The Perimenopause Revolution: How to Reclaim Your Health and Power

Hi and welcome to how humans heal. I'm Dr. Donnie Wilson and I'm really excited to introduce you to Dr. Marita Snyder. She's here to share with us about her newest best selling book called the Perimenopause Revolution. Thank you so much for being here with us today, Dr. Marita.

Shani, honey, it's such a pleasure to get to see you. Thanks for having me.

Oh, of course. When I heard that you're writing this book about perimenopause, it made me so happy. Because who better to be teaching women about how to not only survive perimenopause, but how to thrive through perimenopause and menopause.

Right, that's exactly it. I mean that's a, that's the through line is that when we have the knowledge and we feel confident navigating this transition, we are future proofing our health. That is what it's all about. And I don't know about you, Donnie, I don't want to survive anything, but particularly a 10 year transition. I want to do it with a lot more grace and a lot more joy and a lot more gratitude. And again, when we have those tools and we have the right support, I believe that we can do that when we move through this transition.

Absolutely. And just, I mean, menopause in general and perimenopause has been a lot more in the media, social media lately, so. So it's a term that really wasn't talked about like a decade ago. Right. But now it's like a term that we're hearing much more often. But I still think it's worth it to really talk about. What is this perimenopause that we're talking about? What is it? How do you describe it? How do women know they're in it?

That's the best question. I love this. And yes to menopause, having a moment. Perimenopause having a moment. And I just want to quickly reverse engineer a little bit. I think a lot of us at least knew about menopause. I remember growing up, I was told about menopause and really I was told like saddle up for no more like irregular crazy periods. My mom called them crime scene periods and hot flashes and night sweats and low libido and maybe some sleep issues. And that was all I was really told. And that didn't. That's nowhere near the entire piece of the puzzle. Perimenopause is the transition leading into menopause. And menopause is really defined as that time where you stop cycling for 5 continuous months in a row. And the thing is, is that there is a lead up to that moment. You don't just get to that moment of not having a period for 12 consecutive months. There's a transition. And that that transition is specifically perimenopause. Now, because natural menopause can happen between anywhere between 45 years old and 55 years old, we know that the transition leading to menopause can be anywhere between four and 10 plus years. So women, they can start perimenopause as early as their mid to late 40s, unfortunately, because a lot of doctors in the medical association think that that's way too early for someone to go into peri. Often women are dismissed and gaslit and told that it's just stress, they're just moms, it's just aging or life is just taking a toll on them. And those things can absolutely be true. And, and your hormones could also be erratically declining without permission. And it's that erratic decline without permission that really punctuates perimenopause because it's those erratic, not binding to receptor sites, types of hormones. Right. Whole body hormones, not just sex and reproductive hormones that drives over 40 different symptoms, a majority that are actually brain and mood related symptoms in perimenopause. And we can get into what, what that means in a moment. But I just wanted to lay the groundwork for this profound transition that sets the tone for the second half of our lives.

And it can be really disconcerting when there's changes happening in your body that you feel like, like you use the word control. Women feel like they don't have control over what their body symptoms are or the way they feel the way they used to. And it can, you know, it's like you almost feel like you don't even know your body anymore. And it can become like this unpredictable feeling that can trigger. Then it kind of spirals into other symptoms. And I definitely want to go into the symptoms. Thank you so much for outlining the time frame. I also wanted, what I'm kind of coming into awareness for for is that, you know, it's that perimenopause and then that day of official menopause when you now have crossed the line over into post menopause. And post menopause is the rest of our lives. It's a high number of times.

It's a high number of years. Yeah. And you, if women, let's say on average again, 45, could be natural menopause. That's half your life. You know, on average, you women are in their early 50s when they go into menopause, somewhere between 50 and 52 years old. It's pretty where, you know, I've talked a lot of my patients over the years. I'm sure your patients too. And, you know, not all of us are, you know, are living to 100, you know, depending on the situation. So many of us, whether we're in late perimenopause or even early perimenopause, early menopause, we are in the second half of our lives. I think it's important to note that because I right now, I'm 46, and let's say. Let's just say I live to 91. You know, my intention isn't to live the longest amount of time, it's to live the most quality amount of time. Like, I really want the years that I'm here to be so good and more importantly, on my terms. But let's just say, you know, I live to in my 90s. I am at the halfway point, and I'm at the halfway point not in menopause. I'm in the halfway point in perimenopause. And I think that's really important to denote because a lot of what's happening in this transition, I always call it the window of vulnerability, but it's also our metabolic window of opportunity because of all the changes that happen, the silent shifts that happen during this profound transition and in what we do in this transition is really going to set us for success into the second half of our lives. Because again, for most of us, the second half of our lives is happening in this transition. As we. As we move through it.

It's really something. It was funny because this last week my mom was saying, why don't you talk about. Why are you talking about menopause? Why not about what happens to. Because she's in her 80s and I said to her, in your 80s, you are in menopause. That's post menopause. You know, so it really was like. I always like to point out that even if someone's listening and you're, you know, even if you're through the transition, but there's some of these symptoms we're going to talk about that happen even once you get through that.

