485: Perimenopause vs Menopause: Understanding Your Hormone Changes and What Actually Works with Mariza Snyder

Estrogen is the CEO of the brain. We're talking about a neuroendocrine transition where the brain is vastly changing in perimenopause because estrogen, who is, you know, showing up every single day rhythmically for 20 something, 30 something years, all of a sudden is erratically, maybe showing up, sometimes over showing up, sometimes not showing up at all.

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Welcome to Midlife Conversations. I'm your host, Natalie Jill, and I'm passionate about having amazing conversations that matter to us midlife women. On this podcast, I do what I do best, taking complicated health topics and breaking them down simply so that we can optimize aging together. I share actionable steps to help you thrive in what I believe are our best years to come. Join me as I interview the most inspiring people living their best midlife years and dive into essential topics like hormone changes, health optimization, weight management, blood sugar, emotional well being, relationships, beauty, and so much more. Are you in perimenopause, menopause or post menopause? And how do you know which group you're in and do we need to know? And what if we just have crazy symptoms all over the place that we keep being told, oh, it's just menopause or it's just perimenopause. What do we do about that? And can we actually do anything about that? And does it have to be hrt? We hear a lot of people talking about HRT and hormone replacement, but what if someone chooses not to do it? Or maybe it's not ideal for you or you just, you have the, the ick with it. Who knows? Whatever. Can you do other things? And how do we get through life, balance life, when we're not feeling optimal, when we're feeling off, and we're being told just to accept that it's one of these buckets or one of these groups? Today I'm really excited to bring back my friend Maritza, Dr. Marisa Snider. She's an integrative doctor and she is an expert when it comes to perimenopause and menopause. She walks the walk. She's so super knowledgeable here. And she knows I have been fascinated with this topic recently, asking a gazillion questions. She herself, I believe, is perimenopause. I, I am postmenopause, but I think there's going to be a little something for every one of you here. But what we're really going to dive in today is a lot about perimenopause specifically and what she calls the perimenopause revolution, and how you can sort of take your power back and really walk through this time of life in an amazing way. So thanks, Marisa, for being here. I always love our conversations.

Yeah, thanks for having me again. I'm so happy to dive in.

So I love this topic, especially as of late, because, you know, my brain, I'm, I'm a rabbit hole person. And I walked through all this myself. I mean, I definitely had the 10 years of perimenopause and then my one day of menopause and now you're post menopause and it, it can get very confusing. And I think especially for most of my listeners were Gen Gen X. A lot of us are, a lot of them are millennials where we have this sort of black and white mentality. Like, we just want certainty, we just want the answer. Like, oh, we want this for that. And I know, like, even growing up, if you had a bad period, you were told, here's birth control pill. It was like, that was the certainty, right? So there's a lot of confusion around this. So I want to sort of start with can you help us understand, like, what are those different buckets? And how do you, how do you know where you are in those?

Oh, that's such a great question. Because before, I would say even the last several years, it was all just menopause. We weren't even defining it. And I can understand the confusion, particularly, you know, I think about the through line of what I was brought up with, the narrative that I grew up with, which is that women suffer. That was the narrative. And, you know, I think that was very much what the healthcare system believed to be true, what society believed to be true. And so as women are navigating the kind of the third big hormone shift that we can experience, AKA known as perimenopause, I think it was just easy for us to dismiss those symptoms because they were subjective as well. Women are just getting older, they're, they're just suffering how we've always been told and, you know, we deserve better. I, I consider that to be lazy medicine. So how we distinguish between perimenopause and menopause, Menopause, as you said, it's one day and time where we stop having a period for 12 months or more. But basically that defining moment of like, you haven't had a period for 12 months. Ta da. You are officially in menopause. And then whether you want to call it menopause or post menopause, I call it the second half of your life. That's what you're stepping into. Perimenopause is the transition where your ovaries are going offline and it's really denoted by erratic declining hormones. So we know that by the time we are in our late reproductive stage, we only have so many eggs left. That's really what it's defined by. Like by 35, it's, it's around 10,000 eggs and it winds down to, you know, a few hundred by the time we're in menopause. And as a result, the ovaries know that, hey, okay, I only have so many eggs left. There's only so many opportunities to conceive at this point. And that communication between the ovaries and the brain, the HPO axis, the hypothalamic pituitary adrenal axis, becomes like the game of te where the ovaries are sometimes listening, not listening, sending garbled messages back and forth. And as a result, we know that those really profound pituitary hormones, follicular stimulating hormone and luteinizing hormone are doing their very best to continue to prod those ovaries, to make those hormones and to keep popping out eggs. That's why we, in perimenopause, especially early perimenopause, there's a higher rate of twins because there are some months where you are not ovulating because just didn't happen. And then other months because of fsh and luteinizing hormone just constantly telling the ovaries to keep pumping eggs. You may release two eggs and end up having twins. And so. But because of that disconnection in that faltered communication between the ovaries and the brain, hormones begin to erratically decline. And initially estrogen actually can be more, I wouldn't call it estrogen dominant, but definitely more unopposed as in relation to progesterone in that journey.

Well, you just brought that up. I want to. A lot of people say they use these terms intermingled or incorrectly where they'll say like, my body makes too much estrogen or I'm estrogen dominant or they don't. And. Or can you explain what that actually means? Because just because you're estrogen dominant doesn't necessarily mean you have too much estrogen.

Absolutely. It's kind of like saying adrenal fatigue. The adrenals aren't fatigued. You're burned out. And it's really the hypothalamic pituitary adrenal access that is deregulated. But it's just an easy way to say kind of I'm burned out. So some very similar estrogen dominance basically means that whether it is in relation to progesterone, in that luteal phase of your cycle, progesterone is significantly lower than normal. Now know that you have the concentration of progesterone to estrogen in that luteal phase of your cycle is great. It's massive. We're talking, you know, when you're talking about progesterone, we are talking about, well, estrogen, it's picograms. And progesterone is significantly higher. It's like a hundred times higher than estrogen. But in, in perimenopause, especially early, early to mid perimenopause, those levels of progesterone are going to start dropping. And you may notice, you know, for the first time, you're noticing lumpy breasts, you're noticing more heavier periods, you're noticing more PMS symptoms. And in that way, that relationship between progesterone and estrogen has been disrupted. And we're noticing more kind of estrogenic symptoms. But what can compound that is a liver that is not properly detoxifying estrogen and a gut that is also not properly detoxifying estrogen.

