We’ve Been Getting Perimenopause All Wrong!!

Doctor Marisa Snyder is joining me today for our interview and we are talking all things perimenopause. She has a new book, the Perimenopause Revolution, that is coming out now, y', all, and it is the ultimate resource for women to take charge of their health, embrace perimenopause with resilience and confidence. Please check out her website@drmerisa.com for solutions to thrive. I love this woman. I've known her, gosh, for close to 10 years now. And you're in for a treat, so let's dig in. So Dr. Marisa Snyder is here and she is just. I adore this woman. She's brilliant. She's a wonderful, great, longtime friend of mine in an absolute force for women. She empowers us, she educates us. And there's something really exciting coming up for her that we'll share with you towards the end of this interview, so don't miss it. But Dr. Marisa Snyder, thank you so much for coming on the podcast.

Oh, my goodness, Bicall, thank you so much for having me. Honestly, this is a dream come true to get interviewed by you. I've had the pleasure and the honor to get to interview you a few times. And it's so fun to. To be on the other side.

I know, Me too. Same. Well, we've actually had so many conversations, like personally, professional, all the things about perimenopause. So I'm really, really excited to dig into that today. I think it's a very misunderstood topic for women in general, but I would love for you to tell me about your personal experience with perimenopause and how it's inspired you to advocate for, for other women moving through that process.

Yeah. My first experience with perimenopause was my mama's experience with perimenopause. At the time I was in practice and 95% of my patients were in midlife, so they were in Perry and menopause. This was in 2010. And I wasn't even putting together the pieces. Like, I knew my women who were in menopause, but the women that were heading into menopause had a number of symptoms, many brain related, but also physical. And I remember that a lot of their care was being siloed out to cardiology, psychiatry, endocrinology, and just all different, you know, all different types of kind of medical silos. And I was like, gosh, there's got to be a connection here. And. And I knew a little bit about Perry, but it wasn't until my mom flagged me with that. I Knew she was 47 or 48 years old, mind you. She had been in perimenopause. But back then and even still today, a lot of what the literature says is perimenopause is kind of. It's how they. How they recognize it is that it's late perimenopause. So how we've looked at perimenopause is that, okay, you're skipping periods more than 60 days, you've got hot flashes, you got night sweats, you've got low libido, you've got sleep issues. This is late Perry for a lot of women. My mom had been suffering, but we just kept writing it off as the daily pain points of everyday life for women, and that women just have to suffer through it. So my mom had been struggling with brain fog issues and mood issues and more severe pms. But by the time she got into late perimenopause pause. Like, oh, my goodness, the wheels had come off. At this point, she was in severe rage. Yeah, she found. She found herself. She would stay in her house about four to five days out of the month because she was afraid she was going to run somebody over with a car. That's how rageful she was. Severe mood swings, severe fatigue issues, weight gain, weight resistance, brain fog issues. She was afraid of presenting at work. She was a CFO at the time. And she was like, I don't know if I'm going to be able to do the job that I've been given to do. Like, she was really having that level of crisis. And she went to one of her doctors and she asked them point blank, is it normal for a woman in this time in their lives to want to kill people multiple times out of the month? And her doctor said, yes. And it was, my God. Yeah, she's like, absolutely. Like, that's. And what a lot of people don't realize is that when women come into your. The provider's office so often for HRT is not for the weight resistance. It's not for the irregular cycles. Although maybe they're coming in for kind of birth control management on that. But usually it's because they are. Their relationships are at stake because the mood swings are so bad, the irritability is so bad, the rage is so bad. They're like, you have to have something for this. And so very much the reason why my mom came in was like, okay, the rage is out of control. And so what can we do about that? So she was actually, at the time, given this was again 2010 oral micronized progesterone. But when she was renewing that prescription about three months later, her doctor was on sabbatical and she ended up getting another doctor. And her other. The other doctor, like so many other doctors was said, I don't. This isn't indicated. Although she was doing great.

She's like, it is not changed her whole life. I can only imagine, right?

So she's like, I only. Only antidepressants. That's all I got for you. And that was it. That was the end of her progesterone journey.

Oh your.

So she ended up getting on the antidepressant, I believe. And it made her. I wouldn't call it. She wasn't suicidal per se, but she had very scary thought. She was very scared. I remember getting the call at 11pm My mom was like, something's wrong, something's not right. I'm really worried about myself. And I ended up taking over her care. And I will tell you in that two years of getting to take care of her, it was a. It went from a nightmare unfolding to a complete turnaround. She was. She was playing competitive tennis. She had lost like 20 something pounds. She had her energy back. She was sleeping better. She was no more hot flashes and night sweats like major. And this was. This unfortunately wasn't with HRT per se. She was afraid to go back on it after some of the experiences she had, but she just felt like a different person. She's right now she's training for Multiple marathons at 64 years old and kicking butt and taking names and just really shows what is possible on the other side of this profound transition when we are proactive. Now I will say that when I watch my mom go through this, the first question I asked myself is, is this going to happen to me? I was like, I don't want any of that.