Oh, absolutely. Yeah. It's a continuum. I think one of the greatest myths about Perry is that, you know, a lot of doctors and influencers are calling it the zone of chaos. And they are. Yes, it is a neuroendocrine transition. It is a Full body remodel. You can't go from regular rhythmic hormones that the body has been expecting every single month for decades to erratic binding of these hormones to receptor sites all over the body. And it not be a massive remodel or like reconfiguration. The body's like, what is going on? Hormones that I've relied on and depended on every single month, consistently, they have showed up, are not showing up anymore. Like, what is happening? So the body has to really readjust and reconfigure. And because of that, depending on what we do and how we attune and take care of ourselves in this transition, you know, it can really set the tone for whether we continue to have symptoms. Throughout menopause. Things continue to get worse. You know, we're talking about not just the overt disruptive symptoms. And I would say those are low mental energy, brain fog, sleep issues, mood swings, rage, even weight resistance. These are some of the more disruptive general urinary symptoms of menopause. UTIs, vaginal dryness, low libido. These. These symptoms can really disrupt your quality of life. But it's the silent shifts that I'm most concerned about, Donni. I am concerned about blood pressure creeping up. I'm concerned about muscle loss over time. I'm concerned about bone loss. Up to 20% of bone loss. We can lose up to 20% of our bone leading into the first couple of years of menopause. I'm concerned about the insulin resistance, the, the vascular inflammation, the brain inflammation. These are things we do not feel, and we don't really know that they're playing out until about 15, 20 years down the road when we start to really see biomarkers gene or the DEXA scan showing osteoporosis or the blood pressure cuff beginning to really show hypertension. It's in this transition that those things begin to start. And it's because we don't have our same resilience. I always call these hormones our protective shield. And when, you know why we still have them in our reproductive years and even into early perimenopause, we still have that protective shield. But as these hormones really begin to decline, that shield begins to falter. And, you know, whatever we were holding down or we were kind of keeping at bay starts to present itself, or we start to see these silent shifts. And let me tell you, they don't just stop when you go into menopause. No, they continue forward. They continue on. And that's why I really want to. Although I know some women are Listening to this that are already in menopause or post menopause, whatever you love to, to kind of designate. I like to just say menopause. I don't necessarily think we need another term for after. I'm like, I'm good. I don't need to be like, I'm postmenopausal. I'm just in menopause.

I like how you call it Perry too. Let's say it's peri and menopause. Those are good.

Exactly. That's easy. And so it's important to note that everything that, that I talked about in my book the Perimenopause Revolution, and about what we can do in perimenopause to shore up our metabolic health, shore up our brain health, our bone health, our muscle health, to ensure that we're feeling amazing in the second half of our. I want every woman to know if she's in her 50s or 60s or beyond. All of it still counts. Like, all of it. All of it still. It works in menopause as much as it worked in Perry. I just mean that if we can get in front of it in perimenopause, it's even better.

But so I hope the better that women could catch this. Like, if you're listening in your, in your 30s even, like, okay, get ready, because this is, this is coming.

And what's coming, it's an inevitability.

The way I love that you're talking about it that I really want to point out is in a non judgmental way, because in years past, it would have been like these symptoms like you said, would be dismissed or women would be gaslit, like, or blamed or, oh, this woman's irritable because she's in menopause. Or she, she's, you know, we might consider like PMS or you know, perimeter. And then it just becomes derogatory toward women because of these, these, these hormone shifts that are happening. And so it's the, the idea that we can talk about it in a very supportive, unconditional, you know, non judgmental way and say, hey, all women go through this. Why, why wouldn't we do it in a supportive way and help women through this transition? So I love that you're being part of that shift as well.

You know, there's nothing more like destabilizing and transformative than being in this transition along with so many other women. Like, I'm in it. I am, I am in. I would even say I'm probably still in early perimenopause. I'M heading. I'm headed. I'm headed to late perimenopause. And we. I can. I can shore up the distinctions, if you would love. But I think what's important to note, this is what I've. I've learned in my own journey. There's a big distinction between blaming ourselves and ownership. Blaming ourselves isn't going to move the needle in terms of helping us to feel vital and energized. Helping. Helping us to, like, really set the tone for how we want to feel, but taking ownership. Taking ownership in the conversation with our doctor. Taking ownership in the daily habits that we can stack on top of each other, on top of each other to support our bodies. Taking ownership in terms of our mindset about how we want to feel and who we're going to become and the way that we want to approach this. I believe that we get to rewrite the story of midlife, but it starts with one the knowledge to the mindset. So that that means putting the blame aside. Even if the doctors and the practitioners and whoever you're talking to is still kind of doing that, I feel like that's kind of the through line of what a lot of women experience. Like, you don't have to take that with you. You could set that aside. You could get another doctor, especially if you don't love the care that you're getting. But I want women to know that there's so much that we can do on the other side of deciding that we deserve to thrive in the second half of our lives, that we deserve more than surviving the second half of our lives and even in perimenopause. And so I just wanted to share that distinction as a woman who's in it. And I'll tell you what, not every day is the most amazing day. There are some days where I'm like, perimenopause sucks.

