00:00 - Chase (Host) The following is an Operation Podcast production.

00:03 - Mariza (Guest) These hormones are master regulators of the body and probably one of the biggest hormones that's regulating the brain the CEO of the female brain is estradiol and that our brains have been reliant on estrogen, rhythmically binding to receptor sites and controlling inflammation, managing energy metabolism in the brain. And a big part of what PERI is is not only are these hormones declining, but they are declining erratically, without permission. We start to see some pretty big brain changes. When I knew unequivocally that I was in perimenopause because even again the subtle symptoms for me I was like oh, is this my thyroid? Am I working too hard? Am I burning the candle on both ends, like what's going on with me? Am I just not motivated yeah.

00:48 How I knew was for three months in a row, around seven days prior to my period. So halfway through that luteal phase, I would wake up with this deep sense of dread. Everything felt insurmountable. I didn't know how I was going to get through my days. I also would have these moments throughout my day where I would feel this just awful raging rage and I it just felt so uncontrollable. It felt so. I felt so untethered. Hey, this is Dr Marisa Snyder, author of the Perimenopause Revolution, and welcome to Ever Forward Radio.

01:30 - Chase (Host) Welcome to Ever Forward Radio. Well, I'm so glad to have you on the show because we're talking about something that has loosely been covered on Ever Forward Radio. But I have not ever sat down with someone to just like go all right, menopause, you know, take me to school. What is it all about? And it's something that as a guy, I physically, you know, personally can't relate to. But also, just in my marriage, my wife has not hit perimenopause yet, so I have no kind of, like, you know, secondhand relation to it. So I'm really excited to have you dive into perimenopause how and why it affects so many women, how and why we need to be having a bigger conversation about it. And just to prepare women, to prepare families, to prepare, you know, the whole lifestyle that needs to go along with these hormonal changes. You know, with anybody and we as we hit these kinds of hormonal changes male, female, 20s, 30s, 40s, you know it, hormones affect everything.

02:19 - Mariza (Guest) Everything. They are master regulators of the body.

02:22 - Chase (Host) And so, with that, what exactly is perimenopause? I know this is a big question, but more specifically, how and why is it different from traditional menopause?

02:32 - Mariza (Guest) Absolutely yeah. So let's define. I want to just I think a lot of us know what menopause is and let's just quickly define it. It's that one day where you haven't had a period for 12 consecutive months and then, from that point forward, you are in menopause. Now menopause the average age of menopause for every woman in the world, which is 50% of the population, right? So it's an inevitability for all of us, unless you go into premature or early menopause. So average age for natural menopause is 51 years old, but it can be anywhere between 45 and 55. But we don't just get there. You know, it's a process. So we think about puberty and how puberty was a good eight year process. Whether we knew it or not, we were.

03:19 - Chase (Host) Puberty is eight years Give or take yeah, wow yeah. Especially for women Like 12 to 20 or yeah.

03:25 - Mariza (Guest) Yes, 12 to 20 or 11 to 19. And that is the ascension, heading into a cyclical monthly cycle where your hormones are rhythmically cycling every single month, right, and that happens for like 35 years, give or take. Now, once we head out of childbearing into menopause, where there's no more periods, there's no more menstrual cycle but, more importantly, no more reproductive hormones. That's more important to note. It's not just oh, I don't have a period anymore, I'm in menopause. No, there's a lot of physiological changes that are happening, but there's a transition, known as your kind of your second puberty, which is perimenopause, so the four to 10 years, or more, depending on the person, getting to menopause. And that transition is where these hormones and your ovulatory cycle begins to go offline. But it's not gradual, it's not easy, it's not some steady decline for so many women. It is erratic, it is inconsistent and it is chaos, and that is perimenopause. And so I can break it into kind of what is going on there Chaos that is perimenopause.

04:33 - Chase (Host) I'm terrified already. We just got started.

04:35 - Mariza (Guest) I mean I'm in it.

04:36 - Chase (Host) And there are days where I'm like.

04:38 - Mariza (Guest) Whew, I'm shook.

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05:36 Hey, what's up, fam? You hear me talk about quite a few different things that really enhance my wellness and my daily habits, and if you've been listening to the show for a while now, then you know that I have been absolutely over the moon in love with fatty 15, this essential fatty acid called C15. I've been hooked now taking it daily for probably about two years now. This is the first emerging essential fatty acid to be discovered in more than 90 years. It is an incredible scientific breakthrough to support our long-term health and wellness and you guessed it healthy aging. Based on over 100 studies, we now know that C15 strengthens our cells and is a key healthy aging nutrient which helps to slow biological aging at the cellular level. In fact, when our cells don't have enough C15, they become fragile and are even shown to age faster. And when our cells age, our bodies age too. So let's squash it right here, right now. If you want to learn more about this essential fatty acid C15, and why I love fatty 15, I've been taking it daily for pushing two years now head to fatty15.com.

06:42 Slash ever forward. That's F-A-T-T-Y one fivecom. Slash ever forward. The special offer is going to get you 15% off, an additional 15% off their already reduced 90 day starter kit, linked for you as always in the show notes. But again, that's F-A-T-T-Y one fivecom. Slash ever forward and use code ever forward at checkout. So then, at what age? You kind of hit on this. But at what age do most women start experiencing symptoms, even if they don't realize it?

07:11 - Mariza (Guest) Absolutely so. Again, if we look at natural menopause between 45 and 55 and we reverse engineer that kind of, the earliest time we'll start to see symptoms shifting is mid to late thirties. Now again it can feel very subtle because, um, a lot of life is happening, you know. Often we're maybe raising children, we're in our careers, we have endless obligations and maybe we've already been struggling with things like low energy or a little bit of burnout, or our sleep has been a little bit off, um, but then it's kind of like those symptoms that maybe we've been dealing with, that are lifestyle driven, start to exacerbate. So in our mid to late thirties we may notice that our recovery from exercise isn't what it used to be. We're having to recover longer. Maybe we're having to really change our workouts because we're not feeling great the next couple of days afterwards. Or maybe we noticed that when we used to feel strong and steady and we were just at our edge, like we were just handling business, you know, kicking butt, taking names we're having to do that with more effort. Also, you may notice that you're having to, um, you're just getting more irritated. Your stress tolerance isn't what it used to be. Again, we can blame a lot of this on a lack of sleep, more stress, being a mom, maybe being a new mom, and yet also our hormones are changing, and so what I always tell women two things to be looking out for is one every cycle.

08:35 You know our cycle, our monthly cycle is a monthly report card, so is it shifting? All of a sudden, are your PMS symptoms instead of being two days now they're four to five days, you know? Are they feeling more intense? Have you noticed cycle changes? Or maybe has your cycle gone from 28 days to 27 or 26 days, and then also every month are the same type of symptoms continuing to show up? So I would say that's the subtle changes that start to happen in our late to like mid thirties to late thirties, and then, I would say, in our early to mid forties. You know you, you, you ask the universe, send me a sign, make it impossible for me to miss, like. I find that's when women really know they're in perimenopause, because it is impossible to miss. All of a sudden, it's almost undeniable that you aren't feeling like yourself anymore.

09:24 - Chase (Host) Huh, you were talking in kind of a way that made me believe that you are you. You have a clear understanding of your cycle days and symptoms. Excuse my ignorance here, but you know is is this common for most women? And the reason I asked do most women have this clarity in terms of cycle duration and symptoms with their regular period that they need to be? Maybe begin to cultivate that awareness, or even hyper awareness, so that they can become more aware of these subtle changes to learn more about? Hey, am I getting into perimenopause?

09:57 - Mariza (Guest) Yeah, absolutely. I would say. Even a decade ago, most of us did not know what was going on in our cycle. I would say there's a lot more awareness because of social media and conversations like this. We're like, oh, this, this monthly cycle, it's not just crappy periods, right.

10:13 - Chase (Host) And.

10:13 - Mariza (Guest) PMS symptoms.

10:14 - Chase (Host) It's not just, oh, about that time a month. I should be able to kind of know to the day.