Right. I bet you were.

And I will. Fortunately or unfortunately, I will say that I was blindsided by perimenopause. And the way that I officially knew that I was in it was for three months in a row, seven days prior to my cycle, I would wake up with this insurmountable amount of dread and. And I would have bouts of rage. And within the third month that that happened because I was again tracking my symptoms around my cycle, kind of seeing what are the patterns, what are the cyclical patterns. I was like at the third month in a row, mind you, I was 44 at this point. So I do the math. Like I was obviously in Perry. I was like, okay, this is perimenopause. So I felt a bit blindsided initially by my perimenopausal symptoms. And not every day is the most amazing day, I'm not going to lie. But overall, it has been a transformative journey, and I'm so grateful to be in it while I get to support thousands of women through it.

Well, we are so glad that you're moving through it, too, so that you can support us as well.

Right.

Like, it's. Yes. Created an invaluable resource for us. So thank you for making the sacrifice on our behalf. Can you tell me a little bit about under the surface, like, all of these symptoms? Right. Like anxiety, irritability, agitation, insomnia. Those are certainly like classic perimenopause symptoms. So if you're listening to this and you're again, wondering why you're raging, it could be this. But tell us a little bit about what's going on under the surface, what's happening with women's hormones during this time.

Yeah. I think we always have believed or we've been told that perimenopause and menopause is a reproductive concern or a reproductive shift. And yes, yes, that is true. Our reproductive system is coming offline. But it is so much more than that. What we're really beginning to realize. And I was just interviewing Dr. Louise Newsom out of the UK a couple of weeks ago. We were talking about this at length that she and I both agree. And I think Dr. Moscone's work really demonstrate this, is that this is a neuroendocrine transition. That is what this is. And what that breaks down to it is the brain and hormones are transitioning, and our brains go through a massive neuroendocrine transition three times in our lives. The first time that it happens. And again, all of us go through it. If we live long enough to get to puberty, we are going through puberty. And puberty isn't. I mean, announces. Announces itself with that. With that period. So at least we get an announcement. Perimenopause. There's no announcement. There's no perimenopause. It's like, we're here. It can feel very subtle, or sometimes it can feel like a. Like a Mack truck, depending on the woman, depending on what you're going through. But perimenopause often does announce, sorry, puberty announces itself with your period. I'll never forget getting my period for the first time. I was at a roller skating rink. I was roller skating to Janet Jackson I had a Mariah Carey little. I mean, I had jean shorts on.

And remember these days so vividly. Our childhood sounds very similar.

Oh my goodness. And so I will never forget that day because I was so embarrassed. Luckily my shirt was long enough because I kind of scrunched it to the side that I could cover the blood stain. But so I knew when puberty started. But what a lot of us don't realize is that it is, it is also its own transition. It takes years to get into our kind of our prime childbearing years. I would say puberty can last anywhere from six to eight years, give or take, depending on the girl. Kate the next time we have this neurological change and transition, and any mom can speak to this is during pregnancy and postpartum. You know that once you're a mother in postpartum that you will never be the woman that you were before. You are a different woman. Your brain has completely reorganized to protect those children at all costs. You are just a different, just a different energy, different individual. Your brain is completely different. And then the third neurological, the neuroendocrine transition that we go through is going to be perimenopause. And again we, when we look at it, when we look at the scans, the brain scans, we know that gray matter and white matter is going to decline. Energy metabolism in the brain can decline up to 20%. We know that Estradiol, the master CEO of the brain, right? The CEO who shows up at work every day from 9am to 6pm it's really 24 hours, let's be honest. But now let's just give an example. For 35 years, give or take, she is showing up like clockwork, rhythmically, every single day of the month. And then we get to perimenopause and she doesn't come to work until 1pm and she stays until 2am and then the next day she doesn't get back. She doesn't come back until 11. But then she leaves at 1pm and then the next day she actually doesn't even show up at all. And so that is what perimenopause is. We've had this reliant, reliancy on, on estradiol as a master regulator of the brain, regulating our immune system, regulating the energy metabolism, regulating neurotransmitters, I mean regulating everything relation to the brain functioning. And all of a sudden it's not showing up in same as progesterone. Progesterone with its chill calming, relaxing hormone binding to, helping to bind to gaba Receptors or supporting GABA receptor receptivity all of a sudden isn't showing up as well to work. And so many of the symptoms, actually 80% of the symptoms in perimenopause are going to be brain related, not necessarily physical. Although women are also struggling with physical symptoms as well as.