Okay?

And then other days where I'm like, okay, I got this. Like, you're gonna have those days. Even when you're doing all the things, even when you've got all the support and all the. The supplements and the hrt, I'm doing all the things. I'm checking all the boxes. And yet there are days where I'm just like, oh, like, not my favorite, you know? And I still get up and I still do the things that help me to feel more energized, and I give myself a lot of extra grace. I know that my body is changing and it's way, way outside of my comfort zone, and it is way out of permission. Like, I definitely did not ask for any of these changes. I don't think anyone, any woman does. And I know that this is the only way is through. The only way is through. And so it's with that extra grace that I extend to every woman going through this transition and beyond. Because I'm living it. I get it.

Yeah, I'm in it, too. I'm 53 and I'm at the end of perimenopause waiting for that day.

I call it the waiting room. That Just like, who knows when the waiting room is going to come? You know, you're like, when am I in menopause? You know, there's. I call it the perpetual waiting room.

Well, it is. And it's because we there. We don't get a date.

It's not like, no, there's no date. There's no announcement date. There's no. There's no announcement for the beginning of this journey. There's no announcement on the end of this journey. I always say, like, people ask, well, how do I know I'm in perimenopause? And I'm like, I wish perimenopause just announced itself. Just like, hey, I'm here. Hello. I wish there was a lab test, but no, it doesn't work that way. You know, very different. I. I talk about perimenopause, like second puberty. There's a couple distinctions here, though. With first puberty, you do get a period. It does announce itself. You know, it doesn't tell you when it's going to happen, but one day. And I'll never forget, I was at the roller skating rink. I was listening to. I think it was Paula Abdul. I had like a little, I think even a little Paula Abdul shirt on with some jean shorts.

I love Paula.

Oh, my God. Oh, me too. And I went to the bathroom, I had to go potty. And I was like, oh. And I was so grateful that this shirt. Because, you know, these shirts were long back in the 90s, just like 91 or something like that. And also jean shorts, they're pretty thick. Like, it's you. Not that you can't penetrate some jean shorts I have in the past. But I was like, okay, okay. So, like, I KNEW I was 11 years old. I was like a couple of months away from being 12, so. But I remember puberty being this wild roller coaster ride because it's not. Even though it announced itself for that one day. It takes several years to get into those reproductive years.

Right?

I would say puberty is a Four to six year transition and second puberty is similar in a lot of ways in the terms of the destabilizing symptoms, the transformative phase, except that it's in reverse. And it's a higher stakes game. Because now it's not just school that I'm worried about. I've got kids, I've got a career, I've got obligations. Let's be honest, every woman is like the master coordinator, CEO of her life, her household, her family, her work. There's a lot more at stake. And it's happening in reverse. Right? So we are stepping out of those reproductive years into menopause. And so it's. Whoo. It is a. I mean, we just have to give. Deserves its own. By no means is it reverent, but it deserves its own moment, its own importance, its own. We have to honor the process. And I think when we do that, it's a lot easier for us to get through it.

That's a beautiful concept. Right. I'm sure there's cultures in the world that do honor these transitions for women. And I love that you're pointing out there's that unpredictability and also that it's unique to each person. So, you know, I'm sure you as well. I've been seeing women in menopause for. I mean, I've been in practice for 25 years, and so I was helping people, women go through menopause before I was in menopause. And what was always so interesting is how unique it is to each person and each woman describes it a little differently. So you were mentioning some of the common symptoms before. Maybe we can go into that, a little more detail of, you know, what are some of the symptoms that might surprise women? Because, yeah, we hear a lot about hot flashes and night sweats, and those are pretty common. But there's a lot of other symptoms that women might not realize. Like they might be like, oh, I don't have any night sweats. But I always like to go deeper and say, what about this and this and this and this? Because often there is something showing up and women just didn't realize it was menopause related.

Yeah. Oh, yes, I absolutely agree with you, Donnie. Yeah, I've been taking care of women in this beautiful midlife transition for 17 years in clinical practice. And I will tell you the thing that really kind of ratchets up perimenopause. And this is going to be of no surprise to you and your incredible community. It's going to be stress. It's stress.

It's so true.