10:17 - Mariza (Guest) Yeah, exactly, and also that the entire cycle things are shifting and changing, and so I think there you know if there's anything that we walk away from, especially in perimenopause, as our monthly cycle is going to change and shift, mainly because our you know, our ovaries are slowly, erratically going offline and our hormones are following in suit that the more information and data that you can have about your menstrual cycle, the more that you can understand what's going on with your body Now.

10:45 Is changes in your menstrual cycle the only changes that are happening in perimenopause? Absolutely not, and that was a major kind of myth that we didn't understand. I think it really was, because we used to believe, due to the lack of clinical research in women, that the only thing different between you and me, men and women was that I was just a smaller version of you, and the only exceptions were bikini medicine, so anything that was covered by my bikini, my breast or my uterus and ovaries, like that, would be the only way that I was different than you, and so we're beginning to realize that that is absolutely not true. Thank, God.

11:22 That physiologically there's a lot of shifts and changes that are happening and these rhythmically cycling hormones. So estrogen in both parts of the cycle the follicular phase and the luteal phase and progesterone only in the luteal phase. You know, the only way that we can make progesterone is that we have to ovulate. Ovulate is the main event. So when I ovulate every month, you know hopefully that's happening consistently I'm definitely skipping ovulatory cycles.

11:49 At this point, at almost 46 years old Well, I'll be 46 when this goes live but when I ovulate I then that temporary endocrine structure, the corpus luteum, releases progesterone into the luteal phase, that progestation hormone.

12:05 Because whether I am prepping to get pregnant every every month or not, my body is prepping to do so. And so the more that we can understand what's going on with our cycle, we can kind of start to pick up on the nuances of. You know, in the follicular phase of my cycle I always feel good, I feel energized, I feel strong, like I can do some big stuff, I can really show up in the world. In the luteal phase of my cycle I'm more inward. I, you know, I maybe I tailor my workouts on the days that I'm not feeling so great. And so for me when I knew unequivocally that I was in perimenopause, because even again, the subtle symptoms for me, I was like, oh, is this my thyroid? Am I working too hard? Am I burning the candle on both ends, like what's going on with me? Am I just not motivated yeah.

12:49 I don't know.

12:50 - Chase (Host) Am I feeling human?

12:51 - Mariza (Guest) Never had that issue, but no but a lack of motivation definitely plays a role. How I knew was for three months in a row, around seven days prior to my period, and not three, not four, but seven. So halfway through that luteal phase I would wake up with this deep sense of dread that all of a sudden dread.

13:12 - Chase (Host) It was awful.

13:13 - Mariza (Guest) Yeah, everything felt insurmountable. I didn't know how I was going to get through my days and I also would have these moments throughout my day where I would feel this just awful raging rage and I just felt so uncontrollable. I felt so, I felt so untethered and I was like what is going on with me? I just feel so uncontrollable and it would. It would pretty much lead into my period.

13:41 And the first three, first two months I had had a brain injury earlier that year. I thought, oh, maybe this is a one of those symptoms of major concussions, you know, rage and mood issues. Yeah, so I had, I had been diagnosed with post-concussion syndrome and I was like, oh, maybe that's what this is. But then it was consistent like clockwork on my 22nd day every single month for three months in a row. And I remember on that third month it was October and I was like this is, this is perimenopause, this is, this is what it feels like. This is what it feels like when your brain is massively shifting and reorganizing. This is what it feels like when progesterone levels aren't where they are normally at. This is what it feels like when estrogen begins to decline. And that's when I knew, like make it impossible for me to miss that this was perimenopause.

14:30 - Chase (Host) When you had that realization or when you go, okay, wow, I'm in perimenopause. Was there any sense of relief that came with it, because it kind of gives a reason as to these symptoms, or did you have to go through some kind of period of like acceptance of this next transition of your life that maybe added more worry or, to your point, dread, to the situation?

14:50 - Mariza (Guest) That's such a great question. So I think it was a yes, and one. I was so grateful to know that it wasn't something else, you know, because I had run labs multiple times that year trying to figure out what was going on. I even remember going back to my GP because we have phenomenal insurance and I had a list of labs and I was like I just I need to get these labs ran. I remember her saying to me she's like you know, you've been coming in a couple of times this year with these issues and she's like and you haven't figured it out yet. She's like I don't really have anything for you. And I was like I remember looking at her point blank and I was saying, listen, I know you have nothing for me. That's why I need these labs. I can interpret these labs. Let me just run the labs, let me see what's going on, and I can go from there.

15:33 And so I think so many women come in to this transition. You know, feeling blindsided, feeling like their brain is untethered, feeling like their energy levels are tanking or their motivation is going away, that whatever their slight edge was is just fluttering and they're trying to find answers. And that was me Like I was like what is going on? And I mean, if I did the math, I was I was basically turning 44. It was perimenopause, but I just I wasn't sure.

16:02 And so I will say that once I knew what it was, I was like, okay, I know what I'm dealing with now and I know that this is a transition that I'm in and there's a lot of things at my disposal that I can do. But also I knew that I was walking into a reckoning, you know, and I was like, okay, I need to really shore up my non-negotiables and I have a standard and values about how I want to show up in the world, not only for my son and my family, but for the women I get to serve. And when I am feeling blindsided and untethered and I can't seem to get ahold of my emotions, I was like, okay, I need to take a major step back and bring the tools in and recalibrate myself so I don't find myself like this every single month. You know, a good week out of my, out of my month.

16:49 - Chase (Host) Wow, what you just said right there. I hope any woman listening, watching, goes back and kind of like plays twice. I think that is such a profound and important part of any any experience we have in life, um, whether it's you know something that we know and we're aware of and we plan for. You know getting ready for this transition, um, whether it's in a relationship or a career, maybe you choose to just do something drastically different in your life but to go through this kind of biological transition, um, and to also have that same level of, I'll say, you know self-talk, you know being a hype woman, you know getting ready for this and just reminding, like I heard you say of, I have a standard of life. I have a standard of life that I'm going to do my damnedest to keep during this transition. But you know, basically we have to kind of also understand that you know biology is going to be doing its thing.

17:40 And as much as we may want to or not do something, we have to kind of just go with the flow. No pun intended here, but it's just you know. I think if a lot of women don't have any kind of semblance of the mindset component to the biological component, they're probably going to find themselves just hands up in the air, giving up maybe or just you know succumbing to a lot of these symptoms and not living the life that they want to.

18:06 - Mariza (Guest) No, absolutely. I am not disillusioned with what's happening with my body. You know, I know that there's some major physiological changes, including my brain is reorganizing, my bones are not rebuilding in the same capacity that they used to. My muscle is default. I'm losing it, you know, if I don't do something about it. I'm losing my strength If I don't do something about it. My, my cardiovascular health is shifting, my metabolic health is shifting.

18:31 And so if I'm on a default path and I'm not being proactive about what is happening with my body on a physiological level, in this, what I call this transition of vulnerability, but also transition of opportunity, right, I'm at a fork in a road.

18:47 I could go the default path and I could just be told oh, this is just aging, this is just what happens to me, this is just the course. Or I could decide no, I get to choose how I want to live this transition. But also I'm looking at the next 40 years of my life. I'm looking at how I want to show up with the freedom and the choices to have independence, to pick up my grandchildren off the floor to shop, put my luggage into the overhead compartment at five foot two, I, I, I throw it, you know, or to um, um, or to grab it out of the overhead compartment and and put it down in a very, you know, measured way, um, without help, you know. So I'm thinking about all of those things. So, not only how am I mitigating the symptoms, um, particularly the brain changes that I'm experiencing right now, but then how do I future proof my health for the next 40 plus years?

19:50 - Chase (Host) Okay, so you've mentioned the brain a few times. Yeah, I think you said reorganizing and you just now just said you know a lot of brain changes. It seems like that might be a bigger component to perimenopause than I think a lot of people realize. Can you walk us through what are some of these major or even subtle brain changes that are happening as someone enters perimenopause?