Wow. And then tell me, how do we know? Like so many women are always, well, how do I know if I'm in perimenopause? Is it, do I start that at 40, do I start it at 49? Like is there a way to objectively know? Is there a way to test for it? What does that look like?

I love this question, McCall, because I would say this is the number one question I get from my community and even my patients are just like, am I in perimenopause? And this is literally the number one reasons why I wrote the book the Perimenopause Revolution is to answer this question. So I will say that how we clinically diagnose perimenopause is really based on symptoms, based on your age and based on cycle changes. And so if I were to break it down, I usually start with the late reproductive years, not officially yet in perimenopause. But we know that your ovulatory cycle could be shifting a little bit. There may be occasional and ovulatory cycles where we're not ovulating in that cycle. And we know that progesterone is beginning to decline more subtly. And again, for some women it's actually more overt. It just really depends on the woman. I mean I have patients who have low progesterone levels in their mid-30s and they definitely are exhibiting perimenopausal symptoms. So what I'm looking for in a woman in a late reproductive years is going to be PMS symptoms are a little bit more exacerbated. They're noticing instead of three days of PMS symptoms, it's now five days. They'll notice maybe one less day in their cycle. Again, not major cycle changes, but huh, now we're looking at a 27 day or 26 day cycle versus a maybe a 28 or 29 day cycle. Also they'll notice that their resilience isn't as, as, as they don't have the capacity, the stress resilience that they had. They may notice some emotional changes. Again, a lot of these are brain related. I will also say that workout recovery isn't necessarily the same. They may also notice some body composition shifting, but not too much. And then in early Perimenopause, I usually denote that around really late 30s, but early 40s, I would say, like the kind of. That if I had a given age, it would be like 42, 43. This is when I find my women are like, okay, send me a sign. Make it impossible for me to miss. They're noticing some cycle changes, maybe heavier ones versus lighter ones, maybe spotting. So there are some, you know, especially if they're not on hormonal birth control, that is, that's controlling pill bleeds. They're noticing some cycle changes also. Sleep could be starting to disrupt that. That alcohol wind down with your girls on a Friday. Not feeling. Not feeling the same as it did in your 30s. You're waking up with hangovers. You're just not feeling great. So all of us, you're having more alcohol intolerance. Women will start to notice that their brain is shifting. The brain fog, the lack of word recall, especially a lot of my patients and community members. These are high level women managing households, managing families, managing careers. And. And they have been managing at a high level, at high level multitasking for a long time. And what used to feel effortless is now requiring effort. And the thing that I noticed the most, and this was very much the case for me at 43, 44 years old, was that I didn't feel like myself anymore. That's the thing. Women come to me like something isn't right. Like, I can't just blame this on stress and work and motherhood and all the things everyone tells me to blame it on. Like, no, the rug is getting pulled from under me. Something else is happening here. And it's the math isn't mathing when it comes to my health, like, something isn't right. And it is like, yes, it can be all of those things. And now that we're losing those protective shield hormones, all of a sudden, symptoms that you are managing really well or things that were kind of. You didn't know about yet are now coming up for review. And this is early Peri. And then we've got Late Perry. Late Perry is when you're skipping periods more than 60 days. Again, this is when we always thought perimenopause was. Because it was obvious. It was pretty obvious. Skipping periods more than two months, you.

Notice it's like, objective.

Yeah.

It's measurable.

Objective. Yeah. Very meas. And then what you're also seeing here is now we have pretty low estrogen levels at this point. It's not as erratic as it was in early, because even in early we can see unopposed estrogen. So women are dealing with migraines and breast tenderness and, and, and bloating and kind of weight still at the hips and butts and thighs. But then as we move into later perimenopause, we see that body composition change, maybe over to visceral belly fat. And that can happen in early as well, but we. It becomes more apparent and obvious in late perimenopause. But late perimenopause, if you haven't hadn't been having sleep issues yet, all of a sudden sleep is an issue. Maybe you're dealing now with incontinence and UTIs and general urinary symptoms of menopause. Maybe you're also dealing with hot flashes and night sweats. This is where we really start to see the low estrogen type symptoms come into play. And this is what we always classically thought was perimenopause. At this point, you're about one to three years on average away from menopause. So it's happening in your late 40s, early 50s, depending on the woman.

And it's interesting. So what I'm hearing you say that I don't hear often is even we're breaking this up further into stages. It's no longer menopause. Perimenopause, even perimenopause itself breaks up into further stages, which is absolutely. And they look very different from what I hear you describe.

