Latest / The XX Lab / Too Young for Perimenopause? The Early Signs Most Women Miss | Dr. Mariza Snyder #23

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Too Young for Perimenopause? The Early Signs Most Women Miss | Dr. Mariza Snyder #23 · The XX Lab

• speaker-0: A lot of times when women are in their late 30s or 40s, they hit a moment when they start to realize, I don't feel like myself anymore. Things that used to feel easy suddenly feel like they're requiring more effort. Your brain or your body may not seem to be responding in quite the same way that it used to to things like sleep, exercise, or learning. And because your periods may still be regular and your labs look completely normal, it can be really hard to understand what's happening. My guest today is Dr. Maritza Snyder, and she wants women to know that this can be how paramenopause begins. Dr. Snyder is the author of the Paramenopause Revolution and host of Energized with Dr. Marizia, a podcast that I love. And I loved this conversation with Dr. Maritza because we talk about paramenopause not simply as the years when your periods start to become irregular, but as a much bigger transition, one that can affect how you think. feel and function long before menopause actually arrives or your hormone tests start to look funny. We also get very practical and personal about what women can do to feel better during this transition. Dr. Snyder offers simple strategies for understanding what's happening in your body and working with it rather than feeling like it is suddenly turned against you. But one of my favorite parts of this conversation is our discussion about something we don't talk about nearly enough, and that is identity. What happens when the body and brain you've known for decades starts to change? How do you take care of the woman you are becoming without desperately trying to hold on to the woman that you were? This is such a warm, useful conversation about navigating paramenopause with more knowledge, more agency, and a little more grace for ourselves along the way. This is the XX Lab. I'm Dr. Sarah Hill. Let's get started. Dr. Maurizia Snyder. Welcome to the XX Lab. speaker-1: Dr. Sarah, I cannot tell you how excited I have been to have this conversation with you. speaker-0: I am so excited because you wrote a really wonderful book called The Paramenopause Revolution, which I think is like really fantastic because I think that it does a lot to demystify this experience. All of us go through it. And I want to walk listeners through some of the wisdom that you offer in your book and things that you and I have talked about just in passing or in our On our walks in beautiful Santa Barbara. And I want to start by just talking about like parametopause, like, what actually is it? speaker-1: This is one of my favorite questions because there's still a lot of misunderstanding around what perimenopause is. There was a recent study that just came out looking at 7,500 women. It was the Mayo Clinic was part of it. And they asked women specifically, where were they at in their reproductive life? You know, we was it was it pre-menopause? Was it perimenopause? Was it menopause? And the the the age group that was the most confused about what was going on with them was between 40 and 44. It was 42% of women. And that is early perimenopause. So menopause is that moment in time, defining moment, where we haven't had a period or a menstrual cycle for 12 consecutive months. And what's important to note there is not, it's that this menopause transition has been happening for much longer than that. Defining moment. And that's really the menopause myth that we just arrive at this 12-month mark and ta-da, we're here. No, hormones have been wildly fluctuating and ultimately declining for many years. So perimenopause is that transition leading into menopause. Four to 10 plus years, where your hormones, as a result of the miscommunication between the brain and the ovaries, and really due to the fact that we are winding down our egg supply, those hormones are. shifting and fluctuating wildly throughout those years and ultimately declining. And as a result, women can experience a myriad of over 50 different cognitive, physical, and emotional symptoms throughout that time period. And it really can leave them feeling very just disconnected from themselves. It can leave them feeling very destabilized. But also I think it can be a phenomenally transformative transition. And so that's really what perimenopause is. And then we can break it into kind of two phases of perimenopause to get a better sense of where you're at in that, in that transition. speaker-0: So what are the two phases that break perimenopause into? speaker-1: And I wanna just simplify it into two phases. I think some people could argue that there's a couple more, but let's just keep it really clean. That first phase, early perimenopause, again, it that that zone that I was talking about where women are like, what is this? If menopause, natural menopause can happen anywhere between 45 and 55 years old, that means a lot of us land in our late 40s when it comes to menopause. I have a lot of colleagues and friends of mine that went into menopause at 47. 48, 49, 50, not just that classic 51 or 52 years old. So if that's the case, then if we were to reverse engineer that 10 years prior, we can be as early as our mid to late 30s when we're entering into perimenopause. And what early perimenopause often looks like, right? It's not that we're having vastly irregular cycles or that we're even skipping periods. Now, could that be for some women? Absolutely, but normally we start to see that in late perimenopause. So for many women in early perimetopause, we're still cycling pretty regularly. I don't know about you, Dr. Sarah. I am still cycling pretty regularly. I would still technically be considered early perimenopause at almost forty seven. I'll be forty seven in two weeks, forty-seven years old. speaker-0: I'm 48, and I have my very first irregular menstrual cycle just about two months ago. And so up until that point, you could like set a clock to my periods, and my periods were never different. my hormone levels always look normal, but I knew that I was like entering into perimenopause and I was about 43. So it's been about five years that I've had regular menstrual cycles, at least you know, in in terms of the timing of my period, and then with my hormones looking normal. But for me, I I knew that something was up because I started experiencing a brain fog. The only way I can describe it is that I feel like my emotions are like right under the surface. You know what I mean? Like it used to be like it would take a lot more to get me to cry or to get me to feel overwhelmed. And now I feel like sadness or overwhelmed or you know, is like right under the surface. And so it's like really easy for me to get those responses triggered. And It was those things, especially the brain fog, and I knew what it was, you know, it's 'cause like I study hormones. speaker-1: Exactly. And that's that's what makes it so complicated or challenging to kind of tease out. Is this burnout? Is this stress? Is this is this my hormones? Is this early perimenopause? And especially when if we thought about perimenopause being irregular cycles, being, you know, kind of crime seed periods, hot flashes, night sweats, these kind of classic symptoms of perimenopause. And much later, you know, we thought about perimenopause as like. Those last couple of years leading into menopause, we didn't really recognize the fact that when women were coming to us as doctors and providers and they were struggling with brain fog and irritability and a lack of stress buffer and sleep issues, that actually was perimenopause too. That it is as much a neuroendocrine transition and affecting not just our brain, but affecting our joints, affecting our Our digestive system, affecting our energy, our workout recovery, all of this