Okay, I'm going to have a lot of questions about liver and gut too and detox and that. But before I do that, I want to ask just a little bit for comparison before perimenopause, assuming you are healthy female, everything is working right. Reproductive years, what is the ratio that's supposed to be? I want make sure everyone's kind of starting with this baseline of where progesterone and estrogen is like. So take like a, a 28 year old woman so way before perimenopause. They are fertile years, they're ideal healthy. Like where, how, like how does that work throughout the month? And where does testosterone fit into this? And I'm asking this specifically for a reason, because when we get into what goes wrong, I want sort of a comparison.

Yeah. So progesterone. So let's break it down. In order to even get progesterone in the second half of your cycle, you have to ovulate. Ovulation is the main event. It always was. I don't know, I mean, I get why your, our period became the focal point again. Just connecting with that narrative of women suffer, you know, and, but ovulation is what's driving all of it. And that's hence why we're going through perimenopause as we start to have less ovulatory cycles.

Okay.

As a result, when we ovulate, we have a corpus luteum that releases progesterone and that increases our metabolic rate, that increases our body temperature by a, by half a degree and it allows us to, if we do get pregnant, maintain that pregnancy. That's what progesterone is. It's a progestation hormone. So is the only second half, is.

The progesterone rising during ovulation for that second half? Is that the feel good part? Or is it the estrogen leading up to that that makes people feel good at ovulation?

I would, it's estrogen. Progesterone does not, is not playing any role in the follicular phase of your cycle.

Got it. So it's so estrogen rises first. So I want, because I want everyone to kind of hear that, see the baseline. So estrogen's rising, we're ovulating, you still have some progesterone on board, it's rising, then you ovulate, then progesterone kicks in. And then as that second half is, then ultimately, till then, you're shedding the lining and that creates your period. Is that. Did I explain that right? So everyone has a base. And I know I'm going really basic here, but I want to make sure everyone's on the same page of what goes wrong before, after that.

Yeah. So let's just start with day one of your cycle. Low hormone state across the board. Progesterone, estrogen, testosterone. Hence, why the first couple of days of your period, you're just like, what is going on with me? And every woman's going to be a little bit different depending on your sensitivity to those hormones, particular, your kind of that mental health aspect. I feel like the way that we really feel, not just the physical symptoms, but it's also the mental emotion symptoms that happen when we're in a low hormone state. Then by day five, estrogen is starting to kind of peak up. I call it that early estrogen peak. And all of a sudden you're like, my goodness, thank you, thank you, estrogen, for showing up again. Like, I am starting to feel like myself again. I always joke that Everybody wants day 11 us. So day 11 is that estrogen peak. That's the highest level of estrogen that we're going to get. And it's basically kicking off luteinizing hormone. And that luteinizing hormone surge is what's ultimately going to lend to that ovulatory moment, the ovulation, where the egg is released. So estrogen kicks off luteinizing hormone, and now we have ovulation from ovulation. We have a corpus luteum, mind you, Estrogen went down a little bit. She's dipping. She's still there. And testosterone is typically in that second phase of the, of our follicular phase as well. So we're. When, when estrogen is kind of peaking, it's also when testosterone is peaking. Okay, okay. And then testosterone kind of goes back. I mean, testosterone is always there. It's the most abundantly biologic, most abundant biological hormone that we have in the body at any given time. But in terms of its peak, it's peaking in mid follicular as well, with. With right behind estrogen.

Okay.

Then we get to the luteal phase. Progesterone is on the rise. And usually when she's peaking, it's day 21, estrogens peaking too. But typically the ratio is 100 to 1 to 500 to 1, depending on where you know that, where women are. So again, in relation to progesterone estrogen is actually a very small, a very tiny rise. So we should really be feeling kind of the, the, I would say date, let's say in a 28 day cycle. We're looking at day 21.

We shouldn't be experiencing any PMS symptoms. We should feel pretty good.

We should have good mental resilience, good emotional resilience. If progesterone is not showing up, and that ratio is maybe only 50 to 1 or 25 to 1, we now may start to notice some of those symptoms of unopposed estrogen, like fibroids, like bloating.

Some of those. Correct, yes.

Fibrocystic breath, heavy painful breast, and then those heavy painful periods, or just even heavy periods as we're leading into that cycle. You just notice you're puffy, you're bloated, maybe even migraines, maybe even a histamine response. It really just depends. And that can happen even before perimenopause.

So that's depends on the woman. And that's why I wanted to ask this like kind of before. So we have kind of a baseline. So when we talk about what goes wrong in perimenopause or what changes they have, they have a comparison. So before perimenopause, if I'm hearing you correctly, it's estrogen and T are slowly rising. Day 11 is amazing. It keeps going. You ovulate, you feel good, then progesterone kicks in. 21, it sort of peaks. It should be in a healthy, non fibroid, non bloating person. You're 500 to 1. Then right before your menstruation, the cycle, what happens to your progesterone?

All of it drops. Everything's going low. So estrogen and progesterone are going low and it's that really that low hormone state. Yeah, it tanks. All of it's tanking.

Thus PMS shedding, thus bloating, thus all the things. And then, and I know I'm going back to basic science here, but I feel like we, we learned this in like elementary school. Right. But I want to repeat this again because I, I think it's important. I think a lot of people talk over women and I want to make sure they understand the baseline first.

Absolutely. Well, and we weren't really, it, it wasn't a very comprehensive discussion around our menstrual cycle. It kind of, we kind of got the brush off. If you go back to those books, like we talk a lot about the male and male reproductive health and then with women it's kind of Just like, oh, this happens. And you're like, wait, isn't, aren't women making babies? Aren't we?

So I also, and I know we're not talking about synthetic birth control. That's not the goal of this thing. But when, if you think about how synthetic birth control was designed, it was designed to sort of mimic this. Right. So a lot of the birth control pills will try to mimic this.

No.

Or what?

No.

Explain. Explain that.

Yeah, yeah. So what combination birth control does? So if it's a combination of estrogen and progesterone, even if it's just a progestin, mind you, these are synthetic corn hormones. But the whole point of contraception, hormonal birth control is to stop ovulation. And so if you were to test hormones on hormonal birth control, you're in a low hormone state.