Yeah. What makes perimenopause? Yes. You want to know what makes perimenopause worse? You want to know why it really feels like it's a Mack truck moment for so many of us? It's the stress. It's, you know, and I think that's why it's so easy to blame it on stress for women, because women have always been stressed. Women are always taking on too much. And that is a conversation for another day. Why society has expected so much of us as well and why the, the spinning plates. There's more and more of them, especially as we move through this transition. I always joke that we, we just talked about it a second ago, but how laughable it is that during a time when we are doing the most and you know, we are, we're very much. Women today are very much in that sandwich generation, that messy sandwich generation where we are taking care of older family members, maybe parents or aunts or, or maybe it's even siblings that are older than us. And we are taking care of our children. And so we are, It's a lot that we are managing. And so when I think about the spinning plates of so many of my patients, I think, oh my gosh, even without perimenopause, even without the faltering of that protect armor women in this transition of, of their 40s of midlife, it is so much to contend with and then add on deregulated hormones that our bodies have been reliant on the whole time. I mean, goodness. So the most common symptoms of perimenopause, Donnie honey. Are actually again, brain and, and emotionally related. And it's because perimenopause is a default neuroendocrine transition, meaning that these hormones are having a profound impact on the brain. And when we think about hot flashes and night sweats, those are brain related perimenopausal symptoms, sleep issues, brain related perimenopausal symptoms, migraines, headaches, low stress tolerance. One of the biggest complaints from my amazing patients in community is all of a sudden their ability to handle and cope with life. Stressors just.

That ability. That resilience packs its bags and walks out the door like that is a poof gone. And I've had so many moments where I'm like, where did my stress resilience go? Also cognitive things that come up, so memory, alertness, low mental energy, like the brain is just not working. The ability to handle a lot of high level functioning. So I think women are always so used to having 100 tabs open. And whether it's stuff for the kids, signing paperwork for the family, deals, planning play dates, planning vacations, all this is all happening in one day, by the way. Work activities. What are we having for dinner? Making the list for the grocery store. I mean, think about all the things. Women are multitasking at all times, and they're used to being able to do that. And for many of us, effortlessly, like, you're just running the list through your mind. And then in Perry, all of a sudden, what used to be so effortless, you have to effort so hard to do it. So I think that that lack of executive functioning feels like early cognitive decline to so many women, because they're just like, what is happening to my brain? The lack of word recall, the brain fog. Right? All of that. Like, what are we without our brains, right? As women? You know, we. We think we're like, oh, my God. My most important asset is, like, crumbling. And then you've got the rage, the mood swings, the ir, irritability. You know, all of those things are compounding. And there are some days where all of this is hitting all at once, and then the physical changes that women don't even think about. Phantom smells, frozen shoulder joint pain, inflammation, weight resistance, insulin resistance. Right. Muscle loss, you know, not recovering from workouts or a lot of things the way that you used to. All of this is perimenopause.

Oh, my gosh, thank you for going through that. And I'm hoping those of you listening might have been like, oh, yeah, that and that and that and that. And even it's, I think, helpful to note down, you know, where you can go, okay, how is it showing up for me? And there may be other ways that it's showing up for you that we didn't even mention because it's so unique. I've had women who come in and say, oh, it just feels like I have a toxin going through my system, you know, Like, I feel toxic. Right. And so it can sometimes be a feeling. You can't even. It doesn't even have a name that we usually put on things, you know, so just know that that also could be related to this. And I love how you're really connecting. Like, we think, oh, this is just about the lack of a period or, you know, and as you're leading up to it, a lot of irregular periods and then a lack of a period. But it's not just that vaginal and uterine area that's being affected. It's.

No, it's all this is a bikini medicine. This isn't. This is an entire body that's, that's under massive transition and remodeling. And I think, you know, I think we, we've. Because women have been told they're crazy. We think about kind of the, the through line of hysteria that happened to, to women and this like that through line that has traveled through medicine. And there I go. Women are just hysterical, especially in perimenopause. And it is nothing further from the truth. Like, we know that women's brains are massively remodeling during this time. We're talking energy metabolism is changing. The way that we are building. Neuroplasticity is changing. Inflammation in the brain is shifting. These hormones bind to important neurotransmitters like gaba, serotonin, dopamine. No wonder we are feeling less motivated, less joyful, less confident during this transition. It is crazy. And it's, you know, and it is, it is very individual. You're absolutely right. Like, women can be experiencing, you know, a multitude of symptoms. Some women, it could just be physical. For most of us, there's going to be that mental aspect. And I will say the, the biggest through line that I hear from my patients is in midlife in Perry is going to be I just don't feel like myself anymore.

That's such a. So true. That's probably the first thing is I don't feel like myself anymore. And I want to get back to feeling myself and my body. Feeling like my body and, and, and it is. The menstrual changes can be very, you know, all over the place. Right. I talk to sometimes women who are, you know, is either you end up with a period more often or spotting or less often. And so the period can do all kinds of changes. But what I always, and I think this is maybe our chance to start leaning into what can we do about it, all the ways we can help women through it. Because what I always find is like, oh my gosh, I'd rather know as a practitioner. I'd rather know right away if you're noticing changes in any way in your health, but definitely with your menstrual cycle or if you get a bladder infection out of nowhere, that, right, that's like boop. That right away gives me a flag. Oh, perimenopause might be happening because all of a sudden we become more susceptible to bladder infections, vaginal infections, even high risk HPV and abnormal pap smear becomes more likely. And so any of these things that just pop up for you out of nowhere, that could be your sign. Like, oh, I better start paying more attention. And then, you know, get, first of all, Maritza's book, the Perimenopause Revolution, because she's got all kinds of good support.