can be interconnected to, again, these whole body hormones, not just reproductive hormones that are beginning to shift and change. And so often what I'll see with my patients in early perimenopause, so late 30s, early 40s, often for me, for my patients between 41 and 43 seems to be the sweet spot. But more and more I'm meeting women in their like 38, 39, where they're noticing. Sleep is erratic in their luteal phase. Their stress response is not the same. PMS symptoms are more exacerbated. They, everything is requiring more effort of them. They're like, why are things that used to feel so easy for me requiring so much more of me? Who am I? What's going on with me? Literally, I was with a woman yesterday who was 43 years old, and she's like, I just feel like I don't recognize me anymore. I don't have the same bandwidth and resilience. I I I don't have the same buffer to take on my students the way that I used to. Like, what is going on? And I was like, Yeah, these this is hormones. These are hormones shifting and changing without permission. It's like, it's like your body's going through a full renovation while you still live in it. That it's noisy, it's disruptive, it's it's loud, you know, and and everything feels like you said, like right under the surface. You just don't feel like yourself anymore. You're not responding the way that you used to. that is often what I will see with my kind of earlier patients. They just they don't they're not able to do the things that they used to as easy and it just it really rocks their world. speaker-0: I think that that's really helpful to listeners. Like I said, I had my first irregular cycle about two months ago. And so I think that I'm probably making the transition from early to later perimenopause. Yeah. speaker-1: And how is that feeling? speaker-0: It's not my favorite thing, honestly. The thing that I find that a lot of people aren't talking about has just been the change in identity. Like I feel like I'm having an identity crisis in some ways, you know, where it's like you go through your life in a body, right? A certain body, a certain mental sharpness and feeling like the things that make you valuable in part, and especially for women, is tied to youthfulness. Right. And so I've always like wanted to not be the person who's desperately, you know, clinging to youth, right? Because that gets so expensive and exhausting. It's mentally exhausting. And as the old saying goes, like gravity always wins. You know? speaker-1: Mm-hmm. speaker-0: Also am not ready to go quietly into that good night, right, and get a golden girl's haircut and you know, wearing a frosty the snowman sweater over Christmas season. Like, you I I don't I'm not there. Like I don't identify with that, right? But I also realize that if I just like fight you know, the the aging and you know, which is something that accompanies the decline of of your sex hormones, whether we like it or not. I'm feeling sort of in in this in this space where I don't I don't know what to do with that. So I I feel very much like the same person I have been. And I'm trying to learn how to appreciate right the benefits that we get from being the age that we are. Because I think I'm more compassionate and patient now than I was when I was younger. I'm more empathetic. Than I was when I was younger. And I've got more wisdom and more experience. And so there's a lot of benefits that I've gotten from being older. But I also very much as a woman, and particularly, you know, a woman who has to face the public a lot, like whether it's people seeing me on a podcast or on social media or my students, I'm also aware of the way that people respond to me based on the way that I look. And looking older is related to, you know, all kinds of beliefs about women. It's just an interesting for me, it's been really interesting trying to think about what does this mean for my identity as as myself? Because I think that so much of, you know, it's like we form our identity as young women and and adults, you know, and then trying to shift into this new identity without feeling like I need to try to always look like and be like somebody who's 32. It's is is I think an an interesting Transition for me. speaker-1: I wanna share a little story. When I really understood perimenopause was when my mom was going through it. I had just entered my practice and I had mostly almost all midlife women who were really various stages of perimenopause and menopause and were trying to figure themselves out. At the same time, my mom had a brutal perimenopause and it was such a disparity. Growing up, my mom was a single mom. This is the 80s. So my mom, this is like 85, 86. Like she had the ultimate power suits with a shoulder pad. And she had she had this walk where you turned around because you were afraid there was someone's gonna knock you over. You know what I'm saying? Like that was my mother's power walk and she had her keys and we just knew, like when we heard that walk, it was our mother, and we better grab our stuff because we were going somewhere. I don't know where we were going, but we were going somewhere. And this is this woman was just a freight train growing up and she just handled it. She handled all of it. Like that woman had the level of capacity that I don't know if I'll ever match in my whole life. And I Or don't think I haven't tried. And so when perimenopause hit her, I remember being a bit judgmental because I didn't recognize this woman. I was like, who is this version of my mother? This is a worn-down version of her. And mind you, in early perimenopause, she just shoved it because she kept being dismissed. She kept being told that, it's just, she's working too much, it's burnout, it's stress. And probably it was a yes end of all of those things. Like life was lifing on her. She was still a single mom. My sister was having a really hard time. And it was perimenopause. And it wasn't until she stepped into late perimenopause that it all came up for review. Like it got to a point where she, I mean, Mac trucked. really hard into severe depression, anxiety, massive weight gain. I mean, all of it came tumbling forward. And I'll never forget, we were training for this little this race called the Beta Breakers, which is in San Francisco. And I trained because I was like, my mom's gonna kick my butt. I'm at my like 31, my mom's forty eight. We're 18 years apart. And I'm training and she shows up and we're gonna run this race. And the day before I have us working out, I have us doing a spin class, this poor woman. And the next day we gotta run this race. And she only makes it to mile three. And I was so angry and upset that she had failed me, that she was not the woman I imagined her to be. And I had so much more extra grace for her when I really figured out what was going on. And I ended up taking over her care about a year later. And this woman had this defining moment when she was about to be into in menopause. She really worked on what was going on with her, really addressed her identity around it and made multiple decisions. at Brown, like fifty forty-nine, fifty years old, a couple years after this whole beta breakers incident where I I felt like she failed me. And she had just decided she's well, I'm gonna play competitive tennis. I'm gonna run my first marathon. And you know, fast forward, she's sixty-five years old this year, or sixty-six, she'll be sixty-six in October. This woman just ran three marathons in five weeks. And she plays tennis three times a week. I mean, this woman is, I mean, she had this beautiful transformation and and a kind of an awakening where she prioritized the things that mattered and let go of so much of what she didn't need to hold on to. Now, I'm not I'm not trying to romanticize Perimenopause as this really amazing inflection point where we get to decide because I know that at times it can be so hard. Believe me, Perimenopause has been no picnic for me at times. And It