All hormones, all hormones. Wow.

Estrogen and. Estrogen and progesterone.

Okay, so estrogen, progesterone would stay low. It wouldn't. What would it do to your testosterone?

I, you know, it doesn't affect testosterone. You know, every woman's a little bit different. So in some cases it could have an impact on testosterone levels. But for the most part, testosterone, like, do we see that testosterone rise? Not so much. But in terms of consistent testosterone in the body, that, that stays consistent despite the fact that women on hormonal birth control.

So the reason, at least I'll tell you, my generation initially went on, before we knew better, went on synthetic birth control pills. It was basically to not have fibroids, to not have the pms. So this makes sense because you're basically blunting all the hormones so you just stay even. But you're also not getting the feel good or the benefits or any of that stuff.

Exactly. They are at basically default low hormone state. It looks like a flat line.

And then the sugar pills, you're basically tanking them even more. And that's why you get the little bleed. Is that accurate?

That's why you get the. Yes, that's why you get the little bleed.

Okay, well.

And it's a progestin. It's. It's a call. It's a pill bleed. So that progestin is still there. It's still designed to protect the uterus. So you're going to have your, you know, once that, once that progestin disappears, you're going to get that little, that little kind of programmed pill bleed.

Okay.

It's something some very similar to hrt. If you were to cycle progesterone, like I'M cycling it. I'm going to stop taking it today. If I were to continue taking progesterone right now, oral micronized progesterone, I wouldn't get a bleed. It may be like a tiny breakout bleed. But if I were just to be on continuous progesterone all the time, even though it's bioidentical. Bio.

You know, even if you're still menstruating, you're saying, even if you're still menstruating.

I could use that oral micronized progesterone to blunt my cycle.

Interesting. Okay, so now that we kind of got like the basic, like before. One more question on that, because I know there's gonna be someone listening that's gonna ask this. So let's say you're not perimenopause yet. Cause we're about to get into that. And you are aware you're saying, and you're not on synthetic birth controls, but you're. You're navigating this and you maybe are that person that it doesn't have that progesterone, that Right. Balance of progesterone and estrogen and you are having like, is there is for that type of person. I know this is not quite your specialty right here, but I'm gonna at least ask it. Would they still do similar things to try to balance that out pre perimenopause, as we're about to get into. With perimenopause?

Absolutely. Yeah. Okay. Because you have to think of, like, what can be throwing off your cycle. It could be too much stress. It could be over training. It could be polycystic ovarian syndrome. Right. All of these things. It could be. It could be a metabolic issue more than anything. Great. That's going to throw off. When you think about a reproductive system. If there was ever a system that is metabolically driven, it's our reproductive system. And so what can throw that off? What can throw off, obviously, ovulation. What can throw off progesterone levels is a. It is an issue with our metabolic health that's ultimately impacting our reproductive health. And as a result, we'll start to see progesterone impacted because we're not ovulating. So. And ovulatory cycles can also be a result. So we could see that in our 20s and our 30s, well before we get into perimenopause.

Okay. So thanks for breaking down the first step. So now let's talk about perimenopause in general. Like, because that's a Big span. It could be 10 years. And how do we know and what. Let's take us down back through like the basics and the science here. Like what's really starting to happen. I know you mentioned things start getting confused. It's like telephone game, what's actually happening.

Absolutely. So your ovaries, your body, we're programmed with only so many eggs. That's basically where, where are the eggs going? Where, where did they go? So by the time we're in puberty, we only have a half a million eggs left. And then every single month you prime up multiple eggs and one gets chosen for ovulation. So it's not like you're just pumping out one egg a month. You, I mean, a bunch. And then your intelligent body chooses the most vital egg to potentially get pregnant. Right. And this happens month after month after month for what, 35 years? 30. 25 to 35 years. To a point where you get to a place, I would say mid to late 30s, every woman's a little bit different, where you only have so many eggs left and the ovaries know it. And also I think that the body knows it as well. But let's just say that the ovaries are like, okay, we're getting down to the wire here. And as a result, there becomes a miscommunication between the brain and the ovaries. The ovaries. There's going to be some months, especially in your late 30s to early 40s, where you're not going to ovulate as a result, you're not going to release progesterone, or let's say that ovulation just wasn't as optimal because there can be suboptimal ovulatory cycles as well. And as a result, progesterone still shows up, but just nowhere near the capacity that we are used to, to having progesterone. As a result, that starts to mess with the communication between the pituitary in the brain and those ovaries, and that starts messing with the overall cycle. So even estrogen becomes a little bit more wonky. So in the beginning of perimenopause, the first hormone that typically begins to decline is going to be your progestation hormone, progesterone. And because of that, many women in early perimenopause experience more cyclical symptoms, more PMS driven symptoms and symptoms that could, that are in relation to heightened estrogen relative to progesterone in that luteal phase of your cycle. So a lot of the symptoms we're experiencing in early perimenopause are often taking place in the luteal phase of our cycle.

So like things like brain fog, losing sleep, maybe like you're not, you're waking up at 3:00am, you're, you may be more moody, like just feeling like on edge. Is that what we usually see first? If you've listened to my podcast for any amount of time, you know, there's been lots of guests and lots of talks where we've chatted about what to eat, getting enough protein, eating healthy, the importance of it, why we want to eat organic. But I want to share that as we age, it's not just what we eat, it's what we digest. Even if we eat super healthy, clean, organic food, we can still not have the best digestion. You see, our natural ability to digest food declines with age. This is because your body produces fewer enzymes, which are the proteins responsible for digesting food. And when you have fewer enzymes, this means more difficulty digesting our food. So even organic, healthy, or what you think are perfect foods won't provide enough enzymes to properly digest them. So this is especially true if you cook your food, which most of us do, because cooking kills the enzymes. So if you've ever wondered why you might have digestion problems even after having a healthy meal, it's because your body just can't produce enough of the enzymes to get the job done. So this is where supplementing with high quality enzyme supplements can be a huge help. So I personally use and recommend a specific digestive stack from bio optimizers which includes their mass Zymes, which is a best in class supplement loaded with full spectrum enzymes for digesting proteins, starches, sugars, fibers and fats. So when you take this enzyme daily, and I personally take them with each meal, and replace the enzymes your body is no longer producing, you're able to eat all sorts of things and digest them quickly without the bloating, without the feeling, you know, puffy, without the leaky gut issues, all of that. So when you digest your food properly, you're actually getting all of the nutrients. So I've got an exclusive offer for all of my listeners if you go to biooptimizers.com NatalieJill again bioptimizers.com Natalie Jill you can also use coupon Natalie Jill to save. You'll see my recommended stack which includes the mass times, the HCL and the probiotic.

