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Child: Welcome to my Mommy’s podcast.
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Katie: Hello, and welcome to The Wellness Mama podcast. I’m Katie from wellnessmama.com. And this episode goes deep on the topic of perimenopause and specifically what’s happening with our hormones during perimenopause, lab testing that can be helpful, and most impactful things we can do to support our bodies for as gentle of a ride as possible through perimenopause and menopause.
And I’m here with Dr. Mariza Snyder, who is a functional doctor, a perimenopause and menopause expert, and the author of eight books, including her most recent, The Essential Oils Menopause Solution, which focuses on solutions for women in perimenopause and menopause. She’s also the author of the number one national bestselling book, The Essential Oils Hormone Solution, which goes deep on optimizing women’s hormones through essential oils. And this is what she has done for the past 15 years. She’s well known for her work in this. I was excited to learn from her in this episode today. So let’s join Dr. Snyder. Dr. Mariza, welcome. Thank you so much for being here.
Dr. Mariza: Oh, Katie, honey, it is such a pleasure to get to see you twice in almost a month.
Katie: I know, it’s so exciting. And I’m so glad to have you here and to get to record this conversation because I feel like, well, you have so much wide ranging expertise, but the part that we’re going to talk about today, I feel like is probably really relevant to a lot of our listeners, which is really delving into and understanding perimenopause and the journey into menopause from there, like what to keep an eye on, things we can do, action steps, and so much more. But to start broad, you have such an incredible story. I would love if you could share your perimenopause journey and how this led to your passion for helping women through this same phase of life.
Dr. Mariza: Yeah, absolutely. My perimenopausal journey really began postpartum. So I had my son when I was 41 years old. I’m 45. So he’s going to be four in a couple of months. And I will tell you postpartum, as you know, is its own journey, a major brain reorganization, like who you are on the other side of that journey, you are you are a different woman, like you are in your mom energy, protector energy, and hormones, as many experience if they have had that postpartum journey are at ground zero as well. So it can kind of feel like menopause in its own right. But obviously, it gets to be in its own category called postpartum.
And for the first year and a half, I was really focused on keeping my son alive, let’s be honest, I was breastfeeding and, and tending to him constantly. And I remember having this feeling towards the end, like closer to when he was two years old, that I was really getting my stride, my metabolic health was dialed, I had energy, he was sleeping, he’s really sleeping through the night at that point. So my sleep was, was more consistent at that point. And I just, I felt great.
And so I was about, I would say 43 years old, I remember stepping into 43, wanting to build more muscle, knowing that changes were about to occur. Also, because I decided to breastfeed, my progesterone levels basically never fully recovered, they never came back. And it was at 43 years, when I was really kind of pushing my metabolic health, building that muscle, that I started to experience some pretty big declines. Initially, I thought I was burning myself with working out because I’ve done that in the past. So that’s something I’ve done before. Or I initially thought it was thyroid issues, I have Hashimoto thyroiditis. And I thought that I may have reactivated my hashis, my antibodies were up. And I remember going down so many rabbit holes because I just didn’t feel like myself. I didn’t feel like myself in my body. I went from amazing, super mom, super energy. And within six months, I was like, a shell of my former self.
In the interim of all of that, I ended up getting two major concussions. So I had post-concussion syndrome. And so that kind of confused things for me for a minute. Because so many of my perimenopausal symptoms have been brain related. And so I was like, is it the concussions? Is it perimenopause?
But in the fall, when I was 43 years old, so that was the fall of last year, after going down so many rabbit holes, running labs every quarter trying to figure out what was going on, I began to really notice that a lot of my my symptoms were consistent every single month, in my luteal phase, that second phase of my cycle that were really inescapable. And I remember after three months of that, and I really couldn’t blame it on the head injury anymore. I was like, oh, my gosh, this is perimenopause. This is it.
