Kim Vopni (00:01.504)
Hello, Dr. Maritza, thank you so much for joining me today. is, perimenopause is something that was a bit of a shit storm for me and I sort of talk about it with the community of like my own experience, but we haven't really covered it on the podcast. I would say much of the conversation, if we're talking about the transition period is more so kind of menopause, post menopause. So I'm excited to have.
some light shining on this perimenopause phase of life that when people say, you know, I'm going through menopause, it's usually that is that that phase. It's the tumultuous phase and I'm excited to learn more from you. So before we get into that, can you please introduce yourself in terms of who you are? What got you into the health world? I know you've recently launched the book. You've launched many books, but what why perimenopause as well?
Dr. Mariza (00:56.302)
Yeah, I'll take it back. At seven years old, I had migraines.
Kim Vopni (00:58.528)
Mm-hmm.
Dr. Mariza (01:03.822)
And you know, initially, I was was dismissed, you know, because kids kids don't have migraines, especially in the 80s. It felt like and they exacerbated once I was in puberty and into college. And I knew that I wanted to support kids or women. Most of the people that I knew who had migraines were women and and come to find out 80 percent of migraine sufferers are women and girls. That is that is prevalent today. And when I opened up my practice in 2008, it was really
around supporting women with chronic pain, particularly chronic migraine pain. Lo and behold, the majority of my patients at the time were women in midlife. They were in perimenopause and early menopause. We weren't really talking about perimenopause at the time. We definitely were talking, I mean, I knew about menopause. I had been educated about that in school. I didn't understand the full transition, but I knew that women were still cycling and yet they were having chronic migraines.
On top of that, they're being siloed into multiple disciplines, multiple, with different types of medical disciplines, whether it was cardiology or endocrinology or rheumatology. And I noticed this, this through line.
that although women were being siloed into all these different directions and specialists that there was this root cause undercurrent, which was hormones, and that was completely being missed. So although they were being prescribed antidepressants and they are being put on medication for for rheumatoid arthritis, I just knew that there was something more at play here besides, you know, all of these varied symptoms. And it was when I really dove into this and I was like, OK, this this is a transition that women are going
going through. At the time, my mom had me when she was 19 years old. So I was 30 and she was 48. She was in late perimenopause and man, she was going through it. The mental health changes, the cognitive changes, the lack of stress resilience, the low energy, she didn't recognize herself anymore. You know, she, she, I remember telling me that she felt like a shell of her former self. And I got a
Dr. Mariza (03:18.21)
receipt to my mom's perimenopause journey all while I had women in perimenopause and early menopause in my own practice. And I just knew I needed to be a part of the solution, not the problem. And at the time, I felt like I was more a part of the problem than anything else. was managing symptoms. And that led me for the last 17 years. Women in perimenopause and menopause have been the women that I get to show up and serve. And then I will say that
despite taking care of women for almost 20 years, I was blindsided by perimenopause at 43 years old. And I thought to myself at the time that if I didn't recognize it in myself after taking care of women in clinical practice for a very long time, like how are women gonna know when they're in this profound neuroendocrine transition? And that's when I knew I really needed to start educating deeply.
Kim Vopni (03:56.799)
Crazy.
Dr. Mariza (04:17.936)
about the perimenopause transition and really understanding the nuances of what is happening to us when we don't feel like ourselves anymore.
Kim Vopni (04:25.984)
Yeah, that's so powerful. And that is, I think, the experience of so many people. Even if you know the terminology, even if you still can be blindsided. I hadn't heard the term perimenopause. is now almost, for me, it started about 12 years ago. And the conversation really wasn't even happening as of yet. So I'd never heard that term. I knew instinctively something was off with the hormones, but how the heck?
especially with an allopathic doctor, you get nowhere. told you're normal, the whole thing. And I think this is exactly to your point, the experience of so many people. But even if you have some level of education and knowledge, you still can be blindsided by this transition period. So maybe from a definition perspective, what is perimenopause? I know some people throw around the term premenopause, maybe inaccurately. What is menopause? So let's start there.
Dr. Mariza (05:19.97)
Yes.
Let's start with menopause. I feel like we can really define that very quickly. And that is a one day in time where you haven't had a period for 12 consecutive months. And I will say that, you know, when it comes to that definition, although it's the definition we're rolling with, it's not as clean as that.
You know, nothing ever is, especially when we're talking about massive physiological changes. So even menopause, it's not like everything, like there's a stop and go point here. Like it's all, it's all gray, as far as I'm concerned. But let's just say that's how we define it. So, and the average age of menopause for women here in the US or most countries around the world is going to be 51.6 years old. But we know that natural menopause is anywhere between 45 and 55 years old. Perimenopause,
is the transition. As hormones are erratically declining, as I always say, without permission, because nobody asked for that, as your hormones are declining to that defining moment where we stop having a period for 12 consecutive months. Now I will say that symptoms in perimenopause and postmenopause, it can all feel the same and look the same to women. And so that defining moment for so many women,
It doesn't necessarily help them move them along or move them forward, but it just helps to understand that the transition of hormones shifting, that transition is perimenopause. mind you, hormones are still shifting a bit into early menopause as well. It's not like it's cut and dry, that you hit menopause and hormones have stopped doing what they do or they're already just 100 % bottomed out. That is just simply not true. But it's to the point where,
Dr. Mariza (07:07.876)
Ovaries are not cycling and releasing eggs. Basically, you're probably not going to pop another egg after menopause at that point. But all of it is a hormone transition. It's a neuroendocrine transition. It's a whole body transition. And really, what it defines is that everything is up for review for women. And it's important for women to understand that they are not broken. I know that society wants us to blame ourselves for not trying hard enough, for not doing enough, for not being disciplined enough. And that is not what's going on.
