Perimenopause vs Menopause: What are the Differences?

Dr. Mariza Snyder

Thanks so much. I am so excited for this conversation today.

Dr. Sharon Stills

Yay! So why don’t you tell us, I know you have a story, and how did you get so passionate about women’s health and hormones and all that you do?

Dr. Mariza Snyder

Like so many of us, I would have to say probably like all of us, I come from a lineage of women who struggled with hormones. And my mama did, her mama did, my sister, myself. And at the time, when I was in my 20s growing up, so much of it was just normalized. You just felt like crap. You just had brain fog. You just didn’t have great energy. That was just women’s lot in life. Like you put everybody in front of you and just take one foot in front of the other and just keep plowing. And so that was what I believed to be true, until, at one point, I plowed and plowed my way straight into the ground, to the point where I had severe chronic fatigue at the age of 30. And I remember having patients in my office who were in midlife and had all the symptoms I had. And I was like, oh my goodness. Like I got to have a lot of this earlier in life, which was really such a blessing. But at the time, yeah, I remember going to my doctor, ’cause I wasn’t specializing specifically in women’s hormone health, I was a migraine doctor. 

All of my women had estrogen dominance. All of my women, they had hormonal imbalances that were driving these migraines, and they were being treated for gut issues. They were being treated for migraines. They were being treated for energy. They were being treated for, all these what looked like to the medical system, to their primary care doctor as different problems were actually all coming from the same root causes. And as I was looking at my patients and trying to take care of them, I went and sought out a really well-known practitioner who dealt with hormones, ’cause I knew, I knew that this had to do with my hormones. I was like I just really messed them up. And so I went to the doctor, had my labs run. Wasn’t even the ideal type of labs I would’ve recommended today, but it was better than nothing. And sure enough, everything was a hot mess. Nothing looked good on the labs. But I remember finally waiting with like bated breath of like, what were gonna be my solutions? What were gonna be my protocols? And I just had this hope that I was gonna get fixed. And it was birth control and Xanax. And I remember I had one of the ugliest cries I can ever remember in my car later, like after leaving the office. 

And I think an ugly cry for so many women who were just, this was not good enough. We deserved better. And that became, that was literally the moment that I knew that I needed to be a part of the solution. Not only for myself, ’cause I was only 30, for goodness’ sake. I was nowhere in my 40s or 50s. And so I knew that I had a lot of life and a lot of purpose and passion, and I wanted to make sure that my body was at a place where I could really live that out.

 And I know for so many women, so much of the big stuff in our life, raising the families, the big careers, the big passions are in midlife, are in our 40s and starting in our 40s. and then like catapulting in our 50s. And if we don’t feel how we want to like do and show up in the world, man, everyone misses out, including ourselves. But everyone, all the gifts that we have to give in the world. So that’s my big story. Not only my own crisis in my own hormone issues, but taking care of my mama in her own, and then serving hundreds of thousands of women since then.

Dr. Sharon Stills

Amen to that. Well, we are lucky that you made the pivot to help so many women. And that is so true and that you knew that that wasn’t the answer and that caused you to have that cry, but that sent you on your journey instead of just accepting. And that’s why we’re here today to let all the listeners know you don’t have to accept these. There are so many other options and solutions, and that’s what we’re here to give you. So I know we wanted to talk about perimenopause versus menopause, ’cause I think that’s an important distinction to make. And perimenopause is just so often not discussed at all. It’s not brought up to women. They’re just kinda left to swim in the deep end and try to stay afloat on their own. And so maybe we could just start there, talking about what is perimenopause? How will someone know if they’re potentially in perimenopause?

Dr. Mariza Snyder

Hmm, absolutely. So kind of, I wanna just, you know, experience that a lot of us know ’cause we all came through it is puberty, right? Remember puberty? Like how intense that was. And it was literally the slow tumultuous climb into our menstrual cycle, like into becoming like fully childbearing, right? And that same kind of uphill climb to get to childbearing, where we got the, ideally, the good cyclical menstrual cycle that happens like clockwork, hopefully, throughout our 20s and 30s and into our 40s. And then basically, what happens in our mid to late 30s, but more like late 30s, into our 40s, we start the wind down. So there was a wind up, and now we’re gonna do the wind down. And yeah, it’s mind-blowing to me that we just pretend like it doesn’t happen and we just go straight to menopause. And we’ve been told, I know even myself, there was a myth that I had to really dispel was that the worst of the worst happens in menopause. 

And it just simply isn’t true. And not to say the worst of the worst of it shouldn’t happen at any part of this journey. But I think we really need to give a lot of credence and a lot of grace for the perimenopausal journey, because, man, talk about a journey that could be anywhere between like 8 and 15 years. And you think about it, when you were a teenage girl, there wasn’t a lot on your plate. You know what I’m saying? Like you didn’t have a family you were tending to. You probably are raising teenagers at this time. You know what I’m thinking? Like there was a lot less going on as a teenager through puberty than there is going on with perimenopause. And there’s a lot more at stake, I would have to say.

Dr. Sharon Stills

Absolutely.