And that this whole year really was kind of my, I want to dissension into perimenopause in a way, but the real kind of once I was clearly out of postpartum, I kind of just got drop kicked into the perimenopausal experience. And when you do the math in terms of my age, and the symptoms, I mean, in hindsight, it was very clear. But at the time, because I came into perimenopause, one in postpartum, but also I’ve had health conditions and health issues in the past, it was easy for me to want to go and explore those thinking that that’s what was going on, when all the while perimenopause was really kind of amplifying some of those previous issues that I’d had.
Katie: That makes sense. Yeah, you had a lot going on at once, especially, you’re right, like postpartum is its own whole universe. I think back to that, it was like a different lifetime. You feel so different. And you touched on this through your own story, but can you give us a primer in what is going on with our hormones when we start beginning perimenopause? Which ones are going up, which ones are going down, what tends to decline first, like maybe what to be aware of that you might even be entering perimenopause.
Dr. Mariza: Absolutely. I just want to take us back really quickly. I know people define this on your show, but we, you know, for 25 to 30 years, we are running a consistent and rhythmic menstrual cycle, right? And for the most part, and not to say that a lot of women aren’t struggling with polycystic ovarian syndrome, or that there could be root causes into why our menstrual cycle is irregular, but let’s just, you know, if we can paint the picture of what kind of a regular cycle is? Let’s say 28 days, quote unquote, right. We have about 14 days in the follicular phase where we’ve got an increase in FSH and luteinizing hormone, which are pituitary hormones that kind of drive estradiol to create that endometrium and prime the egg to be released in ovulation.
And then with ovulation, we have the corpus luteum, which is a temporary endocrine organ that then releases progesterone in the second phase of our cycle. And that’s when we see that little bump in our basal temperature. Estrogen also carries through and really the body every single month is priming. Are we pregnant? What’s going on? And about halfway through that luteal phase, which was when progesterone peaks, if we’re not pregnant, there isn’t an implantation, and then those hormones begin to drop. And then we start all over again, right?
And so a lot of this is, all of this is dependent on our egg supply. And that reserve happens when we are in our mama’s womb. So those are kind of it’s already predetermined how many eggs we’re going to have. And basically, the name of the game is like, well, how many eggs do you got, you know, get you all the way to menopause. And by the time we’re 35 to 40 years old, we have a very small percentage of those eggs left. And based on the fact that there’s fewer eggs, we start to see a kind of a shift in what we call the HPO axis, the hypothalamic pituitary ovarian axis. And that’s the communication from the brain to the ovaries that happen every single month that coordinate in this beautiful dance that runs our menstrual cycle.
But as we start to have less eggs and follicles are being less created to make those eggs or to house them, that kind of throws off that communication process. And we stop having as many ovulatory cycles, meaning we stop ovulating as often. And with that, if there’s no ovulation, girl, then there is no progesterone on the other side.
And so what we’ll first notice in perimenopause, maybe for some women, it could be mid to late 30s. For others, it’s early 40s, is we start to see that drop off in progesterone, that’ll be kind of one of those hormones that we can identify on a lab. What’s going on behind the scenes is that communication system that let’s call like the email system or plain telephone, that message is beginning to get garbled between the pituitary and the ovaries. And so that communication begins to kind of start to throw everything off.
And so as progesterone begins to decline, we’ll start to notice things like moodiness, lack of stress resilience, more PMS type symptoms leading up to our period. I will also women will notice less good, just less consistent, good sleep, being able to stay asleep throughout the night. But more so women will notice that they don’t feel like themselves or what used to feel super easy for them, is now requiring more mental bandwidth or more mental energy to kind of effort themselves through the day. And that’s a lot to do with that decline in progesterone. And that’s what I call kind of early, early perimenopause or really, really early, early perimenopause.
And why that often gets missed for so many of us is that we have been taught to brush off a lot of these symptoms, either as motherhood, or as just women doing life. Or maybe it’s just our menstrual cycle in general. And so we often write it off as just the kind of an elevated version of the daily pain points that we’re typically dealing with.
And so I find that early perimenopause can be hard to miss until symptoms begin to become more kind of more exaggerated and that’s typically I find women will notice around 40 between 42 and 43 is tends to be the benchmark of like, oh, it can’t be anything else at this point, it has to be perimenopause.