Yeah, I would say in lately late reproductive cycle, right before we kind of know that you're in perimenopause, it'll feel like low stress tolerance, like you don't have the same level of stress tolerance that you have your PMS symptoms instead of being two days or three days, now they're four or five days. It becomes get more blurry in that luteal phase. It starts to, it starts to stretch. You may notice cycle changes in terms of just Instead of a 28 day cycle, now you're 26, 27. So again, still cycling regularly from what you can tell. But your cycle is a little bit shorter and the symptoms are a little bit more exacerbated. And for some women, yes, sleep is beginning to be an issue. I wouldn't say that that's typically the case until like early peri. But then you'll notice more intense irritability, more intense mood swings in that luteal phase of your cycle. Also, workout recovery isn't the same. You're beginning to notice that you're not recovering as well. You're not able to push as, um, multitasking is becoming more challenging. And you also may notice that, yeah, you're getting a little bit more edgy and that you can't handle all the things that you used to without intention and more effort. That would be some of the. And that's, you know, that's why it's so easy to dismiss because you could easily just say, oh, well, I didn't get enough sleep or I have too much on my plate right now or oh, I'm a mom in an early season of, you know, childhood, of life. And it can be, it can be a yes and it can be all of the things. And your hormones are shifting now.

I know many women also start to experience heavier periods, heavier bleeds with that, that be because they're lowering on their progesterone. So now they're becoming and mimicking a little bit more estrogen dominance. Is that accurate?

Yeah. When you think about progesterone, it's meant to hold that endometrium together. That's the whole point. So that you maintain that pregnancy. But if for some reason progesterone isn't at the level it needs to sustain that, we start to see a more of a bigger buildup of that endometrium. So then we see heavier bleeds. I would say that most of the time when we think about the crime scene periods or the flooding or the heavy bleeding, that's often more towards the, I would say late perimenopause where we are some months you don't have a period at all. So that endometrium has been stacked for multiple months, maybe 60 days or 90 days, and then you have that really big heavy bleed. So that's actually as a result of massive erratic estrogen levels, but ultimately also declining estrogen levels and skipping multiple periods.

Yeah, that's. I literally walked right through that with perimenopause. That was me. And I didn't understand at the time if that's what that was. So it's just like, oh, it's just heavier. But I didn't understand because that would have been an easy fix had I understood that, like, you can add more progesterone or you can, you can add.

More progesterone, you would have been able to manage. But yeah, so many women aren't given that tool and now they're having these crime scene periods.

Yes. Okay, so I'm going to ask you a lot more about perimenopause in a minute, but just to kind of finish the, the pattern here so people can follow. So perimenopause can be up to 10 years, apparently. And then what happens in menopause and how quickly does it all tank? So, like, your period stops for a year. Do all hormones leave right then, like, help, help, help everyone listening understand, like what the decline on hormones looks like once you stop your period after a year?

Yeah, that's a great question. And again, it really is nuanced. Yes, hormones are at a low, low state, Extremely low state. I mean, we could argue that there's such a low state that it is impacting every system of the body. Yeah. Whereas you'll have other doctors are like, oh, but your adrenals are kicking in and you're making estrone and you're like, like, whatever, buddy. Like, it's not enough to get the job done. Not enough to protect my brain, heart and bones, you know, and so. But yes, we. At that point, progesterone has left the party. By the time you're in menopause, it's. Progesterone has been at such an all time low, even in late Perry, that you'll have noticed. You'll have noticed with the sleep, you've noticed with the moods, you've noticed with your cognition. That is very clear. Yes, estrogen is at a low hormone state by the time you are in menopause, by the time you get to that 12 month mark, there has not been enough estrogen to drive any level of cycles. Right. For at least 12 months. Again, I would, you know, you have that argument of like, oh, well, women have a little bit. I'm like, yeah, but is it enough?

Is it enough?

No. For most of us, no. But I will say that because hormones have finally, you know, people are like, oh, they leveled out. I'm like, you mean they bottomed out? Like, let's talk. Let's call them what it is.

Bottomed out. You can't. You can't. They're. They're gone. And I'm not saying that some people can't do well without that, but I. We're gonna. I'm gonna talk about.

That's gonna call it what it is.

Yeah, but it's not balancing. I hate that word, balancing. And I'm glad you don't like that word either, because you're not. There's nothing to balance. They're. They're gone. So, yeah, if you call 0, 0, 0 balance, then awesome, but they're gone.

So. But is it.

Does that. I guess my question is, is it kind of tied straight down? Does it trickle down? Or is it, like, is that different for everybody? How does that typically go?

I would say it is different for everybody, but unfortunately, it's not a. A gradual decline by any means.

It's a tank off the cliff.

Yes. Yes. It's a bit of. And at least for. No, I would say, you know, in that. In that perpetual waiting room where you're waiting for menopause to happen, for that one day and 12 months, you could be in that perpetual waiting room for a couple of years. Like, you could have. You could be nine months clear and then have a period again and technically restart. But as far as I'm concerned, when. So once you're in the waiting room, estrogen is at such a low that, you know, and if you are struggling and symptomatic and needing support, you deserve support.

I like that you just brought up the waiting room. Nobody talks about the waiting room. You're right. But that. There's. That. That's like, next level. After perimenopause, there is that waiting room. So. Because. Yeah. And then menopause that day. Okay, so let's go back to perimenopause. You're. I think a lot of people listening are like, wait, that's me. I. I have this. Maybe I'm low on this stuff. What are my options here? I want to talk first. I want to ask about the traditional Western medicine GYN approach. I hear it too many times, is, here's an antidepressant, and here's a synthetic birth control pill. And many people listening have had that. Is that. Just give us the truth around this, is that an actual option? Is this danger zone? Why are they telling them that?

