← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
571. When Perimenopause Kicks Your A$$ and What To Do About It
00:48:18
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- [00:00]
A
I am starting a revolution, a movement, a rally cry. We're done being dismissed. We want to be heard and we're done suffering needlessly. This isn't a time for surviving. This is a time for thriving.
- [00:12]
B
Welcome to the Thyroid Fixer podcast where we dive deep into the world of thyroid and hormones. Especially for you ladies navigating perimenopause and menopause. And really for anyone struggling with hypothyroidism. I'm your host, Dr. Amy, thyroid and hormone specialist and CEO of a global telemedicine practice where we prescribe the right thyroid treatment and bioidentical hormones to all 50 states and most of Canada, helping you become that badass human that you're meant to be. So if you're battling weight gain and hair loss, you can't lose weight no matter what you do. Your energy levels are plummeting and your libido left town. Then you're in the right place and you have found your tribe. Remember, I want you to embrace every inch of that badass woman that you truly are. So if you're ready to dive in and fix things things. Let's get started. Let's talk about something that's been part of my daily health routine for a while now. And honestly, I'm not letting it go anytime soon. 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They have a 60 day money back guarantee so you have nothing to lose by trying it. You have questions about your thyroid, about your labs, what they mean. What about your hormones? What about insulin? Why are you gaining weight? Why are you so tired? Why are you losing your hair? Why won't my doctor listen to me? Why won't my doctor test these things, all of these questions that you have running around in your brain and you know that if you just had the answers that that could push you over the edge into optimal health, that you could be that badass human that you are meant to be. Well, I got you covered there because I am going live every single week in the just fix your thyroid Facebook group. That is my Facebook group. A beautiful community just filled with amazing people. Where I am in there, my nurse practitioners are in there, my health coaches are in there. There are patients in there that have been with me for so long, they're experts in their own right and they answered just the way that I would. So we have you completely covered in this group. So not only can you post your question every single day, every single hour, if you want, you can mark your calendars for our weekly live Q and A sessions where you get to ask your question to me and I'm going to answer it live on air. And not only that, we are doing product giveaways, we're doing working with our team giveaways. You're going to want to be in there and actually be live on that call. If you're at work, go into the closet, just shut the door, Take minutes for yourself, take a half an hour for yourself, take an hour for yourself so that you can get the information that you need to bring yourself into optimization land, where you're not looking sideways at a brownie and gaining weight at the same time, where you can feel amazing every single day. Because that's my goal for you. You know that I love, love, love to answer your questions, and this is the place where you can get them answered live. There's so much attention on menopause today that perimenopause kind of gets put on the back burner. We forget about the women that are transitioning and starting to lose their hormones and starting to experience symptoms. So My guest today, Dr. Marisa Snyder, is a powerhouse advocate for midlife Women. She has 17 years as a practitioner, author, speaker to spark this massive movement for women in perimenopause and beyond. Her upcoming book, the Perimenopause Revolution, is going to be a revolution. It's the ultimate resource for women ready to take charge of their health and embrace that perimenopause state. With confidence, you can get through perimenopause, ladies, you can so enjoy today's episode as we really unpack what's going on in a woman's body. What are some of the symptoms that you might be ignoring but are really signs of perimenopause and what you can do about it. Marisa, thank you so much for jumping on as we were talking off air. I truly believe that this discussion today is so needed for women everywhere because there are so many women in perimenopause right now, and they feel a little bit left behind with the menopause movement. Now, let's face it, we both love the fact that women's health is getting a spotlight in menopause from, you know, Oprah, Halle Berry, being misdiagnosed with herpes, the whole deal. But what about the peri ladies? What about when your body kind of starts to fall apart and you don't know what's happening and your hormones are shifting? The perimenopausal ladies don't have the answers just yet. And they basically have to wait until all their hormones are in the toilet to get that menopausal book or to get focused on by the FDA or their doctor. So this is a much needed conversation for my perimenopausal ladies out there. Thank you so much for jumping on.
- [07:14]
A
Yes. I mean, this is literally why I wrote my book, the Perimenopause Revolution. It was the book that I needed when I was first going into perimenopause, and I am so Grateful that menopause is having a moment and that perimenopause is beginning to have its moment. Because I feel between the two, the one that we have been medically managing for decades, well, we had a bit of a halt there with the Women's Health Initiative and kind of really big setbacks in terms of offering all the tools in the toolbox. You know, the reason why I'm saying this is I just put my estradiol patch on a couple of minutes ago. Yes. Like, thank God, you know, and there are a lot of doctors out there that are still not even prescribing HRT for women in Perry, but a little bit of backwards. It's in the perimenopause transition, what I call the zone of chaos, or the. I call it the reckoning, let's be honest, because it is that transition where the hormones are erratically shifting and it's where women really do have the bulk of the symptoms. And so although we always, you know, we always kind of focused on menopause, we had solutions and medications for menopause. Really a lot of the chaos and the symptoms and the women not feeling like themselves anymore was well before menopause. And this has been documented for many decades. And so even though we weren't talking about Perry, I think the reason we missed the boat and why it hadn't had a moment or wasn't having a moment until now is that I think doctors simply didn't understand. We have been so far behind in terms of women's health and clinical research around women's health that we missed the boat. Society at large, and even the healthcare system at large has been so, so good at dismissing women. When you think about perimenopausal symptoms, it's not like one day it shows up and it's like, hello, I'm here. Or you can test it. Like you can test a, you know, TSH or a T3 and free T4, but there's no definitive test. And so a lot of these symptoms are clinically driven by subjective experiences. And you know what we do to women when they have subjective symptoms?