Katie: Oh, you brought up so many good points. Okay, so on the progesterone side, you said that’s something we can test for. Does low progesterone, especially at those ages, kind of signal that you are in the perimenopause phase? And if so, are there things we can do either naturally or if you recommend hormone replacement to keep our progesterone kind of in that optimal range?
Dr. Mariza: Yes. And I will say that the one thing about perimenopause that I can guarantee is that it can be and feel pretty unpredictable, even on labs. But I will say looking at hundreds upon hundreds of labs for women, especially, late 30s, early 40s, I will see dips in progesterone levels.
Now, can someone go and run their labs because it’s one moment in time? And maybe in terms of, you know, maybe your cycle is now 26 days versus 28 days, it will shorten in that early phase, you may not even kind of nail the window of when we typically want to test for progesterone, which usually seven days prior to our period. And so note that it can’t always be 100% consistent. And that’s why any doctor will tell you there’s no definitive test for perimenopause.
Really, what you’re looking at is I always tell people to gauge your menstrual cycle. So really track your menstrual cycle. If you if you haven’t before this point, I mean, now is the new later, right? Like today is a good day to start. And then track it around your symptoms. So I always say kind of look at your symptoms, versus looking at what’s going on with your cycle to kind of indicate and then age, age can really determine what’s going on as well. But again, there’s a bit of a gray window there, because you could have been in perimenopause for a couple of years and not really realized it until it becomes so obvious.
And so when it comes to noticing kind of those symptoms of low progesterone, again, the lack of stress resilience, maybe the anxiousness, definitely the higher levels of PMS symptoms, like you’re just like, whoa, it just is just more fierce than it used to be. Or the lack of sleep. The two things you could be looking at, one is if you’re really early in this very, very early perimenopause, something like chaseberry can help kind of boost it. But over time, I mean, progesterone’s declining. That is the name of the game. That is the name of the process.
And my recommendation would be to consider a bioidentical progesterone. Initially, maybe even just a cream, like, a 25 milligram or 50 milligram cream using it in the second half of your cycle. But if you find that that’s not really supporting you, then I would move into, you know, a bioidentical oral micronized progesterone starting at like 50 milligrams or 100 milligrams.
If you go with what you’re like an FDA approved Permetrium, it’s only going to be in 100 and 200 milligrams doses. You’re not going to be able to get something lower than that. And so if you do want something on the lower side, you would have to work with a compounding pharmacist and a doctor that’s willing to recommend a compounded bioidentical progesterone. And then you can kind of play with the dosing.
For me now, that I am still in early, and I want to stay there as long as I can, in early perimenopause. I typically, once I know that I’m in the luteal phase, I start with 100 milligrams. And then towards the second half of that luteal phase, so by day, usually day 19, day 20, because I’m running a 12 days part of that cycle, I will move anywhere between two to 300 milligrams of Permetrium in that second, because I really struggle with the mood aspect of perimenopause. And so that extra progesterone, especially in the last six to seven days of my cycle is a game changer for me. So I play with it depending on what’s going on with my symptoms.
Katie: And that’s a great tip to only do it in the luteal phase of your cycle. So it’s like mimicking what would be happening in the body naturally. And I feel like that’s a great springboard into another topic that seems very relevant in the perimenopause conversation, which is sleep. Like sleep changes seem like very common in perimenopause and menopause. It seems like some of this does go back to like the decline of progesterone. So I would guess getting that progesterone back on board might help alleviate some of the sleep changes. But are there other additional ways to support the sleep or caveats to know about that? And or is it better to take progesterone at night to support sleep or just simply having it on board helps sleep like in general?
Dr. Mariza: Let’s tackle what’s going on with our sleep. You’re absolutely right. It’s definitely connected to the lower levels of progesterone that we’ve been reliant on. And also melatonin levels are dropping precipitously as well. And I think that there is, you know, we’re still looking into the research. The one thing that’s a little bit heartbreaking, Katie, is that up until the 1990s, which wasn’t that long ago, girl, we really didn’t have research on a lot of this, especially in perimenopause. There’s still a lot of developing research happening in perimenopause, particularly even around sleep issues. But there is very much a correlation between lower levels of progesterone and lower levels of melatonin. And so there’s, and also let’s be honest, our circadian rhythm isn’t always very optimal living a life of a midlife woman.