Well, it's all we had. I mean, you think about what happened with the Women's Health Initiative 20 something years ago, 22 years ago, give or take, and hormones were off the table. They were gone. And so what do we have? We have, we have hormonal birth control.

Actually a higher dose than actual hrt, which is so crazy to me. So that's okay. And then we know that 61 million women currently are on an antidepressant or anti anxiety medication. And that number, it skyrocketed to 61 million over the course of the last 20 years. Because as you can imagine, as these hormones are declining and particularly erratically declining, specifically estrogen. Estrogen is the CEO of the brain. We're talking about a neuroendocrine transition where the brain is vastly changing in perimenopause because estrogen, who is, you know, showing up every single day rhythmically for 20 something, 30 something years, all of a sudden is erratically maybe showing up, sometimes over showing up, sometimes not showing up at all. And the brain is desperately trying to figure out what to do. And so with, with all those symptoms and everything that's happening in perimenopause.

Women are coming, they're having mental health challenges, they're having cognitive challenges.

Yeah.

And what we've got for them, yeah, for obvious reason, the brain is desperately, desperately seeking estrogen. And as a result, we're struggling with all kinds of mental health changes or mental and emotional changes. And what we've got for you, what we've always had, at least for the last, last several decades, is some type of mood altering medication. And so, yeah, I mean, to me there's a time and a place for mood altering medication. I'm not saying that there isn't, but it feels a lot like lazy medicine when it's really hormones. Yeah. That are, that are the reason why women are struggling and their mental health is being impacted.

So before you come out, Maritza or me, I just want to share this for everyone. First of all, I am definitely not a doctor. I'm a girl with a mic on my podcast right now. Marisa is an integrative doctor, but she's not your personal doctor. So we're sharing our opinions and what, what we know to be true. But I will tell you, I've, gosh, I've interviewed so many experts on here and I, I've got to say, I don't see. I do also agree that it's lazy medicine just to say here's synthetic birth control pills for your PMS or your menopause. I just, it doesn't make sense to me. And anything that does link to the danger zone, like direct danger zone. There's a lot of danger zones that can happen with hormones gone wrong, and that's a whole different topic. But when you look at like direct correlation between hormones and cancer, there is not that direct correlation with a lot of the bioidenticals, but with the synthetic progestins and what's in birth control, there is actual clear data showing that. So that's concerning to me that this is still kind of like a standard of care.

Yeah. I mean we are. So if, if let's, let's go back in terms of the history of perimenopause and menopause and if how we defined perimenopause as being kind of late Perry into menopause, the way that we defined that was, was skipped periods. So women were coming to their doctors with period changes, heavy bleeding issues. And so. Well, we have a way of regulating and shutting that down. It's called hormonal birth control. And so that's, that's how it became the gold standard of care. In terms of what we recommended to women, the only issue with synthetic hormones is that they don't address the sleep issue, they don't address the mental health issues, they don't address the cognitive changes that are happening, a lot of the other changes that are going on in the body as well. And so, yes, we're addressing just the one thing which is the menstrual cycle changes. And we're basically just shutting that down. And for a woman who is dealing with severe flooding and heavy bleeding and anemia as a result, I'm so grateful for that non surgical option. That feels like a lot less invasive. Yeah.

I don't know what I would do now, knowing what I know. But I was on birth control pills, synthetic ones, my God, for 25 years. And I'm grateful that I did not get pregnant in my 20s. So it did its job with that. I'm grateful that I didn't have the heavy period. So I don't. I do think there's a place for birth control. I do. I just get concerned with.

Oh, absolutely.

How they're used.

It's symptom management. Yeah. It's not that. And I'll be honest with you, I tried birth control when I was 20 years old because again, same with you. It was just, just being passed out like Candy. I was in every magazine you could imagine. Like, it was, I think every other page of all the magazines I was looking at as a teenager. It was being on the pill. It addressed your acne issue, it addressed your bad boyfriend issue. I mean like everything, everything age 15 was a panacea, right?

They're giving them 15. Yeah.

And I, oh my God, I felt like a crazy person. On hormonal birth control. I literally was unhinged. I gained tons of weight. My brain felt like someone had hijacked it. I lasted, barely lasted a year on hormone replace or sorry, on, on synthetic birth control before I was off. And that was it. I was, I was like, never again. I can't, my brain can't do this. And I think it's. 50% of women will start hormonal birth control and within a year will come off of it because of the side effects.

So when I did, again, this is years ago. I don't even know what they have out there now, but I remember I felt that same way. And then I went on one called, called low estrin at the time. I don't know if they still have that, but it was a low. This all made sense to me now later in menopause because I don't actually do well with high estrogen, but I was on low estrogen and I actually felt okay. But that circled back to me later. But what my takeaway message here for anyone listening is if your doctor has just said, here is synthetic birth control pills, here's an antidepressant for your pms, I really want you to lean into this conversation because there's other options and that one is a slippage bracelope. That's like, that's just not a long term solution and there's some danger associated with it.

Yeah, absolutely. And so often it's not really mitigating a lot of the other symptoms that you're dealing with. And, and that's not fair either. Like that it's a band aid approach that isn't often addressing a very comprehensive problem.

So let's talk about what they can do. And I want to be really careful here too, because I don't. I know we're going to talk a little bit about hormone replacement, not, not the birth control type, but the other kinds of. And I know you've got very strong beliefs around that. But I also think it's very important to really outline that not everyone's body is built yet or ever to handle hormones. Right. Could you speak a little bit into that? Cause that's also gotten very muddied where it's like, well, everyone should just be on this, everyone should be on that. And there's a lot, I know we talked right before we hit record just about like our body's ability to, you know, to detox our own pathway that, like, are we metabolically optimized, are we managing other things? So can you. I want to lean into that, but I want to be really aware that it's not just hormones. Like, what can people be doing?