- [09:14]
B
Uh huh. Yeah.
- [09:15]
A
We don't listen.
- [09:17]
B
Yeah, Antidepressants, Right, Antidepressants.
- [09:20]
A
Exactly, antidepressants. And you know, we've seen it in increased rise in antidepressants ever since the Women's Health Initiative when we, when hormones got pulled and we went from 40 plus percent of women on HRT in the 90s into the early 2000s and we pulled basically the big scare about it causing breast Cancer and potentially stroke and heart disease. We're whittled down to about 4 to 6% of women in the US right now on HRT. And not to say that is the only solution in the toolbox here, but it's a driver of the conversation of what doctors have. And as a result, you know, if the most common symptoms of perimenopause into early menopause are brain related and mood related, and the research is super clear on this, what are we going to give a woman when she comes in and she's got rage and she's got mood swings and irritability and anxiety and her ADHD is popping and depression is kicking? You know, we're going to give her an SSRI or we're going to give her an anti anxiety medication. That's what we're going to do. And I think it's like one in four women are on antidepressants and antianxiety medications, particularly in this demographic.
- [10:26]
B
Well, and I would love to know of that one in four, how many actually need it. Now, I never dismiss the people out there that truly have a brain chemistry imbalance where they need that antidepressant, but I would say the majority don't. The majority of the time it is a band aid for something deeper, but not even that deep. Something as simple as perimenopause, which is what the body just, it's what it's. What happens is. It's just what happens. And I feel like unless we can just to your point, unless we can silo people like, okay, this woman is in menopause, she has zero hormones. So now maybe we'll pay attention to her and recognize some of these symptoms that they were talking about at the recent FDA meeting to un. Black box warning. The vaginal Right. Oh my gosh.
- [11:18]
A
I think general urinary symptoms of menopause, GSM. 95% of women will have some level of vaginal atrophy, painful intercourse, UTIs, you know, incontinence, you know, bladder incontinence. Whether it's urge incontinence or, you know, it's. We know that a majority of us are going to be dealing with some type of symptoms. It's mind blowing to me that we have a black box warning for local localized vaginal estrogen. Here we are in 2025 and there are women who are in the hospital because of UTIs, in care facilities because of UTIs, who have their relations, are struggling because they don't feel comfortable being intimate due to the pain and discomfort. The Quality of life. You know, why aren't we caring about this? You know, we know that although women live longer than men, I was actually pulling these stats up yesterday. Men, the average life expectancy for men is between, like, 76 and 78. It's climbing a tiny. I think it jumped a year in the last year. Now that kind of COVID has just calmed down a little bit. It was down to 76. Things like 77. And women, it's 81. And we know that we live about four to five years longer. But women spend 20% more of their lives in debilitating health. Debilitating health with things like uti, with horrible hot flashes, with things like diabetes and prediabetes, cognitive dysfunction, dementia, Alzheimer's, broken hips and bones. And when we think about, you know, what is approved for HRT is going to be hot flashes, vasomotor symptoms, night sweatshirt, osteoporosis, osteopenia, and gsm. General urinary symptoms of menopause. And yet, you know, we start to see these developments happen. Not in menopause, but in peri. By the time a woman is in early menopause, she will have lost up to 20% of her bone density. Women in late perimenopause are having hot flashes and night sweats. Actually, I know a lot of my patients who start having hot flashes and night sweats. Night sweats in particular, like their sleep is disrupted because they're waking up, kicking off, you know, the thermometer foot is coming out. You know, they're kicking off the sheets and everything. This is early Perry. This is early 40s to mid-40s. And then, you know, women, low libido, UTIs. I was just working with a patient who was, at 44 years old, already struggling with recurrent UTIs, where she's finally getting estradiol. Another patient of mine, who is in her early 50s, who, again, low libido, but also vaginal dryness, and she's noticing tearing in the vaginal walls. And so again, these women are going to their primary doctor, getting denied, and I'm like, what is going on? Because they don't fit the age criteria or their hormones aren't completely tanked out. It's outrageous. I get so angry.
- [14:03]
B
Oh, I completely agree with you. Now, you had mentioned just a few symptoms that perimenopausal women may be experiencing. I want you to go a little bit deeper because I'm sure you hear this in your practice, too. I hear this all the time. Well, I think I'm in perimenopause I might be in perimenopause. And I guess, I mean, to that woman's point, there isn't necessarily a definitive cutoff. It's not that every single woman at after the age of 40 is going to go into perimenopause. You could start earlier, you could start later. And those symptoms don't just hit all at once. It's not like it's a punch in the face. It's this gradual kind of trickle effect of symptom after symptom after symptom, until one day you go, oh my God, why is my body rebelling against me? What is this? I guess it might be perimenopause. And then that's when they start speaking up. So what are the symptoms that women can start looking for and paying attention to their bodies to maybe be aware that, yeah, this is happening?