Dr. Mariza Snyder

Happening in this phase. And so I break down perimenopause in four phases. Phase one is that 35 to 39-year-old range where, maybe 35 to 40, where you start to feel things shift. Workouts aren’t as easy as they used to be. Maybe you’re noticing a little bit of an energy slump in the middle of the day. You’ll notice maybe metabolically, things are shifting just a little bit, ’cause this is a really interesting time, our 30s, where a lot of things are shifting. And 30s are setting the tone for 40s, 50s, and beyond. And I think a lot of us women aren’t told this. They’re not told like here, this is the decade that you really gotta lock and load and pivot as your body starts to slowly pivot. Other things you may notice, the shortening of your cycle isn’t happening yet, but PMS symptoms may be activated. You may start to notice signs and symptoms of estrogen dominance. This is a great time to start looking at your labs. This is a great time, if you haven’t done so yet, this is also a great time to, if you haven’t started this, track your cycle. 

Track your cycle, please. So I want every woman to know and own their menstrual cycle in this phase, because you can pick up on so much of what’s going on. You can even see, are we dealing with something adrenal? Are we dealing with something thyroid-related? Are we dealing with something insulin-related? Like we get a better sense of what’s going on with our body through our menstrual cycle. Then, into our, I would say supposedly 42 is the proverbial cliff that we all fall off of. I’m 42 right now and so far so good. But that’s when women will really start to notice a shortening of their cycle. The fatigue becomes a more real thing. Metabolically, all of a sudden, weight that you could easily lose in your 20s and 30s, not so much anymore. We become a little bit more insulin-resistant. Progesterone and testosterone have taken a major dive at this point for just one in particular. So we’ll notice more mood swings. 

We’ll notice more anxiousness, worrying, maybe even affecting our sleep, that mental chatter. So that’s you’ll start to notice. But like if you’re tracking your cycle, maybe your 28-day cycle is now a 26-day cycle. That’s what you’ll start noticing. Not so much an ovulatory cycles yet, but getting there. And the discrepancy between progesterone and estrogen is real. So you may start to notice things like lumpy breast, migraines, PMS, bloating, more estrogenic symptoms, heavier bleeding. At this point, women are starting to develop fibroids. We don’t know it, not all of us do, but 98% of us have them before we hit menopause. So they’re coming in to play. Then that’s a lot to do with the excess estrogen that we may be dealing with. Although this is a temporary time, it can still feel very tumultuous, right? The inconsistency. And if your liver is unhappy and your gut is unhappy, we’re just not clearing hormones the way that we should. So you may just be experiencing more excess of something versus another. Then I call it the eye of the storm. I would say around 47, 48, 49, 50, this is where your ovaries are definitely trying to take a permanent vacation, but the brain is like, no, no, no. So you’ll have a month where you will have no cycle. You’ll have no period. And then another month where you’ll have the heaviest period of your entire life. 

And it’ll go like a roller coaster because your ovaries are on the wind down. And follicular-stimulating hormone and luteinizing hormone, they’re not about it. The message from the hypothalamus is keep cranking those eggs to the very end. And so sleep issues, especially if your liver’s unhappy, hot flashes. And then we get to now a major wind down. I call it the waiting room of a stage four, which is no cycle, no period, no period, no period for like six months. And then bam, out of nowhere, it comes. And then you start all over again, right? Til we get to that defining moment. And this particular definition is definitely up for discussion, but the one year of no period where you’re in menopause and you stay in menopause moving forward. 

And physiologically, the tumultuousness of these three power hormones, testosterone, estrogen, and progesterone have all kind of pretty much settled out. It doesn’t feel as crazy. However, there’s a lot of other things at play behind the scenes. Other hormones like cortisol, thyroid, insulin, metabolic hormones like ghrelin and leptin, if these aren’t measured out and they’re not happy and well-balanced, it could still feel a little bit rocky, just a different kind of rockiness heading into menopause. And I know, we’re not gonna talk as much about it today, but that there is absolutely a time and a place on an individual level for bioidentical hormones that really eases some of the more long-term symptoms that can be coming up like brain fog and cardiovascular concerns, inflammation. Those types of issues that just start to happen as we enter our 50s, 60s, and 70s.

Dr. Sharon Stills

Beautiful, beautiful description. I’d love for everyone to just share this far and wide, because so often, we just don’t think about hormones when we’re going through this. And if we go, if we’re not working with a doctor like yourself or myself, then we’re just given an antidepressant. We’re told it’s in our head, we’re told it’s part of aging. And so this was just such a great little journey. And of course, remembering these are all average ages. Like I personally went through menopause. Was done by the time I was 48. So that’s a little on the earlier side. I have some patients who are still strongly cycling well into their late 50s, and they’re like, when is it gonna stop? 

But that’s just a great, you know, wherever you are, just to know that this is kind of what you’re going through and to realize this is normal, this is inevitable, and that preparation, I wish everyone who was listening, if you know someone, have a daughter, a niece, a friend, a colleague who’s in their 20s, let them listen to this because it’s really about pregaming. And if you can pregame all the things we’re gonna talk about, then your menopausal transition and your perimenopausal transition can really be quite beautiful. For myself personally, it was the healthiest I’ve ever been. It was the best I’ve ever been hormonally. I struggled so bad in my younger years with hormones, and because I pre-gamed, I was able to just fly through the transition and love this time of life, feel healthier than ever. And so, such an important topic you’re talking about.

