WHOOP Podcast - Understand, Optimize, and Regulate Your Hormones During Menopause with Dr. Mariza Snyder

Episode Date: September 17, 2025

This week on the WHOOP Podcast, WHOOP Global Head of Human Performance, Principal Scientist, Dr. Kristen Holmes sits down with women’s health expert Dr. Mariza Snyder. Dr. Snyder and Dr. Holmes break down some common misconceptions in peri-menopause and menopause care, and share actionable tools and insights to regain control of your hormones. Dr. Snyder shares her personal journey navigating perimenopause, the warning signs to watch for, and how tracking data with WHOOP can empower women to better understand their bodies. This episode covers everything from cycle tracking and lifestyle habits that can reduce symptoms, to the role of exercise and nutrition, and the impact of alcohol and stress hormones like cortisol. Learn the practical routines for building a symptom-free lifestyle and the baseline knowledge every woman should have by age 30.(00:21) Dr. Snyder’s Personal Relationship with Perimenopause and Menopause(03:17) The Warning Signs of Perimenopause(08:21) Role of Data in Understanding Your Body(11:51) Navigating The Healthcare System: Advocating for Perimenopause Treatment(17:31) Finding Solutions to Perimenopause Symptoms(19:15) Starting the Conversation Around Perimenopause Symptoms With Your Partner(22:33) Cycle Tracking: Seeing The Early Signs of Perimenopause(28:34) Easing Symptoms: Incremental Lifestyle Habits To Feel Your Best(36:17) Parenting the Next Generation: Healthy Habits and PCOS Management(42:47) Cortisol-Awakening Response: What Is It and How Can You Test For It?(49:56) Exercise’s Role In Symptom Management(01:00:31) Baseline Knowledge For Every Woman To Know By 30(01:04:04) Daily Routines For A Symptom-Free Lifestyle(01:10:03) WHOOP Podcast Rapid Fire Q’s(01:11:22) Hormones, Birth Control, & HRT(01:16:12) How Alcohol Is Altering Hormones During Perimenopause(01:27:06) Dr. Snyder’s Perimenopause RevolutionFollow Dr. Mariza Snyder:InstagramLinkedInFacebookWebsite The Perimenopause Revolution & BooksSupport the showFollow WHOOP: www.whoop.com Trial WHOOP for Free Instagram TikTok YouTube X Facebook LinkedIn Follow Will Ahmed: Instagram X LinkedIn Follow Kristen Holmes: Instagram LinkedIn Follow Emily Capodilupo: LinkedIn

Everything is up for review in perimenopause, and that is okay. I need women to know that and need them to know that we get to create a new way of operating in the second half of our lives. That ensures that you are feeling alive and that you're stepping fully into yourself. Dr. Snyder! So pumped to have you here. You have been on quite a journey. most recently getting your book to a point where it is complete and it is published.

And talk a little bit about that journey and what inspired you to write this book. Yeah, absolutely. I had a front row seat to my mother's perimenopause journey when I was about 30 years old. And before that, even in clinical practice, the majority of my women were in their 40s and their 50s. And I did know about menopause. And I did know that there was a bit of a roller coaster leading into it. but not to the extent. I, like so many other practitioners, I didn't by no means write or brush

off my patience, but I just wasn't connecting the dots until I saw my mom go through it. And it was so destabilized. And this woman was always a superwoman. She was a single mom, but man, she had capacity. She was like a bullet train until she wasn't. And that, I would say, that defining moment for her, I remember her not understanding what was going on with her body, her trying to make sense of all the shifts and changes, many of them were brain related, the rage, the lack of stress tolerance, the fatigue, the sleep issues. Like she was, at the time, I think she was a CFO and she was, you know, leading teams and massive executive functioning.

And there were days where she's like, I don't think I'm going to be able to get through this day. Like, what if they fire me? And I was so grateful for that opportunity to have a front row seat to my mother's journey and to be able to step in and support her in that journey. Mind you, now she's 64 running marathons and half marathons. She competitively plays tennis like four to five days a week. This woman is back on track.

Man, she is back on track. She made a decision, you know, after she went through hell and back. And she's like, this, the second half of my life, I am defining it on my terms with my values. But I remember watching her go through this thinking, is this going to happen to me? Is this what's coming for me? And I remember at 43 years old, I was blindsided by peri menopause. My son was two. I was just coming out of postpartum. I was feeling alive and vibrant. I kind of had like a five-month gap between postpartum and Perry. But it was so destabilizing, you know, initially because I didn't know if it was Perry or not,

although I was 43, going to be 44. I mean, I would do the math. But I think because, I was feeling so good. And then this kind of cliff drop moment, I thought, oh, my thyroid. Is it, is it my fatigue? Are these things that I had dealt with before that are coming back up for review? And probably a combination of multiple things. But ultimately, the through line was, it was also perimenopause. How many years ago was that? That was almost three years ago. Wow. You know, it's interesting to kind of hear you say that, you know, you're an expert. And, you know, this has been very, very, much a part of your life's work, you know, is understanding these different phases of, of, you know, a woman's kind of reproductive life and, you know, how it interacts with the

functional medicine that you do. And I guess my question is, like, if you can be kind of blindsided, you know, what does that mean for the rest of us, you know, who might not have, like, your level of expertise and understanding? Like, you know, what was the, what was the first action that you took. You know, when you recognize, like, wow, okay, I'm entering into perimenopause. Like, what do you do next? Yeah, the first thing I did was I started to document my symptoms. I checked with my values as well. I knew how I wanted to show up for my son. I knew how I wanted to show up for my family and my work. And I just wasn't feeling as resilient as I had been. And so I started really tracking my symptoms. But then I went and ran labs. I ran labs multiple times that year.

Yeah. But ultimately, and I had always been really good, I would say from 30 on, tracking my menstrual cycle. And for some reason, I hadn't been. I think because for about two years in postpartum, I didn't have a cycle. So I think I kind of just forgot. Yeah. And so it was about four months into this journey where I was looking at my biometrics, sorry, it's always on this. Yeah, yeah. Looking at my biometrics. I was looking at labs. But then I was like, oh my gosh, why aren't I tracking my menstrual cycle? And in the beginning, to pari menopause for so many women, it's going to be cyclical. Sometimes we're going to be often in our ludial phase. And so sure enough, about seven days prior to my period, I would wake up with this deep sense of dread that my life was almost insurmountable. And I would have these bouts of rage. And that is when I knew when I was tracking it three months in a row and almost like clockwork, like day 22, like everything started to unravel. Mind you, day 20, things were fine. But day 22, I began to see, oh, there's this shift that's consistently happening. And there's no other explanation outside of that hormones are significantly shifting,

erratically declining, like I say, without permission. Yeah. And that this is perimenopause. What did you notice in your blood bowel markers and your whoop data that kind of gave you an indication that, wow, this is different, my body's behaving differently? What, you know, what were the things that you noticed? So in my, in my blood work, one, my heart. Highly sensitive CRP was up.