- [15:03]
A
I love this question so much, Amy, because that is the number one question I get from my patients in my community is, am I in perimenopause? What is going on with me? And so I want to just walk it back to late reproductive age. So late reproductive age is after the age of 35, right? We think about those late reproductive, you know, kind of late to your pregnancies. And we know that our ovulatory cycle is shifting a little bit silently, hence why, you know, women are. There's more attention to those pregnancies after the age of 35. And we do know that progesterone for some of us is going to start to decline. And so what you may notice in late reproduction age, and I would say this is late 30s, 38, 39, where you're like, huh? It's so subtle because it really does feel like the daily pain points of everyday life, but just an exacerbation. So you may notice that you're not recovering from your workouts the way that you used to. You're kind of a puddle on the floor maybe for the rest of the day after you do that hiit workout, you just don't have it in the tank anymore to push like you did in your early 30s or your 20s. You also may notice more irritability, PMS symptoms. You know, that used to be maybe two or three days is now four or five days. It seems to be stretching a little bit. Noticing a big thing that women tell me too is that multitasking, the things that they could handle all throughout their day, they're having to effort more. So this is what I would say, late reproductive kind of knocking on Perimenopausal doors. And this is where we should be paying attention. This is exactly when your doctor is going to dismiss you because it just sounds like you're distressed or you're just working too hard or you're just a mom or you're just la la la. And yes, it could be those things too, but it's a yes. And because you notice something is shifting, you know your body, right? And that's when you should really trust you and just double down on like, listen, I know something is shifting and hormones are shifting at this point. Testosterone has been, you know, she's been on the dive a little, you know, it's literally dropping down. Not that you would need testosterone therapy at this point, but just note that hormones are shifting at this point. Now early Perry, I always say it's almost semi a sign make it impossible for me to miss. So it's usually when women are coming to me, stuff has been going on again, it's just kind of been ignored. They've been trying to do some things. Not everything's working. Sometimes it is, sometimes it's not. At usually 40 to 43 is when women are coming to me. This is when cyclically they're really struggling with a brain related symptoms, lack of word recall, brain fog, potentially sleep issues, just wired and tired before going to bed, more irritability. All of a sudden their partner and family, they don't have space for it. Especially in that late luteal phase, you know, that sec the week leading up to your period. So you'll notice that symptoms are cyclical. Like it's more intense in that luteal phase, but it's been, it's way more intense than it maybe had ever been before. Let's say you've always had PMS symptoms. It sounds like someone just ratcheted it up a little bit for you. You're like, why I could, I used able to tolerate this. I used to be able to feel stable, feel, feel I had my edge and now things are a little bit more wobbly. I don't feel as consistent, as resilient as I used to be. And then also what women will notice is potentially body composition changes at this point. All of a sudden they're putting on some belly fat, they're noticing more aches and pains. Like again, a number of symptoms are beginning to add up. But I would say that the majority, the most, most common symptoms here are going to be brain related sleep, mood, brain fog, cognitive symptoms. And again, when I'm working with high level achieving Women who are running their household, running their careers, running their everything, and they feel a massive slip up in terms of their ability to highly function. They start to wonder what is going on with me. I do not feel like myself anymore. And this is what. This is me. I'm this girl. Here we are, you know, at 43 years old, all of a sudden, three months in a row, I had this insane same bout of rage. And, you know, thank goodness I track my cycle. Thank goodness I track my symptoms along my cycle. And I was like, oh, bingo. Three months in a row. I can't ride this off as anything else. This is perimenopause. And the reason for this is not only is progesterone declined even more at this point, but estradiol is now becoming more erratic. She's not declining yet, but she's erratic. So she's. Sometimes you're more estrogen, estrogenic, like estrogen dominant, and sometimes you're not. So it just really depends. But send me a sign making it possible for me to miss.
- [19:22]
B
I.
- [19:23]
A
We're still cycling here. We're not skipping periods at this point, but we may notice, you know, shorter periods or spotting or heavier or then lighter. So you will notice some cycle changes, but again, easy to miss. If life is happening really quickly and you've got a lot on your plate, then late perimenopause, this is like the eye of the storm. Like now we've got the hot flashes and the night sweats and the mood swings and maybe some GSM symptoms, you know, now you're noticing a little, maybe you're peeing when you sneeze and you're noticing, you know, all of a sudden intercourse is not. You're not as lubricated as you used to be. Like, there's a lot of these physical and mental emotional symptoms that are happening. This is also now where you're skipping periods. So late perimenopause is defined as you're skipping a period more than 60 days. So she really isn't showing up. And at this point, you're about three, maybe four years away from menopause. So one to three years, give or take, you're basically kind of heading towards menopause's door. And this is when estrogen is definitely on the decline. Still irregular, still erratic, but more on the decline. That's why we start to see these vasomotor symptoms. And this is when we should be running labs. I mean, the whole time we needed to be running labs, but now we need to be looking at lipid markers. We need to be looking at blood glucose markers, inflammation markers, because often in perimenopause is when we start to see these markers, thyroid markers, we start to see them move in an unfavorable direction.
- [20:49]
B
Yeah, yep, absolutely. And kind of going back to that estrogen roller coaster that women are on. It's funny because I always reference that when I talk about thyropause, which my definition of thyropause is when a woman's thyroid gland shits to bed after the age of 40 due to those fluctuating hormones. So it really is in perimenopause, kind of transitioning in the menopause, where we see Hashimoto's present itself. I'm sure you see that all the time with your patients as well. It's almost like it goes hand in hand. So then the symptoms overlap. People don't know what to exactly focus on. And it really is about focusing on both things. Yeah, focus on it. But also, let's look at the hormones.