Like your hormones are shifting. These hormones are master regulators of the entire body including your bone, your metabolism, your brain, your joints, your immune system, your gut microbiome. And when they become erratic in their nature, when your body has relied on them to rhythmically cycle for decades, it is no wonder we don't feel like ourselves anymore.
Kim Vopni (08:00.682)
Yeah, and the premenopause is before Perry. Yeah, so technically you could argue as soon as you're born you're premenopause.
Dr. Mariza (08:05.024)
It's before perimetopause. so.
Yeah, exactly. Well, we're born and then we go through puberty, which is in its own right, its own very profound hormone shift. I think we don't give girls enough extra grace as hormones are coming online. This is also the biggest, most profound neuroendocrine transition that we go through initially because there's a lot of pruning that we do as we step into our reproductive years. Puberty is four to six years.
Like that's how long it takes for the brain and the body to get online to our reproductive childbearing years. And then we cycle pretty consistently for like 20, 25 years, give or take. We hit our mid to late 30s and we start to have an ovulatory cycles.
Right, we only have so many eggs left when we get to our mid to late 30s and the ovaries know that, the brain knows that, the communication between the ovaries and the brain starts to get a little bit more wonky. We don't ovulate on every single cycle anymore. You know, as we move into our mid to late 30s, I would say especially in our late 30s and as a result, hormones begin to decline and that's what's happening in that hormone shift. As hormones decline, again, they're regulators of every single system of the body.
then the system is having to massively recalibrate in order to compensate for the fact that they're losing these rhythmically very reliant hormones that the body runs on.
Kim Vopni (09:32.32)
Yeah, you bring up a good point. said the body knows this. The body knows what it's doing. We just have no idea. We've never been taught.
Dr. Mariza (09:38.36)
We just don't know. didn't. Well, and I will say that modern day life has not made it as effortless as supporting. know, it's yes, the body knows and your ovaries know that there's only so many eggs left. I will say that the ovaries in the brain, there's a bit of a miscommunication. I always say it's like trying to play telephone with a bunch of four year olds. The message is getting garbled. The brain's like, just keep doing your job. And the ovaries are like, actually, I'm good. I'm good this month. Like, I don't want to do it.
Kim Vopni (09:43.712)
supported it.
Kim Vopni (09:58.423)
Yeah, yeah, yeah, yeah.
Dr. Mariza (10:07.87)
And as a result, hormones are deregulating. And I think for so long, we just thought that this was a reproductive issue. This was a reproductive, your menstrual cycle changes. And that's how we actually define perimenopause was menstrual cycle changes. and throw in some hot flashes and some night sweats and some low libido and some sleep issues. But for the most part, it's just a menstrual cycle issue. And now we're beginning to realize that these sex hormones,
our whole body hormones, that there's so much more that is up for review, including your insulin and your gut and your brain and your muscle and your bone and your thyroid. Like all of this is shifting and changing. And I think that really begins to explain, that's why I can't remember why I walked in a room. That's why my joints ache. That's why.
I'm barely crawling out of bed in the morning. That's why I'm yelling at my husband and I'm more irritable. I have low stress tolerance. That's why all of this is happening. Hormones are master communicators. They're relaying information across every single system of the body. And when they stop showing up, your heart is like, what's going on? Your brain's like, how am I supposed to function when my master...
regulator, my CEO, she just stopped showing up at work one day. And so this is what's going on with us. And the more that we understand that it's a whole body calibration, extra grace is so needed in this time.
Kim Vopni (11:40.299)
Yeah, I have heard that the terminology around sex hormones, they're wanting to change that to PET, progesterone estrogen testosterone, which, you know, I'm thinking, my gosh, this is just another layer of confusion now. It's already a confusing time, but I kind of get it. Because again, to your point, it's always just been around reproduction. And by calling them sex hormones, it just seems that it's not influencing the rest of the body. It's just happens to only be influencing
Dr. Mariza (11:47.992)
Pet. Pet hormone.
Dr. Mariza (11:55.648)
It's already confusing.
Dr. Mariza (12:09.23)
They happen to be made in the ovaries. I mean, it is a very patriarchal term. It was created by men, sex hormones. And it's because we didn't know a lot. We only knew what we knew. We knew that the ovaries made these hormones. We called them sex hormones. And hence, that's what created the guidelines. That's what determined the research. And now we're beginning to realize, this is the entire body. Yeah.
Kim Vopni (12:10.749)
Exactly. Yeah.
Kim Vopni (12:19.914)
Yeah, yeah.
Kim Vopni (12:35.222)
So exactly. Yeah. So in your practice, there are I can explain my experience. don't it's not this isn't about me, but many people have many different symptoms. And I know if you look at the list of what could be classified as menopause symptoms or menopause transition or perimenopause symptoms, I don't even know what the number is now, but it's like 50, 60, 70, 80, and I over 100. Right. Itchy ears like weird things can happen. But what what are would you like? Yes.