Dr. Mariza Snyder

Yes, pre-gaming, pivoting, it’s so, so critical, especially for us as women. There’s just a lot going on. And the more that we can prepare our bodies to really move through these beautiful, incredible transitions, the better we’re gonna feel for so much longer. I had a baby 16 months ago. He’s 16 months old a couple days ago. I had him when I was 40. I’m 42 now. The eye of the storm for me was in my 30s. It was not a fun journey. But I knew, I was so grateful for knowing how not fun it could be at an earlier time where I was like, okay, this is how I prep up for perimenopause. I was on the tail end of my mom going through perimenopause, and oh, my goodness. I was like, mm-mm, I’m not gonna do that. So I saw how it could be. And watching her on the other side of it at 62, just oh, my gosh. Who she was at 48, man, she is rocking life at 62. She is kicking 48-year-old mama in the booty. The other thing I wanna walk away with is, as great as it would be for us to prime up in our 20s and our 30s, at any point in time, we really have that ability to move our body in a direction that feels really good to us.

Dr. Sharon Stills

I love that. I say that all the time, reinvent your health. It doesn’t matter how sick you are, how old you are, at any time, you can become empowered and you can take the reins and you can really turn things around. And your mom’s a great excuse. I have so many patients that have done that. And I love that you had a baby at 40. You’re the second amazing doctor on here who told her story and had their first baby at 40. And that’s just another whole level of inspiring for women who have been wanting to get pregnant. And there’s that fallacy that, you know, I don’t know, I think they considered geriatric pregnancies, like 30 something these days.

Dr. Mariza Snyder

35.

Dr. Sharon Stills

Yeah, it’s insane. So that’s great. That is just so super. So we’ve kind of went through the little perimenopause, and let’s just talk about what is menopause. How do you know the difference? And what do you want the listeners to know about that transition?

Dr. Mariza Snyder

Absolutely. So menopause, to me, in a lot of ways, menopause is a big breath of fresh air. After that tumultuous rollercoaster, ’cause we had to get on through the other side. A great example, a lot of friends of mine went to the Antarctic a couple weeks ago. And in order to get from Argentina to the Antarctic, you have to go through what they call The Drake. And it’s where all of the oceans converge in the world. And there’s nothing stopping the tumultuousness. It’s one of the most tumultuous areas of ocean in the entire world and it’s 48 hours. There’s no way to the Antarctic except through this, this tunnel of water where most people on the ship are just throwing up, right? It’s so bad. And I thought about how there’s just a lot of shifts and changes through perimenopause that it’s kind of attributing to like The Drake. We gotta go through this transition to get on the other side. 

And menopause, for a lot of us, if we’ve made the pivots, we loved our body, can really be this beautiful just breath of fresh air, where we get to, it’s a different level of ownership. It’s a different level of wisdom that we get to stake a claim into. And so physiologically, menopause is where our sex hormones and our ovaries have definitely quieted down. There is still adrenals and some beta cells and fat cells are still creating estrogen. And our adrenals are creating a little bit of progesterone, but it’s not as significant levels at all. And then physiologically, in a weird way, we’re more like men than ever before, because we don’t have the cycles that are happening. However, I do think that having good bioidentical progesterone and estrogen depend on where you’re at in your journey can really, really help to have us feeling as good as possible for as long as possible. I just never wanna negate our metabolism, our mitochondria, our gut, our liver, as major players here in terms of helping us to live with incredible longevity. So I would say that perimenopause is that transition where our hormones are transitioning out, and menopause is where they have finally transitioned out entirely. And to me, I consider all of it menopause. That is where we’re at in that next part of our life. That’s the big difference between perimenopause and menopause to me.

Dr. Sharon Stills

Great, yeah, I know there’s that whole, if you’re like really looking at like the textbook definition, it’s like menopause is actually one day. It’s like that day you have not had your period for a year, and then you’re postmenopausal, but I agree. It’s like you’re just in menopause. Your menses has paused. It’s a good time for you to pause and look at all those other major players, if you haven’t looked at ’em yet. So let’s talk about some of them that you mentioned, the gut, the liver, the mitochondria, all these important things.

Dr. Mariza Snyder

Absolutely, absolutely. The hormone I really wanna spend a little bit of time on today if you’re open to it is our really big player metabolic hormone, which is insulin. So many of my patients and my ladies, my women, usually, it’s at 40 where we start to see the more insulin resistance. We start to see a major shift there, and it has a lot to do with lifestyle. And it also has a lot to do with our hormones. The hormone that’s keeping insulin more sensitive is gonna be estrogen. And as estrogen is starting to kind of go up and down, we’re gonna start to see a shift in change. The other hormone that is playing a major role here is progesterone. Progesterone is precipitously dropping significantly faster than estrogen. And progesterone is what I call, they’re both neuroprotective hormones. Progesterone’s like the chill pill. She really protects. She creates protection around cortisol. She allows us to have less sensitivity to stressors coming in, but when she drops, all of a sudden, it feels like the floor dropped out from under us. 