Oh yeah, it's very practical. It is. Because here's the thing, I'm in it, as I mentioned earlier. I know how hard it is to bring on things that can just feel overwhelming. And so the whole intention of the book is that it's practical, it's doable, it's not overwhelming. And the recommendations that I am recommending are science backed and they're easy to integrate into your life and they're going to move the needle. Like, I don't want to recommend anything. I don't want to, I never want to waste any of my patients time. I want, I want to make the recommendations, the types of recommendations that are going to provide wins. Because in this time of life, that's all, that's all I'm looking for. Like, do you got to win for me? Because mama needs a win right now. Like, mama needs a mental health win. She needs a movement win. She needs an energy win. She needs a, like, I just need to feel like myself again win. Like that, that is like, that's where the juice is worth the squeeze as far as I'm concerned. And so that's how I built this book. I kept checking in with my own, my own self and all the women I've taken care of over the years, which is thousands of women. And I built the book from the standpoint of like, what did they need from me? What were they so hoping to get from, from me as their provider, to feel like themselves again in this journey? That's how I built the book. That is exactly what you're going to get. So if I were to break down the book in like four different sections, number one, so many women have no idea that they're even in perimenopause. And understandably so. When doctors weren't recognizing it, we had no idea it existed. Women were just being told that, oh, this is just how it is and we should never tolerate that. Right? So, and that's why I think that's why perimenopause is having a movement is women are like, enough is enough. I'm tired of being gaslit. I'm tired of being ignored. I deserve to be heard and I deserve a new level of care. And so amen to all the ladies out there who are like, I'm over this. We. And I think that there's a level of outrage that is existing because women are like, you're telling me this whole time I was going through this crazy transition and you ignored me. And this transition was setting the tone for decades to come. And yet I kept being told to just suck it up. Like women, women are, they're mad and they deserve to be heard. So number one, let's, let's figure out, are you in perimenopause? Let's. I have a whole quiz. Like, we're going to get down and figure it out. Because it is a clinical diagnosis based on symptoms. Menstrual cycle changes and labs can help us. Right? That's, that's really how we diagnose. If you're, if you're 42 years old and your, your period is skipping or you're, you're having less days and you're having crazy symptoms that are cyclical, that's perimenopause. Right? Like, we can, we can start to dissect it.

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Number two is understanding the metabolic shifts that are happening because at the end of the day, one in three women are going to die of a mostly preventable heart attack or stroke. And if we can stay in front of that, then that is the name of the game. Next, it's going to be the pillars. From HRT to community to mental health, Mastering stress. Just like, I mean, nowhere near the deep dive that you go to. And with your book, Balancing blood sugar building, Metabolically healthy meals, circadian rhythm and sleep optimization and movement. I have got you covered. And then there's a five week plan that puts it all together, including mindset, so that you really are clear on what you would love stepping into the second half of your life, plus all the bonuses and goodies in my book bonus page, so that you are set up for the most epic success moving forward.

Oh, my gosh. Okay. So when people Order the book. They, they could go to Amazon or wherever they're going to order the book and then go to the book bonus page.

Yes. And go and get all the goodies. So I have workout videos, beginner workout videos, exercise snack videos. I have over 70 recipes built around my metabolically healthy meal plan. I've got a lab guide of very complicated comprehensive lab guide with labs. Exactly. To take to your doctor to ask for symptom tracker, menstrual cycle tracker. I have self care rituals, I've got morning and evening rituals. I mean honestly, everything you could possibly need to get started. And I want to meet you where you're at so that you feel like you can take that first step to feeling more alive in your body than ever before.

You know what is making me think about Rita? You know that with pregnancy there's that what to expect when you're expecting book. Because it's like, you know, like. And everybody kind of knows about it because it became like the book to help pregnancy. This is, that's what you're describing is like here's the book to guide you through perimenopause and menopause. To be able to say, okay, am I in it? If so, what tests should I be asking for? And then what can I start to do that you're probably not going to hear from your doctor's office?

That's exactly I remember when I, because I was, I had my son in perimenopause and I read all the books. Right. You know, even gearing up for it. You know, you and I are both big researchers and clinicians and I read the what to expect when expecting. And so when I was writing the perimenopause revolution, knowing that this was one of the first books ever written on the topic, I really wanted it to be so thorough, so thorough, but also doable and actionable. Like I wanted you to have enough information so that you were like, okay, I understand what's happening in my body. I understand what's going on with these hormones. I understand that it's just not stopped periods, that it's just not hot flashes, that there's so much more happening. I go into how these hormones are affecting your bone, your muscle, your tendons, your skin, your hair. I mean they are, they are whole body protector hormones. And as they begin to decline, as long as we know what's happening, we can be prepared. And we deserve to be prepared. More than anything, women deserve to know what is happening to their bodies and then they deserve to know what to do. About it because it's not good enough to know what's happening to your body. You need to know what to do. Right. And you need to know where to get started. And that's how I wrote this book, because I know that's how I would love a book to be written for me. One, what the heck is happening to me? Two, what do I do about it? How do number three, how do I even start? What's the starting point?