So the first thing I would be looking at is one, is sleep is an issue. What is your sleep routine? How are you tending to yourself before going to bed? And the one thing that I have found to make the biggest difference besides progesterone, I think that that is the game changer, is going to be your bedtime, your sleep time and your wake time. And that being consistent every single day, including the weekends. And so the more consistent we can be with going to bed at the same time, ideally like 10pm would be great. Or maybe earlier if need be. And then waking up at the same time every single morning, I think is profound.
Getting enough sunlight. So getting enough blue light on your eyes throughout the day. And then really honoring your biological clock as the sun is going down to really dim the lights or create more amber lighting in the household. I think it’s going to really help protect basically our wake and sleep cycles and particularly our circadian rhythm. And also allow melatonin to do its job to really rise up when it’s supposed to.
The other thing I would recommend is having a beautiful routine that, again, for a lot of women, it could be night sweats and hot flashes. It could be blood sugar deregulation issues. So eating three hours before bed and kind of capping it there. Having an hour, you know, we’re not, we’re not 20-year-olds anymore. Maybe even early 30-year-olds where we could just like run into bed and just go to sleep. Like you kind of really got to ease your body into that. And so a good book, essential oils, just something that is just calming, maybe a meditation where you’re, you really signaling cue the body that it’s time for bed.
I have two anchors that I use for bedtime. One I take my supplements about an hour and a half before bed. So I take magnesium. I’ll even, I won’t take progesterone yet. I’ll usually wait about 45 minutes before bed because they are very sedative. So if you’re looking to read a book, you take them too early, you’re just going to knock out. And so I’ll take my supplements and I’ll use my essential oils. I’ll use like lavender and cedarwood. So these are these little anchors that tell my body and tell my brain who it is time to get to sleep. It’s time you’re we’re winding down that process and then really honoring the low lights in my room. Like I, we most, I mostly just use candles that I can turn on.
But for women that are really struggling, especially with wakeups later in the night, my recommendation is if supplementation isn’t working, like either herbs or magnesium glycinate or maybe even a tiny bit of melatonin, depending on if you can tolerate that or not, then I would strongly consider looking at oral micronized progesterone to help. And for some women, a dear friend of mine uses a delayed release progesterone so that it’s really keeping her asleep all the way through the night. So that’s a consideration as well.
Katie: Well, those are great tips. I know another thing that is seemingly always part of the conversation about perimenopause and menopause are the body composition changes, the potential for weight gain, for insulin changes, for visceral fat changes. What’s your advice for women as they, like sort of before, during, and after to help support the body in maintaining muscle mass and maintaining an ideal body composition and just in general through that?
Dr. Mariza: Yeah, I think this is a good, I think you just had Maria and Kristen on the show. And one of my favorite conversations with them is really about the goal isn’t to be thin. We don’t want to make ourselves small in this phase. We want to make ourselves strong and resilient, thinking about our health span. And so I really want to come in with a mindset of like, how do I support not only my longevity, but also your longevity? And that is building muscle, that’s maintaining that muscle and maintaining good, strong bones and great cardiovascular health and ultimately good, good cellular energy. As Dr. Casey Means talks about as good energy in general.
And so the first place I start is really looking at two places, looking at women’s blood glucose, making sure that things are stable there, looking at fasting insulin levels. Ideally, I would love it under a five or under so that we have good insulin sensitivity. And then like, what kind of changes can we make from there? So one of the real time data biometrics that I love to look at and measure is with a continuous glucose monitor. So I think it’s always it’s a worthwhile venture to put one on even for 14 days to just get a sense of how you respond to the amount of sleep that you’re getting, to your workout routines, to the types of foods that you’re consuming and seeing how your body responds to those. And so I love CGM data to kind of get a sense of what’s going on there.