- [21:31]
A
And here's the thing also, you know, these hormones, estrogen and progesterone are very protective. It's like they're your protective shield. They've been your protective shield. The reason why we are protected cardiovascularly, we are protected in terms of neurologically up until menopause, it's because these hormones in relation to men, once we get to menopause, we like, blow past men. Like, we catch up to men in terms of cardiovascular and dementia risk, and then we just keep going past them. So more women than men die of heart attack and stroke. More women than men are going to have, obviously Hajimoto's and autoimmune conditions. 80% more women than men. 67% of women will have dementia and Alzheimer's, more than, you know, more than men. And so, yeah, we're migraines. 80% of migraine sufferers are women. And it's often in the perimenopause transition that we start to see these changes. What a lot of women don't realize. I think we've been brought up to believe that these reproductive hormones are just reproductive hormones. It's bikini medicine. Boobs and uterus and vagina and ovaries. And that's it. That's the only difference between us and men. So not true. These hormones are whole body hormones. They're impacting the thyroid. They're impacting your brain and their immune system modulators. And so I call perimenopause. It's a neuroendocrine transition. So your brain and hormones are massively reorganizing and changing. And it is a default inflammatory state, especially if you are on the default path that because these hormones are erratically binding to receptor sites inconsistently, like some days, yes, some days, no. It's driving inflammation, it's driving like inflammasome complexes in the brain. And so I just want that to be really clear that if, let's say your thyroid was just maybe becoming hypothyroid, but still it being managed like you're managing it, it's under the hood, you don't realize it's a silent shift. And then perimenopause comes up and your immune system is more activated and more inflammation is happening. All of a sudden, you know, the thing that you were able to keep under control or maybe you didn't know it was brewing behind the scenes, all of a sudden presents itself. And so as a woman who has Hashimoto's thyroiditis and who has, you know, low thyroid function, it's been a really interesting journey for me too. And I've got migraines, I've seen my antibodies go up in peri, I have seen my migraines increase significantly during perimenopause. And really what this tells me is that I am experiencing more oxidative stress and inflammation as a result of these erratically declining hormones. And so for me it is really dialing an anti inflammatory protocol and really managing the root cause of hajis supporting my gut, reducing as much inflammation as possible. It's using HRT and obviously thyroid hormone to mitigate what I'm losing, to kind of manage this inflammatory change and shift. And so I just wanted to just bring that up that if you're wondering, gosh, why all of a sudden am I hurting and I'm in pain and these, there's symptoms that are coming up that don't even make sense. It's most likely inflammation that's coming up for review.
- [24:38]
B
So when we are looking at tests. Yeah, can we. So just if someone has a marker for positive information, inflammation, let's say we test their hscrp, that's not necessarily tied back to perimenopause. And at the same time we won't necessarily, necessarily see that marker increase, but there could still be inflammation going on. I know in menopause we'll look at FSH and when fsh goes above a 25, then we can say, okay, number one, you're going to start gaining weight, you're inflamed, you are going to start having the symptoms of menopause and you are basically in menopause at that point. According to functional medicine, of course.
- [25:18]
A
Yes.
- [25:18]
B
Now what would we look for in perimenopause? I know I threw a bunch of different things out at you right there, but.
- [25:24]
A
No, no, I love that. And it's interesting. I ran all of my labs with function health just last week and My highly sensitive CRP is below a 0.5. I had migraines for almost an entire week last week. Actually, I had a migraine the day I ran those labs.
- [25:40]
B
You were inflamed, but just not enough to be picked up on a mark.
- [25:44]
A
My lipoprotein Little A was 41. I mean, everything. It looked amazing on paper. And so, yeah, it can be really hard. And that's why again, symptoms are so important here. But I'll go over lab. So I want all the labs, I want a comprehensive panel. I want to look at the whole woman. I want to know her symptoms, I want to know her lifestyle, what's happening on the day to day, how is life happening to her, how she's living life. You know, is she a mom? Does she have kids under five? Like, what's the deal? And I also want to know what her goals are, are. And so when I'm running a full panel, obviously I'm looking at all the hormones, including thyroid and including antibodies. Like I want the entire panel. No, just a TSH and free T4 here. I want everything. I want to be able to see reverse T3. I want to. Is that a player here in the conversation of your thyroid health? I want to be looking at highly sensitive crp. I want a full lipid panel. So I want lipoprotein little A. I want apo B, I want triglycerides, I want hdl, ldl, total cholesterol. I want to see. I just want to get a good, good sense of your cardiovascular health because inflammation can be anywhere. I want to be looking at homocysteine and fibrinogen and sed rate. These are inflammatory markers for your cardiovascular health. Again, more women die of. More women die of heart disease than all cancers combined. You know, and so I want to make sure. And it's just one of those things where we constantly miss the boat in symptoms for women, looking at labs for women when it comes to their cardio metabolic health. I also want to see their fasting blood glucose, their fasting insulin, their hemo, your hemoglobin A1C. I want to look at the full metabolic panel. Is she anemic? I want to know So I want to run a full panel for ferritin and iron to see, especially at the end of perimenopause, where we have a lot of heavy bleeding and flooding. Is her low energy levels declining estrogen and testosterone, or is it anemia? Is it blood loss or a deficiency of some kind? I want to look at minerals. I might also want to be looking at all the testosterone, estradiol, progesterone and melatonin. Ideally, I want to take a look at that. And if I can't get a diurnal cortisol, I'll take an AM serum cortisol with a blood draw, I'll take a look at that as well. I think vitamin D, uric acid. So looking at some other inflammatory markers, I mean, this just gives me the breadth of what is going on. So let's say for that particular day, I caught her on a great day because the reference ranges for hormones is pretty wide. It's insane. It's like, oh, she's within the normal range. I'm like, yeah, but she doesn't feel normal. So, like, what does that even mean? And so I want to look at everything. So, yes, she's got a normal estrogen on day 21 of her cycle, yet her highly sensitive CRP is out of range. She is insulin resistant, she is almost pre diabetic and she's got a really low T4, high TSH. Right. And so there's a lot of things to be looking at. And her sleep is crap, right? She can't get to sleep at night. And so although her progesterone levels were still within normal range at that point, still I'm making recommendations to bring on hormones, to bring on thyroid. I mean, like, you know, we're looking at all of these things together as a comprehensive approach to addressing her symptoms and ultimately preventing chronic disease. What's so important I talk about this in the book all the time is let's connect the dots between your symptoms now and your future health outcomes. And if we're not looking at all of this in making decisions, we're going to miss the boat in terms of getting to the root cause of what is going on with you when it's not usually just perimenopause, it's a multitude of things.