And you can even. We added a, if we wanted to add a fourth stage. We're talking about the very, very end of Perry, where you're kind of in that perpetual waiting room where you haven't had a cycle or period for three months and then six months and then. And at this point, estrogen and progesterone are so low. You know, the fact that I really struggle with us needing to have that defining day, that day, because it is all a continuum. There are silent shifts happening beforehand and after that defining moment. Also, if you are on hormonal birth control or hormone replacement therapy like I am, I'm on hrt as you were one of my, my practitioners. I'm never going to know the date girl, right? Because I'm just going pee. I was going to be on HRT the whole time, and I'll never know. And so I just wanted to just share that as well, that I want women to know that perimenopause, not menopause, is the window of vulnerability. And because of that, it is the window of opportunity. The signs and symptoms that I just laid out in the Spectrum of the four to plus ten year transition. Anyway, what some people call that this could just might as well be a career that you've signed up for this inevitability. Because it's that much of our lives, right? We're talking about a big chunk of our lives that we're spending in this time, this zone of vulnerability and opportunity. If you're experiencing any of the symptoms that I mentioned, particularly the brain related symptoms or the symptoms that are disrupting your life, please listen. Your body is calling for a new level of care. Your body is calling for a new level of support. And let me tell you, those symptoms are not just, they're not just nuisances. They're not just like hot flashes and night sweats or just, oh, it's just this thing that I tolerate in late perimenopause, early menopause. No, these symptoms are connected to future health outcomes, period. And if we don't do something about it, if we just keep writing the narrative that oh, women just need to survive through this or women just need to talk through this, I'm telling you, on the other side, in your late 50s, early 60s, you are going to experience the ramifications of that.

I totally agree. And we're in this unique time, I feel like in medicine, of evolution, right? Like we are living through this recognition, evolution and new information about perimenopause that people didn't have five years ago, 10 years ago. So this is all happening in real time and it's so incredibly powerful. I know firsthand personally, but also obviously professionally with my patients. Same as you, how life changing it is to address all of this. It's incredibly important to be informed and empowered. And so I love that that your, your mission aligns with that. I know one recurring theme that I hear literally every day that I'm in clinic, and I'm sure it's the same for you, is women struggling with weight and metabolic issues during perimenopause. Insulin resistance is showing up. Just giant hormone fluctuations are happening. What if you have some, what are your recommendations? What are some tips to optimize our whole body, our health and composition? All of these metabolic changes. How can we move through that process in a way that sets us up for success?