Dr. Mariza (12:57.612)
Yes.
Weird things, Phantom smells. How dare you?
Kim Vopni (13:05.342)
Weird stuff. I had weird rashes. had my lip would swell like weird things would happen. But what are some of the more common like we can talk about some of the weird ones too. But what are some of the more common things that you see the complaints that women are coming to you when you are helping them identify you are in this perimenopause zone and this is why this is happening. So what are some of the more common things are coming to you for help with?
Dr. Mariza (13:28.59)
I would say well over 80 % of women are coming to me because again, they don't feel like themselves. It's the mental and the cognitive changes that they're really trying to wrap their mind around. And it's also the emotional, like not having the same level of bandwidth. So low stress tolerance, everything feeling harder. They just like, why can't I do the things that I used to do? Why don't I have the same capacity? Massive identity shift. Because if...
All your life, you were indispensable. You were the horse to bet on. And now things are feeling rocky, your identity is shifting. You're feeling more irritable. You're snapping at your family and your husband. You're not able to remember what you were going to say in a presentation. You don't feel as mentally sharp or as focused and alert. Energy is dipping. You're also noticing, you know, we move into more physical changes, weight resistance. Like, why is the same?
exercise routine and the way that I've been eating for a decade, it's not working anymore. I'm just putting on more and more belly fat. Women are struggling with sleep issues. They're not able to get to sleep or they're waking up in the middle of the night at two or three o'clock in in the in the morning and then they're googling, you know, am I dying right now is what is going on with me. Those are I would say those are the more common symptoms that I hear is women really struggling with the fact that they don't feel as resilient mentally and emotionally resilient as they used
Kim Vopni (14:44.616)
You
Dr. Mariza (14:57.112)
to. But also women notice that they can't work out the way that they used to. They're not recovering the way that they used to. That they they're hitting a wall at three or four o'clock in the afternoon. Cravings are up as well. A late night eating is happening. And they yeah, they I would say that they're feeling less resilient. So those are some of the things and then and then you'll hear I'll have patients with frozen shoulder or zero to no libido anymore. Vaginal atrophy, UTIs are happening.
and like inflammation across the board. They just feel puffy, they feel sore, and they feel depleted. These are some of the big symptoms that I hear almost every day.
Kim Vopni (15:39.243)
Yeah, yeah, and that was a big one for me, which again, in the moment, I didn't necessarily understand why, but looking back, I had always been very driven, very motivated, very disciplined, very consistent, and I lost my drive for exercise and I've always loved exercise. And if I finally got my mojo one day and did pretty typical workout, I would be so depleted. I would take me days and days to recover.
And was just, couldn't explain or understand what was happening. it is so, it's so obvious when you look back, when you have some knowledge now, but what would you say to the person who has that, you know, they're not feeling like themselves, they're not able to recover, they don't have that same stamina. What from a hormonal perspective is happening?
Dr. Mariza (16:25.614)
I love that question. And I think it's important to note that, you know, lifestyle medicine is mitochondrial medicine. And so hormones are playing a role in mitochondrial biogenesis and mitochondrial function, particularly estrogen.
Kim Vopni (16:38.368)
Just for the people that don't know, mitochondria, I just want to define that for people that don't know.
Dr. Mariza (16:42.382)
Sure, mitochondria are the organelles in almost every single cell in the body. And we think about the highest concentration of these little powerhouses, these these energy factories in the body. The highest concentration of these energy factories are the ovaries. Actually, more are produced in the ovaries than any organ system in both men and women. And are we surprised when women are 3D printing human beings? Next, it's gonna be the brain, because that's a very energy-driven organ.
the body, the heart, muscle, these are going to be the most energy required organ systems of the body. so mitochondria, we're talking about in the tens of thousands in some of these muscles and organ systems. yeah, no worries.
Kim Vopni (17:27.21)
Yeah, sorry to derail you, I just wanted to get that defined. Yeah.
Dr. Mariza (17:30.424)
So your mitochondria are heavily influenced by hormones. Are we surprised? When we think about mitochondrial health being reproductive health as well, that we need robust mitochondria to actually make humans, it's kind of no surprise that they're intricately connected to our hormones, but particularly estrogen. So estrogen is gonna drive mitochondrial production and cellular energy production.
is erratically declining and not showing up to the job as consistently as she used to that has a impact on how we're creating cellular energy. It also is impacting blood sugar regulation. So blood sugar becomes more variable. So think about spikes and dips versus kind of rolling hills. And mitochondria want a stable energy source throughout the day, not big spikes and big dips. And that impacts our ability to make energy.
and that shows up in the way that we recover and the way that we feel. Also important to note that in this time, often cortisol is deregulating as well. And so that workout, like you finally have the energy and the motivation and the capacity to do that workout and then you're literally, you're depleted on the back end. It takes days to recover. That is equally a cortisol situation because life is stressful. Life is, that's the thing you're trying to fit this workout in.
when life is still life-ing on top of you and you're already depleted. Like you're just trying to muster enough of the energy to do the things that you used to do and then you finally have the energy to do it and you got nothing left in the tank. That's often connected to our cortisol as well.