is really has forced me and so many women, I believe, to reevaluate what our energy is worth. Because when we have an excessive output of energy that we can give to everything and everybody, we do. We do that. When when hormones show up with the with the epic scaffolding to allow us to be everything for everyone and to say yes to all the things and to be the horse to bet on. And then all of a sudden that foundation, that infrastructure begins to shake and crumble. And then you got to decide like, what is my energy worth? What am I going to step into? How am I going to prioritize me in this season of life? And I think that's the beautiful thing about this window of opportunity, which often can feel like a window of vulnerability, of just deciding actually, you know what? Moving into this next chapter, which is my chapter. It ain't your chapter, not for your comfort, for mine. Finally, what are the things that are gonna move me forward? How am I gonna really live my dreams? How am I gonna how am I gonna create a body and a life where I get I get to enjoy the richness of it with the people that matter most to me? It can feel like an identity crisis. At the same time, it really is an opportunity for us to say, actually I matter. And this is how I'm going to shift and turn the tide in my favor. speaker-0: Late paramenopause is something that we can usually identify because of the changes in cycles. With the early paramenopause, for somebody who's listening and isn't really sure, like what are some of the things to look for before the cycle disruption? What are what are some other things that they might want to look out for where if they're having these, especially when they're having them all together, right? These different experiences that that they might consider that this could be the beginning of paramenopause. speaker-1: Yeah, I love this question. And I I really want to frame this around agency, because so many of us are told to wait. Wait until labs are totally abnormal. Wait until symptoms get so much worse that we can't function. And I would say that that is the area where we have been so casual around women's health is that we are told to wait until symptoms are so unmanageable to finally go and seek out care. And then often, even when we do so, we're told that. Well, we're too young for this, you know? And so we w it's important for us to have that level of agency. Also, we're told to wait until menopause. Can't do anything for you until you get there. And like that makes no sense to me. My recommendation is to track your cycle. If you are still cycling, this is that window where things g they feel really messy. And it's not that you're not experiencing these symptoms, it's that you're having a hard time connecting the dots between what's going on and and how is it connected to perimenopause. So First and foremost, track your menstrual cycle, get a sense of what is going on. Are you ovulating? You know, are we having an ovulatory cycles at this point? And then track symptoms along with those cycles. So are symptoms non-existent in the follicular phase of your cycle? And then bam, they come back with a vengeance. Is one month sleeps fine, and the next month it's icot garbage, you know? And so having that lived data and collecting that data on yourself is gonna be so important. And then also paying attention to patterns. What are your energy levels like? You know, how is sleep feeling? How are you feeling in the morning? What are your moods like? You know, this is how I knew I was in perimenopause. I had rage and a deep sense of dread on day 22, between day 21 and day 22 for three months in a row. This is how I knew. And I was like, well, Can't argue with the data here. Like it's obviously very metamos, you know, because otherwise I I felt like I was kind of just throwing spaghetti at the wall and trying to make it all work. It wasn't adding up until I really began to track things. But really understanding cycle changes, energy changes, mood changes, even you know, how you're eating. Is anything shifting there? That type of data, when you're bringing it to your clinician or your healthcare provider, can really not only give insight for you and explaining what's going on with you, but can allow for a deeper conversation that feels like you're on a team. So that's what I would tell tell women, because even labs can be such a moving target in this in this season where you know everything often looks fine. Often you're in normal range, except that It's not normal. Nothing's feeling normal. speaker-0: Right. Yeah. And I think that that's such good advice. And for me, definitely the first thing that happened was I was actually writing the period brain. I had just started writing that book. And yeah, speaker-1: How funny, right? speaker-0: I know. And I could not hold sentences together. And that's not like me. I I love writing and it's something that I've always found to be fun. And it was very frustrating because I felt like I couldn't hold complex thoughts in my head in the way that I used to. And so I went to the doctor and of course everything was normal. But thankfully I have a really wonderful care provider. I said, I think that this is parametopology. She said, I think it probably is too. And so then they started me on estrogen and and progesterone. And within three months, like I felt like myself again. And I mean, it was really transformative for me. Like I I I'm so grateful that I didn't have to go through the, you know, merry-go-round that so many women have to go through when they go to their doctor with. A really important but limited symptom. Cause I mean, you know, brain fog was like really kind of it in terms of the symptoms that I had, but it was so important to me. When I talk about the identity loss, I mean, to to be somebody who spends her career, I mean, I'm in front of people all the time. I'm in front of my my students, my PhD students, I'm in front of the public. I'm having to talk about science and to not be able to do that or forget, lose your train of thought. I mean, it was devastating to me. Yeah. I mean speaker-1: Be researcher. Like this is what you do. You research, you translate complex medical information and research into ways that people can understand. And all of a sudden you're like, I can't remember the word fork. speaker-0: Yeah, exactly. It's like what is this device that I'm using to speaker-1: You should have grabbed the and you just like your hands are just reaching, you know? My son finishes my sentences. He's five. There's a lot of kind of controversy right now whether hormone labs are even appropriate for perimenopause. And I think that I think data can be really, really important. And where where I see perimenopause is inflammatory markers. I will see it in increased lipids. I will see it in your blood pressure rising. I will see it in your fasting insulin increasing. And so that's where I will often see perimenopause begin to show up. It's these silent physiological shifts that we don't realize are equally shifting. It's not just the the cognitive changes or the identity shift. It's like, what's going on with my blood pressure? What's going on with my fasting insulin? Because I think of perimenopause. As not just a neuroendocrine transition or a reproductive transition. It's a vascular transition. Your bone is you know is shifting and declining. Your muscle and your workout recovery isn't gonna be the same necessarily. And so there's a lot of things that are happening underneath the surface that we we are we are missing the boat on during this kind of window of vulnerability and window of opportunity. speaker-0: Yeah, I want to talk a little bit about these cardiometabolic shifts. And I want to talk about what happens with insulin sensitivity. And because one of the things that I hear a lot from people in my age group who are in the wonderful world of perimenopause is the difficulty with managing their body weight and regulating