20:04 - Mariza (Guest) Yeah, absolutely so. I mentioned earlier that these hormones are master regulators of the body and probably one of the biggest hormones that's regulating the brain, the CEO of the female brain, is estradiol, is estrogen, and that our brains have been reliant on estrogen, rhythmically binding to receptor sites and controlling inflammation, managing energy metabolism in the brain. I mean, she is NASA for the brain, and so we get into Perry, and a big part of what Perry is is not only are these hormones declining, but they are declining erratically, without permission. The brain definitely did not want it. The brain's like whoa, whoa, whoa, whoa, like I need that consistent estrogen going on every single month.

20:52 And so as we start to uncouple the ovaries from the brain and hormones begin to erratically uncouple from the brain as well, we start to see some pretty big brain changes. We know that we see a reduction in white matter and gray matter in the brain that's connected to memory and cognition. We know that we can lose up to 25% of energy metabolism of the brain, and when you think about the brain, it's the most energy craving driven organ of the entire body. We also know that estrogen is directly connected to the binding of important neurotransmitters like serotonin and dopamine.

21:28 And so when I look at perimenopausal symptoms, particularly with my patients, and what they're coming into me with is a lot of brain-related symptoms, I would say the most common symptoms of perimenopause, especially in the beginning, are going to be brain-related. This isn't just hot flashes and night sweats and low libido and vaginal dryness and maybe some sleep issues, but just know that three of those symptoms are brain related. Right? This is a whole cacophony of brain related symptoms, from anxiety to depression, to ADHD, to low stress tolerance, to brain fog and memory lapses, lack of word recall, night sweats, hot flashes, sleep issues all of these things, all of that is brain related. And when we start to lose that resilience our capacity for our brain to function the number one, most common thing you'll hear from women in perimenopause is that I don't feel like myself anymore. I don't recognize myself anymore, I am not able to do the things that I used to do and I feel like the rug is like being pulled under me.

22:33 - Chase (Host) Hey friends, let me ask you something when was the last time you got your blood work done? And I don't mean just a quick glance at cholesterol or vitamin D, I'm talking the whole thing. I'm talking about the kind of comprehensive labs that actually help you understand your body Things like your hormones, your energy levels, your metabolism, your libido and so much more. See, most people are walking around guessing, and I don't want you to be one of those people. I don't want you guessing why you're tired, why you can't lose those last few pounds or why you just feel off. What if you could stop guessing and start testing?

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23:57 Start by knowing what's going on under the hood, linked for you as always in the show notes today under episode resources. But you can also just go to joyandblokescom. That's J-O-I joy, j-o-i-a-n-d-b-l-o-k-e-scom. Use code chase and take control of your wellness today. Target brain health to help get ahead of or even mitigate a lot of these brain health symptoms of perimenopause. Or is it all just need to be focused on the hormone estrogen?

24:32 - Mariza (Guest) I mean a part of it. I mean, if that's the, if that's the reason why we were struggling. I mean, I think having a conversation as early as possible about your options around HRT hormone replacement therapy I think is important. You know, full disclosure. I have an estrogen patch on. You know, I cycle progesterone and I also have testosterone and I'm on thyroid medication and so I'm taking all the hormones a little cocktail that's really optimized and tailored for me.

25:00 And even in perimenopause, that cocktail of hormones will change, because everything's going to keep changing, right, that's? The thing about peri is that it doesn't. It's not static, it's going to constantly change, but particularly for the brain. Again, if energy metabolism is a big part of how our brain is functioning or it is just defunctioning. So if we take a look at dementia and Alzheimer's, we know that 67% of people who suffer from that are going to be women. You know. So, yeah, so we know that the changes that happen in perimenopause it's because of that loss of estrogen and the increase in neuroinflammation, the decrease in energy metabolism of the brain, mitochondrial dysfunction we start to see. So this is that window of opportunity. So, besides hormones, have the conversation, please, the sooner the better, to just have the conversation. If your doctor doesn't prescribe, hasn't prescribed, doesn't know how to talk to you about them, it's time to just get another doctor. We've got a whole generation where doctors stop prescribing hormone replacement therapy, so there's a lot of doctors who just don't know how to do it anymore because they've never done it. So just a heads up there, also because, again, the energy metabolism piece is so critical here what we think about dementia as type three diabetes, managing and optimizing your blood glucose as best as you can, and so that is eating meals that are prioritized protein, prioritized fiber, walking away from refined carbs, walking away from lots of excess processed sugar, added sugar, just being really mindful that at this time where the brain is more vulnerable, balancing our blood sugar becomes key.

26:39 Another thing that I think really moves the needle is building your life around movement. So I love the big heavy lifting workout I do in the morning, and super early in the morning, before my son even wakes up, and if I sit on my butt for five to six hours a day, it's going to a lot of that's going to be negated, and some women just can't do it. You know their kid wakes up at five in the morning when they're supposed to go to the gym because they're sick. You know things come up. You know, sometimes my son is up at 615 when I'm about to walk out the door and I ain't walking out the door anymore. It all just changes. It depends on what's going on, and so my recommendation is building movement. So I was doing squats before I walked into this studio Of course, Of course I course.

27:23 I just sat in the car for three hours. I knocked out 60 squats before I walked in here. I love exercise snacks and it's just we're talking about one to three minutes of movement, that kind of revved your heart rate, whether it's jump squats or it's mountain climbers or it's push ups or it's walking up and down your stairs, something that just kind of gets you back in focus, like it fires your brain, fires your body, helps to balance your blood sugar, supports your metabolism. So just moving throughout the day. It doesn't have to be the one big 45 minute, 55 minute workout. If anything, it's really punctuating your day with as much movement as possible. That, I think, is really where the juice is worth the squeeze.

28:01 - Chase (Host) Okay, yeah, and do you think someone may be experiencing perimenopause symptoms such as brain fog and these kinds of brain health related symptoms, before they even get into anything else, before HRT? Just to kind of cap this, this point, just maybe adding if they're not, or adding more if they are exercise, just physical activity physical activity can do that and is there like a number of like all right, I'm getting 8,000 steps a day.

28:26 I need to add 25%. I need to double it. If I'm doing a 20 minute workout, I need to do a 45 minute workout. Is there any kind of like magical quantitative formula here?

28:36 - Mariza (Guest) Yeah, no, I would say. I mean, there's a lot of research that's coming out about movement and and brain health, absolutely, and we, we know that how to future proof your brain, the number one thing that we know, besides estrogen, um is is um is to move and so, um, you know, physical activity, or physical like considered physical activity, is 7,500 steps or more. I think very active is over 11,000 steps or more. So I would say, yeah, if you're at, if you're tracking your, you know, I think we have Apple watch and we got your double dip in with your whoop.

29:08 Yeah, we got um, you got your, yeah, um. So I would say track, get a Fitbit, get a Garmin, get a whoop I'm a big whoop fan Um, and track your steps, like and see if you can average. If you're averaging only five to 6,000, I would take it up to seven. Um, if you have a break after a zoom meeting, a work meeting, knock out 10 squats exercise snack.

29:29 - Chase (Host) Yeah, yeah, the exercise snack.

29:31 - Mariza (Guest) Yeah, and then move, at the very least move after meals. Okay, you know, if it ideally it's a 10 to 15 minute walk. But I don't live in the ideally either. You know, my son wants me to build Legos, that's what he wants me to do. He doesn't want to take a walk outside and, um, he's four and a half years old, it is what it is, and so I do.

29:49 I have I call it a buy-in um, either before a meal or after a meal. Yeah, I love buy-ins. I buy in buy-in before this interview, a buy-in before I go and do something else. So I I do a lot of buy-ins Um, and so I do a basically 60 jump squat buy-in um after a meal, before a meal or before when I walk into a meeting or something like that. So that's, that's how I operate. So, yeah, even if you can integrate four, three sets of 60 jump squats throughout your day, and if you can't do jump squats, just squats, I will tell you you will notice your brain is more sharper, you'll notice more physical energy, you will sleep better and have more like more sleep quality and, more importantly, you're going to balance your blood sugar and support your metabolism. So those have been some of the big wins around this research.

