slap a little bandaid on it and that's all. And those are the types of patients that I run into all the time, so I can completely relate to your mission. And it's amazing to see outstanding outcomes with hormone therapy during all cycles, really. I don't know how much you deal with, I know you said you had a variety of ages, but through perimenopause and even through younger ages, it's just amazing to see the transformation and just. I love how you use the analysis of your mom being in the shell of herself, right? Because that's what I hear a lot, like, just don't feel like myself. I really don't even know what's wrong, but I just don't feel like me. And that hits me to the core every time when I hear that, I'm like, I want to make you feel like you. So inspiring. I completely get that. Why do you think perimenopause has been such a neglected conversation in health care?

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Dr. Mariza (09:14)

Hmm. I love this question. I think number one, perimenopause and a lot of the symptoms around perimenopause are very subjective. And so it's very easy for us to ignore easy to tell women that it's just aging or it's just motherhood or you have too many plates in the air. And also I think we just didn't understand. It's not an area that we really looked at closely. You know, when it comes to menopause, it's pretty, it's pretty identifiable. Where you haven't had a period for 12 consecutive months, if you haven't been on hormones or hormonal birth control, right? Like, you know, there's obviously, would, I'd like to, you know, I'm on HRT right now and I always, I always kind of joke with my friends and even colleagues that I don't, I don't really need to know when I go into menopause because I'll be on HRT. But let's say you're not and, and you don't, you know, you don't have a period for 12 consecutive months like that. We can, that's visible. That's a physical, like we know that benchmark, right? And so that we could identify that. And when there was some pretty clear symptoms that were disruptive and identifiable, things like hot flashes and night sweats, vaginal dryness, we think about those classic menopausal symptoms. And so we had medications for those. But the thing about perimenopause, because it was so subjective, often very brain related symptoms, we could write those off as something else.

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And so we just didn't believe women really when they came to us. And we really also were under the standpoint that only difference between women and men were the parts along the bikini area, right? Bikini medicine. And so if your menstrual cycle hadn't changed and you didn't have these classic symptoms of menopause, well then either you were making it up or you're crazy or you just you were just a woman traversing the landscape of womanhood. And so that's the reason why I think perimenopause was written off. Just there wasn't very clear ways to identify and diagnose it. And that's what makes perimenopause so elusive for so many women and for so many providers, even women, you know, the subtle symptoms of early perimenopause. Gosh, I go tell you my, my, my patients can easily talk themselves out of it.

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Ashley (11:18)

Yes, I just had this happen earlier today with the patient. She was like, you know, well, have a little bit of this, but this could be due to this. And I have a little bit of this, but it could also be due to this. And you have to have that conversation of, could it be due to this or that? Sure. Could that be exacerbating the symptom? Sure. But until we try it, like, you don't know how life changing it can be. And ultimately, she was like, that's exactly what I was thinking. And I'm like, that's a win because you're right, they talk themselves out of it. They think that there's all these things going, yeah.

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Dr. Mariza (12:03)

I did. Yeah, I talked myself out of it. I was like, oh, I'm just, because I had my son at 41, so I was postpartum. I was postpartum until I was perimenopausal. And so I was like, is this postpartum? Is this my thyroid? Am I burned out? And so I was like, oh, no. And yes, I always say, as a mom, I read Dr. Becky's Good Inside, and she talks about two things can be true. And she talks more so about boundaries. Like you can hold a boundary and still like regulate your child. But two things can be true in perimenopause. You can have all of these underlying symptoms and your hormonal protective shield can be faltering. You know, because I think that's what happens with peri is that we were, those hormones were holding it down. They were holding down the insulin resistance. They were holding down the weight resistance. They were holding down so much. And then as they begin to falter, all of a sudden these symptoms become, they present or they get exacerbated. But in the beginning, it's easy to write them off as something else. So I always say two things can be true at the same time.

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Ashley (13:02)

Yeah, absolutely. And I think that's like kind of why a lot of women misunderstand this stage of life, right? They see all of these, they have so many things on their plate. They have children, they're going through all the things with sports and physicals and keeping up with the Joneses with their house and their job and it's just often so overwhelming and then it's like, well I have fatigue but it could be due to this and they dismiss it and honestly because there's under education in the medical field as a whole with perimenopause, I feel like that contributes a lot to the misunderstanding for women as well.

