What Every Woman Needs to Know about Perimenopause & Hormone Therapy with Dr. Mariza Snyder

The beautiful thing about this midlife journey is that, yes, it's a time of vulnerability. I'm not going to pretend like your body isn't changing, because it is. Absolutely. But it's a beautiful time of opportunity. You get to decide the life that you want to live, that you're excited to live. You get to decide, like, what matters to you.

The conversations that I heard growing up is kind of like, this is what happens. First it was wait till you're 30. Then it's wait till you're 40. And it's, like, just waiting for your life to fall apart. It's so good to hear that. There's so many things that we can do to help ourselves. Welcome to the Earn your happy podcast. I'm so excited that you're here, Lori.

I am so excited for our conversation.

Me, too.

This is.

This is a topic that is so popular right now, and I know so many people are interested. Whenever I do any topic about just hormones, perimenopause, menopause, I swear, people, it's like. I think it's. I think it's a newer conversation for some people, too, in the way that you talk about it. I love it. And congratulations on your book.

Oh, thank you so much. It is so much more than a book. It is a movement. I'm calling it the rally cry that so many women are wanting. This book was everything I needed when I started going through perimenopause. And I was like, wait, there's nothing out here. And so that's why I'm so excited about this book is that I think women are going to really feel it because they're going to so deeply relate to the experience.

So this started for you because you felt alone during your experience?

Yeah, I felt, I would say, blindsided is a great way to describe it. 43 years old, I was really coming out of postpartum. My son was barely 2, and I was checking the boxes. I was doing all the right things. I was eating well, I was exercising. And all of a sudden, I started feeling this deep sense of dread. My brain felt like it was scrambled. My stress tolerance, where I had felt steady and on top of everything, just seemed to flow clutter away. And I felt like I was losing myself. I felt untethered. And I remember going down all the rabbit holes, like, okay, oh, it's got to be my thyroid, because I have Hajis. Hajimoto's thyroiditis. It's gotta be burnout. It's gotta be something. And so I think so many women like myself, are Going down the rabbit holes, trying to get labs ordered or see their doctors. And on average, a woman in perimenopause will see, see a doctor or go to doctor's visits four to six times before the dots are connected that what they're experiencing is perimenopause or menopause. And so often what ends up happening as a result is that women are delayed care, they're delayed diagnosis treatment, and their quality of life suffers. And so that was very much me. I was in that boat for six months where I'm like, what is happening? Nothing's adding up. It was after three months, after I was tracking my cycle, I was tracking my symptoms, and I. About five days leading to my period, I would get this deep sense of dread and rage. And it was like clockwork. And in the third month in a row that had happened, literally like on day 26 or day 25, I was like, this is perimenopause. That's what this is. And finally, it felt so good to be able to put a name to what, what was going on with me, why I didn't feel like myself anymore.

Okay, so explain to everybody what exactly is perimenopause?

Yes. So I think we all know what menopause is, but I just wanna quickly define that. Cause I feel like we can go from there. So I feel like everyone kind of knows what menopause is. And that is when we women have gone a whole year without a period. And then stamp, that is menopause. And then the rest of the journey is menopause or post menopause, depending on how you wanna call it. But before we go into that defining moment, that one day in time where we hit menopause, there is this transition where our hormones are slowly declining or erratically declining, and our ovaries are basically coming offline. Now that transition is perimenopause, and it can last anywhere from four to 10 plus years. And it is, I remember I, I heard a meme recently that was like, transition, that's a career. It's such a big part of our lives. And yet so many women had no idea or have no idea that that is what's happening in their bodies, that their, their bodies are basically going through a second puberty where instead of ascending into our reproductive cycle, our reproductive, you know, you know, our monthly cycle and our reproductive years, we are now descending into menopause. And that's the transition.

So what, around what age can that start for people?

It can start as early as 35 years old. Wow. So we know that natural menopause is anywhere between 45 and 55 years old, but the average age is 51. But if we reverse engineer, let's say a woman is going into menopause at 45, and, you know, we can never know when it's going to happen to any of us if we reverse engineer that, that women can start experiencing symptoms and as early as their mid-30s, but typically it's early-40s.

Okay.

Yeah.

And what are, what are some of the symptoms for people when they experience them in their 30s?

Yeah. So it can feel like an exaggeration of the daily pain points of life for women. So I think that's a lot of why we don't understand what's going on is that, oh, it's just I'm feeling stressed or my sleep is a little off, or I'm feeling brain fogged, or my energy is off, or I just don't have the capacity to do what I used to do, just effortlessly my mood is off. I'm feeling more irritable mood swings, maybe a little bit of rage. And so again, I think a lot of women in their 30s can already be experiencing some of these symptoms, but perimenopause just kind of exaggerates them or amplifies them a little bit. And so that's why a lot of women are actually in perimenopause, but they don't know it because, again, well, I've been struggling with energy issues for years. I. My brain's been kind of on and off for years. My exercise recovery or workout recovery has kind of just been, you know, not as great as it used to be, when really some of these signs are very clearly early perimenopause.

Is it, is it hard for people to tell, like, the difference between. Because a lot of what you explained is sometimes if we're not eating well or taking care of ourselves, well, we can get just a plethora of side effects. So how do people start telling the difference? Especially because you went to the doctor and you weren't getting, you know, diagnosed with perimenopause at all.