That has a profound impact on our metabolic health and on insulin as well. In the opposite direction, it makes us more resistant. And so, usually, at that time into our 40s, well, this is what we gotta really be paying a close attention to is what’s going on with our metabolism. And we can be measuring that either with real time. You can be looking at that with the CGM, a continuous glucose monitor to get a good sense of what’s going on with you. Actually, I have a CGM on right now. Looking every six months after 40, having your hemoglobin A1C measured, where we can see any changes. And it can really tell us if we’re dealing with some level of insulin resistance, your doctor, your primary is gonna be more willing to run a hemoglobin A1C than a fasting insulin test, because that’s just a much more common test, but it can give us a lot of information. I would say we wanna keep our hemoglobin A1C under 5.5 and ideally around five or lower. We consider anything above 5.6 to be pre-diabetes and anything over 6.4 to be type two diabetes. 

That’s just a really important piece, I think, that we tend to not look at enough, because we put insulin in the prediabetes and diabetes bucket. We don’t connect it to the rest of our hormones as if they don’t communicate with one another at all, and that’s simply not true. And I think a lot of our medical system is doing women a massive disservice for not connecting the dots between what’s going on with our blood sugar levels, our metabolic function and our hormones, our sex hormones. We need to be able to connect the dots. We also don’t connect the dots between cortisol and insulin, and that how we can actually create insulin resistance by simply being in a state of constant chronic stress. 

So if there was another hormone on the docket that I always love to pay a lot of attention to, it’s the mighty survival cortisol. I mean, she rules the whole roost, because at the end of the day, our body will always choose survival over anything else, over metabolic health, over reproductive health, over immune system health, because that’s just how our bodies are wired. And so that interchange and that connection, I think, is super, super important to understand, given the amount of load that women are taking on more than ever before, especially in this particular time in our life. I have not met a woman who’s like, I actually have less on my plate at this time of my life than I did 10 or 20 years ago. It’s always that I have more than ever, especially as we are coming out of this pandemic, I feel like there’s more responsibility, more obligation, more holding the whole thing together on women’s plates than ever before. And that level of stress, whether you’re conscious of it or not, is driving metabolic dysfunction, is driving potentially dysfunction in other hormones as well.

Dr. Sharon Stills

Hmm, I love so much about that because it’s funny. I was writing down, this is what I wanna talk about. I wrote down insulin and then you’re like, let’s talk about insulin. And it’s so true. I mean, I think about when I created my set of red cards and I was talking about hormones. And I didn’t even talk about progesterone, estrogen, or testosterone. I only talked about insulin and cortisol because just like you said, if you don’t handle that, then you don’t have your foundation. And we don’t wanna build a house without a sturdy foundation. And things are changing as we get older. You might notice, oh, I used to be able to eat whatever I want and now I can’t. Or I just can’t get that five pounds off, no matter what I do, if I’m doing the same workout. And so running those levels, and if you don’t have a doctor who’s not willing to run a fasting insulin on you, it’s probably a good sign that maybe it’s time to look for a new doctor because these are important levels. And I know I see a lot of doctors will just run glucose levels. And often, I’ll see a patient has an elevated glucose, but that’s just a one time shot. And so when I look at their hemoglobin A1C, I can see, all right, it is correlating yes or no. You had that one thing and what were you doing right before that. We might find out they were at a party or something, but your overall hemoglobin A1C looks good. And so it’s a great way to really look and see what’s going on over the course of a longer period of time. So I love that you brought that up. I think that’s so important that everyone should be having that run regularly with their physicians other than just the typical cholesterol CBC deal.

Dr. Mariza Snyder

Absolutely. We’re talking about testing. I always want a metabolic panel. I always wanna see where your triglyceride levels are. But I also want that Hemoglobin A1C. But I also wanna see, and a lot of practitioners won’t, let us look at, you know, I personally love both serum cortisol and looking at urine metabolites. I like both. And so I wanna see all of that. I wanna see what’s going on. I wanna see where the vitamin D levels are, your growth hormone. There’s a lot of things I wanna see. Reactive protein. But in terms of those key pieces can really show us what levers we need to pull in terms of lifestyle. And a lot of this is lifestyle, at the end of the day. Since I hit the ground a long time ago, hit that Mack Truck, I knew that 80% of what our longevity was gonna look like was dictated by what we did every single day, every single day, it’s these daily decisions. When I’ve been wearing a CGM, I’ve gotten such good clarity.

I know that before 5:00 PM, like I have some flexibility. But after 5:00 PM, I have massive insulin resistance. My body’s like, the day is done for you. You know what I’m saying? If I eat let’s say two hours before bed or an hour before bed, I’m gonna see it in the morning. And so there’s a lot of things that, and this is my particular body, my unique makeup. Diabetes runs in my family, lifestyle and genetics. My goal is to pull the right lever, so that my metabolic health is working properly. And a big part of that lifestyle is definitely gonna be, what do I need to do to manage stress? Like what are the stress management tools? I am a self-proclaimed stress-aholic. I’m not gonna pretend. You know why I have a lineage of hormone chaos? It probably was the hormones but it was the lifestyle. 