I love it. I can't wait for to be able to have your book as a resource for my patients to guide them. And I love that you're saying, hey, we need to look at stress. Because I absolutely see that in my research as well. If a woman hasn't, when they start to go through perimenopause, if we haven't tested their cortisol levels recently, you know how much I love testing cortisol.

I'm like, and neurotransmitters.

And your neurotransmitters, yeah. So we go, where's your cortisol? Where's your adrenaline? Where's your neurotransmitters? And let's support them because amazingly women end up then feeling so much better through peri and post menopause when they have optimal cortisol, adrenaline and neurotransmitters. And those are not like we're usually just thinking about the estrogen and progesterone and testosterone. But it's like, no, we have to pay attention to these other methods, messengers because they're all in a conversation with each other. And as you said, if we help the stress, we can, yes, we can reduce our stress. We can do all the self care that's essential. And if we can take steps to optimize these biochemical messengers in our bodies, that's going to only make a difference and minimize the symptoms from the hormone shifts. And so I, you know, and it's.

Going to reduce.

Neuro decline, neurological decline. Right. If 70 up to 70% of dementia and Alzheimer patients are women and we know that that critical window of when things begin to shift is when the hormones shift. And mind you, estrogen and progesterone are neuro hormones as well. Estrogen is the master regulator of the brain. Are you trying to tell me that with estrogen disappearing, your brain isn't going to shift, that neurotransmitters aren't going to decline, that cortisol isn't going to deregulate? We have to understand that it's all interconnected. And as I mentioned earlier, this is a higher stakes game. We are losing mental resilience. We are seeing massive shifts in the brain that can go one way or the other if we don't stick on top of this. And so it's so important. I would say that probably. And you know, from my just, I mean maybe from my own personal experience, the amount of brain related changes that I've had have been so profound that I'm just like, why aren't we focusing on the brain? Why aren't we looking at the brain?

And maybe this is good. I'm sure you also talk about estrogen and how hormone replacement therapy has been shown to help prevent both neuro decline and the dementia risk and the osteoporosis risk that comes with menopause. So it's like I'm with you. When women can start using these signs of perimenopause to prevent the health issues that would otherwise start happening even in their 70s, 80s and 90s. But now is the time to start taking action. And yeah, so let's talk about that. Like.

What do you think? I know I've seen you share about your estrogen patch on social media. Let's talk about that a little bit.

Yeah, I am a big proponent of women deserving all the tools in the toolbox, all of them. Whether it's lifestyle medicine or it is bioidentical hormone replacement therapy or to supplement or all of it. I'm a yes, I'm a yes to all of the things and I am doing all the things. I have an estrogen patch on right now. I cycle oral micronized progesterone at the moment. I've even been on, I'm not currently on testosterone, but I've been on testosterone. I, there's supplementation that I'm taking for cortisol support and HBA access support and also all the lifestyle medicine. And I will say that in, in taking care of my patients and even in my own journey, the lifestyle medicine, man, it can really move the needle. And sometimes more than any other way, like if we can help support blood sugar regulation and reduce inflammation and you know, and really I always say, you know, when it comes to the fuel that we put into our bodies, the molecular information that we put into our bodies, the question I always ask myself is, is this going to fuel my future brain? Is what I'm doing going to fuel my future brain? Is the sleep that I'm going to get tonight going to help my brain to work better tomorrow? Right. Because sleep will make or break you. So I think about a lot of the things that move the needle in terms of our kind of mitigating symptoms, but to help us thrive in the second half of our lives. And I hope that every woman has, has all the tools, whether it's HRT supplementation, lifestyle medicine, I believe that we probably are going to need a combination of all of those things so that we set the tone for a stronger, more resilient, you know, time in our lives in our 50s, 60s, 70s, and beyond.

It's such a good point because sometimes we, we get excited about hormone replacement therapy or hrt and then we just think that's the only thing we need to do, do. And you're saying, no, we need to still pay attention to our diet, our supplements, our sleep, our, you know, all of that, and consider hormone replacement therapy for your case.

Yeah, I would love to say that HRT is the ultimate panacea. I wish I could say that, but I, you know, working with so many of my patients, I know sometimes we think that that's going to be the magic bullet. And man, I believe that all vaginas need estrogen. Like that is very much the magic bullet right there. But, you know, I've had so many women go on HRT and hoping it's going to clean up everything, fix all the things. And again, hormones are, they're messengers, they're binding to receptor sites. There's a lot of other things that are involved in those processes that, you know, if, if you're chronically stressed all of the time and you're trying to slap some estrogen on top of that, the estrogen, I mean, it's only going to take you so far, right? If you're constantly in that stress spiral, if you're constantly, you know, triggering a bunch of trauma responses. And so I think it's important that we have, you know, we have all those, all the areas in place so that, you know, HRT can help with sleep. But often, you know, good, good optimal sleep is going to really support HRT working better, Right? It's a yes. And I would say if there was something, if I could bottle it in terms of longevity, two things that, if I could bottle it, I would, is I would bottle community. For every woman going through this, because that is the biggest predictor of our longevity is community and connection. And I would bottle movement. I would bottle resistance training. I would bottle steps after meals, walking. I would bottle movement. Those are the two things that if I could bottle for women and give it to every single woman moving through this transition, it would Be built in community and built in movement every single day.