30:33 - Chase (Host) No, I'm not in perimenopause and I doubt I ever will be. But today, for example, I was not able to schedule in my workout, and so what I did instead was got up early, took the dog out to schedule in my workout, and so what I did instead was got up early, took the dog out, small walk and I hopped in the cold plunge. It's something like that. Can can that be a buy-in for a woman going through perimenopause? Something just like if they can't do a workout, they can still get a nice air quote here shock to the system to increase heart rate, increase alertness, um, add some kind of uh, uh, what's a hormetic stressor? Yeah, yeah, yeah, I think so. Yeah, yeah, I mean, I think we um some.

31:12 - Mariza (Guest) If you're overly stressed, you're overly burned out, you'd be mindful about extended cold plunging. But yeah, a little cold plunge if you've got it. I mean, I want to make things like, if you don't have a cold plunge, you know you don't have the resources. Cold shower for two minutes. Or again knock out a couple squats, you know. Or get outside in nature, get sunlight on your eyes for five minutes. Any of these things. Three shots of espresso?

31:30 - Chase (Host) No, I'm kidding, I was gonna say three shots. Where are we going with this?

31:35 - Mariza (Guest) I'm kidding.

31:36 - Chase (Host) Someone might also be hearing this and going okay, all right, um, to get ahead of perimenopause symptoms or to alleviate them, I'm just going to go all out. You know, maybe I'm a, I normally do yoga, but I'm going to go do a HIIT workout. Is there any benefit or is there more danger for a woman experiencing these symptoms, actually going through perimenopause, to just go full on in their workout? You know, to try to like I, if I'm feeling this way with my normal workout, if I increase my intensity like crazy or do the hardest workout I can, that's going to like kill the symptoms or is that going to be detrimental in some way?

32:10 - Mariza (Guest) I love that question because I know that's what I did.

32:13 - Chase (Host) You're trying to rage against the machine, right? You're like no, no, I'm not dead yet I'm fighting, grasping for straws, and so you try to just do all you can.

32:19 - Mariza (Guest) Yeah, I think we go back to the traditional approaches of what we've been told, or what our doctor even says, which is, you know, eat a little less calorie restrict and work a little bit harder, you know, and especially those HIIT workouts or those extended cardio workouts.

32:30 But we're finding that that isn't, if our muscle is our muscle, our longevity organ right, particularly for insulin resistance and overall, just feeling strong and able and, you know, having our brain fire on all cylinders. I want us to be mindful about how we are making sure that we're maintaining our bone or not bone, sorry, maintaining our muscle or building muscle, and I don't think extended HIIT training is going to get the job done there. So I think we got to be more strategic. So I did the yeah, I did the HIIT training and, um, and I completely burned out and obliterated. And so what? I would ask any woman if you get done with that workout and for the rest of the day you're like a puddle on the floor, like you have no capacity for anything else, We've got to rethink, probably too, much Too much.

33:17 Yeah, way too much. And so if you find your stress capacity is going beyond what you can manage because of that big workout or that, that especially high intensity interval training workout, then we've got to be a little bit more strategic. I'd say most of your workouts you're, you want to be looking at building muscle. That's your metabolic sink. That is going to be your longevity organ. So, and it doesn't have to be a 50 minute weight training or resistance training workout. It can be 30 minutes, like if you're, if you're good and strategic about how you you train, you don't have to spend a lot of time now. But if you couldn't do that, then maybe it's two minute bouts throughout the day of like mini HIIT workouts, you know, instead of like this 45 minute HIIT training workout. So I think sprint training and mini HIIT training workouts are very beneficial. Um, again, you know, get interspersed throughout your day so that you can get back to doing what you're doing. But those really elongated ones where you just feel like you're burned out on the other side, I think that's actually doing more harm than good, and every woman is going to be a little bit different. But again, during this time of perimenopause, when we see more increased inflammation. Our stress resilience just isn't what it used to be. You may find yourself having to tailor Um, so keep it, keep it tighter, keep it shorter, if you're like.

34:34 Okay, where do I even start? You know, you can always hire a personal trainer to help you walk through this, but there's so many great programs online that really walk us through. I have workout programs that I built into the book and I I'm I'm releasing, releasing. I have a whole exercise snack series that I'm releasing as well. To make it simple, right, um, but yeah, I mean, I would say where the juice is worth the squeak worth the squeeze is resistance training, at least two to four times a week, um, ideally sprint training, and we're going, we're talking one to two minutes and it can be in your room, it can be all out mountain climbers, it can be all out jump squats, you know, or you can go and run a track, whatever you want to do, and then walk, move your butt, be physically active, like, try to clock at least. I mean, I still think, ideally, 10,000 steps a day should be the goal.

35:18 - Chase (Host) Do you ever and this might be getting into a little nuance here, but do you worry about someone going through perimenopause hearing this specifically? The muscle building workout focus maybe hasn't always had that, and where I'm going with this is anytime we get into muscle building. You know hypertrophy, we're, you know we're. We're adding weight, we're adding muscle, our bodies are increasing our metabolic rate, our thermogenic rate, and we might already be experiencing some issues with weight gain, weight loss, muscle atrophy. So is that adding insult to injury here? You know, is it something else the body's going to have to work on? And then, mentally, we're going okay, well, I'm focusing on building muscle, but I need to maybe eat a little bit more calories, focus on increasing protein, and I'm having trouble just maintaining my composition as it is.

36:09 - Mariza (Guest) Yeah, absolutely yes. So that's that is definitely what's both happening where women composition changes are happening. But a lot of that composition change is happening, um, partly because we are losing that muscle, so some of that is happening. Uh, the other reason why we're losing that is, estrogen is declining and so as progesterone, and we start to take on a more androgenic kind of body type, which is more that belly fat and even that visceral fat. And so for some of us, moving throughout the day, strategically balancing blood sugar because of insulin resistance is one of the reasons why we see that body composition change due to the lack of estradiol. The more that we can be moving throughout the day and then again punctuating our week with building muscle, I still think that that is very much the direction we need to go.

37:03 - Chase (Host) So maybe don't get caught up in the in like, in that kind of the nuance of the weight I don't want to say issue, but just if we're focusing on building muscle, that overall is going to have better downstream effects for perimenopause as a whole than maybe focusing on just like okay, I'm building muscle, I need to eat a little bit more. I'm choosing to eat maybe a little bit more protein and not, you know, not getting too in our head about like the, the number on the scale issue right now.

37:28 - Mariza (Guest) Yeah, absolutely, and I think at the end of the day I mean, I know weight is a concern, Goodness knows and when your body is changing without permission, especially the weight part?

37:35 - Chase (Host) especially when it's not by your choice. You're like wait.

37:37 - Mariza (Guest) Women were never even acknowledged, for you know I think doctors were just like well, maybe you are not doing the thing you said you're doing, you know and so. But no, we know now that as estrogen declines, we become more insulin resistant, we lose that sensitivity. We know we are losing muscle. We know that we're losing bone. We know that. We know that body composition changes are happening. All of these things are happening.

38:05 Our metabolic health is shifting, and so I actually I'm coming from a metabolic perspective how do we preserve your metabolic health when so many of us become vulnerable after the age of 45 due to the decline of estradiol? How do I shore up your aliveness? How do I shore up your cardiovascular health, your brain health? It's at the epicenter of your metabolic health and your hormones. And so, yes, I want to be addressing the body composition changes, because nobody wants that. And when we start to see more visceral belly fat and belly fat, we know that that is a danger in its own right. But, more importantly, I'm looking at your health span and lifespan, 30, 40 years out. So, yes, let's address the body composition changes. But, more importantly, how are we protecting your cellular vitality?

38:52 - Chase (Host) Okay, Weight gain during perimenopause happens. Right, We'll say maybe probably 9 out of 10 women, or majority of women, are going to experience weight gain, and we just talked about maybe you're building muscle, so maybe that's you know. Women are going to experience weight gain, and we just talked about maybe you're building muscle, so maybe that's you know. I'll say a positive weight gain. We're building more muscle, which is always better than adding more fat. But when specifically looking at perimenopause, is total weight gain more of a concern or the placement of the weight, the placement of the body fat, you know? You said maybe more adipose tissue around the belly or what if we see it in our arms or our thighs is, is the location of the weight gain where we're seeing or feeling? Does it matter more in terms of health detriment compared to just the total number on the scale?