That maternal lineage is strong in how we operate in the world. Just a lot of ridiculous overachievers for really no good reason except trauma. You know what I’m saying? And so what are the levers that I gotta pull on a day to day basis to really support the stress response system, so that I don’t burn out my mitochondria and absolutely deregulate insulin, right? And so these are the things that I think we, women, we really deserve to know more about. When I was taught at a young age, in my 20s, that it was absolutely normal to burn to the ground. Like that’s just the way it was. It was a lot of undoing. It was a lot of undoing of knowing. And once I became a mom, I remember my husband saying, oh my gosh, you are like yourself, but now you’re a mother. You just took who you are and translated it to motherhood. He’s like, oh my goodness. You are so fierce. And I was like, sometimes and women listening, they’re like, I don’t know any other way. We gotta build in a lot of these techniques. And I’ll tell you what. 

I have dug so deep into this, because it has been my own internal struggle for so long. Like what is gonna be the thing that moves the needle? I know when I’m having a stress day. I can see it on the CGM. I mean, I know. You know what I’m saying? I’m still breastfeeding, but when I was cycling, I’m not cycling right this second, ’cause just my body has chosen not to, but probably until I stopped breastfeeding Kingston, I could tell, if I had a stressful October, oh, November was coming for me. You know what I’m saying? Like everything was off. And so I’m super down to talk a little bit about some lifestyle strategies. One, ways to blunt the blood sugar response. If you feel like your blood sugar is at, like just not doing what you wanted to do. But then also some of the stress relieving modalities that actually move the needle. That will actually shift how your labs look and how you feel on a day to day basis.

Dr. Sharon Stills

Yes, I love that. It seems like in every talk I have and every patient, all roads always lead home to stress. And I always say stress is 99.999, add as many nines as you want percent of what causes disease. And so I love that you brought that up. I’d love to start with the blood sugar.

Dr. Mariza Snyder

Yeah, oh.

Dr. Sharon Stills

Tips first. That would be fantastic.

Dr. Mariza Snyder

So I’m gonna share what kinda like my top five ways to blunt a blood sugar spike, because unbeknownst to you, if you haven’t worn a CGM, it is unfortunately pretty easy to spike that up. For so many of us, a lot of us are just completely, like just don’t realize. My husband got his CGM on today, and he’s got a lot of predetermined genetics there too. And so we have to like really bring the hammer for him. I have a lot more metabolic flexibility. My husband’s 20. He’s six years younger than me. You know what I’m saying? And I’m just like uh-oh. Probably the most underrated habit that we can do is walk for 20 to 30 minutes after dinner. You wanna change your life? You wanna change your metabolism, especially at any age, that is the thing. Then an example of this too is if you are, like you know you’ve decided that you’re gonna have that ice cream tonight, or you’re gonna have that milkshake with your daughter or with your partner, and you’re still concerned about the blood sugar response, you walk and drink that milkshake at the same time. It’ll literally, let’s say you drink a milkshake. It’s liquid sugar. 

I don’t care if it’s a frappuccino. I don’t care if it’s a green smoothie. You know what I’m saying? It doesn’t matter. If it’s liquid sugar, it’s gonna hit your system really fast. So let me just share with an ideal kind of the range you wanna stay in is 70 milligrams per deciliter to 110 milligrams per deciliter. You drink that sugar beverage of, let’s just say, an average of 50 grams of sugar in that, that’s your medium frappuccino. That’s a milkshake. That’s a Jamba juice green smoothie, straight up. I don’t care what kind of metabolic flexibility you have. It’s gonna go up. And it’s probably gonna, on average, hit around 150 to 180 milligrams per deciliter. It’s a lot. And so if you wanna blunt that even by 30 points, instead of a 150 rise or a 180 rise, it’s a 120 or 140, you just start walking your booty. You know what I’m saying? And that’s why the Italians and the French can do it. They walk while they’re eating their gelato. They walk while they’re eating their pastry, whatever the thing is. And so walking after a meal, walking after dessert, so, so critical. And honestly, walk as much as you can. Take your morning walk, have your evening walk, get to walking. It is gonna be so powerful. And if you can integrate weight training as well, just in general, it’s gonna help, because your muscles, this is the reason why it happens is your muscles don’t need insulin to take up glucose. They don’t need insulin to do that. They can just do it. And that’s where we want glycogen. 

That’s where we want glucose and glycogen to store. It’s in those muscles. And so walking is gonna be a major player here. Next is, if you know you’re gonna have a sexy processed carb or carb at dinner or lunch, let’s say sweet potatoes are mine. Oh, mm-mm. I love me some sweet potatoes. And I’ll tell you what, they light me up. The most heartbreaking thing was when I saw sweet potatoes on my CGM. And I was like, no! So sweet potatoes and I, it’s one of my big foods that just send my blood sugar into a tailspin. And so what I’ll do is I always have protein before, I have a big salad with fiber, lots, and lots of fiber ’cause fiber coats the stomach and slows down the ability for sugar to go into the bloodstream. And then protein. Protein is huge. So I will have a salad with protein before I have the sweet potato, so that you have set up the digestive system to slow down the glucose from hitting the bloodstream too fast. 