That's beautiful. That's beautiful. It is. It's so important that we take care of ourselves. And as women, we're really not taught to take care. We're taught to take care of everybody else. So this is this opportunity again to be like, okay, how do I take care of myself? By getting enough sleep, getting movement, you know, like you're saying, getting the nutrition so that your body's taken care of. And then, then hormone replacement therapy on top of that's going to be so much more effective. Now, I know a lot of women now have heard with hormone replacement therapy that there's been a shift in what the research is saying, but I want to just put that note in here because I find that a lot of women are still very afraid of hormone replacement therapy because of the research that came out over 23 years ago saying that estrogen was correlated with cancer risk. And now those researchers came back and said we were wrong. Estrogen is not causing cancer. And so this is also part of this wave of, of shift in terms of how women are getting helped with menopause. Right. In hormone replacement therapy. Because now this just opened up the possibility of being able to use hormone replacement therapy in a safe and effective way.

Yeah. One of the biggest setbacks for women in terms of their longevity was the. The preliminary incorrect results of the Women's Health Initiative. Before the Women's Health Initiative hrt, and it was mostly synthetic hrt, it was Premarin and Prempro that was being prescribed was over 44% of the women population in terms of in midlife. Again, most prescribed medication on the market. We go into the Women's Health Initiative into the late 90s, halt, early 2000s, 2002, the estrogen arm. 2002, 2004 for the estrogen and progestin arm. Come to find out, it was never the estrogen arm at all. It was the progestin arm that was the issue. And progestin is a synthetic progesterone that doesn't support the brain by any means. And it's, you know, and unfortunately, and again, we're talking about a relative, so absolute number, it was one extra case. Instead of 4 in 1000 women getting breast cancer. It was 5 in 1000 women getting breast cancer in the premarin conjugated equine estrogen arm. One extra case. And when we look at absolute risk, that looks like a 25% increase in relative risk. It was like 0.01. It was like something so teeny.

After 20 years, the end the of the final results. I mean the study is continuing, it's still continuing, But 23 years later, what we learned from that is one estrogen, even synthetic estrogen.

The women that were on that arm had a 23% or more decrease in osteoporotic fractures. They had a 20% or more increase in overall protection from all cause mortality. And there were so many other benefits that came out of that study. And so there's a lot of things that we got wrong. There's a lot of lessons that we learned from that. Currently right now obviously there's many providers that still don't know how to prescribe hrt. So that's a major problem that we are trying to overcome. That's a hurdle that we're working on very quickly. And the other thing that yeah, we've have this through line of fear around HRT. So currently only 4 to 6, 6% of women in menopause are on HRT and that number is steadily climbing, but it's a slow climb and currently it's like less than 3% in perimenopause where I really do feel like that's the window of opportunity. Why would we ever wait till hormones are bottoming out or symptoms are so severe to put women on hrt? You know, that doesn't make any sense to me at all. And so I think, you know, women ask me all the time, well when should I start? When should I have the conversation? When your symptoms are so disruptive or disruptive enough that they're affecting your quality of life, that they're affecting your ability to function, that's when you need to be having the conversation. For many women that's going to be oral micronized progesterone first. You know, it's usually, the stack is usually oral micronized progesterone, then estrogen, then testosterone. But again, as you and I talked about today, every woman is individual. It's going to be individual. I have so many of my friends where estrogen had fallen much faster than they expected, probably because of stresses and endocrine disruptors. And I always joke that there's nothing about this modern day life that is, that is conducive to optimized hormones. Right? And so we see hormones dropping sooner, earlier and not just progesterone. And so again, it's worth finding a hormone literate provider. If you're wondering, well where the heck do I get one of those, go to your nearest compounding pharmacist who's prescribing hrt. Then get that list and start making calls.

Thank you. And it is, it's so important for women to know how they can access that. And I'm always so proud to say, because I was trained as a naturopathic doctor and I trained with functional medicine practitioners back in the 90s, so I learned how to do bioidentical hormone replacement therapy and have been doing that, that for 25 years in practice. So I have been helping women with, like you said, what's referred to as, well, oral micronized progesterone is a natural or bioidentical form of progesterone, not a synthetic form. And that's what we're, we're using now, like you said, even in the perimenopause time. And then as when the person needs it, then we may add again a bioidentical or natural estrogen like estradiol, not a synthetic estrogen. And that's what research is showing has been so effective. And, and not. Not being harmful or not not being harmful.

Yeah.