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Dr. Mariza (13:41)

When your doctor's like, it's just your this and you're like, yeah, that's what I thought. And then it's ignored. Yeah.

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Ashley (13:47)

You trust your provider. Absolutely. So I guess kind of digging into this a little bit more, what are some of like the most common signs of perimenopause that women might be overlooking when we're talking about this?

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Dr. Mariza (13:59)

Well, let's break down perimenopause in terms of phases very quickly. So let's break down even kind of the before perimenopause, which I would call late reproductive. And Ashley, you probably take care of women in late reproductive. These are women who, they are potentially having some anovulatory cycles. And this is from the standpoint that we're thinking about women where ovulation is the main event. Ovulation is the main event. So we know that on the back end of ovulation is where we make progesterone. That progestation hormone, because whether you like it or not, whether you want to or not, your body is prepping for pregnancy and conception every single month. That is the main operation going on. So progesterone is there so in case you did get pregnant, that it could maintain that pregnancy. And what happens if we have, let it go, it's not just not as robust ovulation. We step into, you know, mid to late thirties, our progesterone levels just may not be where we would love them to be. They just may be lower than normal. And there's a lot of other reasons why this can be. Stress can be compounding this, metabolic issues, insulin resistance, low thyroid function. Again, a lot of these other things can be playing out as well. These were a lot of things for me in my late thirties where my low progesterone levels were due to a number of other factors. I actually used progesterone to get pregnant with my son at 41 years old. And so as a result, you may notice lower stress tolerance. PMS symptoms are more exacerbated. You may notice in that luteal phase, you know, mood swings are just a little bit more pronounced in that late reproductive. This is maybe, again, you're walking towards perimenopause, but not fully there. And life circumstances or lifestyle situations could be the driver of a lot of this as well.

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Ashley (15:48)

Yeah, absolutely. I agree. See those same things, you know, day to day with my patients as well. Digging deeper into this book, and I guess like all of your books, because I didn't know this before today and I'm just so impressed. What strategies from this book can help women navigate the transition with like more ease and confidence and just strengthen this?

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Dr. Mariza (16:06)

I think for the first time, initially it's awareness. I think awareness, understanding your body, becoming the CEO of your health. We're entering a time of bio-reservability and I would say, I would even argue that women were the ultimate first biohackers out there because we really had to understand our cycle. The follicular phase, ovulation, the luteal phase, and even if you didn't really understand what the phases were per se, you understood that your body was changing every single month.

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And as we move into that late reproductive stage and into early perimenopause, we can really notice a lot of things from that monthly report card. So that first step is tracking your cycle, tracking your symptoms along your cycle. So I think, you know, if anyone knows their follicular phase, you get done with your period or your periods winding down, and all of a sudden you start to feel like yourself again, right? You get that early estradiol peak, not, I call it peak, but like a rise.

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And that's like day five, day four for some women, maybe day six. And you're just like, okay, all right, I'm feeling myself. Like I get this. Yeah. And then day 11, day 12, I always joke that everybody loves day 11 us, day 12 us, where you get that estradiol peak so that you can get that LH surge before ovulation. And this is where we are, we feel the most sensual, we're the most connected, we wanna be out, we're alive. We just feel really, really good. And that follicular phase can feel good overall. We have ovulation, we step into the luteal phase, and this is where I think it's important in early premenopause and even late reproductive. It's just to kind of feel how we're feeling. Usually many of us feel really good those first couple of days of our luteal phase, but see when things begin to shift. Like when do you feel like you need to go more inward? When are you getting rage-y? Do you feel the mood swings? The low stress tolerance, the low mood? Does life feel insurmountable? All of a sudden you don't feel like yourself anymore?

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The more that we understand what's going on with our cycle and maybe day five where we're supposed to feel that little estrogen boost, maybe it's lackluster. Like I've had, now that I'm in perimenopause, I'm like, where'd it go? Why isn't it showing up anymore? Why does day five still feel like day two? So I think it becomes really important when we look at our cycle and we look at the symptoms along our cycle. Is this, does this feel like our typical normal or is our normal shifting? Yeah.

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Ashley (18:27)

Sure. Yeah. And I love that you mentioned like just tracking cycles. So one of the like my favorite things is if I have a patient get on a visit and they're like, so I have this app and I have all of my cycles, you know, jotted down in this app. And also on the side notes, I have what symptoms I was feeling when and when they got better and when they got worse. And I'm like, I love you so much. It's like the best thing in world. 