I love this and this is really. People ask me what makes my book so unique. It's really looking at the cardio metabolic changes and shifts, the silent shifts that happen in perimenopause. I know you asked me, do I look at labs during this time to kind of dictate or indicate perimenopause. I absolutely do. And now I know that some women are just like, I just need to know, I want to know. And maybe they're working with a practitioner or provider who one won't run the labs or won't look at them in a meaningful way. And so the reason why I offered that initial explanation of age, menstrual cycle changes and symptoms is that something that every woman can follow for themselves and really understand for themselves. Now, as a provider and a practitioner who is looking at labs in a meaningful way, I would love a timeline of labs, labs, particularly the metabolic labs, fasting insulin, a full lipid panel, including lipoprotein, little A and apob. I want to be looking at vitamin D levels and obviously a full thyroid panel. Like, I want the whole gamut. Because I can see things shifting in a woman's labs over the course of her perimenopausal journey, and not necessarily in a favorable direction, often in an unfavorable direction. And I can start to see. I can, I can, can. I can basically point to perimenopause on labs when I'm looking at the whole cardiometabolic kind of profile. Yeah, and also creeping blood pressure. All of this is because some of, some of which, I mean, obviously a lot of it can be lifestyle and how we were living our lives up into this point. But also, again, those protective shield hormones, as they begin to decline erratically, we start to see an uptick in some of these labs going in an unfavorable direction more towards insulin resistance resistance. And so, yeah, women notice, even if the scale doesn't climb, they start to notice these body composition changes due to erratic declining estrogen and even progesterone. And insulin was becoming more resistant. All of those things are happening. And what I'm recommending to women is one, start by balancing your blood sugar only seven. Well, let's be honest, 6.8% of us are metabolically healthy in this country, in the US specifically. And women become the most vulnerable after the age of 45 as a more women than men by the time they're 45 years old are obese or overweight. And more of them are metabolically compromised than men, even at that age. And it has everything to do with the fact that we're losing these hormones that have been keeping us safe up until this point. So balancing your blood glucose, I think, is number one. And how I recommend women doing that, I have a whole plan, meal plans, recipes, all the things to make it happen. But Thinking about even that first meal of the day, making sure that it is protein focused, it is fiber focused, healthy fats. You're focusing on those micronutrient and antioxidant rich foods and not doing the sugar breakfast, not doing the sugar coffee. And also moving after meals as much as possible. I would say that the biggest needle mover I have seen in my patients when they're wearing a continuous glucose monitor is movement as much as possible. Yes. I want you to do the strength training workout. I want you to build for power and strength, strength and for maintaining that metabolic sync your muscle. But also I want you moving after meals, before meals, like, I'm about to kick off a squat challenge. Because if we could just be squatting after meetings, before meetings, after meals, before, like, yes, it's so lovely to walk after a meal. But if you're like me and your son wants to play Legos, I'm usually building Legos and then I'm doing jump squats and then I'm building Legos and doing jump squats like gone are the days. And I'm so grateful to be a mama to this beautiful little four and a half year old light being. But also like, I can't just go and take a walk after dinner if my son is like, no, we're, we're doing workbook activities, so get in where you fit in. So moving. I would say that I would, if I could bottle up exercise and movement and sell. I mean, I would have every woman taking that because that is the longevity elixir. But mainly because it's such, it's such a beautiful way of balancing your blood sugar. That would be number one, like, how do we get your blood sugar and your insulin under control and more sensitive? I believe that insulin resistance is the biggest driver of cardiometabolic disease and insulin resistance is one of the biggest drivers of weight gain. And so that would be number one. Number two is protecting your sleep like it's a million dollar meeting. Because it is. Let's, I mean, let's just be honest. Like if you're only clocking five to six hours of sleep per night, you are going to make it up in calories the next day. Somewhere between, you're going to eat somewhere between 15 and 20% more extra calories. We also know that if you go multiple nights, only sleeping five hours a night, that you are, you can put yourself into a pretty severe insulin resistant state and even be knocking on the doors of prediabetes. So these are the things that I'm looking At in terms of lifestyle levers, please go get your thyroid checked, see if you need thyroid support. If. And I know that you've got a beautiful weight loss loss clinic where you offer so many beautiful solutions. And sometimes for some women, depending on your circumstance, I mean, if you are pre diabetic and massively insulin resistant and you're putting on weight despite everything you're doing and you need a jump start, it is worth looking into peptides to help support you on that front. But obviously I always want to be emphasizing the lifestyle piece. Always the lifestyle piece.

Right. And that's what we can control so easily. Right. Those are the steps that we can take now, tomorrow, right away. So I. And now is the new now is the new later. I like it. Later is the new smoking, right?

Yeah, absolutely. Later is the new smoking. Yeah. Because if anyone's listening to this right now and you're not in perimenopause anymore and you're thinking, man, did I just miss my window? Did I miss that window of opportunity? No, now is the new later. Right now you could pick up weight right now. You could go for a walk right now you could do, do 20 jump squats or 20 squats, like literally right the second. And that's how quickly you can choose, you can choose how you want to live your life in the second half of your life. Every day you have that choice. Even on days that are not my best days, I still show up for me, because it's my body's way of saying, girl, you better keep showing up.

Yeah. And it's so interesting. I mean, one of the most surprising things about kind of what you touched on the continuous glucose monitor is like, look, if you eat a meal and then you go for a 15 minute walk, your blood sugar spikes reduces by like 30 to 60%. That can happen like right now. It doesn't build up over time. That's immediate. So, yeah, it's fascinating how quick these shifts can actually take place. Even if we can't see the number on the scale shifting, we're improving our insulin, we're improving our blood sugar metabolism, and that's laying the foundation for later being able to move the needle. Right?

Right. Yeah. And if the scale isn't moving, I want you, and you're in the gym and you're working out, you're putting in the reps. I want you to know that body composition changes are happening. Right. May not in the scale is such a. It's not the best way to be measuring this at all. Like my recommendation for Every woman, besides a full blood panel and really advocating for those labs. And I have the labs inside of the perimenopause book. I have the labs, including. Put it in the bonuses. I mean, so many practitioners and providers are talking about the labs that you need to really advocate for yourself terms of. Of understanding your numbers. So I don't even know if we need to go through that. But the other thing that I'm recommending for women after the age of 40 or at 40 is a DEXA scan. Right? Like, let's look at your bone density, let's look at your lean mass, and let's look at your visceral fat and see where you're at. That's. That can really move the needle in knowing those numbers. But if you want real time data, I love a continuous glucose monitor. I love a whoop. I have my whoop on right now. I just took a CGM off. I'm putting another one on in a week. I always put a CGM on on around my birthday. So, like, for my birthday, I'm getting a new. I'm getting another DEXA scan. I'm putting a CGM on. I just ran my labs with Function Health. And so, like, I'm 46 in just a couple of weeks. And when we're recording this, and that's the greatest gift I can give myself is one knowing my numbers. My highly sensitive CRP was below 0.5. I was so happy. I know you'd be happy to hear that. I know.