- [29:10]
B
It just crosses over.
- [29:12]
A
It just brings it all up for review.
- [29:14]
B
So this is something crazy that I learned about electrolytes that I did not know before. Low sodium diets, you know, when you cut back on your salt, can actually contribute to insulin resistance. So, number one, we don't want that. We know that is going to definitely increase our weight. Low potassium status suppresses your growth hormone, your anti aging hormone, and that even just having low thyroid function disrupts your electrolyte excretion. So I mean, if your magnesium is low, we know that that's going to interfere with thyroid T4 to T3 conversion. Now you have this whole electrolyte excretion issues that you're pushing out more electrolytes, but you need to keep them in for that conversion. I'm telling you, the data is crazy on the importance of electrolytes. So I use the OG electrolyte powders, element number one because they taste absolutely freaking amazing. I want to use probably too many packets in a day, quite honestly, because I keep putting them in my water because they taste that good. But of course I also know that I'm getting my balance of electrolytes and in the summer I need more. Even in the winter when I'm skiing and snowboarding, I'm sweating that all out. You need more. So if you want to try some of these amazing, just amazing electrolytes and actually feel the difference, I mean you will feel the difference. You'll feel more energized, you won't cramp up and you will get better sleep with this as well. I'm telling you. Definitely better sleep. Go to drink lmnt.com so spell out drink D R I N K L M-N-T.com Thyroid and this is going to save you some money. You can get the sample box. You can try all the different flavors. My absolute favorite. Just side note, grapefruit and orange drink elementi.com thyroid well, and the hormones are so protective like we, we just talked about. Okay, we see Hashimoto's present itself in perimenopause. Yes, that can be from the roller coaster of hormones, but also just testosterone alone, which can drop in a woman's 30s, much less 40s for sure. That almost has an armor protection to it when we're talking about autoimmunity. That's why guys get hit so much less with autoimmunity as compared to women. So that testosterone drop, it's like it drops our protective layer to autoimmune conditions and we just see more and more come up. And not just Hashimoto's. We'll see arthritis, we'll see celiac present itself.
- [31:59]
A
At that point I'll see endometriosis. If that hasn't already been playing out, even type 2 diabetes to me, I even think, honestly, again it's women's health. We don't have the clinical research to back it up. But I am convinced that migraines are a type of autoimmune condition.
- [32:14]
B
That's interesting. That's really. Because there's so many women that 80%.
- [32:19]
A
Did you notice how 80% of all autoimmune patients are women? 80% of all migraine patients are women. I really do believe it's an autoimmune driven chronic disease, chronic condition. And we know that most often women don't just have one auto autoimmunity. An autoimmune condition, right? It's hajis, it's ra. It's also endo. And then women have migraines. I mean, it's like this. The immune system, it's not selective, right?
- [32:45]
B
No, it's not.
- [32:46]
A
It's a machine gun. Okay? It's a shotgun. It's a shot. It is not a sniper.
- [32:51]
B
No, it's not one target. It's your entire body. Because those soldiers, those antibodies, which I always use the analogy of soldiers, those antibodies, they're looking for something to attack. So once they've completely destroyed your thyroid and it's this itty bitty nubbin, then they're gonna go somewhere else and find other things to attack.