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Dr. Mariza (18:49)

Mm-hmm. That gives us so much insight into what is going on, especially in the beginning of perimenopause, because again, it's easy to gaslight yourself. Yeah.

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Ashley (19:00)

Yep, it really is. And honestly, when they start seeing trends, it's like, okay, now I get it. Now I'm picking up on this. So that just does like a wonder of things for getting the treatment like kind of dialed in from the beginning, honestly, and not having to make so many changes and just getting the patient more aware of what's happening, right? They see the trends and especially when you start them. Yeah.

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Dr. Mariza (19:19)

Absolutely. Yeah, you get to understand your body. 

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Ashley (19:24)

Yeah. Once they get started on these medications, the bioidentical hormone replacement, whatever they're using, then they start to, you know, well now on days, you know, so and so through so and so, I'm not having sleep disturbances or I'm not having the mood swing. Yeah, exactly.

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Dr. Mariza (19:35)

I know. I just put my new estrogen patch on. I was a day late and I was like, let me get this sucker, I just want to go back. I didn't have migraines for a while. I was able to get my migraines under control. And then I, when I got pregnant at 41, they came back with a vengeance, which is so fascinating because most women, that's usually a time where they won't have migraines is when they're pregnant because they're flush with estrogen. And ever since then I've had them and I've been helping to mitigate my migraines with HRT. And I ran out of my oral micronized progesterone, this luteal phase halfway through. And I was talking to my, I have someone managing my, I could manage them, but I have someone, it's always nice to have someone help you out.

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Ashley (19:52)

Yeah, absolutely.

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Dr. Mariza (20:15)

So I called them up and I'm like, I am out. Like I'm out of progesterone. And so we were trying to get a renewal as fast as possible, prescription renewal. Because I can feel like I'm just more prone to migraines when I don't have that immune system modulator coming in and helping to manage some of the neuroinflammation. That's why I love progesterone so much. 

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Ashley (20:38)

Love progesterone and sleep, there's just so many great benefits. But yes, the migraine thing, have many patients that really struggle when they run out or they forget it or there's something going on that prevents them from having it with the of the re-impulse of the migraines. So I definitely see that quite a lot. Talking about migraines and all of that, it kind of brings and cognitive function. Can you describe how perimenopause affects those things? That's a big question that I get asked.

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Dr. Mariza (21:04)

Absolutely. Yeah. And I think women are looking for validation, right? They're like, what's going on with my brain? Something's going on with my brain. And I'm like, absolutely. Something's going on with your brain. Your brain is in a neuroendocrine transition. We're talking a profound, think about a house remodel. That is what's going on with your brain. Your brain is in a massive remodel. And the reason for this is that your brain is reliant on these hormones binding to receptor sites all over the brain.

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When we think about estrogen, I want you to think of it as your master CEO of the brain. And when she stopped showing up for work without slacking you or texting you or voice memming you, like you're, you're trying to scrabble and figure out like, how do we make this, how do we make this company run without her? And, and that's the thing. And it's not that she doesn't just show up. Like she inconsistently shows up. She comes and goes as she pleases. And she's never done that in 30, 30 years, give or take. And so.

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The brain's having to figure out what we're doing and you have to understand that estrogen has a profound impact on neurotransmitters like serotonin and dopamine. Progesterone really impacts GABA receptors. Testosterone, right, builds you up hormone. We can feel that in terms of our motivation, our confidence, even our cognitive function. So you have to understand when these hormones are declining, they're not declining in a linear fashion, in a subtle fashion. It is erratic.

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The brain is doing its best and what we see is we know that we see a decline in gray matter of the brain. We see a decline in energy metabolism up to 25%. Could you just imagine 25 % of your energy was just stripped from you for almost a decade? It's no wonder we can't remember what that word was or we don't know why we walked in a room or we don't feel as alert. Have mental stamina and energy, there's a reason for this. You know, we're seeing a decrease in energy metabolism. The way that we utilize glucose isn't as efficient. We see more increased insulin resistance, particularly in the brain. And we see also, we see an uptick in neuroinflammation as well when we start to lose these hormones. And so it is a real and it is a profound experience and it varies from person to person. But I would argue, you know, we always say that it's about 80 % of women that experience neurological symptoms in perimenopause, but from my clinical experience, it is close to 100%.