Okay. So that was a concern. So I knew that there was inflammation in the system. My metabolic labs looked great. So that really didn't indicate a lot for me. Hormones, again, it can be a mixed bag. And overall, they were in normal and what I would consider relatively optimal range. So that didn't give me a lot of insight.

But it was my inflammation markers. Uric acid was a little bit elevated. Vitamin D levels were low. I will say that because I have Hashimoto's thyroiditis, I had full. flared my Hashimoto's a little bit, and so my antibodies were increased. So I knew something was kind of driving this inflammation. And that's a thyroid condition. Yes, a thyroid condition, autoimmune condition for the thyroid. And that was always the thing I, you know, when I started having the symptoms, I was like, oh, I must have triggered a Hashimoto's flare. That was the initial

thing I thought. So I must have ran thyroid labs three times. We were playing with dosage. We were trying to just get the inflammation under control. But on the whoop, the things that I'm always looking at is heart rate variability, resting heart weight, how is my stress overall, what is my body recovery? And those weren't looking as consistent or as optimal as I was used to see. More variability. Yeah. Yeah.

And that's definitely something that we see in really all of our metrics, heart variability, resting heart rate, respiratory rate, you know, you want the day-to-day variability to be consistent. Yeah. You just don't want it to be super dramatic. And I want it to look good, you know. Yeah. Not just consistent, because you can be consistently crappy.

For sure. And adapt to a lower level of kind of functioning. And I think, unfortunately, a lot of us, especially women, when we enter into midlife, that we kind of have been living potentially at a lower level of adaptability. And so we just not knowing it. You know, it's just what we've been knowing. But I had felt so good for about five months that I knew something was up. Yeah.

Yeah. And, you know, I think it's interesting. I'd love to get your cake. You know, I'm on, you know, and I'm on social media. And there's some really prominent women who push back on biometrics. And it's fair, I think for some folks who are already really into their body, maybe they don't need it. But it's these inflection points, these shifts that I think data becomes really amazing, you know, and you can't notice those shifts unless you have a baseline. So how do you reconcile kind of like the discourse around, you know, it takes, you further away from your body or, you know, like you lose your kind of somatic awareness when

you're relying on technology. You know, as a practitioner and just as a person who uses data, how do you reconcile kind of that, I suppose, tension in the conversation? It's easy for me to reconcile that from my clinical experience. You know, I take care of women who are burned out, who are don't feel attuned to their bodies, who are touched out, tapped out, and don't remember what it feels like to even feel like themselves anymore. I was working with a woman named Sarah just a few weeks ago who her relationship is potentially, you know, falling apart, her marriage of 10 years, her relationships with her family members. And she doesn't feel like she's showing up to work the way that she should. She's afraid that she's going to get demoted or she's not

going to continue moving up the ladder. And remember her telling me, she's like, Marisa, please tell me that I'm going to get through this without losing everything. And this woman has no sense of herself per se. She doesn't know where her heart rate variability is or what her energy levels are or what her sleep consistency is. She just knows that she's barely surviving. She doesn't know where to start. Doesn't even know where to start. Doesn't even know how to tune in to herself, right? She feels so lost in this in survival. Having that data, whether it's from a continuous go-coast monitor, but most importantly, knowing what her energy levels are for the day, what her body score is for the day, you know, where her HRV is, that information can allow us to make real time

changes. As a clinician, I can take that data and I can make recommendations in real time for her. And so, yes, I'm, you know, I love, I love the women that are so attuned. Yeah. That really listen to. It's a privileged position. Yes. That I get, I get frankly, super annoyed by. Yeah. Because I think a majority of us are, you know, we don't exercise. for a living. And, you know, that's great that there's folks that can do that. But I think you also have to recognize that there's a lot of us who are moving through life and aren't actually connected to our body. And the data actually brings us closer and allows us to have a conversation with an expert, you know, that can allow us to pinpoint where things are off faster and get

to a solution faster. Exactly. I think data really moved the needle for us to make those real-time changes, even for me. You know, I was, I was a Tasmanian devil with lip gloss for as long as I can remember. I was either running from something or running to something. And I was rarely attuned to what was going on with my body. Having this information that I can look to every morning, every evening throughout the day really allows me to realign, not just with my values, but then like really connect with what is true for me. I wish I could tell you that I was great at listening to my body all day long. I'm not. I am moving many miles per hour, you know, just taking care of other people and being a mom and showing up. And sometimes I kind of just

lose my way. And whether that is a longstanding pattern from when I was younger, whatever it may be, the point is that the data really helps me to get more aligned. And it really helps me to, you know, take that moment, take that information in, and then I can pivot. my behaviors and my actions, you know, throughout the day. And so I'm very, I have no qualms. I have no problem admitting that I'm very reliant on my data, on my biometrics, because they really helped to move me in the right direction. One of the things that I think is worth discussing is there's a lot of, I think this transition is generally poorly addressed in mainstream kind of health conversations. It's getting better. There's no question about it. But where are your pet

peat peps? Ooh. Where are my pet peeves? That's a great question. I would say the dismissal of women. You know, I think that a lot of these symptoms that we're experiencing, especially the brain-related symptoms, are very subjective. It's a prevailing narrative in medicine in our health care system that women are complaining, that women are, you know, when they're coming in with subjective symptoms, that, you know, we often will brush them off as, you know, oh, you're a mom or, oh, your your life is stressful or you're not moving enough or eating right enough, whatever that may be, there's a lot of blame put on us. You know, in that time where I was figuring out where I, if I was impairing menopause or if it was something else, a little caveat that kind of threw

things, threw a wrench into my protocols, was that I got hit in the head twice, back to back. So I had back to back concussions within a week and a half, oh, two weeks. And it spiraled me into post-concussion syndrome. So there was a good three to four months there where I was just trying to heal my brain. And I remember being on the other side, again, perimenopause is happening. You know, I've got thyroid antibodies that are up. You're a very young child at this point too. I'm very young. He's too. I was still breastfeeding. Yeah, I had to stop breastfeeding because of the protocols I needed to get on for my brain to kind of support this concussion. I was on, I was doing hyperbaric oxygen every day for like almost 60 days. Most of my day was spent in

brain treatments, which I'm so deeply grateful that I had the resources and the time. And I'm, I wasn't, I wasn't able to do anything else besides that. But I get on the other side of it. And that's, you know, I actually thought my rage was a concussion symptom initially. And then come to find out it really was perimenopause. But I go to my practitioner because I want to run another series of labs. It just, if my fatigue is tanking, my whoop is not looking, everything's just tanking. And I go into her and I have, I've got my list. I'm massively advocating for myself. I'm super clear on how my symptoms are affecting my function. Like, I know how to advocate. And I've got my list of labs. And she says to me, she's like, you know, you've been in here a couple

times for symptoms similar to this. She's like, and you haven't figured it out. I have nothing for you. Like, I really, I've got nothing for you. I can't help you. And I was like, I get that you have nothing for me. I don't expect you to help me solve this problem. But I do need you to run these labs so that I can dig deeper into what is going on with me. so I can figure out a path forward. And that... Is this an OBGYN? Yes, this was, yeah, this is my OBGYN.