Yeah, that is a great question, because depending on how you are living your life, depending on your lifestyle, it can really dictate how you're going to feel in perimenopause. And so my, my big recommendation is, number one, track your cycle. Your menstrual cycle is a vital sign, and it can give you so much information as to what is happening in your body. And. And number two is track your symptoms. Are you noticing that you know your PMS symptoms beside outside of being just two days now they're four days or maybe they're five days. Or maybe you're noticing that your mood swings are just more intense leading up to your period. Maybe you're noticing that you know when you're supposed to be feeling alive and incredible in the follicular phase of your cycle, it's not feeling so shiny anymore. And so those are things I would be looking for. The other thing that's really important is that there are a lot of women that are entering in perimenopause with other health issues or other like you said, a poor diet or they're not moving or they're, they have a high stress job or they're brand new moms. And so it's rarely that we come into perimenopause with a clean bill of health. Like for me I was in postpartum coming out, so I had low hormones to begin with. And then also I had, had, I have Hashimoto's thyroiditis, I have thyroid issues and I've experienced chronic fatigue in the past. And so you know, although I had shored a lot of those things up and I had my Hajimoto's in remission, I know that those are always kind of playing in the background into the amplification of what my perimenopause journey is. And so I would say those first couple of years where you're beginning to feel like something isn't right, like trust that deep intuition and, and you know, go get labs, start tracking your cycle, look at those symptoms so that you can start having a conversation about what is happening for you. And the thing about all of those symptoms that you, you mentioned, those side effects is although a lot of those things are normal and normal for women, that they're, they're not necessarily like, they may be common, but they're not necessarily normal. And so again it's so important that when these symptoms begin to arise or get worse to go and seek out a menopause or perimenopause expert so that they can start working with you, address the lifestyle piece, but also address the hormones that are changing in your body.

Where does somebody find a perimenopause expert? Because a lot of people just go, they go to their doctor, they ask the questions, they don't get the answers that they want. So is that something you can Google search or what, where do you find? Pretty much now anything.

But yeah, it would be a Google search. I would say one of the best ways I Recommend to my patients who live all over the country and all over the world is is find your local compounding pharmacist. So these. This is where they're compounding hormones like estrogen and progesterone and testosterone. And who are the doctors that are doing that?

Interesting.

Yeah. And who's the one that's really getting it right? And then ask for that referral or that information. So that would be where I would start locally. That way, you know that you've got someone who's very savvy, understands the dynamics of hormone changes, and even ask that compounding pharmacist is this person. Are you seeing perimenopausal women in here versus just menopaus women? Again, we don't have a lot of standard of care around hormone replacement therapy for perimenopause. It's typically menopause, but we're beginning to see that shift. And so that's what. That's what I would do to kind of figure out who's the menopause and perimenopause expert. Because, yes, a typical OB GYN doesn't have the adequate amount of menopause education. Typically, it's one to two hours in medical school and almost none during residency. Wow. So they are delivering babies, and they do that really well. And it's often a very surgical residency. And so usually when it comes to women in perimenopause and menopause, they're just not educated enough to be able to help you.

Okay, so tell. Tell me about. I don't think we did a deep dive, but all the different phases of perimenopause, and it's sounding like there's a lot of help that we can get with each phase because women have just eternally struggled. I find it crazy, especially knowing, you know, when men start to get older, they get on just different therapies. Testosterone therapy. It's so normalized for so many men. At least here it is. And it's not that talked about yet for women to have support throughout that. So tell me about some of the different phases, and then we'll go into what's available.

Yeah, so we talked a little bit about kind of that mid to late 30s, and I would say that is late reproductive age. I mean, I had my son when I was 41 years old. There's a lot of women having children in their late 30s and early 40s. And so I just want to just point that out that that is happening. But usually around mid-30s to late, like late-30s. Again, it's those subtle shifts. All of a sudden your PMS symptoms are a little bit more intense. Maybe your menstrual cycle went from a 28 day to 26 day, or it's a little bit heavier or it's a little bit lighter. So maybe some menstrual cycle changes. And also your brain is changing. So a bulk of the changes that's going to happen in early and kind of early, early perimenopause is going to be brain related. So I talked about the sleep issues, the mood swings, maybe a little bit more anxiety or depression. Maybe you're feeling a deep sense of dread or just that you knew that you used to feel stable, you used to feel on top of it. You used to feel like you were firing on all cylinders. And that edge that you were handling, that you were doing so well. Now you're not feeling like you've got that edge. You're feeling like you're really having to effort your way through life, through the day. That things that felt effortless are not so effortless. And a kind of a big indicator. Probably my favorite way of describing it is that, you know, I'm just not feeling like myself. Something isn't right. And that's usually in the early, early perimenopause stage. Again, cycles are probably pretty normal. Maybe some changes that are very slight, maybe almost not recognizable unless you're really paying attention. And then we get into early perimenopause and this is usually like 39 to 43 years old. And I have to say, the average woman that's coming to me is usually 41 or 42 and they feel like they fell off a cliff. Like it is almost impossible to miss because now it's really starting to add up. You can't kind of blame some of the, you know, more subtle symptoms on man. I just had a really crazy week, or I was traveling a lot, or my kids had a lot going on. Like it's now becoming a little bit more obvious. You have a lot more symptoms on the scene. You're noticing that your words, you're not remembering what you're saying in the middle of your sentence. You're noticing that you don't remember why you walked in the door in the first place. Happened to me a couple days ago where I went into the kitchen and I was like, what did I hear? I'm charging. I'm a very charge in kind of girl. And I'm charging in there and I'm like, I have no idea. And I was like, it was very I was going for a reason with.