their appetite, where they feel like they're very hungry all the time, no matter what they do. And so I would love for you to tell us. Is weight gain necessary in perimenopause? Like is this just something that we need to expect? Why is it happening if if this is something that is is common for women? speaker-1: I I love this question because up until a couple of years ago, we just keep kept saying that women are lazy and they lacked the willpower and the discipline. And and still, this is still the kind of the prevailing narrative is that, once women hit their 40s, you know, it's they just kind of just give up. You know, it's just yeah. speaker-0: That give up. speaker-1: And I'm like, what woman do you know is giving up? Like, I don't know. I've never met her, you know. What I do know about women in their 40s is that they're holding it all together, that the the demands of life are at their greatest. I mean, it's almost laughable that we would be going through a massive whole body renovation during a time where we are really taking care of everybody and everything. And so I I wish we could just acknowledge that for a moment. And then your body has the nerve. To change without permission? Like, how dare you? And so what's what's happening is as we've we've been identifying how important estrogen is for the brain. I think about estrogen being the CEO of the brain and how, you know, this is this is a CEO kind of similar to, you know, what you and I, Sarah, and our experiences, professor who shows up every day, a professor who is doing her research, who knows how to write her books, right? And all of a sudden her brain's like, sorry, I didn't show up. You know, and and that's really what's going on with Estrogen is the CEO is who's shown up at nine o'clock every single day for years, rhythmically cycling, doing her job. All of a sudden, doesn't show up till two o'clock in the afternoon, doesn't tell you, doesn't send you a message, doesn't email you. And that's the brain. You can imagine how destabilizing it is to have this hormone that is so mission critical to your energy metabolism and to your neurotransmitters and to reducing inflammation in the brain. Well, guess what? Estrogen isn't just running the show over here in in the in your in your neurochemistry. It's also running the show in terms of bone Bone remodeling, it's running the show in terms of your muscle, your muscle protein synthesis. It's running the show in terms of insulin sensitivity and your vascul your vascular system, your your blood vessels being flexible and you know, and and and really working properly. And so as estrogen begins to decline, and again, as we've really emphasized in a very erratic fashion. We know that it's having a profound impact on your cellular energy and ultimately your insulin sensitivity. And insulin sensitivity, as it becomes more resistant, and this is where, you know, when we've got blood glue, we've got glucose in the blood, insulin is utilized as a signaling hormone to allow that glucose to go into our cells so that we can utilize that for energy to make ATP. But as insulin becomes more resistant in this season, we know that a kind of a down A down result of that is going to be more visceral belly fat. We're not gonna be burning energy the way that we used to. And we do start to put on and accumulate weight. 80% of us will gain about five pounds, 10 to 15% of us will gain 10 pounds or more. And so it is a very real phenomenon. And it's not for the lack of effort. It's just more so that hormones are shifting and often the strategies that got us. to where we are today are simply not working the way that they used to. And I think that's important to understand. And this is why running biomarkers, I think, is mission critical, so that we can stay on top of the fact that are we seeing an increase in insulin resistance in our late 30s, early 40s, so that we can stay on top of that, along with looking at highly sensitive CRP and looking at hemoglobin A1C and fasting glucose and and lipids like triglycerides and HDL and all of these kind of looking at the full picture to see is our cardiometabolic health being impacted by the perimenopause transition and and life at the same time too. speaker-0: Do you recommend that women wear a continuous glucose monitor for periods of time just to keep a track, like keep track of how their body is responding to glucose, which obviously isn't going to be as sensitive as like an actual insulin test. It's related. Is that the sort of thing that you'd think that people might want to do? just to kind of get a proxy measure of what might be happening with insulin sensitivity? speaker-1: Absolutely. Yes. And I think it's very much a proxy measure of what's going on with your insulin sensitivity or insulin resistance. Especially if you've noticed that the even on the back end of what you're eating, moods are shifting, energy is shifting, or you're noticing more cravings around late night or mid-afternoon. And and you you just want a better sense of what's going on. And also I just want to note that it's unfortunate that. Fasting insulin is not a standard, you know, lab that you're gonna see on a panel that you're gonna be getting for your annual exam or really kind of any any doctor's visit. And so most likely fasting insulin isn't even on your your panel to begin with. So having a CGM and and what is really exciting about where we're at with continuous glucose monitors is that you can order them over the counter at this point. They they're not, they don't need a prescription even like they did a couple of years ago. You can find typically a two-week CGM, a sensor, for about 50 bucks online. So it's very inexpensive. It's easy to download the app. It's easy to use. It you know, it doesn't require a lot of deep understanding of what is going on. You're basically just kind of scanning it. And what I always tell women the first week of wearing or even the first five days of wearing a continuous gokos monitor is just observe without judgment. Go about your day, do what you do, but scan it throughout the day because it's not just the food that we eat. or how we eat it that's making an impact. It's the sleep or lack of sleep that you had the night before that's gonna have an impact. It's gonna be the movement throughout the day that's gonna have an impact. A crazy big meeting that maybe got thrown at you last minute is going to have an impact. A really hard strength training workout where you hit a PR is going to have an impact on your blood glucose and as a result on your insulin. And so just note that there's a lot of things, a lot of factors that are impacting those blood sugar levels. And so looking at that, you know, with with an un kind of unjudgmental eye that first week really gives you a sense of like how I live my day, how is this impacting my blood glucose? And then after about day five or six, and you can start kind of playing with it. What happens if I only have espresso at 7 a.m. in the morning? What's going on habit? You know, what does it look like after my fasting glucose? And then, you know, what happens, you know, right 90s 90 minutes after my biggest meal, especially lunch and dinner? Or what happens? I took a walk. I did a walking intervention 30 minutes after I had dinner, kind of before we see that full rise. And you know, what happens when I do versus don't? And so what happens when I go to bed on time? Huh? What happens if I don't late night eat? You know, these are all the things that we get to ask ourselves. And I will tell you, I've put a continuous glucose monitor on thousands of women at this point. And It there's always information and data that really change the way that you think about eating. And so I personally put on a continuous glucose monitor probably twice a year. Two weeks, twice a year, often around my birthday. Cause I'm just like, you know, let's take a look and see what's going on. And then usually right after