And so, and I was really grateful for the opportunity to experience with so many of my patients have experienced. And this wasn't the first time I've had this experience in my lifetime. But I, this is so often what women are experiencing. They're told that it's too early for perimenopause or menopause. They're told that their symptoms are simply just stressed. It takes an average of four to six office visits for a woman's symptoms to be connected to perimenopause and menopause. That's what upsets me because what this delays is, one, often we're misdiagnosed, so we're mistreated, the treatment protocol.

Is that a function of just not having the profession, not having enough data on what exactly are the symptoms? because there's a lot of potential symptoms that could be connected to other things. So is it not to make excuses, but is it just really hard to disambiguate? Or is it really just the medical profession has not gotten themselves up to speed? That's exactly what it is. It's a knowledge gap. Only 6.8% of internalists, so basically your primary doctor and OBGYNs feel adequate in taking care of women with paramedopause. And only 6.8%.

And currently only up until five years ago, only 20% of OBGYNs in residency had any menopause education. Now it's up to about 30%. So there's a massive knowledge gap that is going on. Unfortunately, we have over 75 million women in either the perimenopause transition or in menopause. So it's a lot of women who are getting delayed treatment, delayed care, and ultimately that profoundly affects their quality of life. We know that we live longer than men, right? Our average age expectancy is about 81 years old, give or take.

Men is 76. But despite the fact that we live longer, 75% more of our lives are spent in debilitating health. And that's because we are missing the boat when it comes to connecting the dots between our symptoms and what is happening, which is a profound transition. and getting the right appropriate care and treatment to manage this profound transition. What's up, folks, if you are enjoying this podcast or if you care about health, performance, fitness, you may really enjoy getting a whoop.

That's right. You can check out whoop at whoop.com. It measures everything around sleep, recovery, strain, and you can now sign up for free for 30 days. So you'll literally get the high performance. wearable in the mail for free. You get to try it for 30 days, see whether you want to be a member, and that is just at whoop.com. Back to the guests. You had your visit, and it took four times for you to kind of be in a position where you were like, all right, this is actually, this is perimenopause. What were your next steps? Did you consider HRT, hormonal replacement therapy

or menopause replacement therapy? What was your kind of solution? Absolutely. Great question. I mean, I started looking at everything. Number one, it is nice to know just to kind of identify. Okay, my body is shifting without permission. It's good to know. Let's get ready. Yes, because the symptoms in my ludial phase were so extreme. And I've had issues with low progesterone before.

I actually used oral micronized progesterone to get pregnant at 40 years old. So this wasn't a bit of a surprise. So the first step was really getting on oral micronized progesterone in the same. second half of my cycle. And starting between 100 milligrams and 200 milligrams, just kind of feeling out what was going to really move the needle so that I felt more connected to my body. I didn't have that, that bout of significant and serious dread. But also I started having some pretty important and crucial conversations with my partner about that time of my month, about needing more alone time, needing more, just time to myself to regulate my nervous system so that I showed up as

the calm, present mom that I really wanted to be. Like, that's a really important value of mine. And I started just kind of reworking more self-care. I started kind of, there are some days or some months that are better than others, but just being really mindful about how I tend to myself in that second half of my cycle. You know, I think women are grossly undereducated in this area and men even double ear triply. So how did you have that conversation with your partner? Because I feel like that, you know, that maybe isn't discussed enough, but there is these, I think, to help a partner understand, like, what you're going through. It sometimes can be hard. You know, how, what did that conversation look like with your partner? Yeah. It was usually, it was probably after my son went to bed, but I sat him down. And, I mean, I'm sure he noticed that I wasn't, something was off. Something was off. Like, I was not well resource. I had low stress tolerance. It was more irritable. But definitely. And I don't know. I think I hid the rage. I mean, I think having that love. of rage when you don't even recognize yourself can feel a bit shameful. I remember not wanting

anyone to know that that was happening to me. Did that show up as like impatience and like and or just like you would just flip a switch and just go off? Yeah. And I luckily I didn't. I kept it like usually was during my day like my trying to pull a coat off a coat hanger just ripping it all. That's exhausting now, right? Like having to suppress that. Yeah. Just really trying to like shove it as far deep as possible. But I basically came to him and I'm like, like, listen, a good chunk of this part of the month, about seven days leading to my cycle, because that's the thing about perimenopause is that many of us, maybe we had PMS symptoms two to three days leading to our period.

And then with perimenopause, those days start to stretch, right? They become more of that ludial phase. And so now we're talking about five to seven plus days of this cycle. It's a quarter of my month that I'm feeling this way. And so I came to him and I was like, I don't know how to get. get a hold of this yet. But I feel extremely under-resourced. I feel over-stimulated, especially, you know, at the end of the day where I've been working all day and my son needs all the things, a Lego piece, whatever it may be. You're talking, you know, like needs his, his chicken cut

up, all the things. Like he's just, and then my husband has got all these, I have two people, two men asking me questions at the exact same time. I'm just like, I can't, my brain's going to just, it's on the fritz. And so. just asking him permission to just let me just focus more on Kingston, like put my energy there versus taking on the mental load of whatever question he has. And then taking, if he's okay with taking over bedtime routine, a couple of those days, or on the weekend, taking Kingston for two to three hours on a Sunday or Saturday so I can just re-regulate. And basically giving him a report card probably in the morning or in the afternoon about what my status is and seeing if we can

kind of rearrange the schedule so that he is stepping it a little bit more gosh that's amazing i mean can you even imagine that conversation having 30 years ago no no i just i can't even imagine i mean like women have been suffering for so damn long and i'm always i'm always in awe of women their capacity yeah their their their ability to show up even when they don't have it and um yeah i think that comes at a cost though it always comes at a cost yeah absolutely um you you can't operate at that level at that capacity without there being a cost. And I think that's where we see that 25% of us in more debilitating health and men for that part of our life.

And that's sooner than you think. We're talking 60s. We're talking late 50s. That's not far away. Yeah. Yeah, that's scary to think. When you, so you mentioned some of the symptoms, and I think this is really important

because this might actually be a really good way for women to think about, you know, or to understand that they're actually heading into this, this perimenopausal phase, you know, the extension of the premenstrual, you know, kind of length, I guess, you know, for most women, it's probably four to five days, I think seven probably at the most. And you see a feature of paramedopause is that that becomes extended. Is that kind of what you're seeing? Yes.