Full intent, and it seems very important.

It's gone. And I, like, even walked back out and, like, redid it because I thought maybe I'd remember. Yeah, I remembered five minutes later, but I had left. I moved on to something else. I just. I was like, okay, it's over. The intense PMS symptoms, like, all of a sudden you're like, these are getting intense. Like, the cramping, the discomfort, the mood swings. And then the other thing that I think a lot of women will notice besides the menstrual cycle changes, but that they're really having a hard time keeping it together. Like, their weight is starting to shift. They're just like, why is my body composition changing? And I. If I have not changed anything, if anything, I am doubling down on the things that I'm being told. And so usually that is early perimenopause. Again, cycles are still running pretty consistently for most women. So it may be, again, maybe shorter, maybe heavier, maybe lighter, a little bit irregular, but we're still running. And this is usually when we go to our doctor and we're like, hey, something isn't right. I have all of these different symptoms. I'm not recovering well. I'm putting on weight. I feel like I'm losing my edge, and my brain is scrambled. And doctors are like, well, your labs are normal, looks fine. You still have a period, so it can't be perimenopause. And they're mostly sent home. They're just like, well, this is aging. Or you're just. You know what, you have a lot of stress in your life. And, yes, possibly that is absolutely true. And your body is shifting without permission. So it's a yes. And then you go into late perimenopause. And note, by the time you get to late perimenopause, you're about three to four years out to menopause. And this is a very distinct phase where I call it the eye of the storm. Now, you're skipping cycles up to 60 days or more. So your cycle is vanishing for a couple of months, and then it's making a reappearance, and then you're having flooding or no bleeding. Like, it's very inconsistent. It's like, you know, you're trying to find, like, Where's Waldo? Like, you're trying to.

How fun.

How fun to look forward to. And this is where, classically, where the diagnostic criteria around perimenopause really lands in the medical system system. So we. We just assumed that perimenopause was late perimenopause. So any of those symptoms you were having in the first 6, 7, 5 years of perimenopause, you were like, it's all in your head. You're just stressed. Eat less, exercise more, and, you know, be lucky you have a period. That kind of energy, that kind of vibe.

Yeah.

But once you're in late perimenopause, and it's, again, very impossible to miss, even from a medical provider standpoint, where your cycle is being skipped, you're going prolonged times without a cycle now. Hot flashes, night sweats, low libido, you know, painful intercourse, vaginal atrophy. Like, now we're beginning to see what we call, like, classic perimenopause. But really, these are more menopausal type symptoms. So we kind of looped them together. And I think that's why so many women, you ask your mom or you ask your aunt, and they're saying, you know, I don't. I don't remember going through perimenopause. I don't remember it at all. And that's because a lot of the symptoms that we recognized as late Perry were menopause. We called that menopause. And so a lot of women were like, unless I have horrible sleep and I have no libido and I'm having crazy hot flashes and night sweats, I just never went through it. And that's just a lot about how. What we got wrong about perimenopause and also how we consistently gaslit women throughout this process. And so those are basically kind of the three main phases. And then you're kind of in a perpetual waiting room until you hit menopause. But here's the thing. There's no end line. You don't just hit menopause, and you're like, okay, done. There's so many physiological changes that occurred leading into menopause, and that will continue to occur if we don't take interventions, if we don't bring on lifestyle interventions or hormone replacement therapy. Like, so much of what is changing in perimenopause is silent. Bone loss, muscle loss and strength, metabolic changes, insulin resistance. Your brain is massively reorganizing, and potentially you see inflammation in the brain. And so I just want to put, you know, I just want to mention that so often we hear doctors are like, well, once you get through perimenopause, the hormone chaos is going to be over. But it's not necessarily true, particularly for the longstanding physiological changes that we see really play out for women in their 60s, but a lot of it was developing in our 40s.

Okay, so what's happening hormonally? I know there's so many things going on, but what's kind of the main thing that's happening hormonally to us when we start going through perimenopause to menopause?

Yes, that's such a great question. So what is happening to our hormones in perimenopause is that they are declining and they are erratically declining. It's not a. It's not just a gradual shift down. It is an erratic shift shift. And here's the thing, why it's so important, these whole body hormones are so mission critical for us as women is that they have been rhythmically cycling predictably for most of us for 35 plus years.

Yeah.