Kim Vopni (19:14.793)
Yeah. When you were talking about people who notice the change physically with joint aches or frozen shoulder, coming back again from a hormonal perspective, what is happening that is contributing to the joint aches and the changes in how the body feels?
Dr. Mariza (19:31.278)
It's going to also be estrogen again. Estrogen is a immune system modulator. So as estrogen is declining, we are also seeing the immune system responding. Researchers will tell you that perimenopause is a default inflammatory state that will see more inflammation, joint inflammation, gut inflammation, cardiovascular inflammation, and brain inflammation. And so as a result, for some women, they are going to feel it in their joints.
They're going to see it in their antibodies, maybe their thyroid antibodies. They're going to notice gut changes. We're going to see a decrease in gut microbiome capacity. But also in that fuzziness, the brain fog, that's often inflammation as well as a result of erratic declines in estrogen.
Kim Vopni (20:18.943)
With, I remember the terminology coming, like I learned it somehow, I don't remember, read it in a book or something of estrogen dominance. And the challenge I had when reading about that was, okay, so I'm in this, I know I'm in this now state where my estrogen is declining, how can I have an estrogen dominance problem? Because a lot of the symptoms would be associated with, quote unquote, estrogen dominance. And a lot of people now,
you will say, I can't use hormone therapy because I'm estrogen dominant. I can't have estrogen because I'm estrogen dominant. So what is, where, how does that make sense? Where we're in a decline of estrogen, but we're estrogen dominant or that term is used and thrown around what's happening.
Dr. Mariza (21:06.912)
Yeah, and I like to use a term like unopposed estrogen, you know, again, we're talking about erratic hormone levels. So one day you will be depleted and another day you'll see higher than normal levels of estrogen as well. We have to understand that other hormones are at play too. And one of the hormones that is balancing estrogen is going to be progesterone. And progesterone is leaving the party a little bit sooner than estrogen. And when it comes to progesterone, we're talking about leaving the
party maybe years in advance. And so well, in early perimenopause, what women will experience is that decline in progesterone. And progesterone is showing up in the luteal phase of our cycle. after ovulation, that's what allows us to, you know, feel, you know, pretty chill on the back end, although many of us are experiencing peri- know, PMS symptoms, but more exacerbated PMS symptoms in perimenopause. But in this time, estrogen is still there as well. And so we may have a situation where, you know, it's supposed
to be 100 to 1 progesterone to estrogen where that ratio may be thrown off and we'll experience more symptoms of unopposed estrogen. So women will notice more bloating. Maybe they'll notice migraines. Maybe they'll notice fibrocystic breasts, so tender, painful breasts that swell close to your period. Those are often signs of unopposed estrogen. What could also be driving unopposed estrogen is also, again, we do have changes in our liver.
our detox pathways and we do have changes in our gut microbiome, particularly the esterbolome. This is where we're actually breaking down and kind of safely removing methylated estrogen. So kind of like that that kind of packaged estrogen out through our bowels and through our bowel movements. But if any of that is being disrupted, particularly in perimenopause, we may see where estrogen is being recirculated back into the system. And if we don't have progesterone to kind of buffer that, we will notice some of those symptoms.
And so it's important, and I won't say, I wouldn't say that that...
Dr. Mariza (23:10.9)
means no HRT, know, you know, especially if you have symptoms of estrogen getting really wonky on you. And I think it's just really important to be paying attention to that. So, you know, as an example, I remember when I started estrogen therapy specifically, so I have an estrogen patch and I was noticing in that in the follicular phase, everything was fine because I was supposed to be flushed with estrogen. But in the luteal phase, probably because I wasn't
I didn't have enough progesterone in the system. Maybe I wasn't taking a higher dose high enough dose of progesterone to kind of modulate that estrogen I was noticing more swelling of my of the breast tissue and it being a little bit more painful and the first thought was one of two things well one of three things one am I am I taking enough progesterone to kind of counteract this is my liver and gut being supported to kind of manage Detox pathways because I always think about estrogen you need to use it and lose it if it's hanging around we
We know we can notice some symptoms and number three am I taking too much? Do I need to lower the dosage of this estrogen patch? And so the first thing I did is I optimized my liver detox pathways and my I supported my gut microbiome and then just kind of paid attention for the coming months is is my are my symptoms dissipating or am I still noticing this and so again This is why HRT is not a one-size-fits-all And it's important to be looking at estrogen metabolism
on top of bringing estrogen in, particularly in a time of perimenopause where estrogen is going to be going up and down, especially in the early part of that phase, versus late perimenopause where we know estrogen is very much on the decline.
Kim Vopni (24:56.466)
Yeah, when I was going through again, not not nobody had ever used the term yet that it was perimenopause. It was sort of chasing symptoms. One which was very bothersome was very, very heavy bleeding and all the things there was very bothersome, very common. And in my world, one of so do I. I would say we're just saying but so many women are given a hysterectomy.
Dr. Mariza (25:14.12)
very bothersome. Yes, I call them crime scene periods.
Kim Vopni (25:26.74)
because of heavy bleeding. And the top three reasons for hysterectomy are pelvic organ prolapse, heavy bleeding, and fibroids. And heavy bleeding and fibroids can so often be attributed to that imbalance, that unopposed estrogen, and nobody goes down that path. When I was going through it, and this is something I hear from many people, there's supplements and there's lots of lifestyle things we can do and we should do 1,000%, but so...