Absolutely. When we think about hormones, let's just, let's just call it what they are. Which are really profound chemical messengers, right? They are delivering messages all over the body. And at the end of the day, they have to bind to receptor sites and you got to lose them and use. You got to use them and lose them is what I meant to say. And so what that means is that our liver and gut are constantly processing and metabolism metabolizing and moving them out. But if you're not able to do that, well, you're going to find that, you know, HRT or hormonal birth control, you know, whatever kind of hormones you're getting end up having side effects. And so just note that whatever you're putting in your body, you've got to be able to metabolize, especially when it comes to hormones. And so I always talk about how important it is to be a good host for hormones because they are optimizers. Again, again, hormones aren't going to, aren't going to. I always say, like, they're not gonna, they're not gonna do the lifestyle strategies for you. Right. At the end of the day, you still gotta implement those. I will say hormones can be helpful in giving you the motivation to actually do the things that are really necessary to feel amazing in your body. But if you, if you've got poor gut health, you've got a sluggish liver, you've got non alcoholic fatty liver disease, you're gonna find that those hormones that you hope are going to be that magic bullet, they simply aren't. They aren't going to be addressing a lot of the symptoms that are being driven by unhealthy gut or an unhealthy liver or ultimately just an inflamed body, hormones aren't going to fix your inflammation.

So, Maurice, I have a question here. Every time I bring up the idea of let's make sure we got what's your DNA look like? Or is your gut? Because I think there's an order of operations like is your gut gut working well, also, like we talk about sluggish liver or detox pathways. Like are you. And I know there's lots of testing we can do for all this, and I know you're a fan of testing, by the way, but do you want women because, Because I think this is also a slippery slope. Like do women need 20 million tests? Like, I've got to have a gut test and I've got to have a urine test. Or do we just assume that maybe these aren't optimal and let's all do some, some cleanup first? Like what's your approach here?

Yeah, that's a great question. I love that question. You're right. I mean, as much as I love functional testing, it's expensive and there's a lot. Yeah, it's a lot. And sometimes it's not necessary. It doesn't get us the answers that we're looking for. It doesn't move the needle. Meaningful for you as a patient? I think it's important that we start with the basics at least looking at basic testing, basic labs, in terms of inflammation labs, even highly sensitive crp, vitamin D levels, uric acid. These are all labs that your primary doctor could work.

So blood labs.

You're talking about blood labs, labs. Yeah. So let's start with serum labs and see what's going on there.

Okay.

And then let's talk a little bit about your symptoms, what you're experiencing and building from there. I do find that a lot of us, you know, living in this very modern day world of ultra processed foods and fast paced light life and blue light and just stressors that there's a, we can make a few tweaks that will make huge changes in the body in terms of, you know, feeling, feeling more energized, optimizing your mitochondrial health, balancing your blood sugar. To me, your cellular energy impacts everything that you think and everything that you do. And that should really be the starting point. I don't necessarily think we need to go down the rabbit hole of a ton of functional testing before we focus on the foundations of just helping to support your cellular energy. Okay, I think that's a good place to start.

I'm going to push you a little bit on the cellular energy thing. And I'm, and I'm guilty of dropping that word a lot too. And I say mitochondria think I want to help people understand what that actually means. So let's, let's, I want to, let's dive a little bit more into what does that mean, cellular energy. And mitochondria like what is that to you? And what you. When you're working with people and yourself and you know, there. And then you mentioned light. I want to talk about that too, because I do think that those two things are really huge components, and I think those are overlooked. So can you help us understand both of those things and what those mean?

Absolutely. So how I define cellular energy, it's. Well, one, it's definitely a little bit complex and complicated, but in the sense of how we process energy on a cellular level. So how your cells take on substrates, whether that's glucose or triglycerides, you know, basically fat substrates, or it's going to be sugar substrates, turns that into energy, into ATP, and as a result, you know, we're able, you and I are able to have this conversation. We're able to do the things that we want to do and have the freedom and capacity to do them. So that's kind of how I. It's all the processes that every cell needs to actually function and thrive in your body. And so you think about every single cell as its own organism. Yes, it may be a part of a liver organ or an eyeball or, you know, or even your blood cells, but at the end of the day, they're still functioning as an individual unit. And so how do we ensure that your cell has the energy and capacity to do its job and to feel safe enough so that it is able to communicate with other cells and they're doing a job collectively? That's what I think about. And ultimately that translates to what we think, what we feel and how we're able to perform in life.

So there's a lot of supplements that I, like, use for that, and you're probably familiar with some of them too. But how important is like, supplementing for that type of thing versus, like, some things that we can do natural? Like, for example, I'm a big fan of like, urolith and a. And I use like Mito pure to help with that. I'm always looking at things for, like, mitochondrial health. So, like, you could say, like, red light helps with that. But you can also say the natural sunlight is like, where do you kind of think we've gone maybe too far with supplementation? Do you think it's important or do you think there's some natural things we can do to help with this?

I think we should always start with the natural things that can help. And I do love the supplements as well. I'm always hoping that they're going to give me a little bit of a boost, and it's not very clear which ones are going to actually do that versus not. But no, I would say that we start with a foundation. Ultimately we've come a long way in terms of technology and this modern day life and I think light is a big part of that. I think that we are diurnal beings and that sunlight. Light is, we are, we're sunlight beings that we are ultimately we've got a circadian rhythm that runs from light. And so how we attune to our circadian rhythm is going to be a big part in how we function at an energetic level. So for example, getting sunlight in the morning when you wake up, I think it's important being outside as much as possible during the day and then doing your best to mimic an environment of low lights or dim lights or less blue light in the evening so that, that cortisol is doing its thing in the daytime. Melatonin is doing its thing in the evening time so that we are, so that we not only mitochondrial or energy wise in terms of our cellular energy, but also that we are getting that deep restful sleep. That our hormones are in sync with our biological rhythms and that our, that our energy is in sync with our biological rhythms.