And those physiological levels of rhythmic hormones, estradiol and progesterone and even testosterone, they have been modulating your immune system. They have been protecting and helping to grow your bone. Estrogen is the master regulator of the brain. Progesterone is a beautiful regulator of sleep. We're talking about cardiovascular protection and gut microbiome protection. That's what these hormones have been doing. And so it's not just about boobs and your reproductive organs or having babies. It's so much more than that. And so as these hormones begin to unpredictably stop binding to the receptor sites that your body has been expecting every month, the same thing every month. All of a sudden your body's like, what is happening? What is going on? And so I just want to give the brain as an example. So we know that the brain is fueled on. On estrogen. Like, if there was a fuel source besides glucose, Right? We know that glucose is the big fuel source for the brain. But if we had a regulator, if we had a CEO in charge of a woman's brain, it's going to be estradiol. So our brains are reliant. Estrogen is helping to control mitochondrial energy metabolism. It's modulating inflammation. It's helping your brain to create growth factors. It's allowing for your brain to be flexible and for. To support your cognitive function and your memory and your mood. I mean, estrogen is the star of the show. And as she starts to erratically decline, it's almost like having a really bad boyfriend that keeps ghosting you. That's what's happening with estrogen. The brain's like, where'd you go? Wait, I need you. And so the brain begins this massive reorganization of trying to get by without its most critical regulator. And that's why we see a bulk of perimenopausal symptoms being brain related, including hot flashes and night sweats, including sleep issues and memory issues, and brain fog and alertness, mood swings, depression, anxiety, all of this is brain related. And so that's why perimenopause is such a tumultuous time for women, is that their brains are massively shifting and changing. And it can feel like an untethering, it can feel like a disconnection. It could feel like they're not really able to function. And so. But on the back end of that, our brains have a really difficult time functioning. On the other side, we see an increase in inflammation, we see a decrease in. In glucose metabolism, energy metabolism, by like, 25%. So it's no wonder women are like, do I have. Is this dementia? Like, what is going on? This doesn't feel okay.

Yeah.

And it's because the brain is really trying to recalibrate at the best of its ability due to the loss of these hormones.

Oh, my gosh. I feel like looking back at, you know, this is even helpful. Like, looking back at my mom, looking back at some of her friends, looking back at some people who I'm going, oh, I feel like they had a massive life change, like in their early 50s. Like, even just with how they were and who they were, it's so interesting to go, oh, my gosh, maybe that wasn't situational. Like, maybe a lot of that, too is so hormonal for women. Like, I feel like this is so empowering for me to know right now, because I, you know, I'm 44, and I feel like what I notice right now is just having to work a little harder for my drive. And I hear some of my friends and I can relate to this a little bit, but you can feel like you lost your quote, unquote, sparkle, which is probably just your estrogen.

Yeah, it's your estrogen. Yeah. She's the sparkle. She's the sparkle, please.

Exactly. So what, like, what does the support look like around that? What is it? Is it hormone therapy? Is it. I know we talked a lot about, you know, lifestyle and things like that, but what are some of the things that people can start doing?

Absolutely. I mean, I think HRT should be a conversation as soon as you start to feel symptoms.

And what does HRT stand for?

Oh, sorry. Hormone replacement therapy. Okay. And bioidentical hormone replacement therapy. You want the real stuff. You want body identical hormones. And the beautiful thing is, is that's what most providers are recommending and giving. So. But it's important to ask for it, especially for progesterone. Progesterone. Often there can be some confusion between a progestin, which is a synthetic progesterone, and actual bioidentical progesterone. So it's important to ask. Even usually with estradiol, you're going to get bioidentical estradiol, you're going to get the real deal. But with progesterone, there's a little bit of nuance. You know, even with like a marina iud, some doctors think that it's actually progesterone when it's not, it's a progestin. And especially for women, I think it's like over 60% of women in midlife are struggling with sleep issues. A lot of that is due to the lack of progesterone. Progesterone is allopregnenolone in the brain and it helps to support gaba, which is a very calming, relaxing, sleep inducing kind of hormone. And when you lose progesterone, all of a sudden you're really struggling with sleep issues. And let me tell you, you go a couple of days without good, deep, restful sleep and no wonder your brain feels like it's scrambled.

Oh, I'm a different person.

Yeah, no, you can't function. Right. And so women deserve, you know, the real stuff. So when you're taking oral micronized progesterone, which is the bioidentical form, you're going to be able to see those sleep benefits. So making sure that you are getting bioidentical hormones, I think is very important in the conversation.

And so you were saying, you know, some people can go and get labs and everything looks normal.

Yes.

Like, I know for me, I definitely feel a decline in just drive.

And is that motivation for you?

Motivation?

Yeah, yeah, yeah, yeah.

Just like motivation. I have to work a lot harder to get where I used to be all the time. But all of my labs are totally normal. So what is that something that you would look at or is that just like what, what is, what is that conversation like when people are, are starting to go, no, I feel different. What does that look like?

Absolutely. Well, you have to understand that when it comes to normal labs, it's a pretty, pretty big range. And what is normal may not be your normal. Got it. And you know, if you go to your doctor, they run kind of the baseline preliminary labs and you come in because you are low resourced and you are Struggling with energy, and you're having a hard time going to sleep, and your brain feels like someone scrambled it, and your doctor comes back and is like, well, you're normal and you're 42 years old. No, I would not take that. I would be getting a second opinion. And so, because the ranges are so large, you could be very, very high normal. You could be very, very low normal. And so I think it's important for not only us to get the labs that we deserve, but also understand. And it's not fair that, you know, we have to advocate so hard for ourselves. And it's not fair that we have to, like, take our list and our symptoms and have our piece of paper so that we can really get what we need from our provider. But it's just. It's a time that we're living in right now. But I would say if your doctor is gaslighting you and telling you that everything looks normal and that, you know, oh, it's just. You're just aging or it's just midlife or whatever the excuse is, go and try to find a different provider that will actually look at your labs in a meaningful way. And I can go over, we can talk about what labs I recommend going through. Reference ranges, I think would be a little bit complicated, but I have. I have podcast episodes and guides where I. You can literally cross reference your labs to more optimal functional ranges so that you can kind of piece together what may be going on with you, especially if you can afford someone who does more functional, you know, work, like, total doctor.