- [33:10]
A
So I just wanted to throw that out there that, you know, as a woman who is in the beautiful reckoning right now, perimenopause journey with migraines, chronic migraine pain with hadjis, which again, antibodies are, you know, in the 150s right now. I'm not mad, you know, and so my. I've seen him in the seven hundreds before. And so overall doing fine, but still riddled with migraines and, you know, different types. I can feel, I mean, I know that the erratic shift in these hormones aren't doing me, you know, any favors. And so for me, a woman in perimenopause, I am playing with estrogen dosage, I'm playing with progesterone dosage. I'm playing. You know, there's a lot of things that I'm trying to do to mitigate this oxidative stress in my brain. And I always say that we're not broken in this transition. You know, this is. It's just a profound shift. And it requires a new level of care and a new level of support and directional intention. It's one thing to have intention. I think we have to be very intentional about this transition because what we do in this transition is going to set the tone for the next 40 years. But also it needs to be directional. You can have intention but not have a direction of where you're going. Be mindful about where you want to go. And that is such a big part of the book is talking about your future healthy self. Who is she? Who is that 65 year old woman, you know, what is she doing? Because I have seen a varying degree, like multiple women at 65 years old, 64 years old. I have seen women who are 65 who can barely get off the floor and have a hard time getting out of a car. I have seen women in 65 climb mountains. And so you do get to decide. And a lot of us, when we think about our 65 year old selves and women are listening to this, are probably in their 40s and their 50s, maybe not in their 60s yet, but maybe there's some women listening to this that are in their 60s too. What we do in this time of transition, where blood pressure is creeping, bone loss is happening, metabolic labs are shifting, you know, how are we being proactive about safeguarding our cardio metabolic health for becoming strong and resilient and having power and agency over our bodies? I always say this is the time where you still have freedom to choose agency for your body. You have the freedom where you're not heading back and forth to the doctor's office, to the hospital, right? That's when you've lost your time and your money towards the health care system. Right to sick care system. Right now we still get to choose where we want to put our time and our money and our efforts. And even on my hardest days, on my migraine days, on my days where I'm struggling, it is just such a beautiful reminder that I get to double down on the habits that are going to help me feel resilient. Not just tomorrow and next month and next year, but 30 to 40 years down the road.
- [35:56]
B
Okay, so on the topic of habits, I know we need to start changing our habits in perimenopause and menopause because what we once got away with, we're not going to get away with that anymore. And weight is so big. I mean, it's one of those things that as women maybe we shouldn't focus on it as much as we do. But the reality is when we carry excess body fat, that is not healthy. So even if we're in a body positive movement, that's fine, that's great. I want women to feel good in their skin and have confidence. But if you carry a large amount of excess body fat, that increases Your risk of heart disease, that increases, your risk of cancer, type 2 diabetes, Alzheimer's and the like. So what is happening when we see that weight gain starting to come on in perimenopause and then much more so in menopause with the complete loss of estrogen?
- [36:50]
A
Yeah, I mean, estrogen is again, that protector hormone that keeps us insulin sensitive. I always say weight gain is a byproduct of insulin resistance. And so the first thing is we really got to understand is, are you metabolically healthy? Every woman needs to know this at any age, are you metabolically healthy? Because only 7% of us are metabolically healthy. And the way that you know this is when we're looking at adiposity, so particularly belly fat adiposity. So your waistline, is it under 35 inches? And I would say that being 5 foot 2, I'm petite, we're both petite. That if I had a waist of 35 inches, that would be very problematic for me. I have a waist of 20, 25 inches and I would, I always tell women that it needs to be half that, your height, not 35 inches, you know, depending. Unless you're like, you know, 6 foot something. But how we define metabolically healthy is that it's got to be if it's 35 inches or more, that is an indicator of adiposity. Right. That you've got visceral belly fat that is driving metabolic issues. Next, a fasting glucose at 100 milligrams per deciliter or more. More. That's pre diabetes, by the way, that it would be considered metabolic dysfunction. Number three is going to be a high density lipoprotein. So an LDL cholesterol under 40 for women. And so if it's under 40, which again, I don't want it anywhere near 40, then we know that, that good cholesterol is not saving you. And then triglycerides, 150mg per deciliter or more. And then lastly, blood pressure, if it's 130 over 85 or more, and what the newest research, I was just listening to a, you know, a functional cardiologist and now we're seeing that if you have Blood pressure above 116 over 70 now you're starting to create inflammation and vascular compromise. So once you're 130 over 85, that's full on hypertension. But now we're knowing that we don't even want to be 120 over 70. Like we're becoming more riskier at that point. We're learning More about this very preventable disease. And so if you have markers, three of those markers out of range. So let's say you have a waistline of 35, your blood pressure is 1, 130 over 85 and your fasting glucose is 100 milligrams per deciliter. And it's not being managed with medication or if any of these levels are being managed with medication, like your blood pressure, that is a diagnosis for metabolic syndrome. And 93% of Americans fall within that criteria of having these biomarkers out of range. And so that's the first question you have to ask yourself. Now we can have body composition changes and the scale not move, but again, often due to declining estrogen, but also due to insulin resistance. And so knowing your numbers is so mission critical at this time and then what we can do about it. I'm a big proponent of eating a very protein, fiber, healthy, fats driven meal, especially breakfast, lunch and dinner. I'm not a big snack kind of girl. I want to keep your blood sugar and your insulin levels stable throughout the day. Do your best to remove as much ultra processed food and added sugar and refined carbs as you can from your diet, particularly in the morning. Because if you want to get on that blood sugar roller coaster, start with the sugary breakfast. That'll do it. That'll do it every single time. Oh yeah, Sugar in your coffee, Just a teaspoon of sugar in your coffee. That is liquid sugar. It's going to put you on that blood sugar roller coaster, especially if you're breaking your fast with a coffee and creamer with sugar in it. Next is to move as much as possible throughout the day. I mean, I would say that if I could get everyone to build their life around movement, I would. I want you moving. After meetings, I want you moving. After meals, I want you. I just want you moving. Whether it's exercise, snacks or it's walking or it's strength training. You know, I used to believe the myth that as long as I did the one 50 minute workout, whether it was a HIIT workout or it was a strength training workout, that I was good for the rest of the day. I didn't have to do anything for the rest of the day like I did. The one thing went in there, I went hard and then I went to work or whatever and then I would just sit. And we know that if you're sitting for five to plus six hours every single day, it basically negates that workout. And so what we're beginning to learn Especially when we look at the blue zone research is that it's really about being physically active all day long. And one of my favorite ways to do that is with little bursts of hiit exercise, I call them exercise snacks. And it's like jump squats, it's jack squats, it's mountain climbers, it's push ups, it's going up and down your stairs with weights. Again, we're talking 60 seconds to two minutes throughout your day. And that's going to keep your blood sugar stable, that's going to keep your insulin more sensitive. And then the other thing is going to be sleep. I always say protect your sleep. It's a million dollar meeting. If you're only averaging five, six hours of sleep, you are more inclined to be insulin resistant. You're compromising your cardiometabolic health. And obviously there's sleep aids that we can talk about, including oral micronized progesterone. But what I say is, hey, treat this very seriously. Treat it like it's a million dollar meeting. I want you going to bed at the same time every night and waking up at the same time every morning. Learn to sync your circadian rhythm so that you are getting that deep restful sleep that you need or else you're going to be compromising your cardio metabolic health.