39:36 - Mariza (Guest) Yeah, I would say I mean, and I any woman. If I'm a woman talking to you right now who's 45 years old and who's seen body composition changes on me, who's seen, you know, weight gain happen, um, and I've had to make some pivots, I would tell you there is no place I want it to be that I don't that?

39:57 you know that, that it wasn't there before, um, but no, I would say the area that is most concerning, that lends to less protection, is going to be the belly fat. Okay, right, we know that that becomes, especially the visceral belly fat becomes its own kind of endocrine structure that is, you know, becoming very inflammatory. And we know that there's an independent risk factor for visceral belly fat for cardiovascular disease. And when cardiovascular disease is affecting one and two women, it very much needs to be on our radar. So I would personally I mean I'd love it more on my butt than I would- you know, on my belly.

40:35 - Chase (Host) But I think maybe a woman should be paying more attention to again. I'm just trying to think of, like. You're going through changes and you might be looking at a change on the scale. So what are some things that we can be looking for to maybe get away from, you know, worry about that number on the scale and and focus on things that matter, not necessarily worry.

40:54 - Mariza (Guest) Yeah, absolutely yeah. I mean, I think when we, when we're going through this transition and our body is changing without permission, it's going to lend to a little bit of worry. Um, I, where the focus really want I really want women to focus on is okay. How do I feel more energized? How do I feel more resilient? How do I, how do I ensure that I am shoring up my bones and my muscle and that in my overall metabolic health, how am I looking at my numbers? You know, I think those are the things that are going to matter most, um, in terms of the longterm.

41:25 Um, and I, you know I think those are the things that are going to matter most in terms of the long term. And you know the big pillars is OK. How am I eating for my metabolic health? How am I moving? I would say if there was a magic pill besides HRT, it's going to be movement. You know, a big part of this is this journey is going to be movement. And then you know how am I building a plan and how am I being open to pivoting as I see my body changing?

41:46 - Chase (Host) Okay, and what about chronic stress, poor sleep and modern living? What roles do these play in intensifying perimenopause symptoms?

41:55 - Mariza (Guest) They play a huge role, you know, and I think that's why it gets a little bit messy. You know, we have a lot of women who are moms in this transition or who have a lot of things going on. I always say that this transition is almost laughable. It's like how is it that we are managing a household, taking care of kids I mean, I was ordering shoes online yesterday for my son, you know, I think about all the, the many tasks that are running through my mind, just as a mom, you know, supporting our partners, the endless obligations I have. You know, I have aging parents that are, you know, are having struggles a mother-in-law who just had a major concussion, and so, you know, there's always things that are happening. My sister, who's already had a stroke and who has type two diabetes, you know. And so you know I was just talking to my mom about my sister's. You know, health situation that is always evolving and I'm very much involved in that. I never know when I'm going to get that call from. You know, a family member who's having some health issues that I need to step in and support, and so you think about all these things. It's like a high stakes game, you know. And then here we are.

43:00 Our bodies are changing, our mental health is potentially shifting and not necessarily in a good way. It's a lot to manage, it's a lot to take on, and so I think we used to just blame it on stress, we used to just blame it on the lifestyle and we used to just blame it on well, it's all in your head, right? That was kind of always the narrative up until maybe a decade ago, and when you kind of intercept all the lifestyle and all the stresses and the lack of sleep and and the thing about sleep is that it feels like it's like the chicken or the egg, like was my sleep disrupted because of my hormones? Are my hormones disrupted because of my sleep? Like, where does it start and when does it? When does it end? You know, it just becomes like this crazy spiral and I think it's like 67% of women, once they're in perimenopause or over the age of 40, are going to have sleep issues.

43:49 And we know that if someone doesn't get like gets, let's say they only average five hours of sleep, like four days in a row, they could actually be diagnosed with prediabetes, like that's how serious I think about you know, new parents, you know and how you know you think about a new mom in perimenopause. You know it's, it's, so we know that all of these other aspects of living this life, this very modern day life, is impacting the, the big changes that are happening in the body, and I think what the through line is is one knowing, recognizing, like, okay, my body is changing, um, and I know it's changing, I can feel it's changing and I also still have all of these obligations, people who rely on me, people who depend on me every day. And I also know that if I don't start to prioritize myself in a world that is telling me to prioritize everything and everyone else, like, it's not going to go well for me in terms of how I feel moving down the road.

44:46 - Chase (Host) But realistically, what does that look like? How can a mom, a working professional, you know, someone who's a caretaker, has all these other people places things, responsibilities on her plate? How does she really go realistically, practically go wait a minute. I need to focus on me right now, while not letting all these other obligations fall.

45:09 - Mariza (Guest) Absolutely. I mean, we just all become super women.

45:12 - Chase (Host) Okay.

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46:17 - Mariza (Guest) So I mean I think, first, that you have a partner, it's communicating with your partner. So I'm I'm always in constant communication with my partner. What I have capacity for that day, I mean, I don't think any relationship, especially when you're a family, that it's a 50, 50, you know, you hear Brene Brown talking about that of like checking in, like where are you at versus where am I at, and and then kind of reconfiguring. Um, yesterday I had a very debilitating migraine. Honestly, I don't know any other flavor of migraine.

46:46 - Chase (Host) Yeah, yeah, yeah, it's not like oh, a fun one.

46:49 - Mariza (Guest) No, yeah, and I really hope that I didn't have a migraine hangover today for this interview. But I let Alex know immediately. I wake up with them at six in the morning and they're not going anywhere and so I let him know, and so later in the evening, as all the medicine and everything we're wearing down, alex did the whole sleep routine with Kingston and so we it's just a lot of communication about. Okay, I just don't have the bandwidth to show up, you know, just having that conversation and then building in you know time for yourself. You know whether that is five minutes or two minutes or 20 minutes, whatever that looks like if it means getting up a little bit earlier before everyone else or really honoring your sleep routine. I always say that I sleep will make or break me, like if, depending on how I get, what sleep I get the night before, it'll really determine how I can perform the next day.

47:42 - Chase (Host) What's your sleep routine? How do you, how do you try your hardest to get the best, most consistent sleep possible?

47:48 - Mariza (Guest) Yeah, absolutely so. Um, after Kingston does his, we do his sleep routine and I'm just like I mean we think about these kids who have these, real. I mean his sleep routine is consistent like every single day.

47:59 - Chase (Host) I know, I know now yeah.

48:01 - Mariza (Guest) He has. We have black you know blackout curtains and all of the rooms. Everything's dimmed. Um but he's in bed. Lights are off, everything's done eight o'clock, um I I take my supplements at eight, 30, eight, 45. Um I'm taking magnesium. Um, I am taking some. I'm taking my Omega. Sometimes at night I am taking a type of sleep support supplement. It has L-theanine in it, 5-htp, it's got chamomile, it's got all kinds of goodies in it and you take the same kind of sleep supplement cocktail every night, every night, yeah, yeah.

48:35 Except for the second half of my cycle. I'm also taking progesterone in the second half of my cycle, between 1 and 200 milligrams depending on where I'm at in that luteal phase. So that kicks off my sleep. That's a signal to the brain.

48:48 - Chase (Host) And this is around 830?

48:49 - Mariza (Guest) 845, 830. Yeah, then I go to the room, I go to my room and I shut the door. Nobody, nobody's coming into this room.

48:58 - Chase (Host) That was a power move. Right there You're watching the video. I feel like shutting the door is like mama's in sleep mode.

49:03 - Mariza (Guest) Yeah, do not mess with me, I am now unless you have a million dollar meeting with me, like, do not talk to me about anything. Talk to me. Don't talk to me about my whatever's happening to Kingston the next day, or we have a headline that I need to approve. I don't care. No.

49:19 - Chase (Host) No, why is that? Is that just you're trying to like so definitively decompress and separate from the day? Or is it just like turning off the monkey mind, or are you going into like?