I'm so proud of you.

Lipoprotein Little A was 40. My fasting glucose was 80. My insulin was under 5. And so I was like, this is 46, baby. Like, this is what I'm talking about. This is how I'm stepping in to this, into this next year. And that's. Those are the things that are worth celebrating. But it's hard to make changes if you don't know your numbers. Yeah, and here's the thing. A lot of your doctors are just looking at the red, yellow, green. They're not looking at your labs in a meaningful way. I don't say this lightly. And if you're working with someone like McCall, like, what a blessing. But like, no one's coming to save us, especially the mamas and the women that are holding it all together for everybody else. I mean, everyone's turning to you. You're. You're scheduling the doctor's appointments, you're checking your husband's labs, you're making sure your partner is taking their supplements. It's usually you. And if you're a practitioner or provider and you're listening, well, you absolutely know that. You know that you're in it. Everyone is calling you. And so it is important that if you really want to get a hold of your health and you want to be involved proactively in this time, this window of opportunity, you need to know your numbers, you need to know your DEXA score, you need to know your bio labs, you need to know if you are part of the 7% of metabolically healthy individuals. These are the things that are going to move you forward in a meaningful way. That to me, because we live in a time of bio observability, take advantage of it. And, and then like, because I'll be honest with you, I grew up being told not to really listen to my body because I was always told it was going to betray me anyway. And that you just need to push through. That was very much the narrative. I still, it's still the narrative very much today in society for women. And I didn't know how to listen to my body. I didn't know when my stress response system was out of control. I didn't know when, even though I was burning out in the gym, that I should stop doing that. Like, I just wasn't attuned to my body. And I'll be honest with you, I think after decades of not really listening, I'm better today. But, but looking at my numbers, looking at my heart rate variability, looking at my stress levels, looking at my body score, looking at my continuous glucose monitor numbers, those, that information really helps me make real time changes, right? Because I can easily talk myself out of something or talk myself into something, even though my body's like, please don't. You know. But if I have the data to be like, actually, I can validate with the math enough that you should not do this today.

Right. I'm so curious. What is your hrv? I always want to know it. Mine's so bad too.

So you want me to tell you?

Okay, I do. I'll tell you mine if you tell me yours.

I will. Absolutely. I have no problem. Full transparency. So most days of the week, my HRV is probably 36.

Me too. We're hardwired very soon.

I know the thing about this is we, what we haven't talked about too is the kind of, again, those, those, those silent shifters in the body trauma being one of those kind of insidious kind of amplifiers of perimenopause. So if you're coming into perimenopause with a lot of trauma. Like, let me tell you, it's coming up for review. If you hadn't addressed it yet, oh, you're gonna get to. And so I. I'm coming into perimenopause with a adverse adversity adversity childhood score of a six. And anything above a three, they're just like. Anything above a three, like, you're just gonna have some trouble and some. In some health issues. And so I know that your childhood adversity score is going to impact your hrv. Like, we. We're starting. We're starting to connect the dots between that. And so for. I'm always trying to do all the things that I can do to raise my heart rate variability. And two things that have made a mark marked difference for me. One is putting. And I get that not everyone lives by a body of water, but one is getting my feet in the ocean. Now, okay, I'm just a block away from the ocean, so I can do this. And I try to get my feet in the ocean almost every day. On days that I can get my feet in the ocean, my HRV jumps to 45, sometimes even 50. 50 is, like the highest I can get. The other way that I can get my HRV up is putting grounding in. In grass. Grounding my. Grounding my feet in. In grass. And I have the most beautiful tropical garden that my husband Alex has created in our backyard. And it's so beautiful. There's hummingbirds and butterflies and everything right now in our backyard, but we have the most luscious grass and clover everywhere. And so my son and I go outside barefoot every morning and we ground and just look at all the flowers blooming and looking at all the nature that's happening in our backyard. And even if it's just for five minutes, not only am I optimizing my mitochondria and I'm telling my circadian rhythm that, hey, it's. It's go time. We're awake. Let's reset this. Let's optimize this. But also that grounding in nature helps to raise my hrv. I don't even know what my HRV is today with a migraine. I'm curious.

I know literally has a migraine right now, y'.

All.

Can you believe it? We wouldn't believe it.

I know I've had a couple of moments, full transparency, that I haven't been my sharpest. Okay, so my HRV today is 40.

Okay.