Another one that I absolutely love is pairing every meal with protein, making sure that every meal is paired with protein, no matter what. But also, if you know you were already on the alert that insulin is not where you want it to be, I highly recommend apple cider vinegar 30 to 45 minutes before a meal, or berberine 30 to 45 minutes before a meal because they will blunt that blood sugar response as well. And then the other thing that I absolutely love that I think makes a huge, huge difference is to eat. Eat around five or six o’clock. Like have a timeline where you have dinner before 6:00 PM, because the later it gets, the more insulin resistance we get. And ideally, if you can have a three-hour window between the last meal and bedtime, before you go to sleep, that’s gonna help not only manage the blood sugar response, but it’s gonna give your brain that opportunity to really clean up shop at night. Those glial cells will be able to go in and clean up any of the amyloid plaques, all of the yucky buildup. If we’re having to manage sugar super late night, your brain doesn’t get to do that job. You can hear a baby behind me, I’m sorry.

Dr. Sharon Stills

Is it gonna make appearance?

Dr. Mariza Snyder

No, no, they must be running upstairs somewhere. So those are my go-to hacks. And then also, I mean, we know this to be true. We just gotta cut down the sugar. Easier said than done. That’s why I was giving you some of the other ways to do it. But I mean, we do eat a lot of sugar. It is what it is. And a lot of us don’t realize how many foods and how many, you know, when we eat it, has such a profound impact on our bodies. So if you can, it’s not easy to get your hands on, but if you ever get a chance, I think having a wearable where you really get a sense of what’s going on, like getting, even for a month, and just see what happens. Test it out. I have tried so many things with a CGM, ’cause I really wanna know, well, how does my body respond when I eat this or when I do this? And it’s been such an enlightening experience for me personally and so many of my patients. But whether you get a CGM or not, those tried and true lifestyle hacks will change everything about how your body manages blood sugar and insulin response.

Dr. Sharon Stills

They’re fantastic. I hope everyone was writing those down or is gonna buy the recording so they can listen to it again and again, ’cause those are priceless tips and I love the CGM. And I’m sorry about the loss of your sweet potato relationship, ’cause we often say to patients, oh, don’t eat white potatoes, eat sweet potatoes. They’re much better for you. But you just gave such a beautiful story about how, for you, personally and how we all are metabolically individual that, for you, sweet potatoes are really, they spike you. And we often think they won’t. So the CGM is a great tool to utilize.

Dr. Mariza Snyder

Oh, yeah, that’s such a great, and there’s a lot of food that I learned very quickly. I was like, oh, I thought, even I thought. I can’t tell you how often my patients are like, oh, I thought that was healthier. I thought I was eating healthy. And I was like, nope, nope, nope. And then, here, I was having my own. Well, I thought that was healthy. Well, I thought that was healthy. Oh, my goodness. Well, not for me. At least not for my blood sugar, and the numbers don’t lie.

Dr. Sharon Stills

Exactly. I know there’s a lot out there that we think is healthy, but we really have to dig deep, whether it be with the CGM or it be doing intense food sensitivity testing and really looking, ’cause often, what we think is healthy, maybe, but it might not be healthy for us. So let’s move on. And if you could just share, you said you were gonna share some of your stress reduction tips. So I wanna hear those now.

Dr. Mariza Snyder

Absolutely. So oftentimes, we have no idea. We’re very unconscious when we are firing up the stress response system. And I would say that many of us are firing right up dozens upon dozens of times a day. And what it could even feel like is your slight edge. It could literally feel like you’re kicking butt. You could be like, oh, you mean in my zone? No, that is called you when you’re stressed. ‘Cause women thrive in that. Checking off those boxes, handling lists, handling business, running from one thing to the next, that’s called rushing women syndrome. You know what I’m saying? So I think it’s super important. One is to send the brain safety signals. The brain is looking for stranger danger. The amygdala is on. She is on 24/7, looking for the next dangerous situation, setting out the sensors. And so I think it’s really important to bookend our day with self care. It’s breath work, that’s gratitude. 

A gratitude shower. One thing that we do every day is we all in bed, when we’re cuddling, we gratitude shower three things. So Kingston, gratitude for him, for dad, for mom. Kingston doesn’t wanna do it yet, but he’s getting it. So it just really sets the tone for the brain to know that nothing is wrong. Nothing is wrong. That’s actually one of my favorite affirmations. Nothing is wrong. ‘Cause I just need to tell my brain that nothing is wrong. My brain is looking for something to be wrong all the time. There’s always, as a mama, you’re thinking about all the fires you’re putting out, all the problems you’re solving. Everything is wrong. There’s always something wrong. And so I love the affirmation of nothing’s wrong. So having affirmations, breath work, a 5 to 10 minute mindfulness meditation, a walk outside, your blood sugar is gonna love it. This is again just sending these preemptive, again, priming the pump. You’re telling the brain, hey, we’re so good. Everything is so good right now. Nothing’s gonna get in the way. And day setting. Like having super clear like understanding about how your day is gonna unfold for you, not to you. And then the same thing is bookend the evening with non-negotiables, where you’re breathing in your favorite essential oil. You’ve got your favorite sleep meditation. 

You’ve got a great book. You’re not scrolling through Insta or crazy news, or you’re not going back to bed with that crazy to-do list of the things that you didn’t get done that day. And oh my God, I’m such a failure. Like that is not happening. So bookend your day with a lot of these brain safety signals, so the brain can just say, okay, cool. The other thing is when you’re in it, is to recognize the cues for you. Is it how you are talking to people? Are you snapping, fast, fast words? Things like I’m busy, I gotta go. I don’t have time for that. I got something to do. Like start to notice where you’re breathing, notice the tightness. And if you start to notice what your body does when you’re in a stress response mode, what I recommend is that second that you notice it, take a moment and just shake it. 