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Ashley (23:32)

I was just going to say the same. I would say that pretty much every female patient that I have in that stage has had some sort of cognitive impairment of one shape or another. And that kind of leads me into lifestyle factors, nutrition and movement and sleep and stress management and exercise and all these things. How do we help use these things, these aspects of life to balance in perimenopause? Do we change things? What do you recommend whenever people go to that?

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Dr. Mariza (23:59)

I don't believe in half solutions. I want the full solution. I believe women deserve the best of everything, not the least of things. And so in part two of the book, I go through all of the most profound principles that I think are going to move the needle in a really great way, including hormone replacement therapy. That is one of the principles.

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But movement, gosh, movement can mitigate so many of the symptoms that we're dealing with, particularly the neurological and the mental health related symptoms. So movement's gonna be a big part of this. But more importantly, I want women to be thinking about when it comes to their brain is how do we fuel our brain? If we know that our brain is experiencing a bit more inflammation, we notice that we know that we're gonna have a decline in energy metabolism, how do we create more stable blood sugar?

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How do we ensure that we are giving our brain the right micronutrients and macronutrients to actually function and thrive? And so that's gonna be the first two pillars of this book. It's gonna be how do we balance our blood glucose? Because it's a powerful barometer for our overall cellular energy and mitochondrial function. But also it's how we fuel our brain. If we don't have good stable blood sugar, we're gonna see these energy deficits in our brain.

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Next, it's going to be, well, how do we build a plate? And I always want women to be thinking, is what I'm eating right now going to fuel my future brain? Is this what I want my brain to be made of? You know, that's the question. And so how we build this plate, and I give all of these very practical ways to be thinking about how do I increase my fiber? It's something, you know, it's one thing to say, I want you to eat 25 grams of fiber a day. That's not helpful.

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Ashley (25:23)

Nope, not at all.

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Dr. Mariza (25:41)

Not at all. So how do we do that? Like, how do we sprinkle in more chia seeds and ground flax seed into our smoothies? You know, how do we integrate more legumes and seeds and blueberries and fiber into these salads? Like, how do we get creative? How do we stock our pantry in a way that we can just sprinkle these things on in a much more easy and effortless way? And so the book is very practical in that way that I want to show you. Not just how to do it, not just tell you to do it.

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Ashley (26:12)

Yeah, yeah, and absolutely. I think like with nutrition, you know, oftentimes we're given like macro guides, right? This is how many based off of your body weight, your BMI, this is how many grams of protein, carbohydrates, know, fats that you should have. And that's a great baseline if somebody really is going to sit there and put everything into an app and track it. But realistically, like you said earlier, we're moms, we're business owners, we're busy, we're wives.

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Dr. Mariza (26:22)

Yeah, I would love, like I didn't this book is available in hardcover and on Kindle, but it's it's on audio because we're moms.

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Ashley (26:42)

Can like listen to that on my daily commute. Okay, okay.

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Dr. Mariza (26:45)

Exactly, exactly. I don't have to, I mean, it's, I love books. I read a lot of books, but it's such a luxury to read, you know, to actually read a physical book. And so I, I'm an audio book mom, like as we drive, I'll be listening to a book as we drive to Disney today and back, because like getting where you fit in. And so, yeah, I just want you to know that so much about this book is about being practical.

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Ashley (26:57)

Sure, it is.

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Dr. Mariza (27:10)

Like how do we integrate this practically into our lives? How do we habit stack on top of the things that we're already doing? You know, like when I'm running the bath for my son every night, I'm doing an exercise snack. I'm doing jump squats. So I do my, yes. So I'm like, okay, I'm running the bath. You know, you gotta make sure that you don't let it overflow. So I'm like paying attention, making sure it's not too hot, not too cold. You know, he loves that Goldilocks perfect temperature. And so you kind of have to stay there. And so this is what I'm doing. I'm doing my jump squats. I'm doing some lunges, maybe some pushups. And so I've got five minutes. Why don't I stack, habit stack on top of that, yeah.

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Ashley (27:52)

I can just picture you like doing lunges past the bathroom door and just like constantly checking the water. That's a great idea.