And so it's, it's something that, you know, definitely, if anyone, if anyone's listening and wanting help, you can always reach out to my office as well. And, and you mentioned vaginal estrogen, which I'm so glad you did, because this is one of the things I'm always on my soapbox about is the vaginal estrogen. Because a lot of times people will go, even if you find a practitioner who's recommending, let's say, oral progesterone and an estrogen patch or estrogen cream, but sometimes they're not recom. They're not talking about the vaginal estrogen. And so I want women to know that it's. We talk about systemic hormones, right? So we want the estrogen progesterone, and if other hormones, then that too. But we want them to be something that's circulating around your whole body. Because. Because as Dr. Maritza mentioned, we gotta be able to help the bones, the brain, the skin, everywhere. So it needs to circulate around your whole body. And we need vaginal estrogen because the circulating estrogen is only a small percentage, percentage is gonna make it to your vagina. So what we also know is if we women use vaginal estrogen, and you don't need to use it every day, but the common dosage would be twice a week. Twice a week, you can maintain vaginal estrogen, which helps prevent not only the vaginal dryness, but all the infections, including infections uti Yep.

Well, and what a lot of women don't realize is that UTIs alone when women are in their 60s, 70s, or 80s are reason why women end up in assisted living.

Yes.

So we're talking major issues here that we could have been avoided if we had given women vaginal estrogen.

Yeah. That means that even if you're. If you're in your 70s, 80s, 90s, you need vaginal estrogen, like, at least twice a week to prevent these bladder infections, because.

Yeah.

Imagine that women could be more independent and be not having to be on recurrent antibiotics or having systemic infections simply by using a vaginal estrogen, which you can. You can get from a doctor prescribed through a pharmaceutical company or you can get from a compounding pharmacy or from a practitioner like me. But, you know, this is something you can get access to. Access to and use safely.

Yes. Yes. I mean, we need to shout this from the rooftops. And, you know, we didn't even mention the vaginal atrophy, the clitoral atrophy, less robust orgasms, low libido. I mean, all of this is shifting. It's. It's. I think it's at least 93 to 95% of women. I want to call it 100, but nothing's ever 100%, unfortunately. But let's just say it is. Close to 100% of us are going to have vaginal atrophy and vaginal changes as a result of little to no estrogen in the vaginal tissues. And there is no reason why we shouldn't be given vaginal estrogen to every woman who's starting to experience some level of symptoms or even after a certain age. And if your doctor is saying, well, you're on systemic estrogen and you're still having symptoms, it's not, not good enough. We got to go find a provider who's willing to give you. Because most women, at some point, even on systemic estradiol, whether it's a patch or cream, you're going to need vaginal estrogen, too.

I love it.

I love it.

Thank you so much, Marisa. I mean, thank you for coming to share with us here. Thank you for the book. I will definitely have the link down below. So it's easy for everyone to get to the book and get to your bonus page so they can get all the support around the book. And it's just. I'm just so grateful for you to be able to share this and be part of this movement of creating support for women through this time in. In our lives. That wasn't there before.

No, I agree. And that's why this is a perimenopause revolution. It is a movement that we are starting because women deserve and demand, are demanding better. And that's what it's all about, is we get to rewrite this journey story on our terms. We get to band together and, and ensure that women are getting the quality care and support that they deserve. And I also want to put the power in women's hands individually, because if you're having a hard time finding a doctor, you're having a hard time getting the resources and the solutions. I want you to know that it's laid out in this book, the perimenopause revolution, so that you've got a starting place. That's what matters most to me, is that you have the knowledge to advocate for yourself. But to take that step forward, whether or not you have a doctor that is on your team just yet, you're giving me goosebumps.

Actually. This, this revolution of, of perimenopause and revolution for women's health, it's so needed. And even though the research is still catching up or, you know, we're having to ride that wave, right, we're at the cusp of what the research is giving us, so we need to stay on it. I don't think women should have to wait for more research to come out. I think we got to be like, okay, we're going to take the research we have and the clinical experience we have, and we're going to start helping women more. Because every decade that goes by now, women are already rolling into post menopause and maybe missed that opportunity. So don't let this opportunity be missed. Those of you who are listening in, get Dr. Moritza's book, ask and get. Get going on taking care of yourself through peri and postmenopause. Thank you so much for being here today, Marita. It's such a joy to get to share this with you and, and, and I feel like you're part of my community. So I really appreciate that being in community with each other as practitioners.

Thank you so much, Donni. Honey, thanks for having me. I agree. I feel the exact same way. I know that we're on this. We're on a similar mission. Girl, we are doing this together. We are in this together.

Definitely. All right, well, I can't wait to share more about your book, and I'm so happy for you. Congratulations and I'll talk to you again soon.

Okay, honey. Bye.

Thanks, everyone for joining us today at How Humans Heal. Be sure to check out Dr. Maritza's book at the link down below and also subscribe to How Humans Heal if you haven't already. I'll see you soon.

Thanks for listening to How Human Humans Heal. If you liked this episode, leave a rating and a review. And for more resources, visit drdani.com.