Shake out the energy. ‘Cause you think about, when we’re running, we’re running from the peripheral tiger or the bear or whatever it used to be, we’re flooded with cortisol. Your body’s flooded with that corticosteroid and adrenaline, and your body wants to do something with it, right? You just sitting and trying to meditate it out, it’s probably not gonna work. You gotta shake it out. You know what I’m saying? You gotta shake it out, take a walk, walk around, shake it, shake it. Call your best friend. Leave someone a voice memo. Go hug somebody, whether it’s your grandbaby or your kid or your partner. Like touch is such a big thing, but find a way to release that flooded cortisol from the body. And then if you’re thinking to yourself, well, yeah. Well, Dr. Mariza, Dr. Snyder, that would be great. But I don’t know when this is happening to me. I say every 60 minutes to 90 minutes on your phone, chime it up. Something nice. No dog barking at you, right? I don’t need you to elevate that cortisol anymore than it is, but something nice that is a reminder to you that it’s time. You already know that you’re lit up. You just assume that that’s what’s going down. And give yourself a moment to shake it off. So either put your favorite Aretha Franklin song on, or Stevie Wonder, whatever it is, Lady Gaga. Just dance it out, shake it out. And that gives your body and your brain a chance to reset the system, right? That’s gonna be a big one. Now, the other thing, if you’re thinking to yourself, well, like what if I just can’t do the lifestyle piece, right? The other thing is to bring in key adaptogenic nutrients. They’re gonna work at a hypothalamic level to help. So things Tulsi tea in the morning, or Tulsi tea in the afternoon will help calm the brain down. I also love if you can tolerate them. 

Ashwagandha is phenomenal, but night shade. You just always make sure, if you’ve got an autoimmune condition, to see if you can actually take that. Rhodiola is one of my absolute, absolute favorites here as well. And there are such great adaptogenic drinks these days. One of my favorite companies as a coffee substitute, ’cause caffeine’s gonna just crank those corticosteroids as well. You wanna crank that cortisol? Drink that coffee, girl. So my favorite company right now is Rasa, R-A-S-A, and they make these coffee subs with cordyceps and adaptogenic herbs, and they make all different types of, they’ve got a calm, they’ve got so many wonderful things. And if you know that coffee’s lighting you up and actually causing you more of a disservice than not, like you’re just not processing it fast enough, then that’s a great company to go to. But the key to this is like getting in front of it. Like if you know yourself, get in front of that. The second that you notice is find an activity that you can shake it out and send as many brain, happy brain signals to the brain as possible. I think meditation’s probably one of the best ones to do. That just kind of flosses out all of that stress response system mode.

Dr. Sharon Stills

I love that. And I love midday, early morning, dance parties, in your kitchen, in your living. That’s such a great way. And you can make dance. I mean, I’m a big fan of meditation. I think it’s the best medicine around. But you can make dance and meditation. You can make your walk of meditation. You can make what you’re doing in meditation. And I love that you brought up about like, I think you said day planning, like really looking at. And so I often say to patients, like one of the best tools that’s gonna help you get better is having a calendar and using it. And just like we were talking about in the beginning and now as we’re winding down, pre-gaming. And so pre-gaming your health, pre-gaming your hormonal journey, and pre-gaming your day and knowing what you can and can’t fit in. And I think it’s really important that you do that in accordance with where you are. I remember, when I was a single mom and going through med school and then running a clinic, I didn’t have as much time as I have now that I’m semi-retired and my kids are grown. And so back then, it was like, what are the non-negotiables? 

And for me, it was sleep. It was a half hour of meditation and a half hour of getting some cardio in. And I figured out a way to get up early, not skimp on my sleep. So I had to go to bed early, but to get that in. And now that I have more of my own time, because I’m in that beautiful menopause life stage, I have much more time to do all these other things. And so it’s not to stress yourself out. It always makes me so sad when I go to a yoga class and you see people rushing out at the end and they don’t stay for shavasana because they just gotta get going and do the next thing. And it’s like they miss the beauty of the piece at the end of corpse pose, of embracing it all, of integrating the whole practice. And so it’s not to pile things on, ’cause that in itself becomes stressful. But it’s like Dr. Mariza says, planning, gaming. And each day maybe a little different journey, but really giving yourself that space and sticking to it and not putting yourself care. If you don’t put your self care in the calendar first, it most likely won’t get there because you’ll be too busy. So I love what you say, start out your day. I’m like, can I come over for the gratitude shower? That’s so fun.

Dr. Mariza Snyder

Oh yeah. It’s so good. It takes a minute, you know? Here’s the thing. How we operate is there is no lack of things to do. There is no lack of people who need something from you. There are people who need something from me right outside this door. If I were to walk outside right now, there are people who have a to-do list for me. I didn’t ask for it, you know what I’m saying? But there’s things going on. And yeah, I’m a big proponent of, yeah, like if you’re already overwhelmed, if you already got too much on your plate, it’s one thing. It’s two things, right? It’s the thing that’s gonna, it’s gonna be the thing that opens the big, like the hinge that opens the biggest door for you. For me, that is always working out. For me, that’s sleep. As a new mama to a toddler that to runs to everything, you know what I’m saying? And also, trying to run a business at the same time. And walking. Walking is such a big one for me, ’cause I listen to Audibles. I do walking meditations. Those are the things that are going down. And then supplementation. Like that, I’ve got locked and loaded. They’re already pre-ready. I get them ready on Sunday.