So for people listening, if they're like, oh, I want to go get some things done, what would they be asking for specifically?

So I'd like to look at the whole. The whole everything. I want to look at a full functional panel so I can get a really great sense of what is going on with you. In perimenopause, as I mentioned, a lot of things are shifting. Your body composition is shifting, your bone is shifting, your muscle is shifting. Really, a lot of these things are declining or changing. Inflammation markers may be going up. Your metabolic markers may be shifting as well. And so you want to get a full picture. You know, the one thing I will say about perimenopause is because these hormones are erratically shifting and declining, we could. We could get a good day. Your hormones could look great today, totally not look great tomorrow. You're like, please look bad on the day.

I need you to.

Exactly. And so when you've got a great perimenopause and menopause doctor, functional doctor who can read the tea leaves. Right. I could. I could see that maybe estrogen still fine, but your highly sensitive crp, your inflammation marker isn't. Okay, that would be a good indicator. Or your fasting insulin is above a six. I'm like, okay, there's a little bit of insulin resistance. So when I start to look at all these labs and I'm like. And one, it's. It's. You're telling me you've got symptoms. I believe you. I deeply believe you. And then I'm taking a look at these biomarkers, and I'm like, okay, yes, maybe estrogen still looks okay, but everything else over here is looking a little out of range, and it really validates what you're experiencing. Then it's, you know, then we start to talk about, okay, what are some of the lifestyle levers that we can make? How can we prioritize you right now? And then if, depending on what those symptoms are, would hormone replacement therapy make sense for you right now?

With a lot of women, they talk a lot about weight gain throughout this process. It's kind of one of the biggest. It's sometimes the biggest thing that sets them off first because you just feel so not like yourself. And you're doing the same thing. You're eating the same way. Maybe you're even exercising more, or maybe you don't even have the energy to exercise like you were, but you just feel like you should not be gaining this much weight. Tell me a little bit about that process and what we can do to help that as well.

Yeah. So I want women to know that this is very typical, and it is not your fault. It is your hormones. It is your hormones declining. So estrogen in particular, and we know progesterone plays a big role too. We just don't know enough because we haven't studied that hormone enough. But we do know that estrogen is a powerful metabolic hormone. And estrogen helps to keep insulin sensitivity. It helps to keep glucose and blood sugar in check. It helps for. It allows us to build muscle. So it's great at helping to support muscle protein synthesis and actually building that lean muscle. As estrogen begins to decline, we start to see a redistribution of fat. So your. The scale may not even move, but all of a sudden it goes from the hips and the thighs and the. In the butt to the belly area, and it starts to maybe become more visceral. Visceral fat, which becomes very dangerous for us also. We know that, you know, again, insulin begins to shift it's not as sensitive, and that is also a fat storage hormone. So with estrogen significantly declining over perimenopause, we are going to see changes in your blood markers, in your metabolic markers, your body composition, your muscle. And if your muscle, which we know is your metabolic sink, your organ of longevity, you losing it isn't going to help your weight loss. It's going to unfortunately lead to more weight gain. And so that's a big player here. Also a decline in testosterone for some of us. It's also playing out in our motivation, our confidence, our getting to the gym. Right. That's going to be a big one. You know, we always think about, you know, testosterone isn't even FDA approved for women, but when we think about a reason to give it to women, it's usually for libido. You know, you have a low libido. But we know that it does so many other benefit. Has, has so many other benefits, including cognitive benefits, muscle recovery, and also building muscle. So testosterone may be dropping as well. And then we've got cortisol. And I think we, yeah, you've probably had people talk about cortisol on the show and, and how it deregulates. And particularly in perimenopause, with life lifing and these other hormones shifting, we will also see deregulated cortisol levels, which if, again, if it's deregulated, it's also going to contribute to more fat storage. So there's a lot of hormones as they begin to deregulate, that homeostasis of keeping our metabolism in a good place kind of just begins to falter. And we see that in the weight gain. So, yes, we're okay. A little bit more stress, you know, a little bit more mood changes. Maybe we can't stand when our partner is chewing and breathing anymore. But when we care is when we start to notice that we are putting on weight or weight is moving on our body without permission. And I want you to know that, you know, how we trained and how we ate in our 20s, even in our early 30s, just has to shift differently for us when we enter midlife.

So does hormone therapy help with this also? Like, do you see, once you get people in a good place with hormone therapy, do you notice that they feel a lot better with motivation? Do they drop weight? What does that all look like when they get to a place that you feel they're in a good spot?