So in the beginning. In the beginning. And that can, and those symptoms can manifest. So maybe, you know, what was three or four days is now maybe, you know, six, seven days prior to your, when you're supposed to start your period, you have more sleep disturbances or, you know, what are some of the symptoms that women can start to pay attention to that might be an indicator that, hey, you're kind of heading into this phase when your cycle might still be regular, right? Because that's kind of the first signal, right? Yeah, absolutely. Those subtle symptoms. So that, I would say we're talking about late reproductive stage, which is around 35 years old. give or take. What women may notice, again, that's why I think it's so important to track your menstrual cycle, especially if it's still a regular menstrual cycle, because it can give you so much information. It's your monthly report card as to what is going on with your body every single

month. And also be paying attention to the follicular phase as well. I always joke and say that everybody loves day 12 us, right? That estrogen peak right before ovulation, you know, give or take depending on how long your cycle is. It's magical. Your skin's glowing. Your lips are fuller. Like, what is happening? I feel amazing.

Well, let me tell you, as you go further into perimenopause, that estradial peak isn't peaking the way that it used to. So I think it's important to be paying attention to the follicular phase as well. Like, are you starting to feel good again on day five when esterile begins to rise back up? So paying attention to the entire cycle can give you so much information as to what's going on with your body. But, you know, during our late reproductive years, we are potentially having an ovulatory cycles. So we're having cycles that we're not ovulating. And we need to ovulate in

order to make progesterone in the second half of our cycle. And maybe ovulation just isn't as robust, whether we're dealing with some insulin resistance or metabolic issues or maybe just high levels of stress even in that time of our lives. And just note that a not robust ovulation can drive less robust progesterone levels on the back end in that luteal phase. And so what you may notice is, you know, again, maybe seven days into your cycle, you are feeling a little bit more irritable. You are noticing that you're not able to get to sleep as easily as you were in the earlier part of your cycle. You will notice that you don't have as much stress tolerance. Exercise recovery is shifting potentially. It depends. Every woman's a little bit different. This is just based on my

my clinical experience and that in the data I looked at. You also may notice that you are, your executive function is that you're just not firing the way that you were a few days ago, that your focus and your alertness, your concentration is a little bit off. Things are requiring more effort. You're having the effort to get through your day versus it being pretty easy to get through your day. And then you're going to notice some mood swings. And you may notice you're snapping at family members. Like, you just aren't as resourced. And that's what women will tell me. Like, they'll notice, again, it's subtle enough to write it off. It's easily to write it off. Oh, I didn't get enough sleep. Or, man, I've just been pushing myself too hard or motherhood.

Whatever it may be. But, like, if you're, like, really listening to your body or you're tracking, you're going to see some shifts. Like, because you're going to push when you may not, you just may have the ability to do so. And then we get to early perimenopause. And that's typically. anywhere between late 30s to 44 years old, again, give or take, maybe 45. Still cycling regularly, but you notice cycle changes. And this can happen in late reproductive, but it tends to happen closer to like early Perry. Now you're, instead of being a 28, 27 day cycle, maybe it's now 26, 25. You may notice that the luteal phase of your cycle is a day less or two days less. And now we're noticing more symptoms of low progesterone. A lot of the

symptoms that I mentioned, but they become more exaggerated. I think about these reproductive hormones as being protection hormones. And as they are not binding to receptor sites rhythmically, the way that they have been rhythmically binding for decades, you're going to notice that that protective shield that's been holding it all together, that's been kind of mitigating those symptoms, begins to falter. And all of a sudden, things begin to present. So now sleep is really becoming more disruptive. If you're waking up in the middle of the night at 3 o'clock, you're noticing your periods are heavier or lighter, mood is really shifting. Brain fog is becoming more predominant.

You're feeling more like life is feeling more insurmountable. I would say that women come to me clinically around 4243 because they are noticing. Something isn't right. And the things that they were doing, even three years ago, four years ago, all of a sudden, they are having to try so much harder to do them. This is where my A players are like, I'm just not as sharp. I'm not as focused. I used to feel steady.

I used to feel like I was at my edge. Like I was able to do the things that I could do. My workout recovery was okay. But now it is impossible to miss that something is happening and something is changing in my body. And this is usually where I'm connecting. Now, when I dig into the history, the health history of these women, And usually things have been happening for quite some time, but just not enough to, like, to come to me about it.

Yeah. What are some non-pharmaceutical interventions that you'd recommend to kind of deal with this shift, you know, so the dysregulative nervous system, the swings in mood, you know, sleep disturbances, you know, what are some things folks can do, some habits? Absolutely. You know, I think lifestyle is always going to be at the foundation of everything. Yes. I would say a couple of those big interventions are going to be food is number one. I always think of food as medicine. And making sure that you're eating food that's going to balance your blood sugar. That's not going to put you on a blood sugar roller coaster that can really tip the scale. So non-processed. Unprocessed. Unrefined grains. No added sugar in drinks or in food.

Protein focused. So I'm a big fan of starting your morning with a metabolically boosting routine. So first thing in the morning, one, sleep consistency. So let's see, we start at night. Yeah. We start at night. And I will tell you, sleep or make or break me at this point in my life, especially after the double concussions at 43, you know, there's no way around it. As we age, that becomes a non-negotiable.

It just, you know, it's kind of no way around it, you know. And I think women, frankly, you know, it's a little unfortunate, but we're even more sensitive and we see this in our data very very clearly you know women need a little bit more sleep and we are when we have a regular sleep wake time it presents in our physiology more acutely than it does in the males same age so it just you know it's just the reality of our situation we have to accept it and we have to make decisions that allow us to show up as our best version the next day and one of those is sleep consistency yeah i mean i love dr stacey sims who, you know, we are not small men.

This isn't bikini medicine here. You know, we have different physiology. We 3D print humans is what we do. And that physiology requires a different level of attention. So, yeah, sleep consistency. So bed at the same time, I always say treat your sleep routine and your sleep like it is a million-dollar meeting. That Netflix show is not a million-dollar meeting. Your partner asking you about whatever the next day schedule is is not a million-dollar meeting.

You unloading the dishwasher is not a million dollar meeting, not before going to bed. So be consistent and then wake up at the same time consistently. Ideally, get outside, ground, get that sunlight. Tell that cortisol awakening response that we are ready. We're ready to play. Come back in. I get water. I always recommend water and electrolytes before coffee.

Have your coffee. Swap your sweetened creamers or your sugar. or your honey for cinnamon, like, let's not get you on the blood sugar roller coaster right out the gate in the morning. Remember, you're breaking your fast. I would say no sugar before noon. Exactly. Oh, I love that. Yeah, don't break, yeah, don't break your fast with sugar. Don't break your fast with a vanilla latte, right? With one, I don't even one pump of sugar, it doesn't matter. It's liquid sugar. It's going to get you on that blood sugar roller coaster. And with continuous glucose monitor, like CGM data that I've looked at for years now,

if you get on that blood sugar roller coaster in the morning, it won't. recover for about 36 hours, give or taken. You're going to see it on your whoop data. You're going to see it on your continuous glucose monitor data. Yeah. You definitely hum at a higher level. You know, when we look at stress monitor data and sugar, there's, you know, a week. There's a correlation. It's kind of stronger in some folks than others. But you definitely, you know, your resting heart rate, your heart rate will be a little bit higher. Your heart rate variability will be a little bit suppressed. And that's really an indicator that you're less capable of adapting and managing stress.