- [41:58]
B
Yes, yes, yes. I love progesterone for sleep. And I think a lot of women even kind of tying back to something you said earlier regarding estradiol and that you are on estradiol even in perimenopause and you are on progesterone, which really, like you've already stated, is the first hormone to decline. So you know, why is it that women are so scared to start hormones, especially estrogen, because they're being told even some, by some of their functional doctors that oh, we're just going to wait until you are totally in menopause to start with estrogen or totally in menopause to start with progesterone. Why is there this fear of starting things that can help with your sleep that then, exactly as you said, has a trickle down effect on your entire health? If this one hormone can help you with sleep, my God, why aren't we bringing it in?
- [42:49]
A
It's such a great question. Yeah, why are we, how are we mismanaging our patients? How are we being so extra, extra careful? And it's again, the Women's Health Initiative really perpetuated a lot of fear. A lot of fear. Like oh my gosh, that study set us back and it's gonna, it's gonna take a minute. I mean, we're moving quickly in the age of social media and the experts out there really recommending and really educating about the safety of transdermal estradiol. I know that it's gonna shift, but it is gonna take a minute. You're talking about two generations of doctors not prescribing hrt. They are not HRT prescribers.
- [43:28]
B
Right.
- [43:28]
A
They're birth control prescribers. That's what they are. And so antidepressant and anti anxiety medicine prescribers. And metformin prescribers. That's the type of prescribers we are. So a lot of doctors are not even literate on how to prescribe hrt, particularly with estrogen. And this is what really breaks my heart because again, as we talked about earlier, perimenopause is the time where we see lipids markers and blood glucose markers and cardio metabolic markers go out of range. This would be the time to bring in a hormone like that. If estrogen is the reason why we see vascular compromise and vascular inflammation, why wouldn't we bring it in before it becomes an issue? We also know that women are losing bone in perimenopause into early menopause. Why would we not intervene when they were losing that percentage of bone in the late perimenopause stage? Why aren't we looking at DEXA scans to make this decision to look at bone density levels and be like, oh my gosh, this woman is already osteoporotic and she's 48 years old. We're really going to wait until she's 53 to bring on HRT when it could be the biggest needle mover for supporting her bone health and remodeling and building back her bone? And so again, I think it's, we've got to re educate our clinicians and we have to understand what is at stake in this transition. The only reason why we're choosing menopause, it just, it feels safer because we know for a fact that hormone levels are at an all time low at that point. But what if we could have intervened when she was really suffering with hot flashes and night sweats, when she was really struggling with body weight composition changes, when she was really going through it with the severe depression and anxiety and the cognitive dysfunction, and she thought that maybe this was early dementia. Why aren't we intervening then? And we need to be basing, yes, I want to look at the labs, but we need to be listening to our women. We need to Trust that what they're saying is true. And we need to be also working with symptoms. You know, if she's saying that she can't function, that she may not be able to stay to her job, that her relationship is on the fritz, you know, it. This is a hormone driven situation. We need to step in with hormones. And that's the beautiful thing about hormones. If they're not working, let's say she starts with an estradiol patch or she starts with oral micronized progesterone. And that isn't working. Let's get educated enough to work with her to change the dosage to, you know, play with the application and go from there. This is not a one size fits all situation. Women are not one size fits all. And so it's important that we're working with women in this journey, listening to how they're feeling, understanding if their symptoms are being mitigated or not, looking at these biomarkers and moving from there. And I get that requires a multifaceted approach, but my goodness, don't we freaking deserve it?
- [46:12]
B
Absolutely. Amen. Goodness. That's the mic drop moment of this interview right there. But there's so much more. Obviously, women can find this in your new book, the Perimenopause Revolution, because you're starting a revolution.
- [46:26]
A
I am starting a revolution, A movement, a rally cry. We're done being dismissed. We want to be heard, and we're done suffering needlessly. This isn't a time for surviving. This is a time for thriving. And this is what it's going to do. We're going to get it done. I have a whole chapter on HRT so that you feel literate enough to have the conversation to be like, hey, do you take care of women in perimenopause and menopause? Do you offer perimenopause and menopause care? And if so, are you recommending HRT to women in perimenopause? Because if you're not, and I'm suffering like this, then I'm going to go find somebody else who will.
- [47:00]
B
And I love that because you're literally saving women time from doing that doctor jumping behavior, where literally you become so depressed with each doctor that denies you hormonal help, that tells you that it's all in your head, that just medically gaslights you. Just use the book and ask the questions before you even make the appointment.