Can I, I want to elaborate a little bit here real quick, Sue. I, I think I'm naturally, and I think you and I had talked about this before. I'm naturally a circadian rhythm person. Like I literally wake up with the sunrise, I am tired with the sunset. Like I, that is my natural flow. I also thrive when I'm outside. If I'm in nature. Like I can feel it. Like, and if I, if actually if I'm feeling stressed or whatever and I go in the sun for like it changes me. Like it just shifts me or even just being in nature. But I wanted to share that my husband was definitely not a natural circadian person. Like he was like, he liked to stay up late, he's a night out, using blue light at night, night. And then he would, you know, not wake up early in the morning and he started digging into just how powerful. And he's, he's not in perimenopause obviously or he's a man, but he started digging into just like the power of light and all that. And he, he, if he could change his patterns with this and I believe anyone listening can. Like he, he had to start with like he, it took practice. Like he had it first thing in the morning, he could literally goes outside, he, he sets his phone to wake him up when the sun's Rising. Like, he goes outside, he gets real light in his eyes. And then during the day, what we shifted is we have a lot of those daylight LEDs. During the day, fine in our house, but outside more. And then at night we stopped using those. So basically we. You have to literally dig to find these. But we had a. We went and bought amber bulbs, like actual amber light that mimics fire light. We would have done candles, but he doesn't trust me. My ADHD would probably set the house on fire. It's not a good idea. So we bought amber lights. And um, we literally at night when the sun sets, we put amber lights on. And if we're using our computer or phone or tv, we are wearing blue light blockers. But I want to share, like, if he's someone who was like literally a night owl and slept in and he shifted this and we have watched as a result of that. Not just him shifting that, but he also, he goes out in the sun. Um, he does like 45 minutes, like in the actual sun. His testosterone like shot up through the roof naturally just from that. So I just wanted to kind of share because he's like a case study for me of someone who is not circadian rhythm that was able to shift this over, over like a month period.

Yeah, I love that. Thank you so much for sharing that story about you and your husband. I don't think we all realize how much our hormones are on a biological clock, including insulin, including ghrelin and leptin. So our metabolic hormones, our blood glucose regulating hormones, all of these are on a biological cycle like in our biological rhythm. And when that is disrupted, all of it can be disrupted. We can see more insulin resistance in the evening times. We can see, you know, our cortisol awakening response being dramatically impacted by that when we're off rhythm. We also know that our sleep is not as high quality. We know that we don't feel as energized. Many of us are so far away from optimized circadian rhythm that it absolutely impacts our energy, our not only mental energy, but also our physical energy. So the more that we can attune to that, I think we really can move the needle in terms of feeling, feeling more like ourselves again. So I don't think it's always going to be just hormones. Like we need to be looking at what's actually a driver of our energy. Yes. When we lose that protective shield, that hormone shield, we will begin to notice that we really don't have a level of resilience that we thought we had because a lot of those other pieces weren't in place. And so I think hormones are really just showing us like how off we potentially are because as we lose that protection, it all just comes up for review. It begins to really present itself. And so there's a lot of things that we can do every single day, that level of consistency that help us to feel like ourselves again, even as hormones are declining.

Okay, so light looking at our cellular energy, possibly bringing hormones on board with a practitioner like understanding that what is else can people do in perimenopause?

Yeah, I would say balancing their blood sugar.

Talk about how, how do they do that, what do they do? And do you recommend the continual glucose monitors or like what, what are your thoughts around all that?

Yes, I do recommend a continuous glucose monitor. I think again, we've been all taught, taught to not really listen to our bodies. Especially if women are just like, oh well, our bodies just don't feel good. And so we may not know what it feels like to be on a blood sugar roller coaster. We may not know what it feels like to not have good, good mental energy or have good capacity. We may not realize that our cravings and our mood swings are actually related to massive blood sugar fluctuations. Yeah, if only 7% of the adult population in the States has good metabolic energy, I would say that that is a good place to start, particularly in this transition where we start to notice all of these types of symptoms. I, I believe that looking at our blood sugar throughout the day, or at least our fasting blood sugar, is one of the best biomarkers of determining our cellular energy. And when we're wearing a continuous glucose monitor, not only are we able to look at our fasting glucose in the morning, but we're able to look at what our glucose looks like after meals, 90 minutes after a meal, two hours after a meal. We're also able to learn, is sleep being impacted by what we're eating at night or is our blood sugar being impacted by our sleep? How does movement impact our overall energy level levels? And what is stress doing or even, you know, us not aligning to our circadian rhythm? How is that impacting our blood sugar? Because ultimately that's one of the best ways that we can measure our overall energy. So taking that information and data really, really helps us to make real time changes to feeling better in our bodies.

Do you have an ideal A1C? And A1C is our combined blood sugar over a three month period? And I know they say Pre diabetic at 5.7 but I, I believe you had told me along why while ago, if I'm remembering correctly, you had like a different range that you felt was like the ideal. What's your number that you would like to see for an A1C?

I don't want it above 5.4.

Good. Okay. So if you're in the fours, you're fine. Like if you're in the high fours, you. That's good. Not good or is that.

Yeah. And I. No, no, it's great. I would say, I mean I, I'll be honest with you. I have not seen an A1C ever under a 4.9.

Okay, but so, but you've. Mine's a 4.9 right now. So mine's actually literally like a 4.9. But that's. But I will tell you guys, mine was a 5.8 when I started like really paying attention to that. So that's, that was a process to get it. And now I'm like, it's. I'm through. I feel great at 5.4.9 and I will hope to keep it there. So, so it's. So you said 5.4. I agree. I think that unfortunately we do hear a lot of western medicine say, oh well, you're not pre diabetic unless you're 5.7. But I, anyone I've interviewed about metabolic health, they will. You're. That's. Even 5.4 is even a little on the higher side. I usually hear like five point.

I would say I don't want it.

Any higher than five, any higher than.

So ideally I would love it between 4.9 and 5.2, 5.3. But it's a reactive number. So a lot of things could be throwing off hemoglobin A1C. It's not my favorite way of measuring blood glucose or measuring your overall. Like if we're looking at your metabolic health or insulin resistance, there's other labs I would be looking at instead. I don't mind taking a 1C into account count, but it's usually not. I'm not.

What are your favorite ones to look for? What do you want people to look at?

I. I like the. I like fasting insulin.

Okay.

I like, again, I do, I like real time data. So I do like continuous glucose monitors to tell me what the trends are in terms of your glucose variability. So how, how you're responding to your environment, what's going on with your glucose as a result. Like that to me is a gold standard of what is actually happening day to day, day.

So Marisa and this might have just been a ME problem, but with cgms I find that you have to calibrate and check with a fingerprint because they could be off. Do you find that to be true or is that just a Natalie problem?

It depends on the person. You know, if I see, if I see it wonky within like the first 48 hours to 72 hours, I'm going to want to calibrate it.