You know, so the fact that food is, you know, the food is just so core to how we manage the day and how we end up sleeping that night. I mean, it's connected to everything. So I love that you highlight food first. Oh, yeah. I mean, it's got to be foundational because all the, I mean, I do believe that sleep is also foundational, but food is going to be. Well, they're interrelated.

Yeah, absolutely. Yeah. It's the building blocks. It's molecular information for your body. And so I always think about what I'm putting into my body, is this going to feed my future brain. That's always the question I ask. I come through. Is this going to feed my future brain? My family's future brain. So we are very protein focused in the morning and with fiber, big time. So protein, fiber, a little bit of healthy fats. How much fiber do we need a day?

I would say, I aim for 30 grams of fiber every single day. You know, it's wild. I think, I'm not sure the percentage. Maybe you know how many Americans get 30. 11%. Okay. I knew it was so low. It's so low. And, you know, I don't know why there seems to be some sort of, movement against fiber. Why is that? That's another one. Yeah, no, I think, yeah, I mean, you think about the amount of protein to consume for muscle protein synthesis in midlife, you know, in perimenopause and beyond. And it could feel like it's a part-time job to get that much protein in. And I think we're coming from a place where women still believe heading into this transition as we're putting on a little bit body composition changes are happening. We are, we're,

even if the scale hasn't moved, we see that things are moving. And I think, you know, we've been conditioned for decades. I grew up in the 80s and the 90s where you're a cardio bunny. You calorie restrict, you know, significantly. And so. They don't eat fat. Yeah, exactly. Yeah. And so, you know, we have this eating a gram of protein per pound of lean body weight. That's a big lift for so many women. I think they're like, okay, well, if I'm prioritizing a food group and it's protein, I really don't have room for anything else. And so I think we're really missing the bucket in terms of, you know, making sure that we're getting enough fiber. When I think about eating metabolically healthy meals that are going to fuel your ultimate metabolism, we need to talk

about gut health as well. And so fiber is a big part of that conversation, not only blood sugar regulation, but gut health. And so I always talk, one, yes, protein forward, but fiber forward as well, making sure that you're getting micro nutrients and antioxidant rich foods, like the color of the rainbow. Ideally, you're aiming for 20 different types of plants every day. You want variety and omegas, you know, making sure that you're getting good omegas into the diet as well. So you're supporting inflammation and you're supporting your brain. And so that's what I'm always thinking about when I'm building the plate from my family and myself. I love that. So that's just food. Yeah, that's just food. Yeah, that's the first morning routine. But that's, you know, for someone who is,

maybe doesn't have the financial resources, you know, how do they think about it? Yeah, I would say frozen. Luckily, frozen veggies, frozen fruit. You can get much cheaper. You know, we put frozen cauliflower into our smoothies, you know, multiple times a week. You know, Costco buying bigger batches of greens ready to go and bigger batches of frozen. And I get that there's a lot of food deserts in our country that make it really challenging. But to really focus on, you know, foods with one ingredient. That would be my intention is just just trying to focus on being in the outer rim of that grocery store. Try to do your best to not buy processed foods.

But I feel like we can do unprocessed, real food, nutrient-dense food, cheaply. We just got to be more intentional about maybe going to, you know, maybe food co-ops and going, again, frozen section and then also kind of just staying around the perimeter. I mean, stores like Walmart and Aldi have done such a great job, I think, of like making these types of. the food's more accessible and affordable. And yeah, I love the idea of, you know, frozen berries and, you know, being able to put them into smoothies or you have a son, obviously, Kingston. How do you think about kids and getting them on the right track? This is a little bit of a small tangent.

But I know as a, you know, there's lots of moms listening and dads and who are trying to think about how do we get, you know, because a lot of like setting ourselves up for the future is kind of getting these good habits early. I just wonder how you deal with, you know, getting Kingston eat good food. Yeah, it started really early. It started when I was pregnant, really. I was very much primed for, I mean, I was wearing a CGM throughout my entire pregnancy. I was on an autoimmune protocol when I was in my pregnancy.

Like, I really wanted to reduce inflammation and to really build his brain in utero. But I think about the N. Hane study that's continuing where the newest researchers came out with one in three children are pre-diabetic and one and four are full-blown diabetes. And I just, oh my gosh, it breaks my heart. And then, you know, are we surprised that, you know, one of women and girls are struggling with polycystic ovarian syndrome? We're at the epicenter of that. We're looking at insulin resistance. And so, you know, I think about the women and the girls that are coming in, you know,

with something like polycystic ovarian syndrome into perimenopause. Which is a metabolic disorder. It's a metabolic disorder hands down. And how it's no wonder that perimenopause is feeling more intense, more exacerbated when we're already coming in with, you know, kind of metabolic disruption. Does it come sooner? Oh, soon. Absolutely.

When you have metabolic. Yeah. Is that data firm? We are still looking at, I think right now we know that women are experiencing paramedopause earlier, a bit earlier, like as early as our mid-30s. So lifestyle can accelerate the onset of paramedopause. Absolutely. Can lifestyle delay the onset?

Yes. So, I mean, reproductive longevity? Yes. We don't have a lot of data in terms of how. much we can extend that reproductive longevity. Let's say we know that the average age of natural menopause is between 45 and 55 years old. And ideally we want to be on the 55 years old spectrum. And yes, I do believe that there are things that we can do lifestyle-wise to reduce the amount of stress, to keep our metabolic health really dialed and optimal so that we can extend that cellular

longevity or that reproductive longevity. Absolutely. Again, lots of, I would say that's a lot of the emerging science that's coming out about how we can do that. But I think women at this point, we can stretch a little bit, you know, at least maybe a year or two kind of prolong. But unfortunately, more so when we only have 7% of adults that are metabolically healthy, we tend to see it probably go the other direction. And it starts with our children, you know, kind of going full circle. So with Kingston, I'm really mindful about, one, what we're buying. You know, my son goes to farm camp. So he's picking vegetables, you know, throughout the day. He's cultivating dinner in a lot of ways. And we're buying from that beautiful

farm as well. You have a little farmer's market. And so he is, he is attuned to the process of how food is made. He gets to be a part of that journey. And then it's on his plate. So we really focus, again, focus on protein, lots of fiber-rich foods, whether it's fruits and veggies. And so and healthy fats. So like avocado and olive oil and things like that. And that's just been the through line. We don't bring food into the house that is ultra processed. I don't serve up. I remember when my son was two, probably during this time where I was going through the concussion healing journey, I think we were, I was kind of making a little some shortcuts, you know, a couple, just because I was barely getting through my life and my day. But maybe it was a research article that

I had just read or a study. And I remember going to my husband and I was like, listen, we are cooking. That's just what we're doing. Like in order to ensure that our son is healthy and thriving and that is metabolic health is fully dialed, we are making like every day, we are taking the time and the energy to be in the kitchen to make food for the family. Like that is a priority. And I understand that people are hearing that and thinking, like, I just don't have time. But I'm telling you like you're either spending time now on taking care of yourself on having, you know, having discernment to like really nourish your body or you're going to be spending the time later and that's going to really be addressing those debilitating health conditions. And so probably

one of the most time that I spend that's the most intentional but is the most worthwhile time that I'm spending for my family is being in the kitchen. Yeah. And food prepping. Yeah. Yeah. It just has to be kind of a way of being in the world and you just have to embrace it. Yeah, yeah. And I always think, like, you know, going out to dinner is awesome, but that needs to be a couple times a month. You know, I feel like if you cook meals at home, you give yourself a chance. You control the ingredients. Yeah. You control, like, what you're cooking with, how you're cooking. You control serving sizes, portion sizes, all of that. And you're connecting with each other. We have a record player in the kitchen.