I would say absolutely yes to all of that. So if you're taking progesterone and you're sleeping Better. You have more hot, deep quality sleep. You're going to feel more energized in the morning. You take estrogen and she comes back on the scene and your mood's more stable. Serotonin and dopamine are firing again. You're feeling more motivated and more energized. And again, it's giving you that umph, that sparkle to get back into your routines that really were working for you. Also, it's making building lean muscle a little bit easier, if not a lot of bit easier. I'm not going to say that HRT is a weight. Are weight loss drugs. They're not, but man, they really turn the tide on how you're feeling and also how your body is changing and functioning at a physiological level. And then testosterone, which I am a big fan of as well. For a lot of women that talk about bringing the sparkle back, talk about feeling like you're back at your edge, that confidence, that motivation, you know, these hormones will get you back out the door again. They'll get you feeling more energized and more confident and self assured that you are beginning to implement those lifestyle strategies. And it feels a lot less, it feels more effortless. It feels like you're not having to work as hard. So that's what I think they really bring to the table. Also a physiological level. They are helping to protect your heart, they're helping to rebuild that bone, they're helping to build that muscle and the helping to support your brain. You're giving your brain the fuel that it needs to function. And so we can't not mention those because those are. We're talking about longevity here. We're talking about future proofing your health.

I have a couple of friends on it and they're always like, it's amazing. Just for motivation because truly that is, I think that's the main thing I've noticed is even I'll still go to the gym, but I'm dragging myself there and I don't want to. It's like I don't want to be there, even though I do want to be there.

Yeah.

It's like nothing I could explain because my whole life I've always enjoyed my workouts and now I'm like, let's get these over with. That's so interesting. So is this something that you like are women, once you get on, is this something you do for the rest of your life and it kind of helps protect your, I mean just your mental health, your bones, all the things.

Yes. Okay. Once you're on Them, you're going to want to stay on them, because once you get off of hrt, all of the protection that they were providing begins to disappear. You know, because it's. If you're in menopause and you're not taking estradiol, your body's not making it anymore, not, not to the degree that you need to protect your bones and protect your brain and protect your heart. And so, you know, I would say write it until the wheels fall off. And the sooner we can get on it to mitigate symptoms and again, to create a better health span for you, the better. And so I think we're beginning to realize that it's not menopause that is the window of intervention with hrt. It is sooner than that. I don't understand why we feel like women should suffer needlessly and, you know, six years prior to menopause with all the symptoms, but because she's not in menopause yet, we're not going to recommend hrt. Like, that doesn't make any sense at all to me. And so it's. We have got a little bit of a ways to change that way of thinking, but we're getting there. And women are demanding it. They're just like, I'm not, I'm not going to suffer like this. I'm not going to feel like this. The amount of responsibilities that women have at this time of their lives, particularly midlife parents that are aging and struggling, they have a, a family member, a parent right now who had a really bad fall, and we're managing that at the moment. Even siblings that may be having a hard time, children, careers. I mean, the endless to do list of all the things that are going on. And then, not to mention now we're talking about you're struggling with symptoms and health issues that are popping up. Like, it's just a lot. And so we deserve all the tools in the toolbox, including hormone replacement therapy, so that we are feeling the most alive in our body, not only today, but 5, 10, 20 years out.

Okay, so what do you think of mental health and hormone therapy? Because I feel like from everything that I've experienced from women in their 40s and 50s and conversations, it's kind of like we're not necessarily feeling. It feels like life feels like a lot. And, you know, the depression and anxiety, I feel like goes is a lot higher amongst the people that I know around that age. Do you feel. Feel like this is something that can be controlled with that as well? It sounds like it is from the conversation but have you noticed that that really does take a big turn for people when they start it?

Yeah. I mean, if we look at the Women's Health Initiative study that happened in the early 2000s, where the big scare was that we saw one extra case of breast cancer, it was relative risk, it was almost nothing. And we just got blown up, it got sensationalized and everyone was super scared of HRT. And so it's been 20 years since that study halted. And what we have seen is one, we're now down to only 6% of women on HRT. At the time it was around 40%. But the uptick in in medications for depression and anxiety have significantly soared in those 20 years. And we know that because women don't have adequate hormones in their body, particularly for their brain. Right. That they are being put on antidepressants and anti anxiety medication to manage a lot of the mental health issues that they're struggling with in perimenopause, over 60% of women in midlife are going to struggle with mental health issues. And that is not okay. And so with hormone replacement therapy and again, lifestyle, it's a yes. And it can really be so helpful. Again, if better sleep improves your mental health, that is such a big win. And if you can get better sleep with progesterone, then it's a full body. Yes. If bringing estrogen back on the scene before she falls off a cliff to help stabilize your mood and your brain, then why wouldn't we do it? Right. And we need to be looking at the types of lifestyle interventions, you know, things that I recommend. Again, besides getting that deep restful sleep is going to be spending time with the women that matter to you, having safe friendships that you can connect with, having community. This is the loneliest time of a woman's life is in midlife where she is feeling a lot of shame about the symptoms that she's dealing with. She's feeling like she's not getting a lot of answers. So it must be her fault. And she doesn't know where to turn to. She feels like she's on this journey by herself. I a little vulnerable. Share. For the past two and a half weeks, I have had a migraine every other day. And today would have been the migraine day. And I prayed two days ago that I would not have a migraine today. And in those days where I have migraines, not only do I still have to show up to some degree, but it is such an isolating and lonely experience because it is so painful and it's so just. It's so isolating. Even no one in my family understands what's going on. And obviously there are millions of women who have migraines all over the world, particularly in perimenopause hormone. There's a hormone connection that we don't fully understand. But even still, gosh, on the days where I can't function or I feel like I'm half of myself, it is just so lonely and it's so hard to communicate that to everybody else. And so you can imagine a woman who's having leakage issues or she's having horrible hot flashes or migraines in this time. It can be so hard. Hard to know who to turn to or to have those really safe conversations. But it is the time. I know as uncomfortable as it is to double down on the. On. On your friends, on the people that matter, I'd say probably one of the biggest longevity hacks that we can implement is spending time with the people that we love in real life. And if I was to double down on that longevity hack, I would say walking in nature with your besties, like, be outside in nature with your girls, walking or hiking or doing whatever you love, Right? So community is so critical in this time where we're really struggling with our mental health. And then the other thing I think is really important is carving out time for you to take care of you. Whether that is, you know, breath work, or it's meditation or it's walking outside or it's listening to a really great fiction book or reading or being in your sauna, I don't know, whatever it may be, carving out time to do the things that you love. So the question I always pose to women is, do you know what you love? Like, what would you love today? What would you love this week? And the more clear that we can get about what we would love, we can start scheduling that into our lives. And I believe that when we're living in gratitude and in joy and doing the things that we love, man, it changes our chemistry, it changes our sparkle. It really shifts us and motivates us to just tend to ourselves even more. And so in the mental health journey, I would say get really clear about what you need to prioritize, how to help yourself feel good along with the supplements and eating well and reducing inflammation and getting on hrt. I mean, I think all of that is something we need to consider and, and think of it as something that is very mission critical. We deserve to have good mental wellness and we deserve to feel amazing. Not only in our body, but also amazing mentally and emotionally.