49:28 - Mariza (Guest) okay, yeah, all of it. So the phone is put away, phone's gone, all of it's gone. I don't want to be. I can easily just go into mom mode. I can go into CEO mode. I can go into, I can. There's so many things that need to be done all the time, right, chase? I mean, that's life, oh you're preaching to the choir.

49:43 - Chase (Host) I know, yeah, yeah.

49:44 - Mariza (Guest) And so, but it's a full body stop. It's a hard, no, it's a full stop. There's none of that. Is a million dollar meeting for me Not as critical as getting to sleep? So then I'm in bed, I brush my teeth, emotional support water by the bed, and even my bathroom door gets shut, like I am closed into the bedroom. Lights are super dim and they're red. I've got blue blockers on and I am reading. I am reading a romantic fantasy book, most likely some type of fiction book, and I am. Lights are off and I am going to bed nine 30. My sleep consistency is so core to everything about my day, like how I'm going to feel the next day, so lights are off at nine 30, the latest nine 45. I my, I don't even need an alarm. I am up at six o'clock in the morning.

50:36 - Chase (Host) Now, did this kind of sleep routine start during or because of perimenopause, or did you always have this and you felt like it helped your perimenopause experience?

50:44 - Mariza (Guest) No, it started because of perimenopause. Because of perimenopause and because of my post-concussion syndrome. So that's when I really began to realize, like, how mission critical my brain was. And, um, and I did. You know, you think you can get away with inconsistent sleep you think you can get. We can't, we really cannot Like if you and I did in my twenties, I got away with it. In my early thirties I got away with it. It's just like drinking alcohol, Like it is a full body. No, Like I always think about how am I supporting my future brain? And sleep is such a big pillar of that. What I eat and put into my body is a big pillar of that. Not drinking is a huge pillar of that. But I I know, when I wake up in the morning and I'm ready to go cause I'm going to the gym, that's what I'm doing that if I got great sleep, if I got consistent sleep, quality sleep, that I can crush my day.

51:37 - Chase (Host) Okay. Is there any worry or concern for a misdiagnosis of perimenopause, for maybe the woman hearing these symptoms or these lifestyle changes, maybe their doctors told hey, you're in perimenopause, like too soon, or it's actually something else. Is there any concern in terms of symptom masking or just blatant misdiagnosis of perimenopause? And, if so, are there any inherent dangers in that? If a physician or somebody tells a woman, hey, you're in perimenopause, and if so, are there any inherent dangers in that? If a physician or somebody tells a woman, hey, you're in perimenopause, and she goes about making these changes, is that detrimental to her health? Or is it just, you know, putting the cart before the horse, so to speak?

52:12 - Mariza (Guest) Yeah, and that's a great question, cause I think, yeah, there's a lot of conversation, a lot of social, I mean, perimenopause is having a massive moment right now, and and I think the reason why is women are like, well, I've been feeling like crap for a long time and now we have some, we have a way of defining what it is, um, but also I think that that's not always the reason why we don't feel great, right, it could be we're dealing with insulin resistance and we don't know it, you know.

52:35 Or maybe, um, polycystic ovarian syndrome and we don't know it. Even in these kind of key, I would say, yeah, mid, I would say mid to late thirties, early forties, um, or we could be dealing with a thyroid issue. I was diagnosed with Hashimoto's thyroiditis when I was 38, right before I was trying to get ready to get pregnant, and I took a whole year off and, um, it easily looked like perimenopause, um, and I had low progesterone levels. Easily could have been, you know it, it could have been perimenopause at that time as well, but it was very clearly a thyroid issue, right, and so it could have been perimenopause and yeah, so it absolutely could have been.

53:12 At the time I was looking more at the inflammatory markers, the blood blood sugar markers, the metabolic markers and then also my, my thyroid markers, and so we a lot of the things that I recommend in this book. I did at that time one because I knew I was prepping to get pregnant at 40. So I was doing a lot of these things as well. But, yeah, I think we really need to be looking at the whole picture. When I, when I look at a patient, I'm looking at her symptoms, I'm looking at her labs, I'm looking at her goals and I'm looking at her lifestyle, how her every day is looking and making a you know kind of reading the tea leaves from there and making a plan with her. So all of that needs to be considered. I think a lot of us come into Perry already dealing with other health issues.

53:57 I don't think very many of us come into Perry super healthy, like with a clean bill of health, not living in this modern day world, you know, with toxins and extra stress and sleep issues and blood sugar issues. I think many of us are coming into Perry and then perimenopause is like the fuel on the fire.

54:13 - Chase (Host) Is there ever a situation where it could be non-symptomatic perimenopause and thus therefore the woman goes undiagnosed? Not misdiagnosed but undiagnosed and therefore losing you know a treatable window.

54:26 - Mariza (Guest) Yeah, absolutely yeah, cause, whether you know it silently, your bone is beginning to, you know, not rebuild silently your muscle is full blown sarcopenia there, like yeah like, yeah, no, in perimenop we are losing up, but in the first two or three years of menopause we have lost up to 20% of our bone, our bone. That's happening in very. It's a silent shift. Our cardiometabolic health is changing. I look at women's labs at 42, and then I'm looking at them in a timeline into, like at 48, you know, everything was great and now her labs are out of range, you know. So they're silent shifts happening. Your strength is changing and shifting and declining. Your muscle mass is declining. We know this is happening. These are the silent shifts that are happening. So, yes, can women go through? I would say millions of women have gone through perimenopause and we have missed all of this.

55:22 - Chase (Host) Damn Yikes.

55:25 Well, I want to jump now into what you've talked about a little bit, and that's HRT, hormone replacement therapy.

55:32 I feel like, due to the world of well, social media, telemedicine, telehealth really taking off, in my opinion, a lot of good ways and definitely some ways still room for improvement.

55:43 Over the last several years, we've brought education and access to care, and cost just has just been cut tremendously. People who desperately need this kind of work can get access in the middle of nowhere, in a food desert, and also because of you know the scale of economics, so to speak. You know where there are a lot of, there's a lot of competition, so people don't need to just you know, save up thousands of dollars to go to a specialty in the big city. They can, for 99 bucks, get a telehealth console, get these labs drawn. Some companies will even send a phlebotomist to your house. So there's really no barrier to entry here, except for do you have internet access and do you have an extra a hundred bucks typically, but that doesn't always mean that a woman should get hormone replacement therapy. Hormones are super delicate, and so I feel like with access to care with lower costs, someone might just be jumping the gun.

56:42 So to speak and just going oh, I need HRT, this work for my friend, or because it's so easy, because it's so cheap, now, like it just has to work for me and so I can find someone to give it to me. Walk us through the key considerations and maybe your preferred labs or just kind of you know experience, when a woman should be getting this information and then considering with a provider is HRT right for me? And then what does the actual care period look like?

57:09 - Mariza (Guest) Yeah, absolutely Such a great question. I mean hormone replacement therapy. I feel like we're kind of coming into a new age and the pendulum is swinging. Still with that, there's still only around 6% of us on HRT in the US women and that number is changing.

57:25 - Chase (Host) That's pretty low. That's women overall or just women in perimenopause.

57:29 - Mariza (Guest) Well, mostly women in perimenopause and menopause on HRT.

57:31 - Chase (Host) Oh, so you're also going to be on HRT, yeah, yeah.

57:33 - Mariza (Guest) And still a very low number. Before the Women's Health Initiative in the 90s, when it was like the number one prescribed drug, it was about 40% of women again and only in menopause. Then very few women in Perry, because we didn't have it.

57:48 - Chase (Host) I want to hijack my own question, I'm sorry. Going from 40 to 6%? Yeah, that's a huge drop. Is that just because you know? You're talking earlier about so many providers? Just stop prescribing it Immediately, why? Why such a huge drop?

57:59 - Mariza (Guest) Yeah. So the Women's Health Initiative was a very defining study, one of the biggest studies of its kind, looking at women. We wanted to see the relationship between HRT and heart risk or heart benefit, you know, did it mitigate breast cancer or cancer? And we wanted to see what happened with women as they got older on hormone replacement therapy. And so these studies started in the nineties, mid nineties, and one of them was halted. They were all. They were both halted in 2002 and 2004. And there was a big outcry and it's all been walked back now, but that the arm where women were on basically synthetic estrogen. Mind you, these were all synthetic hormones. These were not bioidentical hormones and synthetic progestins.