the right after the holidays, I'll put one on in January as well, just to get a sense of what what you know, how my body's responding. And it's it's so interesting that level of accountability. I will tell you, girl, I can't. Keep it really tight when I have the continuous glucose monitor on. But I take those beautiful habits and what I learn from the CGM and it translates throughout the rest of the year. I've also noticed, because I've been wearing a continuous glucose monitor since 2020, that I have to like be a little bit more intentional now in 2026, six years later, now that I'm kind of at the cusp of heading into late perimenopause. And so despite even how intentional I am about movement and eating and building a power plate, a metabolically healthy plate, that I'm noticing that I've I've don't have the same level of wiggle that I had six years ago, you know, I'm making more slight modifications and pivots based on that. I also have a significant family history of diabetes and a significant family history of cardiovascular disease. And so I'm just paying attention to those biomarkers every single year, but also making sure that I'm paying attention to my blood glucose levels, especially when I'm wearing the CGMs. speaker-0: I think that that's so smart. And something also to note for listeners is that you actually get changes in insulin sensitivity across your menstrual cycle. It's also worthwhile just to understand how your body works, is to wear a CGM during the first two weeks of your cycle when estrogen is the primary hormone during your follicular phase. And then during the last two weeks of your cycle when progesterone is the dominant hormone and you're in your luteal phase. Because generally what we see is that insulin sensitivity does decrease in the luteal phase. And I love sweet potato as an example because I like sweet potatoes and so I eat them and so I'd have a lot of data on myself because I wear a CGM periodically to just kind of see what's happening with me with respect to my cycle. And then also, as you have recommended, to just kind of keep a track of how things are going as I'm aging. And my insulin response to a sweet potato is very different depending on where I am in the menstrual cycle. And it's it's been really interesting for me. and being able to observe those things. And one of the things that you talk about in your book that I think is just really wonderful advice for people who are busy. And that means all of us. All of us. speaker-1: I wasn't that. speaker-0: Yes, every woman I've ever met is busy. And I love some of the ideas that you have for, you know, taking a brisk walk after dinner or doing these little exercise snacks as a way to try to increase your insulin sensitivity and try to forestall what many of us think of as inevitable weight gain and paramenopause and try to nip that in the bud and allow ourselves to maintain a healthy body composition. And so can you elaborate a little bit on some of these ideas? Like what are some of the ideas that you describe in your wonderful book, The Paramenopause Revolution? But then also what are some of the things that you do in your own life to try to increase insulin sensitivity to regulate your appetite and in in, you know, help Keep your body in a nice state of of good glucose control. Yeah. speaker-1: This question because I think ultimately what it comes down to and body composition is so important, but also that we feel energized, that we feel good. Like I sprint with my son, who's who's starting kindergarten next week. And we, you know, it I love that I can sprint with him. I love that I can play soccer with him. Like I just I keep imagining the future version of me that really has energy and capacity. And so yes, body composition matters, but what matters most is that I am living, I'm gonna be I wanna be living independently for as long as freaking possible. And I think blood sugar Management is a big part of that conversation because it has an impact on your your vascular health. It has an impact on your brain health. You know, brain health is vascular health. It's it's it's blood sugar regulation. It's all of these things that are tied together. It's it's it's helping to maintain good muscle. And so a couple of things you talked about sweet potatoes, right? And we're and we're not villainizing sweet potatoes here. I think early what we're saying is that maybe naked carbs. You know, can be can be a little bit more challenging as we get older. And so I one of the things I always talk about is dressing your carbs. You know, with that sweet potato, we're having a little bit of protein or some fat that really helps to to round it out because I think sweet potatoes are bringing really wonderful polyphenols and beta carotene and l all kinds of good stuff to the table, lots of good fiber. And, you know, you eating a sweet potato at like 8 p.m. at night and you're in your follicular phase, I have have a feeling it's gonna respond in a way that it's not gonna, that isn't gonna be wonderful on the continuous glucose monitor. So dressing your carbs, I think, is a big one. But probably the intervention that you had mentioned that is the biggest intervention that I've seen in wearing having my patients and myself wear continuous glucose monitor is that movement after meals. And I don't wanna overcomplicate it. I will say that window of intervention. kind of where it's more optimal is sooner after dinner or sooner after the meal versus waiting for that blood sugar response to happen and then your the curve is going back down. I mean move movement at any time is a good time. And when life is busy, I will take, I'll take any movement at any time is a great time. But if we're really trying to get into that window of intervention, it's usually within 30 to 45 minutes after a meal, especially later in the day. The beautiful thing is that that intervention doesn't have to be a long time. If you can get outside and take a walk after dinner, like I love it because it supports your digestion, your nervous system regulation. Hopefully, you're having a beautiful conversation with your family. There's so many positive benefits. But if you're like, woman, I don't got time for that. Like, I get it. Also, I have I know that life because my son doesn't always want to go outside after dinner. He wants to build Legos. And so I'm usually doing mountain climbers when I'm helping him. I'm doing jump squats. I'm going up and down my stairs with 15 or 20 pound weights and three to five minutes of an intervention, especially if it's an exercise snack where you're kind of basically think of high intensity interval training, but for just two minutes. I think we can all do that. We can all do some jump squats, we can all do some jumping jacks. We can all do some mountain climbers or maybe even I'm just challenging you to do some push-ups. So and again Two to three minutes and you're back to doing whatever else you gotta get done the rest of the evening or the rest of the day. And I think building in those movement snacks throughout the day not only improves mental clarity, it helps you to get more deep full restful sleep, but it balances out that blood sugar and it helps to it helps to build muscle and helps to mitigate body composition changes that are not very favorable. The other thing I recommend, the last thing I'll say here, and so one of the things that I do in the morning is my morning metabolic ignition method. Which is movement the first two minutes of the day, hydrating, upgrading your coffee. So no sugary stuff that you put in your coffee, getting morning sunlight, and building a power plate full of protein, fiber, and healthy fats. And that little ignition protocol can literally change the course of your day because you are starting your day with building energy so that you have capacity to get through the at least the first part of your day that you can then build. moving forward. And so starting your day, I