It's like, we just have to like, you have to wait, you're not quite at menopause yet, we won't start HRT. I think, had HRT for myself at least been started earlier, I think it would have made a transformative, it made a transformative difference when I finally got there. But it seemed to be that we're just like, not quite yet. Like, what's the fear do you think about starting HRT when you haven't reached your menopause?
Why do you think that belief is there that we have to wait till we're in menopause before you can benefit from HRT?
Dr. Mariza (26:25.718)
Inherently, it's a knowledge gap and a research gap. That's what it is. And we've had research that steered us in the wrong direction. Actually, it wasn't really even estrogen that steered us in the wrong direction. It was a progestin specifically. So I think it's a lack of research and understanding. And so yeah, you have a lot of providers and practitioners that are really trying to figure out, from a clinical perspective, when is the right time to start a patient on hormonal placement therapy
woman. And up until recently, it was only menopause. And it was the, you know, you know, wait until menopause, the lowest dose for the shortest amount of time. And that narrative, obviously, that way those guidelines are shifting and changing very, very rapidly. And because a lot of women were have been suffering needlessly in the perimenopause transition well before they ever got into menopause, because of what I consider to be inappropriate.
fear around hormone replacement therapy. And so right now what we're noticing and what new research is pointing out is that hormone replacement therapy is more a preventative more than it is a reactive and that we should be thinking about it in terms of longevity medicine not just symptom management. if we if the zone of vulnerability is perimenopause not necessarily menopause it's menopause too but it starts in perimenopause. Why
Kim Vopni (27:45.845)
Hallelujah.
Dr. Mariza (27:55.454)
would we just wait for the sake of waiting to get women on hormone replacement therapy, at the very least vaginal estrogen, or at the very least oral micronized progesterone, right? And also estrogen, you know, when symptoms are appropriate, or even in terms of...
You know, we're still of the mindset that once symptoms arise, the conversation should start. But I really think we should be talking about hormone replacement therapy as specifically as a preventative tool for longevity, that we're optimizing for longevity. but.
Yeah, it's a little bit tricky. It's gonna be different for every single woman. Like I've had friends and colleagues that, you we would not expect estrogen to decline so significantly in what we would consider to be early perimenopause. But the numbers are there, the labs are clear. And so, you know, if a doctor was just basing on symptoms, wouldn't necessarily start that person on HRT or estrogen therapy in early perimenopause. But even when you look at labs, it's very indicated, especially when it validates those
symptoms. And so we really have to change the way that we think about it. And mind you, guidelines are changing. The black box warning has just come off with the FDA. And so we have to start looking at women from an individual standpoint and really looking at her and saying, OK, what are the symptoms? How are you feeling? What is going on with you? And the beautiful thing about hormone replacement therapy is we can start it. And if it's not working, we can modify it. We can come off of it. I there's a lot of things that we can
Kim Vopni (29:04.01)
Yeah.
Dr. Mariza (29:33.154)
with hormone replacement therapy to figure out the right dosage and the right strategy for you so that you are feeling better and that we are increasing your health span versus you suffering needlessly. But we've got a ways to go. Unfortunately.
Kim Vopni (29:44.052)
Yeah, hallelujah to that. We do, we do. Where with regards, I want to come back to you said, you know, working on your liver and your gut. And I want to come back there. But before we do, I just want to jump in from a testing perspective.
There are some people that say tests don't guess. There are some people say just rely on symptoms. You don't need a test whether you maybe test in perimenopause but not postmenopause. Where do you sit in the testing? Do you think that there's value in it and what type of testing? know we think there's no real test to say you're in perimenopause or you're not like you can. It's not a definitive diagnosis per se. Where do you sit in the testing realm or would you rely more on symptoms?
Dr. Mariza (30:34.626)
I'm a yes and. So if it comes to one, I'm of the mindset of accessibility.
Not everyone can afford testing. Not every woman can get to the lab and run labs at 8 a.m. when they got to get their kids to school. And so there's there's something to be said. So would I would I ever recommend a doctor deny a patient hormone replacement therapy because that patient isn't able to not only afford testing but get in and actually test? No, I think symptoms can really help to indicate what's going on. Also, new research came out in the
UK really recently looking at, you know, basically the like estradiol patches and what's actually getting into a woman's body. You know, if you you talk to a lot of women that are on HRT, they'll tell you this patch didn't work. This patch worked. This dosage work. This dosage didn't work. When I put the patch here, it worked. But when I moved it over here, it didn't work. And so like there's all this nuance. And by no means am I sharing this to overwhelm, but just that it's not it's not cut and dry.
There's so many ways that we're taking in. Is the adhesive actually sticking? Is it working for you? Because that's where the estrogen is. so based on that, even though let's say we put a 0.05 patch on a woman and we're expecting a certain blood level of estrogen, it just doesn't translate. And so if we were to say, hey, we put this level of patch on this particular woman at this age,
we would expect estrogen levels to be at this, that's just not what's translating. And so if we were to just base it on labs, we would be doing a massive disservice to women in supporting their symptoms. So I think we need to be looking at both. Also, I think it's not just hormone labs that we're looking at. I can determine...