- [47:21]
A
Exactly. Yeah. It takes four to six visits on average for doctors to connect the dots between your symptoms and perimenopause. And Menopause, four to six visits. And yeah, it's disheartening.
- [47:30]
B
It's so disheartening because there's so many practitioners out there that are brainwashed, like you said, from the Women's Health Initiative study, that they're literally going to tell you that if they prescribe you hormones, you know you're going to get cancer. And they put the fear of God into women to where then they just shut up and they don't advocate for themselves.
- [47:50]
A
No, exactly. And that's kind of how we've all been trained. We also have been trained that women are just complainers or women are making it up, or again, it's just stress. And it is a yes. And if you had been managing stress, okay, and up until this point, and all of a sudden it feels like the wheels are coming off, There is a reason. The hormones that were helping to keep that stress under control, they're not showing up consistently anymore. It's like, you know, I always say that estrogen is the master CEO of the brain. And let's say that CEO is been coming to work from nine to six every single day for 35 years. And then all of a sudden she doesn't show up to work until 1pm, but doesn't go home until 12am and then the next day doesn't come to work until 10, 11am but then stays until the next day. You know, it's like. And then she only shows up from nine to two. You know, it's inconsistent. And so the brain is like, what is going on? My master regulator isn't even showing up consistently anymore. And your brain is having to massively reorganize. And so if you are not feeling like yourself anymore, something doesn't feel right, trust that. Trust that you know yourself better than anyone else and go and seek the health that you deserve, the health care that you deserve. And if your doctor isn't going to give it to you because they fall short in what they know, because that's just the reality of today, then find somebody else who can.
- [49:12]
B
Amen, sister Pre, you're saying exactly what I always say. You know your body more than anyone, and yeah, just keep moving on until you find someone that's going to help you and take you to that next level. Because we all deserve to live our best life. Just because you crest the age of 40 or 50 or 60 does not mean that you just throw in the towel and accept all of these symptoms and a miserable life. So we really do need a survival guide for this, which you Actually have you have a perimenopausal survival guide. This is an amazing gift that we're going to give to my listeners. So thank you for providing that. We're going to put that down in the show notes, but tell us about that gift and then we're also going to link where they can find the perimenopause revolution. So tell everybody where they can find you, where they tell us about that gift.
- [50:00]
A
Absolutely. So the book the Perimenopause Revolution is available pre order. I don't know exactly when this is coming, coming out, but right now it's available for pre order with all the bonuses. But I want you to have something that you can get started with. Now, a lot of what I talked about today in terms of advocating for your health, asking the right questions, knowing what labs to demand and request, all of that is in the survival guide. And then the book has a insane over $500 worth in bonuses, including my perimenopause Revolution masterclass. It's my power toolkit. So that it's all laid out for you. You. While you're waiting to get this book, I want you to know that you can take action to feel alive in your body, literally today. I don't want you to be like, man, I just got. I gotta wait until this thing comes out. No, I set you up to win. Meal plans, recipes, workout videos, self care, advocacy, all of it. It's all there for you to get started now. And so in both the links, whether you go and get the book or you get the survival guide, I want you feeling more like yourself as soon as freaking possible.
- [50:58]
B
Oh my gosh, I love this. I Love this. Well, Dr. Marisa, thank you so much for providing women with this tool, for writing the book that's going to be their handbook, their guide through their perimenopausal years and really into menopause because the same principles apply. And thank you so much for jumping on here and sharing this with my audience as well. This is going to be a, a game changer, life changer for many women.
- [51:24]
A
Oh my gosh. Absolutely. When we feel alive, Amy, you know what's up, right? It changes our families, it changes communities, it transforms the world. That is what we're talking about here and that's what I want. I am ready for a world transformation. And when we get women feeling alive, that's exactly what we're going to get.
- [51:43]
B
Bam. Exactly. Another mic drop moment, girl. So we will put all the links in the show notes. You guys got to order the book, pre order or order and just let it guide you. Let it change your life. And if not, if you're not, if you're not in perimenopause, if you're a dude, listen to this. Buy it for your wife, Buy it for your sister. Buy it for a woman that you know is struggling right now with hormonal chaos and she needs this guide. So once again, thank you so much for listening. Thank you for being on and we will see you next time the information shared on the Thyroid Fixer Podcast is intended solely for informational and educational purposes. It is not a substitute for professional medical advice, diagnosis or treatment. Always consult with your physician or other qualified healthcare provider with any questions you may have regarding a medical condition, treatment or before making changes to your healthcare regimen, including medications, supplements or other therapies. Use of the information provided in this podcast does not establish a doctor, patient or client provider relationship between you and the host or between you and any other healthcare professionals featured on the show. Any medical opinions or statements made by guests are their own and do not necessarily reflect those of the host or affiliated parties. Statements regarding dietary supplements or health related products mentioned in this podcast have not been evaluated by the fda. These products are not intended to diagnose, treat, cure, or prevent any disease. Some episodes of the Thyroid Fixer podcast may include sponsorships or affiliate links. The host may receive compensation for discussing or promoting certain products or services. Any such sponsorships or affiliations will be clearly disclosed during the episode. All opinions expressed are those of the hosts or guests and do not necessarily reflect the views of any sponsors. The inclusion of a product or service does not imply endorsement by any healthcare professional featured on this podcast.