We have dance parties in the kitchen. My son is helping us make dinner and make meals or he's helping to make, you know, really yummy fiber-rich muffins for school, for snacks, like protein and fiber-rich. So he's very much involved in the process. And then we all sit down as a family together after that and we talk about our day. Like, what is the one thing you would love for me to know about your day? Or what was the one thing that felt really good or what are you most appreciative? So we're really mindful about connecting and communicating.

community around the table. And I think that whole through line of making dinner together and then sitting together, that to me is really building connection as a family, but also helping to support my son's overall vitality, energy, and life force. You're invited to join the waitlist for WOOP Advanced Labs. Advanced Labs delivers clinician reviewed lab results right into your Woop app for the most complete view of your biomarkers and biometrics and the most comprehensive. And the most comprehensive understanding of your health. Unlike other tests, WOOP integrates your lab results with your WOOP data. See how your habits and behaviors influence your biomarkers and get clear guidance on what to change to improve your results. To join the wait list, visit our website or

the health tab in the Woop app. Okay, let's talk a little bit more about metabolic resistance and just midlife, because that just seems to be a really important through line. And you talked about food, you talk about sleep. What are some of the other, you mentioned cortisol awakening response too. Maybe just tell our listeners like, what is that? And what should they be paying attention to there? Because I think that's something that you can get measured and you can measure in a lab. That could be the first sign that something is going awry potentially if all other things are equal. So just maybe describe what that is and why that may be important marker. Yeah, absolutely. I think, you know, especially right now all over social media, cortisol is

is the bad guy. Yeah, people don't understand it. They don't really understand cortisol. And yes, can it be overused? I think about our hormones as really profound chemical messengers that are just doing the best they can with what they got in the circumstances that they're in. And if you're living a survival-driven life where you're running from one emergency to the next, well, then you're going to have these hormones that are doing their best to just maintain capacity

while you do that, cortisol being one of those. And I'm not going to pretend like it isn't a really profound survival hormone, but it is queued up in the morning to wake us up. And that actually starts even earlier than when you wake up. Your cortisol begins to kind of slightly raise around 4 o'clock in the morning and then 5 o'clock in the morning. Let's say you're getting up at 6.30 in the morning. But that cortisol awakening response is that spike in cortisol in the morning right around when

you wake up a little bit after you wake up. That really tells your body to go from getting in bed, waking up to let's go. Like, let's do this. Let's do this day. And for many of us, if we are, you know, again, under capacity, we're really not getting good restful sleep. Our circadian rhythm is not well optimized. You know, we're not seeing that melatonin rise as we would love.

And we've just been, again, running on fumes for many, many years. And we're not honoring that sleep consistency and treating that sleep where they gets a million dollar meeting. We're going to see that that cortisol awakening response is just not responsive. Yeah. You're not going to wake up in the morning. I remember being. 30 years old and that's when I knew something was inherently wrong when I wasn't able to even get up

and get out of bed. Like I was like, okay, now I know that things are so deregulated that I've got to pull, I got to really reassess how I'm living my life. That was my kind of defining moment. So I've had an interesting relationship with cortisol over the years. And that's not cortisol. It's a interesting relationship with my stress response system that I've over activated over the years. But I would say that if you're not able to wake up and get up, that, you know, I would highly recommend testing your cortisol. And I would recommend a diurnal cortisol, like a 24-hour cortisol curve, just to see, you know, what does it look like when first time wake up? What does it look like mid-morning, mid-afternoon in the evening? Is it even following its circadian rhythm? And if it's not,

then we're going to have to bring in lifestyle strategies that help get it into alignment. And one of those strategies that I absolutely love, like let's say you just had, for whatever reason, crappy sleep, you know, majority of women in midlife are struggling with sleep issues. Maybe you ended up staying up too late because you had to respond to all the emails or whatever, whatever the reason was. Still getting up consistently at that same time in the morning and getting sunlight in your eyes is going to help regulate the system. So there's a lot of interventions that we can bring in that can help get us on track

as we are trying to re-regulate that cortisol response. Yep. And I would say, you know, this happens a lot with frontline health care. and, you know, folks working shifts and, yeah. And I would say, yeah, I completely agree, you know, waking up at a consistent time as often as possible is going to be the best thing that you can do for your hormones. I will say if you do have short sleep, you had to attend those emails for whatever reason. You do the thing that you're saying, you wake up, you will probably feel sleepy around lunchtime, take a nap. Like, that is a great way to not kind of ruin your nighttime sleep, but.

to honor the rhythm that you're talking about in terms of cortisol. So, you know, I think we can get into these vicious cycles, you know, and one way to maintain it is to indeed kind of wake up at a consistent time, kind of even if it means you're getting a little bit of a shorter sleep, but you can kind of mitigate that with a nap. Yeah, like a small nap. Yeah, a short, a 30-minute nap, you know, is going to do a lot to just, you know, block that adenosine and kind of get you in a place where, you know, you have, you know, best. alertness and you can kind of attend your task in a way that feels good.

And so, yeah, I think these, like, little kind of tweaks can help us. So what's happening when, you know, because you probably hear this all the time, I know I do, you know, folks are waking up at 2 a.m. and they get that spike in cortisol at 3 a.m., which is really unfortunate, right? You feel wide awake. What is actually happening there? And because this is really a feature of parimenopause, I think, and just a feature of just how we age. Is it not managing stress during the day?

Is it something hormonally that's happening? You know, what's going on? It's a yes and. Yeah. Yeah, it's definitely not managing stress throughout the day. I would say that, you know, midlife and perimenopause is the messy middle. It's very much the messy middle. But I think what makes it the messy middle is that your hormones are radically shifting, particularly progesterone.