Dr. Mariza (32:34.606)
You know if a woman's in perimenopause even if she doesn't necessarily know that she's in it based on metabolic labs based on inflammation markers based on nutrient deficiencies on iron and ferritin and looking at you know Where are her where her iron levels? mean thyroid levels like there's so much information that we can gleam From the full what I consider to be the full panel that that hormones won't indicate. You know even in my own journey
Estrogen looked great progesterone looked great. I felt like hot garbage now my inflammation markers my highly sensitive CRP was going out of range my lipids were going out of range a little bit my blood glucose had jumped and so I Saw things shifting because I have a timeline of lab. So I was like something isn't right I know that lifestyle wise I was really dialed I knew something but every time I tested hormones I kept
I just picked the best day, I picked the best day. My hormones were like, we're gonna show up beautifully today. would still, know, days later, I would feel completely terrible. And so I think labs are, they can give us lot of insight as to what's going on with women in general in terms of their health span and overall vitality. But in terms of pinpointing whether they should be on hormone replacement therapy or not to mitigate symptoms, it's a little bit more nuanced and we should be going based on symptoms and allow
Kim Vopni (33:30.237)
You
Dr. Mariza (33:58.077)
labs to help us to help us really to help validate what women are experiencing.
Kim Vopni (34:06.503)
One thing that happened with my own investigative journey was figuring out that I had Hashimoto's. I'd never heard it before. I was the one that had to ask for the labs because I kept checking all the boxes. And after that point, when I recognized the list of symptoms and how it mimics perimenopause and hypothyroid, and they're all the same, and how many women are getting diagnosed with hypothyroid but nobody's investigating if it's autoimmune or not, I became very bullish on recommending women.
when they're doing their hormone testing also having a full thyroid panel. Now adding to that list to your point, looking at other markers like inflammation and the metabolic side of things. just, you don't have to name every single test, but what are some of the, okay, go for it, please.
Dr. Mariza (34:48.078)
I would love to name the labs.
And I have Hodges too, and sure enough, I mean, it was missed. We wouldn't look at the TPO's, we wouldn't look at the thyroid globulin, and sure enough, because again, thyroid labs can be within range, and you can still have an autoimmune component. And the same thing as well with hormone labs too. I think about, or even a fasting glucose, it's a very reactive test. You could be insulin resistant up to a decade prior to glucose finding.
Kim Vopni (35:10.985)
Yeah.
Dr. Mariza (35:20.912)
finally starting to go in an unfavorable direction. So I think it's important to note that. Okay, so what I would normally recommend and ideally in an ideal scenario, we're running these labs in your 30s so that we have a timeline. So that you have a timeline because labs will allow you to advocate for yourself. And, you know, I wish we weren't in a situation today in this modern day world where women are having to constantly advocate for their care. But unfortunately, that's just where we're at. And the more data that you have on yourself, the more that you complete the case. So I
I say not only have labs and have a timeline of labs ideally, so even annually. mean, if there's anything, you've got insurance and you have an annual exam every year, just go to the annual exam to get the labs ran and nothing else. If that is the one thing that you do, like do that. So my recommendation is a full lipid panel.
So that is HDL, LDL, total cholesterol, triglycerides, but also ask for an ApoB, which is the protein that's on lipids that can really be an indicator for cardiovascular risk, and lipoprotein little a. These are such inexpensive tests, they should be able to just add them on. So just ask for them. And like my mama always says, if you don't ask, you don't get. They're not normally gonna run these, but just if you ask for them, they probably will. A complete blood panel with differential, this is gonna show you your white blood cells, your red blood cells, your platelets,
all that information, your hemoglobin. Next, a comprehensive metabolic panel. This is looking at liver enzymes. This is looking at your kidney function. It's looking at your sodium and potassium and chloride and all of that. But it's also looking at your fasting glucose. It's important to still look at that number. You also want to be looking at a fasting insulin and a hemoglobin A1C. Let's take a composite of all three of these to understand what's going on with your cellular energy. Vitamin D, B12, ferritin, I think is going to be super important as inflammation markers.
full thyroid panel that is a TSH, a free T4, a free T3, reverse T3 and antibodies. Like let's look at the full thyroid panel. inexpensive to run. It's just a matter of one more tube of blood to draw from you. Inflammation marker, kind of the general catchall is gonna be highly sensitive CRP. And then optional but extremely powerful is gonna be homocysteine. This is like a mitochondrial methylation stress, but it'll also tell us what's going on with cardiovascular
Dr. Mariza (37:41.984)
Cardiovascular methylation basically is telling you if your cardiovascular system is at more risk uric acid It's an oxidative stress marker can also indicate insulin resistance Fibrogen its inflammatory burden again cardiovascular indicator here and then hormone testing so estrogen progesterone So you're looking at estradiol progesterone testosterone and that is sex hormone binding globulin total testosterone free testosterone and ideally if you can get it a DHEA that's
Kim Vopni (38:11.37)
Yeah.
Dr. Mariza (38:11.888)
what I would be asking for in a lab draw.
Kim Vopni (38:17.373)
Super valuable, thank you so much for sharing that. I want to come back to your point that you made with your journey where you were on the estrogen patch and you were very well supported with everything's going well, you're eating properly, all the things, but you said you worked on your liver and your gut. Why did you start there?