This is so power. Powerful for making people feel hopeful. Because the. The conversations that I heard growing up is kind of like, this is what happens. You're getting older, your life's done. Just wait till you. I mean, the amount of times I heard just from random people all through the years of. First it was wait till you're 30. Then it's wait till you're 40. And it's like, just waiting, you know, for your life to fall apart. Like, wait until you feel like you're falling apart. Just wait till you're 40. You're gonna feel depressed or overwhelmed or anxious or all of the things. And it's. It's so good to hear that there's so many things that we can do to help ourselves.

Absolutely. Again, we talked about signals earlier and how it's the opportunity to listen to our body and to say, you know what my body's telling me, listen to me, tend to me, take care of me. Well, the beautiful thing about this journey, this midlife journey, is that, yes, it's a time of vulnerability. I'm not going to pretend like your body isn't changing, because it is. Absolutely. But it's an also. It's a beautiful time of opportunity. And in this opportunity, you get to decide the life that you're going to want to. That you want to live, that you're excited to live. You get to decide, like, what matters to you, what are your priorities? What are your boundaries? How do you want to live this part of your life and the second half of your life? Because that's what we're looking at. And so I think, you know, it's really about our mindset. Yes, we can get so caught up in how we're feeling. Yes, I can get caught up in how horrible my migraines are. But also, I think it's my body telling me, like, hey, it's time to listen to me and take. Take note in terms of what you need to do to feel more alive, what you need to let go of the obligations, the relationships, the habits that are not serving you. So I think that this is a beautiful time. I call it the reckoning. But it's really. It's. Everything is up for review. It's. It's the opportunity to be like, you know what? I'm going to reevaluate how I've been living my life. I think I've been living it for everybody else. And my body's like, you know what? That. That time is over. We get to now live it for you. And when we step into that empowerment of saying, I am going to take care of me, I am going to get clear on what I love. I'm going to get clear on my non negotiables. Not only my health non negotiables, but the things that fuel me up. I think it's such a beautiful transformation and awakening. You know, perimenopause is not the beginning of the end. Perimenopause is stepping more into you, more empowered and more just more taking no from people and just stepping into your Yes.

I love that so much. I just want that whole clip every morning. But it's. It's so true. I think perimenopause can kind of serve you in the beginning, which I feel like if it's done, if me getting older has done anything, it is that there is like a. You have less tolerance for things that maybe you were tolerating in your 30s and now you're like, when your hormones go down, you're just like, actually, my actual ability to tolerate this is no longer here. So it is a super powerful time. I feel like when people in their 30s, like, ask about turning 40, I'm like, honestly, it's so much clarity on what you won't put up with anymore and how you want to live. And I do think we have this whole. I've been just talking a lot about it and thinking a lot about it because it's. It's very here and real for me right now of how do I want to live the second half of my life? It's. It's very like, I feel like the beginning is. Is like building and you're building this career and all of a sudden you hit your 40s and you think you're. Maybe it was supposed to feel a certain way or look a certain way, and you never really thought how you want to live your late 40s, your 50s, and your 60s. Like, we never stop and do that. We just think of the building phase so much. But what happens when you've kind of built that? You know? And I don't think the conversation is. I don't think there's enough conversation around it yet. Because I think that has felt really lonely for me of like, how do I want to live this? I hate to say the back half, but. Yeah, the back half. Better than the first half.

Yes.

We're not talking about that.