Yeah, I noticed when I was doing it that person. Yeah, yeah. It could be off like 20 points. So it was like before you panic, I think you're low blood sugar, like you have to kind of check in with symptoms and then cross check with a finger prick. Do you. So for lowering blood sugar if they cannot do it diet wise, like someone's like really dialed into whether they're going ketogenic or what you teach or like really working on having a solid diet that is the right balance to not have, but they're still not getting it to that level. Do you at that point recommend things like microdosing metformin or GLPs or, or other ways?

Yes, yes, yes. And okay, initially I'll start with supplementation. So things like berberine and chromium and see if we can work and move it in that way. See if I can make meaningful change with supplements because that always feels safe. I mean there's a lot of like you're talking about ick the ick around hormones or the ick around peptides. Some women are like, do I really have to go down that, that. Yeah, that rabbit hole or down that realm. And if I'm, if I'm getting on that train, am I going to have to be on that train forever? And so, so if we can manage it with supplementation like bermaine, then I will try or fenugreek or you know, it's a lot of different herbs that can help move the needle. But if that's not getting the job done for whatever reason and it could be just long standing damage or lifestyles that just have compounded over time and again taking hormones, it can just be a cacophony of things. If nothing is working, then that's when looking into medications would be the next move.

And do you have a preference?

Always an ascension.

You do have a preference on metformin. I know they're kind of like both. In the biohacking world, people will talk about doing tiny amounts of either GLP1s like a tirzepatide or they'll talk about doing small amounts of metformin? Do you have like a either or is that a matter? And like, how do you advise even people get into something like that?

I mean, usually it's not that women just want to address their blood sugar issues or their insulin resistance. They're looking to look to lose weight. Like, they're looking to lose stubborn weight, that no amount of weight training or walking or all the things that they're doing are working. And so usually that. That leads into a conversation of a GLP1.

Okay, got it.

So that we can, we can double dip.

And I'm gonna just put my disclaimer. I feel people really need to work with a clinic, somebody on that. Like, work with somebody, not just go online and buy from some. Yeah, I, it's my own trigger. So I just think we're, we're, we're playing with fire here. If you're just going on to some website and figuring that out, like, you need to really work with a clinician, get testing and know what you're doing there, that can go down a slippery slope.

I mean, I think anytime, whether it's hormone replacement therapy or it's peptides, working with someone where, because again, none of this is a one size fits all, your body's going to be different based on your gut health, your. Your resilience, where your hormones are at. All of these things are having an impact on these peptides and, and bringing in exogenous hormones. So working with someone who can make changes, who can keep you accountable, who can look at the labs, I think all of that becomes very, really, really important as we are navigating your journey. Remember, this is your body, it's your health. We only get one chance in one life. And so I want to make sure that you are as optimized as possible. Always work with a clinician.

Marisa. What are some. And I know, by the way, you guys, she has a book on the perimenopause revolution. And if this is all resonating with you, I mean, obviously I'm going as deep as I can here on this episode, but there's so much more in this book. And I mean. And I'm gonna say don't just. I always say don't buy one. Buy like five and give them to your friends too. Because this is. If you're at all like me or Maritza, if this resonates, like, I like to talk things through with my friends. Like, as. Do you do that? I know you do that, Marisa. Like, as I love.

There's a whole Chapter on community and soul sister friendship. Because you want to know that you're not crazy, right? When things are shifting and changing and you want to be like, okay, what is working for you? Whether it's skin care to Peptides, if that's the route you're going, or even just lifestyle strategies, like, what's working?

So my kind of thing is, once a topic resonates with me, not only do I do I send the podcast episode to everyone I know, like, all my friends know, but I also, like, if I'm buying the book, I buy it for my friends. I'm like, okay, we're all here. Let's all dive into this topic or whatever it is, because that, it just makes it to me as I'm learning and sharing and talking. It's probably why I love my podcast. I. I learned too, you know, and as you're talking about it with others, you. You go to another level. Tell us a little bit about. I want to kind of wrap up with two important questions here. I know I asked you a million questions here. We were kind of all over the place, but can you dial in, like, what are the most important takeaways you want people to know? And what. Why did you write this book? Like, what is the main thing, the reason you want people to go dive into the book deeper?

Yeah, I wrote this book the Perimenopause Revolution, because I was blindsided by perimenopause, mind you. So women are having babies and then moving into perimenopause, and that was very much my story, too. I thought I was going to have a longer Runway between postpartum and Perry, and that did not happen. And so I want women to be prepared, especially as we're having children later and the demands of life and motherhood are happening to us. I don't want you to feel blindsided by what is going on. Also, I want you to know that you deserve agency and you can have agency over your health and that you get to advocate for what is right for you. Right now, the medical system is very behind how we are taking care of women in perimenopause. And so you are going to have to advocate for yourself. I wish it wasn't true, but that is just where we're at. And the book is going to give you everything you need to be able to have that conversation and really get what you need to thrive in this profound transition. Lastly, a lot of the things that I am recommending are things you can do in your home every single day. Like we talked about circadian rhythm optimization. We talked about balancing your blood glucose, we talked about moving your body, but also regulating your nervous system. You know, I do, I don't go into a lot of supplementation in the book. I just didn't want to make it all about that. I wanted to focus on the lifestyle strategies that were going to move the needle for you, but also building community and even understanding enough about HRT to have the conversation. That's really what this book is all about. But the through line of everything is how, what's the quality of your metabolic health? How do you know what the quality of your metabolic health is based on levels, labs, and then how do you make pivots and changes so that your, your metabolic capacity is, is at least where it needs to be moving through this transition, but that you are, you are securing that, that cellular energy into the second half of your life? I believe every woman deserves to thrive in the second half of your life, of our lives. And right now women aren't. And so how do we change the narrative and how do we ensure that you get the care that you deserve? That's what the book says about so good.

Where do you want them to get the book? I mean, do they just go on Amazon? Do they go to the bookstore? Like where do you want them to go?

You go anywhere you want to go get the book. If you go to drmarissa.com book there are bonuses. So right now I don't know when this is going live, but it's available for pre order at the moment. But I have all of these incredible bonuses including symptom trackers, lab ranges, so good recipes, workout videos.

Heck, the lab ranges alone, we all need that, that everyone's always asking about. Lab ranges changes.

Yes.

So dramica.com forward slash book and I'll link that up in the show notes as well. Thank you so much as always. I love having you on. Thank you.

Thanks for having me.

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