Dr. Mariza (38:29.762)
Oops, we're hurting. Yeah.
Dr. Mariza (38:40.654)
Great question.
Kim Vopni (38:42.675)
And how did you and what did you do, I guess? Yeah.
Dr. Mariza (38:44.814)
Kim, I had really severe estrogen dominance in my mid 30s. And I often find that that's when women will experience estrogen dominance is somewhere starting in their mid 30s into their 40s. And so I knew what estrogen dominance or unopposed estrogen had felt like. you know, I remember growing up, my mom used to tell me that the women in my family, we just don't make progesterone. And I was like, huh, that's interesting. And she's just like, you know, at some point we go from, she would say, it's so funny, these things that your family would tell you your mom
would tell you one moment someone will sneeze on you and you'll get pregnant and then the next moment we don't make progesterone so I went from like sneeze on you you're gonna get pregnant you're you're Latina and then by the time you're 30 you better have had those babies because you don't have any more progesterone like it was always so black and white none of this made sense to me
And sure enough, I did have suboptimal progesterone levels in my mid-30s. And as a result, I did have unimposed estrogen. Estrogen, she was thriving. Progesterone, she just stopped showing up to the party. And as a result, I had bloating. had definitely hips and thighs, booty, definitely estrogen distribution. But my boobs would swell really big. would have these migraines. I just felt super puffy in my legs.
luteal phase. And so, you know, I dug into the research. I'm like, okay, how do I improve estrogen metabolism? And besides bringing on progesterone to kind of help mitigate it. And, you know, basically, gut health and liver health were a big, big aspect of that. And so for me, it was, you know, a lot of nutrition, but also supplementation as well. And so when I started estrogen therapy, I really knew the
of unopposed estrogen because I lived it and I had reversed it way back in the day. And so I was taking calcium deglutarate. I was taking more sulfurane in my diet as well. So lot more like broccoli sprouts, green juices, cruciferous veggies, making sure that I was getting good probiotics and digestive enzymes. Even when symptoms were really severe, I was doing a little bit of DIM to help support as well. I typically, although I may recommend that in the beginning of a
Dr. Mariza (41:08.688)
protocol, usually have women step back after a couple of months. And then really supporting the gut microbiome. you know, reducing things like alcohol and things that are driving inflammation, any processed foods, bringing in, again, a lot of the things that are supporting the liver are also going to support the gut, but making sure that you've got a good probiotic and again, those digestive enzymes and some other gut supporting supplements if that's necessary. But I find that even making some of those changes just to optimize estrogen metabolism is always a good idea.
I mean, again, I want to make sure that we are using it and losing it at all times, but especially if I see symptoms arise.
Kim Vopni (41:39.37)
Yeah.
Kim Vopni (41:45.651)
Right, yeah, yeah, So liver, would you do both at the same time? Would you start with one first?
Dr. Mariza (41:50.542)
I think both at the same time is appropriate. And even things like dandelion tea and milk thistle, these are easy things. Lemon in your water first thing in the morning, making sure that you're really well hydrated. Sometimes it's gentle detoxing that I think our bodies are needing every single day. Epsom salt baths can be really helpful too. Dry brushing, those types of things. But usually I start women pretty light and adding a little bit of supplementation to the mix. And then if we need to step it up, we will.
Kim Vopni (42:20.086)
Yeah. On that same tangent, you've mentioned a lot of things that just in general are going to be optimizing your health. Are there other things that you would recommend to somebody going through the perimenopause transition? So we've talked about the HRT component, we've talked about liver, gut. Is there anything else that you would recommend that people have to get sort of checked, get dialed in on that can help support that transition?
Dr. Mariza (42:44.14)
I mean, if I could bottle one thing, it's going to be movement. And it's going to be movement with friends.
That is I would say that that is the the unsung hero of longevity and health span is not just moving but moving with with the women that support you like having good community is probably the biggest predictor of your health span that I would that I would build into your protocol and and regulating your nervous system. You know, we know that when you have a deregulated nervous system, when you have high levels of stress, which I mean, I feel like it's almost inescapable during this transition in our
Kim Vopni (42:54.698)
You
Dr. Mariza (43:20.11)
lives that symptoms are going to be exacerbated. So building in rituals of self-care and and again I'm a big fan of
It's a yeah, like it's there. I'm doubling down like I'm like I'm getting a maximizing on my rituals. So I walking outside in nature, not only is it balancing blood sugar, it's helping to support my bones and muscle, but it's also helping to support my nervous system. So what are some things that you can do where you're getting multiple benefits out of the same activity or the same ritual? So moving after meals, moving solo, sending voice memos to your besties.
I do a lot of walks where I'm talking to friends on the phone. So movement would be a big one. And then optimizing sleep, that's huge. Honoring your sleep routine, it is a sacred act. just really, it being a non-negotiable for you. And building in time just for you. Because if you're a mom, if you're a caretaker, the demands of your family are not going anywhere. People always ask me, what is motherhood like? I'm like, it's just constant.
It's constant.
Kim Vopni (44:28.249)
Constant, yeah, constant change, chaos, yeah. In your book, so you have many books, you have a recent book, The Perimenopause Revolution. It's the ultimate resource for women ready to take charge of their health and embrace perimenopause with resilience and confidence with a five week reset program. What?