I meditate. My resting heart rate is 60, you know, and let's see my, and my, My recovery was 72%. My sleep was 98% with a consistency of 90%. So that, that is the thing when I was talking about sleep and circadian rhythm optimization. Sleep consistency is everything like going to bed at the same time, waking up at the same time. Yes. There are natural sleep aids like oral, micronized progesterone and magnesium and L theanine and some, some really great sleep aids out there. But again a lot of it like let's be honest with ourselves, how consistent are you about going to bed at the same time and getting up at the same time?

Because literally woke up at three in the morning this morning. So not good.

Yeah, sorry.

It happens.

Yeah. So yeah, consistency is everything. And optimizing that circadian rhythm, getting sunlight on your eyes in the morning, big game changer. If you can ground in your backyard, in your grass. If you've got it, even better still. And the other thing that I do, because we're on our screens, we're looking at computers all day, we're looking at our phones all day, usually things are within like a foot away from us or less. And that can, that can really mess with our melatonin levels, our circadian rhythm. So what I do when I'm outside in nature, especially walking in nature is I always look out at least 5 to 10ft out and that helps to re like that sends safety signals to the brain, that calms the brain and that creates a lot of peace. And I don't know about you but I, if there was anything I'm calling in for the second half of my life, it's more peace and it's more safety in my body.

Yeah, me too.

And that's what the HRV indicates, right? The hrv. That's what your HRV is telling you if your body's safe or not. And if you're running around like so often, you than us CEOs are your HRB. It's not great, it's not the biggest, it's not gonna be the greatest.

Yeah, I love that. Any other kind of. Well one question. Do you have any non negotiable strategies for to future proof your health? Anything that you haven't already mentioned, which I literally am going to do a lot of the things that you've already shared. So thank you. But anything else you can think of?

Yes, absolutely. So non negotiables. I think we talked about the big ones. Know your lapse abs, know your numbers, advocate for yourself and start the conversation around hormone replacement therapy. Earlier than you think. I want to quickly debunk them. I want to debunk two myths. Number one, that once you're out of perimenopause, it's smooth sailing. No, this is a continuum. Once you're in menopause, you are now in a low hormone state. We know that by the time you get into early menopause, you've lost up to 20% of your bones, you've lost well over 10% of your muscle, and you are probably silently struggling with some metabolic issues that you don't know about. A lot of these, you don't feel the blood pressure creeping up. You don't feel the insulin resistance happening. You don't necessarily feel the inflammation per se, especially in the brain, that's leading to dementia and Alzheimer's. Often these are silent shifts. And in terms of the knowledge gap in the healthcare system, so often these early signs and symptoms are brushed away way. And so if you are not paying attention, who is? If you're not looking at those numbers, who is? And what I can say is that HRT is more of a preventative than it is a reactive solution. And so we are beginning to realize that when we should be looking at hormone replacement therapy for women is really in the zone of opportunity in perimenopause. And the research is beginning to back that up. Again, not a lot of clinical research for women in perimenopause because we weren't even acknowledging that women were going through it. So. So that's an issue with that knowledge gap. But more and more research is coming out today now demonstrating that the earlier we can start hormone replacement therapy if, as indicated, again, not just for symptom management, but also for prevention, that we can really shove back, like, shove back the chronic conditions. Women do not deserve to suffer needlessly in this transition and beyond. And women do not deserve to be given the brush off. You know, so you go to your doctor, you treat that meeting like it is the most important meeting you have that week. You come with a paper, you come with your most disruptive symptoms. You come with your sleep patterns, your mood patterns, your menstrual cycle patterns. You come with the data and you connect the dots between what you're going through and how it's impacting your life. Because they have to listen at that point. And then you give them your list of biomarkers. And if you need a list, girl, I got your list list. You got to print it and cut it out. Just be like, this is the list I need. Run all of These, please. And, and then ask them, hey, do you provide perimenopause and menopause care? Find out. And are you willing to have the conversation about HRT like now? Because I want to have that conversation. I want to know what is available to me. So that is a non negotiable. Like fight for yourself, fight for your. Fight for yourself. Like it, like it matters for the rest of your life. Because it does. And there are providers that are getting educated. You have to know that there's been 20 years where providers were not prescribing HRT. We're just catching up and it's going to take a minute, but there's a lot of people that are actually doing it, including, including McCall. And so that would be a non negotiable for me. The other non negotiable for me. I have two more. Is one alone time.

Yeah.