You know, progesterone is that calming hormone in that second half of your cycle. And when that's being disrupted, when I think about perimenopause, I think about it being a neuroendocrine. transition. So majority of the symptoms are going to be brain-related, including sleep. So I think women overall, they're probably taking on, they're at capacity during the day. They're continuously up-leveling that stress response system, whether they know it or not. You know, they can just feel like they're just handling business. It could feel like they're just handling the demands of their day, that they don't even may not notice that they're up-regulating that stress response system and the HPO axis. So now we've got this kind of spillover of cortisol throughout the day

that's not being well managed. We've got potentially blood glucose deregulation heading into sleep as well. And then we have declining progesterone levels that can start, you know, as early as our mid-30s. And then melatonin is declining too. So melatonin is declining very similarly to progesterone starting around our mid-30s. And that melatonin decline has a profound impact on our sleep. So yeah, you get that first little cortisol hit around 3 o'clock, 3.30 in the morning, but you've got spillover from that it's completely deregulated, then it's going to feel like an actual cortisol awakening response, you know, versus just it should be imperceptible because melatonin should be there and melatonin should be, you know, keeping that maintained. But if melatonin isn't keeping it

maintained because she didn't show up to work, you know, for a multitude of lifestyle reasons, and whether it's age and perimenopause, that hormone is declining as well. Yeah. Yeah, it's when we bypass that natural pressure for sleep. We don't end up releasing melatonin, and then we're waking up at 2 a.m. Exactly. So I think a lot of women might say, I am doing all the things, you know, but I still have these, like, really insane symptoms. Is that true?

Are women really doing all the things? Or are they they think they're doing all the things? Is there a way to really bypass these symptoms of perimenopause? I think a lot of women are doing a lot of things. I think that they are doing probably too many things. You know, like we do anything. How you do one thing is how you do everything. And so there's a lot of over-efforting.

I think the big through line for this transition is being discerning, is discernment. And we can really gather a lot of information about ourselves through, our labs through tracking our cycle, tracking our symptoms, and looking our biometrics. I think discernment is such a big part of this. You know, what got you here isn't going to get you to the next level. We need a new plan, a new strategy. And for so many of us, again, we talked about the big pillars, how we are tuning to our bodies in terms of the molecular information that we're putting in our systems, how we are really honoring our sleep routine and our sleep consistency. We haven't talked about movement.

honoring our circadian rhythm. And more importantly, honoring ourselves. You know, up into this point, you probably could get away with not prioritizing yourself because we've always been told to prioritize everyone and everything else. But now everything is up for review. You know, how you have been living your life up into this point, we have to shift it, especially if you are symptomatic. You are struggling with some pretty severe symptoms that are disrupting your life and disrupting your health. And I think the more clear that we can get about what, we need to prioritize what your non-negotiables are, the sooner you get to that, the better. Another big thing I think, at least for me in this journey, has really been movement.

Yeah. You know, I'm just going to say it. I think, you know, this can feel a little bit controversial because the idea of asking someone to do this, I think can be a bit much. But I truly believe that we need to build our lives around movement throughout every day, all day. I agree. I mean, morning, I mean, every hour, on the hour. You know, I grew up with the myth that if I did the big workout, the big string training workout, the big stringing workout, I could sit all day. I know. I'd have to do anything all day. Like, I did, I did the thing I needed to do.

That's one of the great things with CGM data. You can see that that is not a path. No, it is not a path. That is not a path. Yeah. No. I mean. And so I, the CGM data is really where I learned this, not only with my patients, with myself. And I, when I moved consistently, continuously, throughout my day all day long. Feel better, sleep better. Periods better. Everything is better. And my blood glucose was in optimal, optimal range. We're talking like 75 milligrams per decilator to 95 milligrams, is a tight. And sleep was better.

Sleep was more consistent. I had more deep rest of sleep. Oh, it was so much better. I felt more awake. I felt more alive. I felt more mentally ready to go in my day. And I felt more regulated in my body. That was probably the most important as a, as a.

As a practitioner and a woman who has spent many of my years deregulated, moving my body has been one of the most mission critical things that I have done to help regulate my system. And we're talking walking or exercise snacks, definitely resistance training, but walking has been one of my absolute favorite ways to regulate my stress response system throughout the day, but also gently keep my blood glucose in range. Now, I get that walking is not always available to everyone depending on where you're at, where you live, how hot or cold it is. Yeah, might not be safe, yeah.

Exactly. Or that your son doesn't want to walk after a meal. He wants to play Lego. It's like you can't just leave the house, whatever it may be. And then integrate exercise snacks. You know, I walk up and down my stairs with weights. I do usually 60 jump squats or three sets of 20 jump squats. Like there's so many ways to create movement into your building into your day,

especially after meals, that it should be doable for every single one of us. I love that. You know, I have become just an enormous fan of exercise snacks. I just feel so much better when I'm building them in throughout the day. Like I did, I did a kind of a two mile run this morning. And then throughout the day, you know, I have kettlebells in my office. I have fans in my office. And, you know, I'll just, I just put like little kind of check marks. And I just do, I have to, you know, just check off these 10 things of course the day. And it might be, you know, I'll do five to 10 golf squats. I'll do, you know, five to 10 kettlebell

swings. And I'll do some sit-ups. I'll do some body squats. And, you know, I just have to do 10, 10 things over the course of the day and I have to have these little check marks. I love this. You know, it's just a simple way. So this is always going to be above and beyond my kind of workout, you know, whatever it is that that I did in that consolidated hour of, you know, kind of training. But I think it's just a, it's a shift in kind of our mindset, I think. And an important shift. It's huge. Huge. It's a game changer. And you feel so much better. Like I used to hit a wall at three o'clock every day. And I would supplement that wall with a coffee or something. And I realized, I was like, there's another way that I can recharge my mitochondria. I can boost my metabolism.

I can create short bursts of movement very quickly, mountain climbers, jump squats, jack squats, kettle squats, you know, I have weights right next to my, I have a kettlebell and weights next to my desk at all times. We're talking 60 seconds, two minutes, up to five minutes, where you were just revving up your heart rate and you get back into whatever you're doing. Increases the blood flow in the brain. Tell me you don't feel better. Tell me you don't feel more energized. Tell me you don't feel like you can tackle the day.

And you'll get so much. You'll get fit. You'll get really fit, I think, with you incorporating that. Yeah, you're going to lose. We're talking about fat burn. We're talking about blood circulation to the body. We're talking about increasing oxygen capacity. Yeah, it's just, it's a win all along.

And again, for any of us that are at, you know, work spaces all day long, you're going to have meeting breaks. You're going to have that ability to just take a little moment. And this should really be considered. Just literally one minute. One minute. Between meeting. Like you can do 20 kettleball swings. You can do a lot in 60 seconds. There's like no excuse in my opinion. I mean, and I'll be, sometimes I'll be like in a, you know, I'll have heels and jeans on. And I can still do kettlebell swings and heels and jeans. Well, that's what makes women so incredible. I know. Right. So I really believe that there are no excuses at this point. And it has become just a non-negotiable. We know that the link between quality muscle tissue and longevity

is irrefutable at this point, right? So we need to be thinking. And women especially, every woman on the planet must strength train. For their brain, for their heart, for their metabolic health, for their aliveness. I don't know about you, but I am, yes, exactly for their symptoms. I am training for my grandma self. Yeah. You know, and that's a long way away. I know. My God, I'm not that far. My kids are 18 and 17. It's that wild. I'm like, I could be a grandma soon. I'm so excited for that. But yeah, it's, I love that mindset, you know, of just being. And I just think when we are strong, we, the how we move in the world fundamentally shifts. Fundamentally shifts. I see that in my patience. Just an example, I was talking a little bit of my mom is 64 and she can pick my son up