I'm assuming a lot of what we've talked about here is going to be in that five week. I have not read the book yet. I apologize, but it's that's part of your five week reset. Is that correct?
Dr. Mariza (44:57.526)
Yes, so the five week reset kicks off with mindset. Now I always want women to know that they are not broken. They're just going through a profound hormone shift that's calling for a new level of support. But we get to build resilience and vitality. Like this is that metabolic inflection point. And it's really understanding that we are stepping into the unknown, but we are stepping into that unknown, standing on your hard earned lessons and successes. No one gets to take that from you. And what I love about the word midlife
is that we're talking mid. We're in the middle of your life. And if we can step into that next chapter with resilience and power, we are winning the game. We are living our life's dreams. And so I just want women to understand that it gets to be on your terms. You get to decide what it looks like. But let's make sure that you've got good cellular energy to back it up. And so the first step of that is mindset, getting clear on who you want to become, the life that you want to live,
Being on your terms and then I build in movement and again movement that it's aligned with you I'm not just saying you have to be in the gym 30 minutes five days a week like that doesn't work for so many women like how do we incorporate exercise snacks? How do we incorporate moving after meals like things that feel in alignment with where you're at in your journey? That is moving the needle for you forward Food that is going to nourish you reduce inflammation balance your blood sugar build muscle
and support your gut microbiome. If food isn't the molecular information that is moving you forward, then we've got to renegotiate what that meal looks like for you, and we can do that. And we can do that with more effortlessly than you think. So those aspects, and then building in morning and evening routines. I was talking to Dr. Mindy Pels a couple weeks ago, and we both agreed that if you can bookend your day with solid morning and evening routines that are yours, the chaos
of the middle of the day like you can handle.
Kim Vopni (46:59.668)
thousand percent.
Dr. Mariza (46:59.788)
You can handle the chaos as long as you book in. So treat those three your morning routine and your evening routine like they are sacred acts, but they are your sacred act. So don't give away your time to social media. Don't give away your time to email. Like protect that time. Protect your energy on the back end and the front end of your day so that you can handle the middle of your day. And that's what the five week program builds out for you. But it builds it out to meet you where you're at. It's not just some blanket blind
protocol that you're just like, this woman's crazy. Like, why would she recommend this for me?
Kim Vopni (47:32.726)
I don't think you're crazy. think you are incredibly brilliant and I love that you have a focus on longevity. You have a focus on self-care. You have a focus on education. I wish that I had had this book when I had no idea what the hell was happening with my body and the information that you've shared. I came to it but I came to it as you say you have to we have to advocate and it took a lot of time and uncertainty and asking. I got there but I feel like your book is something that
It gives you that resource, that Bible, and answers so many questions and gives guidance and thank you for writing it and thank you for the work that you do and also for sharing your wisdom here today. I'm excited to read your book and I know it's going to be another resource that I share with my community.
Dr. Mariza (48:18.422)
Yeah, I mean, Kim, it's designed to do four things because hopefully I'm catching you at the beginning of peri or even before peri and you're kind of wondering like what's going on with me and the first part of the book is really like this is what's going on with you. This is how we identify peri menopause. But more importantly, this is how you advocate for the care that you deserve. Women deserve a gold standard of care, not the least of things. And so it really allows you to advocate for yourself in that way. One, it's important that we recognize that our symptoms are signals for future health
outcomes. Again, a lot of doctors are going to dismiss you and be like, oh, it's just all going to go away. Like, like someone's going to wave a magical wand. I'm like, no, no, no. What about the silent shifts that are happening under under the scene that you're not picking up on? No one feels creeping blood pressure or creeping muscle loss or creeping bone loss. Like, you know, and that's that's happening. So it's important that we pick up on those and that we recognize those signals. But then what do we do about that? Again, that lifestyle medicine, equally mitochondrial medicine, like what
Kim Vopni (48:50.113)
percent.
Dr. Mariza (49:18.256)
are the levers that are going to give you the best outcome to feel resilient and strong? And then putting it all together in a five-week plan because nobody's got time to figure it out by themselves. It needs to be done for you. I want women to know that they don't have to second guess. And with the book comes an insane amount of bonuses because I wrote too many words. I had too many recipes. I had too many exercise snack recommendations. And so all of that got pulled. Some of it got pulled. Not all of it got pulled.
Kim Vopni (49:39.01)
Ha!
Dr. Mariza (49:48.226)
And so we put that all in the bonuses so that you have the most of everything. So I stack the deck on the bonuses as well. So I don't want you to feel like you have to go and search for it. Like I want it to be handed to you on a silver platter. And that's where you'll find it, drmeresa.com forward slash book. The book is there, the bonuses are there, everything you need is there so that you're not having to scramble to find it.
Kim Vopni (50:14.495)
Amazing, amazing. I love the emphasis on taking agency, taking agency over your body and your health and your decisions, your mindset. Once you have the information, you can do that. And we don't need to rely on permission to please, can I have HRT?
know, please can I do this for my health and the preventive side is so important and you're setting people up for success. So I'll have all the links in the show notes before. Thank you so much for all of your time, for your wisdom and I know so many people are going to take a lot of benefit from your book. Thank you.
Dr. Mariza (50:48.004)
Thanks Kim