No, no. And we need to be talking about it. You know, the average age for women is 81 and 76 for men, so we live longer than men and yet, you know, if we're in default mode and we're not clear about how we want to live our life, we end up really struggling with our quality of life in that 25% of menopause and that is not okay. But if we can get clear on how we want to live, we want to age powerfully, we want to. I don't want to negotiate with myself when I'm 70 about what I have energy capacity for. I don't want to have to get help to get off the toilet. I want to be able to shot put my suitcase in the overhead compartment, you know what I'm saying? And so when we can get super clear about how we want to live, our 50s, our 60s or 70s and beyond, then, you know, a lot of that maps out itself about the level of consistency that I am going to tend to me, the level of consistency that I'm going to spend time with the people that nourish me and love me and that fill me up, that I'm going to get super consistent about honoring my body so that I can do the things that I want to do in my 70s and beyond. And you have, if you're looking for permission today, you have full out permission to do that, to get that clarity. And I feel like that first question really is, is what would you love? What would you love? You know, and start thinking about your future self. What, what is your future self doing? What kind of activities, where is she traveling, how is she nourishing her body? How is she moving her body? That feels really good, you know, that you're excited about? What is she saying no to, what is she saying yes to? You know, who is she bringing on to support her? Who's her support system? And you know, how does she want to live her day to day? And these are very rich questions that we can get a lot of clarity on. And once we have that clarity and honestly, again, you could use ChatGPT, you know, to get some of this clarity. You can honestly reverse engineer the roadmap on how you want to live.

I have loved this whole conversation. I want to answer for anybody who's, who's thinking about this right now. Is there an age that's too early? Is there an age that's too late to start?

Two stars.

Hrt.

Hrt. Great question. That is such a great question. I would say that on average, and again, we use hormones for women who need support with fertility. So I think it depends. It's a different kind of conversation there. But I would say you usually having the HRT conversation probably at 40, just start having the conversation based on your symptoms. Now, if you're not symptomatic and you're doing great, probably don't need them. But if you're noticing some major shifts and changes and your quality of life is shifting and not in a great way, then start having that conversation. Even if it's just bringing in progesterone just to help you kind of ease out some of those PMS symptoms or ease out the mood changes and the sleep issues. I mean, that all gets to get addressed. You get to feel good in early perimenopause with a little bit of progesterone. And then right now, based even on the Women's Health Initiative study, we know that the kind of, the, the best window of opportunity is 10 years around menopause. And again, I think earlier is better. But between, let's say menopause is 51 years old. Between 51 and 61 years old, we really see no contraindication. But even, even 10 to 20 years out, we don't really see a lot of contraindication. So if a woman is 62 or 68, it's still a worthy conversation. We should be looking at your cardiovascular numbers. We should be scanning your carotid arteries for any plaquing, and we do our due diligence, do the screenings that are necessary for, for a woman to decide if she's still a great candidate for HRT. And then it's only until a woman is 20 years out do we see some, some issues, some contraindications, particularly around your cardiovascular health, around stroke and heart attack. And so again, by the time you're 70, hopefully you know, you're on HRT. But there are still providers that if a woman in her 70s has beautiful arteries and low inflammation and no diabetes, that it's still a potential, not only a conversation, but that she can get on it. Wow.

Interesting. Okay. What do you want to leave everyone with?

I want to leave everyone with that my deepest desire is for you to feel alive in your body, that at any age you deserve to feel that. And that you deserve a wellness team to support you on this journey. And that right now I know that you're hearing a lot of information, a lot of content around perimenopause. And the reason for that is that it is truly a movement, that it's truly a rally cry, that we are tired of being dismissed, we're tired of being ignored, and that we are demanding better for ourselves. And so I want you to know if you've been feeling a shift in a change and you're thinking, gosh, maybe I should investigate this and get some support. Yes, please. And you deserve it. Don't settle for anything less than you feeling amazing. And that is really what I want to share today is that there are tools and there are resources out there and that if something feels not right, you are always the CEO of your health. Trust that intuition. Deeply.

So good. I loved, love, love this conversation, you guys. We can grab her book wherever books are sold.

Wherever books are sold.

We're going to put that in the show notes if you want to grab her book. It is called the Perimenopause of Revolution and you want to go get it. Because if you love this conversation, she goes so in depth into everything. And when you know and you have the knowledge, you can really. I feel like that's really going to help people walk in and ask for what they need.

Yeah, exactly. That's the goal. It is a revolution. It is a movement. There are so many goodies that I built alongside of this book to get you started so that you feel like you have everything that you need to, to feel again, to feel amazing.

And you have, you have a gift for them.

Yes, I have a gift. So also I have an amazing toolkit.

Okay.

So while you're waiting for your book to show up, right. This toolkit will walk you through it as a symptom tracker. It has all the labs, reference ranges, everything you need and all of my non negotiable lifestyle habits to move the needle in you feeling amazing in your body. And you just, you know, as you're reading this and going through this, you just pick the thing that you're like, okay, this is the one thing I'm going to do because even one change, one shift, one little mini habit, whether that's a couple squats after dinner or walking outside in the morning to get sunlight, or it is, you know, taking a moment, just having your own moment with yourself or with your friend. Like these are simple things. These shifts can add up over time to make profound changes. So it doesn't have to be complicated. And there's always a beautiful place to start where you are feeling like you are winning.

Amen. Well, I'm so grateful for you. Thank you so much for coming on today.

Thanks, honey.

And like I said, everything is in the show notes for you guys. So grateful for all of you. Make sure you share the, share this with a friend that maybe you feel has been struggling because I just think this conversation needs to get out to everyone that we know, and thank you guys for tuning in, and we will.

See you next week.

Bye, everyone.