I just take ’em throughout the week. But they have made the biggest difference because when we are running at this level, we become so nutrient-depleted, right? I’m just gonna wager a guess that you all are running at a certain level. And that you probably are burning through a lot of stuff. I already know that there’s just a level that I’m gonna run at. And I wanna make sure that I’ve got the vitamin D levels that I need to do the job. I’ve got the magnesium, I’ve got the B vitamins, that my mitochondria being fully supported with all the cofactors to make sure that those little divas, I call them the divas of ourselves. They’re running, they’re happy, because if they’re not happy, they will shut down. You know what I’m saying? And so those are the types of things for me that are the non-negotiables. And I find that I can do a lot of them, again, my languaging pretty quickly.

Dr. Sharon Stills

I’m trying to look at your back and see if there’s like a superwoman cape on there, ’cause you’re certainly a superwoman. And so I see your beautiful book in the background. And could you just tell us a little, or maybe just give us a tip, an essential oil that everyone needs to know about?

Dr. Mariza Snyder

Absolutely. Probably one of my, talk about who’s wearing a cape is peppermint essential oil. Peppermint, she is, ooh, hot. From hot flashes to cravings to headaches, to you need to get back and focused and alert, peppermint’s gonna do that for you by simply breathing it in. And I bet you’re thinking, oh my God, I need the trifecta. I need to stop that craving. I need the energy boost, and I need to be focused again. It’s four o’clock in the afternoon and it’s all melting. And so peppermint will literally do that for you. And if you want a little bit of a joy zinger, zinger to go with peppermint is any citrus. Tangerine, grapefruit, whatever you love, combine those two, a drop of each, rub your palms together, breathe it in, and you are like a new person in less than 30 seconds. And that’s what I loved. When I was looking for, I think we all deserve quick wins. Especially women holding it all together, going through this transition, we deserve quick wins. And honestly, the only thing I knew that was a quick win before oils was sugar. 

It is the only thing. I mean, no wonder we struggle with sugar, you know what I’m saying? And so I was like, what is gonna give me the energy boost? What’s gonna gimme that feel good moment? What’s gonna shift my mood besides chocolate? You know what I’m saying? And I am a big fan of dark chocolate. A chocolate meditation I think can really serve. One of my favorite chocolates is Hu Chocolate, ’cause there’s no dairy, it’s vegan, paleo, no emulsifiers, super 70% dark chocolate. And you know what? It doesn’t move the needle on my CGM at all. I can have one square of that and my CGM is like, you’re good, you’re good. But for women who are like, they want the non-caloric energy booster, mood booster, it’s gonna be an essential oil. It’s gonna be a citrus oil. It’s gonna be a clary sage or a lavender or a peppermint. Any of those. You pick the thing that feels really, really good with you. And that gets to be a moment for you. That gets to be a ritual that takes very little time that can really move the needle in your emotional and physical wellbeing.

Dr. Sharon Stills

I’m just sitting here imagining smelling them all. So I can’t wait to dive into your book. And so where can people find your book and then where can people find you? And do you have a free gift for our listeners? ‘Cause I’m sure everyone fell in love with you just like I did and wants to know more about you.

Dr. Mariza Snyder

Yeah, so the best place to find me is my podcast, which you are coming on. So I can’t wait to continue this conversation together. The Essentially You Podcast, over four million downloads, focused 100% on women’s health. For women 35 and older, we dive deep into all these particular topics and more. The book on Amazon, it’s literally about menopause and perimenopause, mostly menopause though in midlife. And what are those root causes? What are the levers we need to pull? I talked about two of them today, blood sugar and cortisol, but there’s other ones as well that we gotta investigate. And so that book is where, it’s a year old this month. I can’t believe it. It came out when our smart baby was like almost six months old. And so it feels really good to be a year now. And then the free gift is, again, we talked about the nutrient deficiencies at the end, and so many of us are struggling with those and they can really fill in the gaps where modern medicine is kind of failing us. And so the gift is gonna be the top 11 supplements that every women need at this age to really help support their hormones.

Dr. Sharon Stills

Fantastic.

Dr. Mariza Snyder

Yeah.

Dr. Sharon Stills

Well, this has just been, I’m like, bummer, we have to end.

Dr. Mariza Snyder

I know.

Dr. Sharon Stills

But this has been fantastic. So thank you for sharing your in depth knowledge, that just range from so many different areas that are so important and your beautiful personality. You’re just so lovely. And I know everyone is gonna need to hear this again and again and again, because it’s just so inspiring, and there’s so many juicy tidbits in here. So I know I’m telling everyone as you listen, it’s like we’re making this map of all the things you need to do. And we just put some really important pieces on the map, from your nutrients you need and how to handle your blood sugar and your stress. These are just key, key, beautiful things. So thank you for sharing and helping to spread the word and educate. And it’s just been a great, great time speaking with you, and we’ll be back soon with another episode for you all. So be well.