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Dr. Mariza (27:57)

Yeah. So it's like, how do we anchor to the things that we're already doing?

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Ashley (28:02)

Yeah, absolutely. That makes sense. If there was like one habit that you could think of to recommend, what would be just one?

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Dr. Mariza (28:07)

The ultimate longevity habit that I would recommend is make a date with your best friend or one of your besties in real life, or it can be on the phone and it's a walking date. It's a walking date. It's either on the phone and you're walking with her on the phone or you're together. So my favorite, what I call habit stack or pleasure stack is grabbing an unsweetened organic matcha down the street at Nectaring Grove. I'm in Encinitas, California, grabbing my bestie and heading to the beach and walking the beach for 30 minutes while we catch up. Like to me, there's so much, the juice is worth the squeeze right there. You know? Yeah.

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Ashley (28:47)

You're getting so much in that, right? Because you're getting like a little bit of emotional support. You get that one-on-one time with somebody that you can kind of talk to about the ins and outs of your life that maybe you couldn't talk to somebody else about. You get a little bit of free time. You get that outside fresh air, sunlight, andmovement.

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Dr. Mariza (29:01)

Yeah, I mean, the, want amazing longevity, you want to improve your health span, that is it right there. I really love that suggestion. I've never heard that in any podcast that I've ever done or asked that question in and I really like that because that's so true. I hear the five, 10 minutes of sunlight every morning. Great. That's a great one. Meditation, great one. That suggestion gives multiple solutions in one activity, which I love.

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So let's talk a little bit about mythsand misconceptions hormones. So what the most consistent myths about perimenopause that you wanted to challenge in your book to better help your readers understand that?

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Dr. Mariza (29:37)

One of the biggest myths that I want to dispel in this book, that I hear so often is that perimenopause is a zone of chaos and then it's all just going to level out. And in some degree, yes, some of those symptoms are going to level out. But what about the silent shifts? What about the bone loss? What about the muscle loss? What about the insulin resistance, the body composition changes, the laying down fat, the neuroinflammation?What about these changes, the creeping blood pressure and lipids?  These are silent shifts that so often we don't really notice because they're disguised or they're trumped by some of these other, by rage, know, things like that. Right? And so I really want women to understand that this is a metabolic inflection point, perimenopause. And it's important that we are looking at these numbers in a meaningful way. It's important that we are really listening to our bodies and understanding that these, night sweats, these hot flashes, these kind of what we think just are kind of nuisance symptoms are actually indicators of a potentially bigger issue down the road. If we're not mitigating, if we're not being strategic about managing it. So that's going to be myth number one. Number two is that there's nothing you can do. This is the thing that I have always heard the narrative of like, okay, now you're in perimenopause and menopause and it's this decline and there's nothing you can do about it. And I think women are just resigned themselves to thinking, well, this is just, this is it. This is the, this is what happens. And I'm like, no, it, isn't what happens. It doesn't have to be this at all. There's so much that we can do to build strength and endurance and power and being metabolically resilient. And I just want women to understand that we have the power to turn so much of it around if we decide we want to.

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Ashley (31:30)

Absolutely. Yeah, leads to empowerment. A lot of patients, women in this stage, they feel so discredited. They feel so discouraged. Once they get to me, half the time they've been told this is normal, you'll get through it, this is all something that we'll just balance out over time, and they're discouraged. And almost one of the first things that I have to do for a lot of these patients is like rebuild them back up. Like no, let's talk about all this. It's not normal. There's things that are normal about it, but can we make this better? Can we optimize this? Can we make you feel more comfortable? How do you reframe perimenopause into a time of empowerment for women rather than just a time of decline and depression?

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Dr. Mariza (31:59)

I love this question because I think about how much of a life we've lived in leading up to this moment and how perimenopause is really about discernment because there becomes a moment. It's kind of another inflection point where our capability and capacity kind of meet, all of a sudden we're like, I know I'm capable, but my capacity has shifted.

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And really what that is, our bodies are calling to attention the need to prioritize. Prioritize you over the world telling you to prioritize everyone and everything else. Prioritize boundaries. Reassess those beliefs and know that you're stepping into the unknown, but you're stepping into the unknown, standing on your hard-won lessons and your greatest accomplishments. And you get to springboard from there.