But then that other piece about, again, building towards resilience and building strength, a big part of that is going to make sure that we’re getting adequate amounts of protein. And so I feel like that first meal of the day breakfast is one of the best ways to really kickstart that muscle protein synthesis. So my recommendation is kind of similar to a lot of other people’s that you’ve been hearing recently, which is at least 30 grams of protein in the morning up to up to 40, depending.
But kicking off that muscle protein synthesis first thing in the morning really sets us up for success. One, that we’re not hungry a couple hours later. So we’re not practically in our arm off or looking for something more refined carb, more sugary. But also that we are really protecting the muscle that we have. And even just eating protein on its own without kind of working those muscles can help to maintain some of the muscle mass that we have.
But also the name of the game is to really build that muscle, too. And so, the one of the best ways that we’re going to be able to do that is through lifting heavier things. So strength training. And it doesn’t have to be anything crazy. It could be, you know, 20 minutes, three times a week. As long as you’re really helping to kind of build those muscles and putting some strain on them to actually create resistance. As we lose estradiol, we lose that ability to really force those muscles to build, to kind of activate them. And so we kind of have to work a little bit harder as we head into later perimenopause.
The other thing that I absolutely love that I find is probably at least the biggest needle mover for me, and a lot of the women that I work with is moving your body consistently throughout the day. So I remember growing up, I would do my big workout at like six in the morning or seven in the morning. And then I would be sitting like I’m sitting right now with you for five, six hours. And we know now that that ain’t the move. Like, yes, get that workout in. Yes, please. But how do we make sure that we’re moving our body throughout the day?
Research is really clear that if the person that moves their body throughout the day is actually more is better off than that person who did that big workout and then pretty much sat for the rest of the day where you had a mostly sedentary day. And so I’m a big proponent of exercise snacks or walking after meals or just walking consistently throughout the day. And an exercise snack is really it could be jump squats. It could be mountain climbers. It’s just like maybe two minutes of movement every hour, every 90 minutes. Just to make sure that your body is consistently moving. And I find that when we’re able to move throughout the day, we have better metabolic biomarkers. We’ve got better glucose management, better insulin sensitivity. And we’re really able to leverage those muscles. Our cells are just meant to move. And that would be my greatest recommendation is just move your body as much as you can throughout the day.
Katie: Absolutely. I feel like that is such a recurring tip for every area of health, from longevity experts to hormone experts to even for our kids, they just need more activity than they’re currently getting in today’s world. And I love that the more we learn, it seems like science reinforces what kind of our intuitive wisdom has always known of like, we need to be outside. We need to move our bodies. We need to give our body actual nutrients. Like, I love that that’s what we’re getting reinforced from science right now too. Now we talked a lot about progesterone. When it comes to hormone therapy, are there other hormones that you find women often need to consider or that can decline and that can be helpful to also supplement in some way?
Dr. Mariza: Absolutely. All the hormones. All of them, girl. Yes. I believe that as I talked a little bit about earlier, you know, menstrual cycle being a fifth vital sign and how mission critical. I think many of us were brought up with the thought that our sex hormones were really just about reproduction and fertility and our cycle, but we know that they are whole body hormones.
Estrogen has a profound impact on our muscle glucose regulation, our mood, our brain function, our immune system, our cardiovascular health and protection. Progesterone, same thing like ligament health, brain health. I mean, our brain actually makes progesterone. And it’s a powerful anti-inflammatory for the brain as well. I would say that so many of the symptoms that women endure and struggle with in perimenopause are really due to the brain shifting and reorganizing because they’re losing these beautiful hormones. They’re not binding to those receptor sites inside of the brain.
Also glucose metabolism is shifting in the brain as well, but it’s a major reorganization due to the loss of these hormones. I don’t always like it’s, I don’t want women to think that this is a deficiency state per se, but it is, it’s a natural process. And perimenopause sets off an acceleration of events that aren’t necessarily going somewhere good if we don’t pivot. And part of that pivot, I believe is bringing in these protective hormones. And if women are a candidate for them, which many of us are, I think that they’re worth giving them a try.