feel is a lot easier for many of us versus kind of ending our night. I feel like a lot of us kind of like we we we will mess with our sleep routine before we will before we will really optimize it. But what we will do is often carve out a little bit of time for ourselves in the morning to have a much more energized day. So that morning ignition takes 20 minutes and it can really set the tone for your blood sugar, your energy and your capacity. speaker-0: Can you tell us about your morning? Yeah. speaker-1: I'll I I'll even share my my morning today. So I get up before my family because you know that is just the way it is. when you especially when you have a five year old. speaker-0: So you wake up early. speaker-1: Wake up early before my family. And I I I'm really intentional. My son really likes to see me in the morning when he wakes up, although I kind of missed the boat this morning, but I think I was two minutes late. But I I get up, I go to the bathroom really quickly, and then I move my body. Usually I kind of shake it out. Maybe I'm like a kid at heart, but I love some jumpy jacks. Nothing wakes me up than like 40 jumping jacks. So I'll just knock out some jumping jacks. I will go downstairs. I've got my emotional support water. So I usually put electrolytes in it. I've got I've got my water and I step outside. We have a little grassy area. I'll get some sunlight. Or even better still is I will take the water and I will walk. Then I I made breakfast and coffee. So I did my coffee. But again, what I mean by upgrading coffee, we just don't realize the types of creamers and the sweeteners that we're putting in our coffee. And let me tell you, the fastest way to get on that blood sugar roller coaster is drinking liquid sugar. And it's often disguised in our coffee. And we're just like, but it's just a little bit. I'm like, yeah, but put a continuous glucose monitor on when you've been fasting for 12 hours. See what happens when the first input is sugary coffee into your system. You're you're, you know, it goes straight into the bloodstream. Like your body doesn't care if you need a coffee boost. It's that sugar that's making the difference. And it's so hard to recover from that as we get older. And so make sure that your coffee is really it's unsweetened. Add a little bit of cinnamon, maybe add some collagen or whatever, whatever you love. Just try to keep it so that you're not, you know, causing a blood sugar spike out the gate. And then really building your plate so that you actually have energy and capacity to get through your day, that you're not crashing by 10 or 11 o'clock in the morning. So adequate protein, at least 20 to 25 grams. If you want to hit your 30, by all means, get it done. But fiber, raspberries and strawberries and flaxseed, and you know, making sure that you're getting fiber, that's equally as important. Your gut microbiome matters so much when it comes to energy and blood sugar regulation, and even your mitochondria. And then a little bit of I think a little bit of healthy fats go a long way as well. A little bit of olive oil. Maybe it's leftovers from the night before. You know, it's salmon and a salad, some berries. I mean, it doesn't have to be complicated, but you want to make sure that you are, you are feeding feeding and fueling your future brain. And that really means optimizing blood sugar. Your brain is running on glucose, but if it's constantly being bombarded by that, it's it's gonna, it's gonna get real messy and it's gonna be really hard to think. I do love setting your future self up for success. The night before my clothes are out, my water is ready. It's so easy to do this, you know, at night when we're handling other things already. You're cleaning the kitchen. Just put your water, just get your water ready, put it in the fridge. You're just gonna grab it. You know, have the coffee machine prepped and ready. You probably maybe already doing that already yourself. And then you're grabbing shoes and walking out the door. Or if if it needs to just be in your living room, you're doing it in the living room, or you're stepping out of the porch for a minute. speaker-0: The after dinner movement, that can really be as simple as doing some of the prep work to help yourself out the next day. So for example, for me, I don't go for a walk after dinner, but what I do do is I clean up the kitchen. I load up all of the things that I'm bringing to work the next day. So I usually have chopped up veggies that I put into a storage container that I'm able to bring into work. I then get the coffee pot set up. get the water and the creatine set out. So I'm up and moving around for about 15 to 20 minutes after dinner. And there's a lot of really good research that shows if we're intentional with our movement, right? If we're moving and we recognize the fact that we're engaging in movement, that it actually has the same benefits as going for a walk, right? It's that intentional movement, taking steps, moving your body. And you can use that to actually set yourself up. So that way the next morning you can do like you do, Dr. Mauricia. And just like roll out of bed, have everything waiting for you. And it's like you helped yourself twice. And one of the things that you talked about was this early morning sunlight and getting that directly into your eyeballs. If you get that morning sunlight, it does activate your superchiasmatic nucleus, which is always so hard to say. but that does help to regulate your circadian clock. And as you noted, Dr. Morizia, that you know, one of the big issues that women have during perimenopause is getting dysregulated sleep. And this really can make a difference. So I used to work out in the gym and now in the morning I go for a walk outside without sunglasses. and then I do weightlifting later on. But I I I do morning outside exercise and and I did it intentionally because I was trying to fix my sleep. And I mean, what a what an intervention that is. It's a game changer. speaker-1: Getting sunlight on your eyes and really throughout the day when the sun is still out. I think that, but the morning, if you can even five minutes, 10 minutes, and even better still, walking or doing some type of movement while getting sunlight. Who doesn't love to multitask? Like I was like knocking out multiple birds with one stone. And then also having a good routine. There's something I I teach my patients, I call the 2020 20 rule, which is landing the plane before bed. And it's 20 minutes, it could be 30 minutes too. You can do 30, 30, 30. 20 to 30 minutes to handle your business, close your loops, finish the things that you need to get done. Another 20 to 30 minutes to do hygiene, setting out your clothes, brushing your teeth, washing your face, maybe it's taking a shower, whatever it is in terms of hygiene, just kind of getting everything ready for the day. And then the last 20-30 minutes is your kind of your sacred sleep kind of reset rituals, whether that's meditating, your four, seven, eight breath, reading a good book. But I think when we give ourselves permission and we block off, like, I get this time to finish out those emails. I get this time to handle these things. Now I have this time to get myself ready. And then finally I have this time to take care of myself and kind of wind down the body, wind down the brain. It just it makes it makes sleep so much easier. But it's about intention. speaker-0: Yeah. And I think that having a a really nice intentional window ritual, I think can be so helpful. Like one of my favorite things about the brain is how how much context cueing goes on, meaning that if we set up a certain context, our brain like is like, that's what you know, we are doing dinner time now, or you know, which is why like when we see something that looks delicious, right, our mouth starts to salivate, our our digestive juices start churning because our body is like, This is the f tasty food context. And so I'm gonna prepare