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But what becomes really important here is that we can't springboard optimally into the second half of our lives unless we've got good cellular energy, we've got that good foundation. So that's why it becomes so imperative. I feel like the body is calling into attention that, we get to shore up our metabolic health, our cellular energy, so that we can step into this beautiful unknown. We can step into the most powerful chapter of our lives.

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Given we have come so far, right? We've come too far to give up. Now it's time to step into this powerful chapter and we get to do this on our terms. And we also get to do this without having to negotiate with ourselves about what we have capacity for because we have taken care of ourselves moving into this next chapter.

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Ashley (33:34)

Yeah, and I'm sure you see these transformations in patients all the time and I think like one of the best ways that I can get the word out there for my patients is through word of mouth. You know, one patient tells another like, I started this. I know you've been complaining about, fatigue. You've been complaining about libido. You've been complaining about weight gain. I started this and it changed my life. And one of the things that I do as a provider with Thrivelab is I make it really personal. I will put my story out there. I'm not ashamed. I feel like when you put that personal edge on things, as a provider, it kind of takes it to a whole new level for your patients. They're like, wow, this is a real person that had real struggles, and maybe I'm not in the same stage that you are, but here's how this hormone changed my life, and this is how this symptom was fixed, or even tying it into comparing to another patient and letting them hear the stories, and I think that helps as well. It's a tricky thing, right? Because sometimes it's a conversation that you have to gain a little trust and you gotta get reasons to understand it. The first meeting can be a little bit, you know, okay, well don't know if I'm talking.

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Dr. Mariza (34:43)

Tricky? Yeah.

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Ashley (34:49)

You know, this is new, I've been discredited for so long, but like taking that moment in your initial appointment with the patient to empower them and give them a whole new fresh sense of yes, we can help you, let's do this, we're gonna do this. So how do you feel like providers and organizations like ThriveLab can help women feel more supported through this stage?

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Dr. Mariza (35:10)

One of the things that we're looking deeper into is hormone replacement therapy in perimenopause and how that can future proof your health. And I think that's exactly what we're looking for here is not just symptom management and mitigation, but optimized health, future proofing a woman's cardio metabolic health, her brain health, her bone health. Like these are the through lines that I want to see, you know, as women move into their sixties, seventies and beyond. That’s what Thrivelab is doing is it's helping women to not only, again, mitigate symptoms today, but also to set them up for better optimization down the road. That's what makes it so beautiful. So this isn't just about symptom management. This is so much more than that.

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Ashley (35:54)

Yeah, I a thousand percent agree. If you could leave women with one empowering message about perimenopause, what would it be?

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Dr. Mariza (36:06)

I always want my patients to know and I want any woman listening that you are not broken. You are going through a profound transition that is calling for a new level of support and you get to have that. With the right tools, the right people backing you up. You get to step in what I consider to be the most powerful chapter of your life. That's what we're talking about here. And I'm so grateful we get to have this conversation and have the dialogue around what is possible for you because you get to have all of it, not just the least of it.

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Ashley (36:38)

I love that. And where can listeners find your book and more about your work, your other books?

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Dr. Mariza (36:42)

Yeah, so the book, you can go, all the options for getting the book and all the bonuses, including more recipes, workout videos, symptom tracker, menstrual cycle tracker, all the things are available, even a complete lab guide so you really understand your biomarkers. I mean, I left no stone unturned because I was, what would I need? What would my patients need as they navigate this journey? I built all of it for you. Again, no half solution here. I want you to have the whole enchilada. You deserve all of it.

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Ashley (36:58)

Amazing, I love that.

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Dr. Mariza (37:14)

It's Dr. Mariza, drmariza.com forward slash book. It's all there. The links to get it on audio or hard copy or wherever you want to go and buy it. It's available where all books are sold right now as well, hard copy. And you can find me on my podcast, Energized with Dr. Mariza. This is about helping women usher into that second half of their lives with all the tools that they need to thrive.

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Ashley (37:28)

I love that you have the tools incorporated and everything just easy peasy, making it the most accessible platform for patients. Because the easier it is, at 1000%.

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Dr. Mariza (37:46)

Yeah, accessibility is everything.

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Ashley (37:49)

Well, Dr. Snyder, thank you so much for joining us today and shedding so much light on this topic. And for our listeners, thank you for tuning into the Hormone Harmony podcast by Thrivelab and head to thrivelab.com to learn more about hormone balance.

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