So the three hormones I would consider definitely progesterone. And that’s the one that you’ll probably bring in first, because she’s the one who’s going to drop, initially. And most of us are going to notice because it has, it’s a lot, losing progesterone is very deeply connected to the brain. And so you’ll notice that your brain is shifting and it doesn’t always feel super great. I know it hasn’t felt great for me. And so I’ve been so grateful for having progesterone.
But then, you know, as we move into late perimenopause and we are really skipping those periods and estradiol is very erratic, ultimately estradiol is dropping as well. And estradiol in many ways is a build you up hormone. It’s a, it’s a profound protective hormone, especially again, metabolic cardiovascular, brain, bone, general urinary. And as you begin to notice those symptoms, it could be your mid-forties or mid- to late forties that you really start to notice some of these other changes that are very disruptive. That’s a time I think it would be worth looking into bringing on estradiol.
And then we have testosterone and testosterone, although again, not FDA approved for women, unfortunately, it is still readily available compounded for us. You’re going to have to find a practitioner who’s able to give it to you. And many are at this point but looking at that as well. So if you’re lacking in motivation, confidence, you’re looking like you’re losing muscle mass, low libido, it’s honestly the only thing that technically is a kind of approved for testosterone, but also brain too.
If you’re starting to notice those types of things, it is absolutely worth testing total and free testosterone along with sex hormone binding globulin and seeing where you’re at with that and bringing on that as well. And I think that for, you know, there’s a lot of camps in terms of which one to start with, how to start it sequencing. It’s very, a complex conversation and every single one of us is going to have a very unique perimenopausal journey. And so our hormone replacement regimen is going to be very unique as well.
And so it’s going to really be based on symptoms and also testing, not guessing. Again, it’s a fine balance of the two because in perimenopause, it’s unpredictable across the board. So multiple testing to look at things. If you go to an allopathic doctor, they’re only going to, they’re only going to base hormone replacement therapy on symptoms. It’s going to be symptom management. That’s how they look at it. That’s how all of our healthcare system looks at all of it. It’s like, okay, how are we mitigating these symptoms?
If you work with a functional doctor, they’re going to be looking at a combination between testing and symptoms to make sure that you’re at the level of which it’s actually protecting you versus just mitigating symptoms.
And so all three of those are up for grabs. Also, I would love for women to be looking at insulin, not necessarily that they need to be taking it unless they’re diabetic, but also thyroid hormone. If you look across thyroid symptoms versus perimenopausal symptoms, they look eerily similar. And it’s no surprise that women are really struggling with thyroid issues in perimenopause as well, because we tend to see an intake of inflammation in the body during the perimenopausal transition due to the fluctuating nature of these hormones.
And so it’s always worth looking at a full thyroid panel and figuring out if you do need a little bit of thyroid support, or if we need to dive deeper into what the root cause will be around the thyroid. So as a perimenopausal woman, I’m on thyroid medication. I’m on progesterone. I’m on estradiol. I don’t need testosterone yet, but I’m willing to use all the tools in the toolbox to ensure that I am thriving and functioning as best as possible. And then also I can show up for the people that matter most to me.
Katie: Well, that was such a great primer. And I know we’re going to get to record another episode to debunk some myths around perimenopause. But before we wrap up for today, I know you’ve also created a resource for people listening. And I’ll, of course, link to it in the show notes. But can you let us know what that is and where people can find it?
Dr. Mariza: I believe it is my perimenopause survival guide. And if it isn’t, it is now. So I have a very comprehensive perimenopause, thriving in perimenopause survival guide that goes over labs, that goes over your hormones, symptom tracker, the whole nine that really helps you to start navigating. I think the first step about perimenopause is knowing that you’re in it and then what you can do about it. So that is all in the guide.
Katie: Amazing. Well, like I said, that will be linked in the show notes for any of you guys listening on the go and stay tuned for another episode with Dr. Mariza. And we will go into the myths around perimenopause. But for this episode, thank you so much for being here. This has been such a fun conversation and I’m so grateful.
If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.
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