58:49 - Chase (Host) Sorry, I'm familiar with that, but can you walk us through the difference between synthetic and bioidentical?

58:54 - Mariza (Guest) hormones? Yeah, absolutely so. Bioidentical. All of them are made in the lab. So just letting you know that. But bioidentical is identical to the molecular structure of the hormones that are made in the lab. So just letting you know that. But bioidentical is identical to the molecular structure of the hormones that are made in our body. The synthetic whether it's conjugated equine estrogen, which was Premarin, the big estrogen medication that was being recommended, and then Premarin, which was a combination of a progestin and the conjugated equine estrogen. These were synthetic. They are not of molecular structure identical to the ones that we make in our body.

59:31 So that's what was used in the Women's Health Initiative. So we learned a lot of lessons in that, but unfortunately there wasn't one extra case in 1,000. So instead of four in 1,000, there there was five in a thousand cases of breast cancer and because of that it looked like the you know absolute risk was something crazy, like 25% increase, when it was literally less than a percentage, and so it was newsworthy. It was all over the headlines and literally abruptly in 2002, like almost 80% of women who were on HRT were pulled from HRT, and then we've gone. Now it's 2025. I would say up until 2022, the majority of providers, medical providers um have not been prescribing it for a generation.

01:00:21 - Chase (Host) And so now here we are, I should say, retrained on it, or they're just so. Oh, we saw this study, we saw this data. We're just we're anti estrogen right now. Is there a definitive reason?

01:00:31 - Mariza (Guest) Yeah, so I mean, it's all I mean. The information and the education has swiftly shift and changed into what we know is that estrogen is a beautiful preventative hormone and that it is cardiovascular protective. It is bone protective. What we know is that estrogen is a beautiful preventative hormone and that it is cardiovascular protective. It is bone protective. It is general urinary system protective. It is muscle protective. Like we are, we are beginning to realize, like the more and more research is coming out, that it is brain protective, particularly when we are giving it to women in perimenopause and in menopause. It's when, as we get way out, if a woman's been, you know, 20 years out of menopause and in menopause, it's when, as we get way out, if a woman's been, you know, 20 years out of menopause and she's looking to start HRT for the first time, there there are definitely considerations. We want to do more screenings to make sure that she's a candidate or a great host for them.

01:01:14 - Chase (Host) Okay, yeah, okay. So then walk us back to. You know, I'm a woman hearing this and I want to, you know, you know, take action. Um, what is the best process for me for looking at HRT, for getting labs, and whether it's through telehealth or coming through you know, a clinic. You know, and then what, what's just like the safest, best way to go about consideration of HRT?

01:01:33 - Mariza (Guest) Absolutely. I again, you should know that, when it comes to Perry particularly, there's no lab test there's.

01:01:39 - Chase (Host) We don't have a lab test, you're not going to get results back and be like yep perimenopause you hit it?

01:01:45 - Mariza (Guest) Yeah, no, so it's symptoms, it's symptom driven. That's how we. That's the clinical presentation of PERI. One it's your age. Are your cycles at all changing? Anything going on with your menstrual cycle? And even you could be in PERI before your menstrual cycle begins to change.

01:01:59 And yeah, and so we used to think you know the CDC. If you look at the CDC right now, perimenopause starts at 47 years old. Because we just didn't know, we all just thought that it was just the last couple of years before menopause and we got it all wrong. You know, and so we know, that it's many years before that, well before your cycle begins to change or it begins to skip, that hormones had been changing and declining, and so the only way we can really diagnose peri is with symptoms. So if you go to your provider, I still want labs. As a provider, I still want to see. It's not just hormones. I mean I may catch you on a great day with your hormones. Your hormones look great that day. It doesn't mean that you are feeling great, but what are your inflammatory markers showing me? What are your metabolic markers showing me? All of those are shifting too, due to these very protective hormones shifting, and so I want to see everything.

01:02:54 - Chase (Host) Are there some markers more important than others we should be looking at for perimenopause, despite being symptomatic or not, at for perimenopause, despite being symptomatic or not, absolutely One.

01:03:03 - Mariza (Guest) I think. Always we look. We should always look at a hormone profile. We should be looking at estradiol and progesterone and testosterone. We should be looking. We should be looking at a full thyroid.

01:03:12 - Chase (Host) No matter what, no matter what, yeah we should be looking.

01:03:15 - Mariza (Guest) Yeah, we should know that information, but then we should also know what your fasting insulin is, what your highly sensitive CRP is, what your where your vitamin D levels are. A full iron panel make sure that you're not anemic, you know what kind of? Looking at B vitamins and magnesium. Looking at a full lipid panel including APOB and lipoprotein little A like if, if cardio, if more women die of heart disease than men. I want to be looking at those numbers, you know, and I want to see is are these things shifting? I want to be looking at homocysteine and sed rate. I want to get a great sense of what is going on with your overall cardiometabolic health. And perimenopause is the shifting point, is that moment of vulnerability when those labs begin to change. I want to see all. I want to see all of it. And so when you're working with a provider yes, a lot of the telemedicine companies you have some symptoms, you want some, you want some HRT and you're prescribed, yeah.

01:04:13 - Chase (Host) You just say a couple of few keywords, yeah, and you're in A little Google search of what to say in your telehealth call.

01:04:17 - Mariza (Guest) And you can. You can kind of quote get what you want, yes, yes, and, and and. It's not a one size fits all. This is not.

01:04:24 Again, as you mentioned, they're highly sensitive. They are master regulators, cell signalers, cell communicators. They are driving a lot of process in the yeah yeah, and so I think it's important. You know, it's an interesting come through because, in a lot of ways, so a lot of women are not on HRT, that need to be on HRT, I believe, but then also there's a lot of people that are abusing it, like putting women on high levels of testosterone. That is very inappropriate and so, yeah, I mean there's a lot of, there's a lot of nuance here, but I would say, ideally, you're working with a provider that is looking at everything, that's looking at your symptoms and your goals, and is working with you as you start the journey, you know, and to see how you're doing. Do we need to tweak it? Do we need to tailor it to work for your body? I cannot tell you how many times I've tweaked my hormone placement therapy protocol and I know it's going to keep happening. Mine's personally, yeah, yeah.

01:05:27 - Chase (Host) Is there? Is there a frequency preferred frequency of getting labs rechecked and therefore altering, changing the dosage? And also, is there a preferred starting dose for women going through perimenopause of estrogen?

01:05:43 - Mariza (Guest) Yeah, I mean, you know that again, it's all debatable. You know most doctors are going to put you on that low, that lowest dose, I would say. In terms of application, transdermal estrogen is always the way to go. You know a patch or a cream because it mitigates any, any potential risk. You know whether it's cardiovascular or you know cancer, so any, any of those know whether it's cardiovascular or you know cancer, so any, any of those considerations, um, it, it, it's a very safe application. Um, including vaginal estradiol like that is very little to not systemic. Um, and then progesterone.

01:06:14 Oh my gosh, I mean, what if most doctors are going to put you on progesterone first, because it's usually the hormone that's going to drop first that you're going to feel? You're going to really feel those PMS symptoms. You're going to really feel the stress, intolerance. So progesterone, and I would say the standard dosage is 100 milligrams of oral micronized progesterone, but for some women they may need even more than that, and so I think most doctors will start with 100 milligrams of oral micronized progesterone in the second half of your cycle. See how you do, particularly for sleep.

01:06:44 Usually take it about 45 minutes before going to bed. Give or take one hour to 45 minutes to really help support sleep. And then if you're finding that it's not you know you're not seeing symptoms being addressed or kind of mitigated then it's a worthy conversation to talk about. Well, can I see what 200 milligrams do? Um and same with estrogen. If you start on a low dose patch like a 0.05 um and it's you're not feeling the benefits, um, usually most doctors will tell you to give it a go for 90 days, um, and then you know we can talk about going up another, another dose.