Oh, when the moods are popping and the rage is going and you're feeling. Take. Take a minute to yourself. Just 20 minutes. Whether it's morning, evening, it's during the day. And talk to your partner, talk to your family. Let them know what's going on. Be vulnerable. Re real this morning. I usually get my son ready in the morning and I knew immediately. I wake up with migraines and so I knew. And my husband usually sleeps in because he's been working late at night. And I came into the room and I was like, hey. And I tried to whisper it. I didn't want. I don't want. I just don't want my son to always be like, oh, gosh, mom now has another migraine. I was like, hey. I was like, I have a migraine. Can you help me? Can you help support me in the morning? And it's just that communication. And he's like, oh, man, that's such a bummer. Like, I'm gonna get up. Let me come help you.

Way to go, Alex.

Yeah. So it's again, I could have just not said anything and suffer through the morning and maybe Kingston would have caught some of that energy because I just wasn't feeling good. So just communicate over. Communicate what's going on with you so that the people in your life understand what you're going through. And then the other one, probably the biggest longevity hack I can offer you today is make sure to have soul sisterhood friendships, friends that feel safe, friends that know what you're going through so that you don't feel crazy. So that when you're starting to forget words. I would say I always joke about perimenopause in the wild, when I have a friend who's like, you know that thing over there? I'm like, oh, that's. That's perimenopause in the wild, I'm going to use that. Like, or when I can tell on a voice memo where my. Where my bestie. These are in their cycle. I can tell when they're in their late luteal phase. I'm like, oh, that girl's getting spicy. You know? So you can tell, and that's just the beautiful thing. When you can hold space for that without judgment and with love and compassion, or you have someone that you can rant to because you had a crazy day. Like, there's so much, so much benefit to that, so many, so much, like, longevity that you can. You can reap from that and see them in real time. But if you can't see them in real time, FaceTime them, memo them when you're walking. For example, I. A couple nights, a couple days ago, I had 30 minutes before a podcast interview, and I could unload the dishwasher and I could clean my kitchen. And, yes. Would that help my future self for later on that day? Absolutely. Or I could go for a walk to the beach and get my feet in the water. And I looked at my phone and I saw three voice memos from three of my best friends, and I was like, decision has been made. I am going for a walk and I'm listening to these voice memos. And. And I'll be honest with you, so many people are going through it right now, including every friend that had memo'd me. And I wasn't having my favorite day that day either. And it was, gosh, I cannot tell you how quickly I get out of my stuff. And I'm so present for their stuff when I get these beautiful messages and. And it fills my cup more than anything. Outside of getting yummy Kingston cuddles, it's like, the best thing ever. So to get those voice memos and to connect with friends. And I was on my way to LA yesterday, and two of my besties stopped at my house, literally, as I'm trying to pick dresses for the live podcast. And they're like, that dress, like, they just showed up at the door, and I got to see them for five minutes before I had to run into the car and head to la. And so it's. These are the moments that matter the most, and they will make the biggest difference as you move through the second half of your life. Life.

Amen, sister. Amen. We've teased about this a couple times but I want you to give us a little bit of information. So you have your new book, the Perimenopause Revolution. The ultimate resource for women ready to take charge of their health and embrace per menopause with resilience, confidence and it's a five week reset program. Tell us all about it.

Absolutely. Three things that you are going to get from this book because this is the book that I wanted when I was going through earlier, early stages of perimenopause. Like this is a movement, it's a rally cry. But three things. One, you're going to be able to know what's going on with your body because you deserve to know what's happening on a systemic level, like every single organ system level. And you're going to be able to connect the dots between what you're going through now and your future health outcomes. You're going to know the labs to run, you're going to know how to advocate for yourself. You're going to know how to have agency for your health so that you are thriving now, not surviving through this phase. You're going to, I'm going to go through the non negotiable principles. Optimizing circadian rhythm, optimizing your sleep, boosting your metabolic health, moving your body in meaningful ways, even deep soul sister connection, hrt, all of it, I'm covering all of it. I'm leaving no stone left unturned. And then it's the five week reset and I know it's, I want to just preface this with yes, do the five weeks. But I want you to know the way that I built it was that it's a lifestyle. I want you to come on the end of this five week program and say, you know what? I am a different person. I have more energy, I have more resilience, I have more capacity, I feel stronger, I feel like I have more power and I have more agency and I am continuing this for the next 20, 30, 40 years. That was the way that I wrote this book. These are not, these aren't. This isn't just a flash in the Pan five week program. This is a lifestyle to help you be more resilient and stronger than ever before. Get ready to rewrite your midlife story because it starts today.

I am so excited and so grateful. Like women need this, they need this information. We are in the time where again we're evolving in real time. So thank you so much for helping us propagate that evolution and being such a voice of reason and knowledge for women everywhere.

And.

And I just love you. Dr. Marisa Snyder. Thank you so much for coming on and sharing your message and your passion with us.

Thanks for having me, honey.