for that. And if we do the same thing before we get ready for bed every night, that tells our brain, all right, it's time to start shutting down shop, right? It's time to put all of the mice and wheels away and and be able to like actually down regulate and and be able to get some sleep. I love that advice. So, you know, for a woman who's listening and thinking, like, okay, I'm listening to all of this and I think I might be in paramenopause. Like I my sleep is kind of weird. I'm feeling emotional. I've got a little bit of brain fog. What do you think is like the first thing to do? Like where should she start in terms of her journey and understanding where she is? And then also helping to get her to feel better. speaker-1: This is a great question. The first step I would tell my patients, and we talked about it a little bit, is really tracking. And if you have a practitioner or a healthcare provider who doesn't do perimenopause or who doesn't do HRT, like I had a patient recently who whose doctor was like, Yeah, I don't do that. And it's like, what? Like you don't get to opt out of women's healthcare. This isn't a niche issue. This isn't a specialty. It's freaking percent of the population. I'm just speaker-0: So it's like it's like, could you imagine like I d I'm sorry, I don't do strep throat. So you're gonna have to go somewhere. You don't do tonsillitis. What? speaker-1: It's just mind blowing to me. And so it's yeah, get a second opinion, but also women, you do not deserve to suffer needlessly, even just a little bit, that you deserve a gold standard of care. And I really truly do believe that women deserve the best of things, not the least of things, especially after everything that you have given to everybody and that you are still giving today. So that would be my piece of advice is one, get some data on yourself. And two, make that appointment. And before you pay that copay, call the office and say, Does my provider take care of women in perimenopause? Do they do perimenopause care or menopause care? And if it's like a or I don't know or you know, then it schedule, find another provider. speaker-0: If there's a woman listening who knows in advance that she doesn't want to use hormone therapy, let's say that she has a history of breast cancer or she doesn't she just doesn't want to do hormone therapy, do you s you you still think that there's value in seeing a care provider, even though you're not going to be getting a medical treatment for it. Is that right? speaker-1: I think it's still worthwhile, at least for data. Data's purposes. Again, we talked about some of those silent shifts that are happening. This is a great time to look at a DEXA scan, not only for body composition, but also for bone density. This is a really great time to maybe ask for advanced testing when it comes to your cardiovascular health. Maybe we should also be looking at your fasting insulin. I think again, this type of information, if you're not feeling like yourself and we need a bit more validation or we want to stay on top of anything else that could be arising. The more data we have on ourselves, we can get in front of things that that hopefully never turn into an in an in-state disease. speaker-0: For somebody who's maybe waiting to see their doctor, so they're in that waiting period, or maybe they've met with their doctor and their doctor doesn't think that they need to be doing anything different. what are some things that you would recommend? Like what is like the like one or two like most high impact things that a woman can do to ease the transition as she's going into perimenopause to make to make her feel better, take the edge off the emotional. Liability, maybe improve her sleep, maybe improve the way that she's feeling physically, improving her energy levels. speaker-1: Absolutely. I am a big fan of wins. I want I want the kind of wind that helps you feel amazing in like five to seven days. I will say that that sleep is a force multiplier because man, it will make or break your next day. And I think we all have felt that, right? It makes everything feel harder. So sleep would be the first pillar that I would focus on. And I would take a look at what is that morning routine look like if we're getting enough sunlight. That alone will help you feel a bit better. but having that routine, taking a look and being consistent with a nighttime routine and then your wake-up time as well, having a kind of that that landing the plane routine, if we need to bring supplementation in, maybe a little bit of oral micronized progesterone, if you're open to that, like those are the things that I would be looking at. Number two is movement. And and that again, as easy as walking. I I think about How how mission critical walking is for not only your blood sugar and your energy, but also your nervous system. I think the majority of us, when we step into perimetopause, you know, our systems have been in overdrive or in some level of survival mode, whether, you know, it's just the way that we've been programmed or we we could kind of get away with it for many, many years, or the way that, you know, it's just how busy life is. And so b building in these little mini breaks, whether it's breath breaks or movement breaks or reading breaks. I think just punctuating your day with moments where your body and your brain feel safe can change the game, just allow you to exhale a little bit. And then the third thing that I would recommend is reaching out to your besties, connecting with best friends, creating more connection, meeting them in real time in real life, or sending voice memos to one another, especially when you're having a hard day. You know, I have so many besties that are in perimenopause. I can tell where everyone is in their cycle without them even telling me. I can tell with the edge in their voice. I can tell with ooh, their partners are getting on their nerves all of a sudden, like, ooh, this girls and late, late luteal. You know, and I think we are a safe place to land when it comes to our friends and connection. That it we feel seen and we feel like we're not alone in this, that we've got people that we are walking it together. And there's something, there's something really profound and potent about that. when, you know, perimenopause can feel so isolating. The symptoms can feel so lonely. And when we've got friends who understand us and who will always hold space for us and allow us to walk that journey with them, I mean, makes the biggest difference of all. And so those would be the three big needle movers that I would implement with my patients immediately to help them navigate it a little bit better. speaker-0: Love that. How do you feel about hormones and hormone therapy? Is that something that you've seen with your patients or with yourself? Is that something that you see having positive effects? speaker-1: Absolutely. Yeah. I've got my progesterone. I've got my testosterone. Estrogen, we're still a little bit wonky on because I find I get really estrogenic on estrogen. So I I pulled the yeah, I pulled it back a tiny bit. But I I mean I sl I slathered my testosterone on today, and that has really helped with feeling like myself and my brain firing and feeling more motivated and confident. And cause that too, gosh, that's another thing that women will tell me of like, man, I just I'm not as motivated as I used to be. I don't have the same confidence. The way that I that once like I used to just go into the gym and now, man, just driving there feels like the most monumental task of all. And so, you know, bringing hormones on really can be a light bulb moment. Now, they're not gonna lift the weights for you or take you on that walk, but they could give you the ump that you need to get back in the game, which I think is a game changing. So I believe that we deserve all the tools in the toolbox that Lot of the tools in that toolbox had been withheld from us, and that that is a bunch of