01:07:18 - Chase (Host) Yeah, now, is this something? If a woman starts hrt, is she on it for the rest of her life, or just until she's no longer symptomatic or goes into menopause or on the other side of menopause? What's the timeline expectancy here?

01:07:29 - Mariza (Guest) I would say we ride them until the wheels fall off. Yeah, because once those hormones are not in our system, we lose that protection. So once you're not taking estradiol anymore, your bones are going to start breaking down again. I see, yeah, so, and so there was a. You know, we always talk about kind of that window of opportunity to get started, which is somewhere 10 years within menopause. Yeah, you know, and now we're realizing, oh, we could.

01:07:55 If the zone of vulnerability is actually a lot of peri, why wouldn't we start women even earlier? Why should women have to suffer needlessly in perimenopause until they hit that mark of menopause, even when those, even those last two to three years, women can be in an estrogen deficit, but they're not in menopause. So we just wait. Uh, yeah, so we're realizing, oh, why should have women have to wait for this perpetual date, a moment in time where we can start supporting them when estrogen has been low? You know, we, we know that the symptoms are so clear, the labs are so clear, right. And so we're beginning to realize, okay, at least in late Perry, we should be looking at this when the symptoms really dictate. But there was this. You know this from the women's health initiative we learned that there's this window, this 10 year window, the healthy cell hypothesis, where if you start HRT in that window, you get the most benefit without the, without any, without big risk.

01:08:48 But now we're beginning to realize that we can even go further out of that window, you know, especially because there's a lot of women, like my mom, who's 64 years old, who was in that generation where it was a no go, and now she's 65 or 64, about to be 65. And things are, that means she is metabolically healthy. That woman just ran a marathon a couple months ago. She ran a half marathon last weekend. Yeah, she's a competitive tennis player. This woman is kicking butt, taking names. She's gorgeous and I'm like, okay, you're 64. You know, I just don't. I want you to keep feeling alive, you know. And so it's a, it's a worthy conversation. But we're looking at her labs. We're like doing a carotid artery scan. We're seeing if she's a good candidate for her for HRT and I, you know, my recommendation is for my mom to get on it If, if, she is a candidate for it.

01:09:37 - Chase (Host) I could keep going with you, but I want to leave the audience hanging on a little bit more because now they got to stop the podcast and go get the book the perimenopause revolution. But I do want to ask one other question before my last question here. What can you know me, you know my wife's partner. Do you know in preparation, or what can I do when my partner's in perimenopause, what can someone not going through perimenopause do to actually support the woman going through perimenopause? What can someone not going through perimenopause do to actually support the woman going through perimenopause that you feel, uh, is going to actually make an impact?

01:10:10 - Mariza (Guest) Yeah, I think that's probably one of my favorite questions today. Um, I think the first step is is conversation, is communication. You know really doing a check-in with each other about where you're at and where she's at. You know, and, and, um, you know my doing a check in with each other about where you're at and where she's at. You know, and, and, um, you know my Alex knows my cycle we can tell, like even a couple of days leading into day 22,.

01:10:31 I, there's a little, there's a like a little shift.

01:10:34 I'm just a little bit more irritated, I'm a little bit more snap, I'm just, you know, there's an edge to me, but subtle, and it can even feel like, man, I had a really stressful day but no, everything's declining right, like it can feel this, this shift, although with HRT it's it's been a lot less intense, and so we are like, okay, how do, how do we, how does this next seven days look?

01:10:56 You know more, basically, more alone time, you know where can he pick up a little bit of support with Kingston, my son, and just giving me more space, got more space to kind of just tend to myself and implement some more self-care, and I think that's really what it is is if women on average take on the majority of the emotional load and the mental load, even the physical load that's going on, how can you take on more of that, especially during a time where things are transitioning and then a lot of extra grace and compassion?

01:11:29 I mean, I think we can never go wrong when we're leading with kindness and compassion. But when you've been with a partner for however long, and you've got kids, and life is stressful and life is lifing, it can be really hard to maintain that level of compassion. But I think if your through line is my wife, my partner is going through something that one um is happening without her permission, you know, and there's going to be days where it really blindsides her, like the the more compassion and understanding I can have in this journey, the more that I seek to understand and then, you know, pick up the slack when she's really struggling. I feel like that really strengthens a relationship in such a big way.

01:12:09 - Chase (Host) Oh, without a doubt. Without a doubt, um, and perfect segue into the last question I want to ask you. This information is meant to help me and my audience pull extracts, you know, apply things and unique areas of our wellbeing to move us forward in life and to keep living a life ever forward. I believe I asked you this back in the day. I got to go back in time, time time check, when I started asking this question regularly. But uh, I'll have to see what your answer was last time. If so, marisa Everford, those two words, what do they mean to you? How do you live a life ever forward?

01:12:38 - Mariza (Guest) I would say that I am always envisioning my future Epic health. I am very clear on who she is and what is she doing. What is she saying yes to, what does she say no to what her day-to-day looks like. And I because I've got that North star that I am so crystal clear on who I'm becoming and where I'm going and that I'm just basically taking those steps to get to her. I'm going and that I'm just basically taking those steps to get to her. So I am very future facing. I'm very future facing in terms of my vision self. And then I, you know, I, every day I wake up and I'm like, okay, how do I get? How am I stepping closer to her? And that's how I think about being ever forward is stepping closer to that future Epic person, that future Epic health.

01:13:19 - Chase (Host) I don't think anyone's ever used the word Epic to describe that question, and I love it. Yeah, why not? Why not live an Epic life?

01:13:26 - Mariza (Guest) Yeah, why not live a life with joy and doing the things that you love with the people that you love? Why not do it on your terms? I think that's ever forward.

01:13:34 - Chase (Host) Well, this was fantastic. It was so great to have you back on the show this time sitting down in person. Also, you know you've been a new homie for a while now in LA. It's so good to always see you out and about at all the things, and we always find ourselves overlapping it, you know, and you name a wellness event. I feel like Marisa's there, and so it's always good to see you. You know, outside of the studio as well, when can my audience go to connect with you now to learn more about the book? Of course we let's sit down in the show description. Show notes.

01:14:01 - Mariza (Guest) Yeah, I mean. The perimenopause revolution is a movement. It's a rally cry for so many women who are looking for a path through, so that everywhere books are sold. My podcast is energized with Dr Marisa and these are the conversations that we're having, these very nuanced conversations of how to navigate the second half of your life.

01:14:20 - Chase (Host) Did you by chance? Is there an audio book version?

01:14:26 - Mariza (Guest) Did you? Yes, I yep Yep Recording Amazing, okay, cool. So I'll always remind my audience. I love.

01:14:29 - Chase (Host) Audible. Thank you, yeah, if you want to get the audio book version read by Marisa, then check it out. We got a great deal for you. You can get a free trial. And I always tell there's a little life hack Just sign up with a different email address. You can get a free trial, which is a free credit. So, 30 days free, you get a free credit. You can get the book for free. Basically, go to audibletrialcom, slash ever forward, uh, register a different email, uh, and then boom, you get a free book.

01:14:51 - Mariza (Guest) Yeah, I love audible. Oh my God, I am obsessed. I probably consume five books a week because of audible.

01:14:57 - Chase (Host) I love. It's the end of the conversation. I can't talk anymore. It's the end of the conversation. I can't talk anymore. I do audible and I love to get the hard copy both. It just really helps solidify my comprehension. Also, I'm just like a hard copy old school book kind of guy, um, which you know I can't wait to get yours and put it up on the shelf yeah, especially books that have meal plans and workout plans. There's something to be said about having that, because you want to reference I just like having that open.

01:15:19 - Mariza (Guest) But, man, I'm as a as a mom with a very full schedule, full life, like listening, like I'm listening on the way to pick up, I'm listening on the way to drop off.

01:15:27 - Chase (Host) Can you get like one and a half exit, two exit. Oh, I'm a two X. I'm a two X girl. 1.4 to 1.6, depending on who's reading is my sweet spot. But yeah, again, audibletrial.com/everforward. Mariza, thank you so much, yeah thank you. Thank you for having me for more information on everything you just heard, make sure to check this episode's show notes or head to everforwardradio.com