BS, and that we deserve all of them, including HRT, and that we should be having that conversation and bringing on that intervention well before late perimenopause or menopause. It's really when you start to not feel like yourself. And for many of us, that is early peri. speaker-0: Yeah, and I I think that, you know, there was so much misinformation out there for so long about the potential breast cancer risk associated with HRT. And then they've finally set the record straight on that. And any of you who are kind of science nerds and you want to dig into it, you can look at the original research that was published that found an increased breast cancer risk among women. Who were using supposedly HRT. And what you learn is that the HRT that they were using was actually birth control pills. And so the women weren't being given estrogen and progesterone. They were being given ethanolestradiol and progestin. And it turns out that progesterin, the synthetic form of progesterone, which doesn't have many of the beautiful qualities that progesterone has, is seems to be the offending agent. And when they do studies looking at estrogen alone or estrogen plus progesterone. What they find is no increased risk and many times a decreased risk of breast cancer. And now they're finding that there's also a d decreased risk of things like liver cancer and a d decreased risk of esophageal cancer. And it seems like estrogen is actually protective in a lot of ways against cancer in midlife women. So a lot of benefits there and the risks that many people believe to be there just simply aren't there. They're there for progestin instead of. instead of actual hormone therapy. And so as we begin to close up, I want to know what is some falsehood about paramenopause that that you think w needs to be overturned. speaker-1: Falsehood that I would love to dispel today is that perimenopause is a moment of time and that it all just vanishes once you get into menopause. That all of it just goes away. And yes, there are definitely symptoms and shifts that happen in peri that tend to equalize in menopause. But as I mentioned earlier, there are a lot of silent shifts and changes that are happening underneath the surface that many of us aren't privy to until our 60s, like our bone changes. You know, our bone remodeling slows down significantly. I think we lose up to 20% of bone in late perimenopause and early menopause. Our vasculature is shifting as well. The way that our brain is producing energy shifts. And that can continue to affect us into menopause and post-menopause, depending on what else is going on in our lifestyle. Sleep architecture, you know, isn't gonna just go away magically when you get into menopause. And so I just I I feel like we talk about this zone of chaos that's parry, and then it just it's all eradicated once we get into menopause, and that's simply not true. And that this really is. When your body is talking to you in this way, when it's sending you signals, it's so important that we listen and that we are being proactive. This is that zone of of opportunity for us to make longstanding changes for our health and our health span. speaker-0: Right. Yeah. Cause we're not just moving from a state, right, into the zone of chaos and then going back to the same state. Right. We're going from the state to the zone of chaos and then to a new state. Right. And that means that it's going to be related to a whole bunch of like new experiences for us. And so I think that there's a lot of wisdom in that and understanding that you're you're moving, right? It's it's a shifting state. You're going to speaker-1: low hormone state for one. So I just wanted to acknowledge that. And I'm not saying that menopause isn't phenomenal and there aren't really incredible things that happen on the other side, but I also want to recognize the fact that, you know, about 66 to 70% of Alzheimer patients and dementia patients are women, that 80% of migraine patients are women, that more women than men have heart attacks. And strokes. And this is all often happening in postmenopause. And so that that we we tend to have a lesser quality of life than men. And so these are things that we can be get in front of in perimenopause when these symptoms are kind of for many of us at their height, that these are often signals that it's important for us to listen to. speaker-0: So for somebody who's listening and is thinking to themselves like they they just feel like they've lost themselves in this transition, right? They feel like they don't know who they are anymore. Their body isn't responding to things the way that they used to respond to them. what does she need to hear? Like, what do you want her to know? speaker-1: Perimenopause can be an awakening because your body becomes much less willing to tolerate the things that you have been getting away with, whether that's poor sleep or chronic stress or under-eating or overtraining, overgiving relationships that drain you, living without boundaries, really putting yourself last. The strategies that allowed you to hold everything together, it may simply stop working. And while that can feel at first like everything is falling apart, I feel like it also becomes an invitation to ask, you know, what actually deserves my energy right now in this season of my life? What do I want my next 20, 30, 40 years to feel like? And what am I willing to stop carrying that, you know, that I I've been carrying over these last couple of decades? And ultimately, what am I ready to prioritize? That's why I say perimenopause is a reckoning, but also an opportunity because everything is up for review. You know, the goal isn't to become the woman you were at 25 or 35. The goal is to build the strongest, healthiest, most alive version of the woman that you're becoming. And to me, that speaks to the revolution and the evolution of who we're becoming. That's growth. And this is why I wrote the Perimenopause Revolution, because I wanted women, we could imagine ourselves stepping into this chapter, this new chapter, this new evolution of us, feeling stronger, feeling resilient, but also. Prioritizing ourselves, especially if we haven't done it in the past. And so if you find yourself in this transition, not not understanding what's going on or second guessing, I want you to know that I've got a roadmap, but also this is time to take inventory. This is really that opportunity for you to take care of you, maybe for the first time. How do I want to prioritize my energy? What's a full body know? versus a full body yes. What feels contracting versus expansive and really attuning to that intelligence of my body and and honoring that process and honoring me. I think that's been the greatest gift of perimenopause. speaker-0: I love it. That's such a wonderful note to end on. Dr. Mauricia Snyder is author of the Parimenopause Revolution, which I highly recommend any of you check out, in addition to offering lots of great information about how to identify whether you're in perimenopause. It also offers a five-week reset, which allows you to really feel like you're taking control back of your body when it can feel like it's completely out of control. And you're also host of the Energized Podcast. And you have a number of other books. So definitely check out Dr. Maurizia's work and where can people find you, Dr. Maurizia? speaker-1: I love it. Yeah, the book is available and I've got epic bonuses. It's drmarisa.com forward slash book because as I mentioned, I want you to have the best of things, not the least of things. So I stacked the bonuses so that you have everything that you could possibly need. And then the second place I would say come and find me on the podcast, energize with Dr. Marisa, that it's focused for you, on you. It's about midlife changes and shifts and what we can do to build resilience as we move through this transition and beyond. speaker-0: Thank you so much. And thank you everybody for listening.