off the ground. She can race with him, run with him, play with him, be on the floor with him, doing a puzzle. I have a best friend of mine who's little boys about the same age as my son. And her mom is the same age as my mom. I think a couple years younger. She isn't feel comfortable watching him without somebody else present. She can't get on the floor with him. It's a very different experience that she is having with her grandson, then the experience that my mother is having with her grandson, right? This particular grandma is negotiating with what she can and can't do. You know, can she get in and out of a car easily? You know, these are the things that she's having to deal with in her early 60s versus my mother who is traveling solo, climbing mountains,

hiking. Running marathons. Yeah, running marathons. Like, nothing is up for review. my mom in terms of her capacity and it just it can go one way or the other and I think that's what perimenopause is mostly more importantly than anything else is it is a crossroads right we've been told that we just have to go the default path but it doesn't need to be that way we can decide we can choose how we want the second half of our life to be and how we want to live it I love that so do you mind talking about fasted training real quick. Just curious, your thoughts on it. I know it's some recent discourse that it's totally fine and that we're kind of over-indexing on the dilettarious effects. Can you give us your insight? Yeah, I mean, from my own patients and from a clinical perspective and even

myself, you know, when we show up to a workout, especially a heavy lift day, which is three to five days out of my week, you know, where I'm lifting, I'm doing some pretty big, because I'm trying to, again, I'm trying to Maintain that muscle while hormones are shifting and declining. And when I show up fasted, like I don't have as much capacity. I don't have the energy thing, right? Yeah, I don't have the energy. Yeah. Like, it's just the quality of that workout isn't the same.

And so even if it's a small protein snack, something that's going to give your body the fuel to get through that workout, it sets us up to win. Yeah. Yeah. I just don't think we as women, particularly in midlife, have that level. of resilience to push through a really big workout like that without some type of substrate, something very nutrient dense in our system. Yeah. I find running much more capable of kind of pushing through.

And I seem to be, fat seems to be a decent fuel source for me to manage, you know, longer runs and, you know, without any taking on any fuel. But lifting, I cannot lift without, like, feeling like I have, yeah, a good meal in my body. I think, too, if I end up eating later, sometimes I will train fasted just because I still have those, the glycogen, you know, accessible, still kind of available. What's the baseline knowledge you wish every woman had by the time she turns 35? And 35 the right age? I would say yes. Okay.

I would say 35. I mean, 30, even better. Even better still. But I'll take 30. I'm trying to educate my daughter now and she's 17, you know, just so she's armed. Gosh, the puberty transition, we think about that transition as hormones are coming on the line, you know, how we can really support our girls metabolically in terms of being well-nourished as their hormones are coming online for the childbearing years.

I mean, even then, that can be so turbulent for so many girls. And that's when we start to see. I mean, if there's compromised metabolic health there, we start to see significant irregular cycles and maybe even early signs of polycystic ovarian syndrome. So I think as soon as possible. But particularly to prime up for Perry, I would say mid-30s is probably a great place to start because we do know that progesterone is going to start to slightly begin to shift and decline. Every woman's a little bit different.

But as a whole, in my experience, we'll start to see a little bit of that. There's a reason why when we're talking about women trying to get pregnant after the age of 35, we know that we've got to be more intentional even as practitioners in terms of looking at hormones for women at that age. Because there's only so many eggs left at that point. So I would say gain agency. As much agency and knowledge and data about your body as possible, ideally be tracking your cycle every single month, especially if it is your regular so that you can understand what is going on with your cycle. That type of data allows you to advocate and really kind of fight for what is going on with your body. Start the timeline of labs right now at 35 years old so that we will know your normals, you know, because what may be normal for you may not be normal for you may not be normal.

somebody else, but only way where I really know that is if I've got a timeline of labs. I am able as a clinician to really make very, you know, critical protocols for my women based on a timeline of labs. And so the more data that I can take in to help support you, that just really allows me to kind of dictate that protocol. So tracking symptoms, knowing your labs, you're having that timeline, and then becoming very intentional about your values and your non-negotiables. I would say the majority of women will start to see and feel some level of a shift, pay attention to that shift when it's still a whisper. Instead, so that you don't have a Mack truck moment at 41 or 42 years old. So well said. Yeah. So that's what I would recommend. That information is going to help really

indicate and dictate your lifestyle, your habits, and how you have that conversation with your provider and how you know if you need a second opinion or not. And then most importantly, if you're really, really want to attune to your body is track those biometrics. Mack truck moment. That's really good. And that's exactly what it is. Yeah. Yeah.

And I mean, I love, you're obviously, you know, speaking as a clinician and someone who's experience has had these mactruck moments. And that's what you're warning, you know, the rest of us against, you know, and pay attention to your body to the signals, understand what those signals are, you know. And I think that's the knowledge piece, you know, because a lot of times women might not know what to look out for, you know, and that's where I hope every woman follows you, you know, because you lay this out so clearly, you know, and kind of the conversations you have online on Instagram and you've done just a beautiful job. You're one of the OGs, you know, in terms of helping women

level up in all areas of their life. So just really grateful for the work that you do. It's epic. So finally, I wanted to know a little bit about kind of some of the routines that you have really been kind of go to for you and for the women that you support. You know, so just any part of the routine that you want to maybe highlight that you think is really protective against, you know, some of the symptoms, I guess beyond, you know, maybe the exercise, the big rocks, you know, what are just some of kind of the more supportive things people can do around these big rocks that you've already identified? Yeah.

I know I've spoken to a little bit of the evening in the morning routine, but I will tell you if there was an area, a time of your day to protect, it's going to be in the evening and the morning. Like, I love that quote by Louise Hay, is how you live your life, it's how you live your day. And how you live your day is how you start your day. I remember starting my day. It was controlled chaos for several years. And I was like, oh, I wonder why the rest of my day is me reacting to everything.

There's no intention. You know, I'm not clear. I'm not day setting. I'm not setting with gratitude. I'm not setting myself up for success. And I believe that we deserve to set our future selves up for success. And so in the evening, after my son goes to bed, that is now me time. Now we're in my million dollar meeting. There's nothing or no one, unless it's my son that is as important as that routine. And for me, usually it'll be the sauna. I'll go in the sauna. I'll read in the sauna. No

screens are allowed in the sauna. So I'll do the sauna for about. 30 minutes and then I take my supplements, my magnesium, and I take, you know, I'll take omegas then. I got a little, you know, all of my. So I think there's always some evening supplements, but that is a signal. Usually the supplements are a signal to my body that, okay, we are winding this down. We're taking our evening supplements. I head upstairs. Lights are already pre-dimmed in my house. I feel like a vampire. Like I can't even like be in a bright lit anywhere. So I'm in my room, you know, you do your kind of your face routine, brush your teeth, all those things. But then I am Without the glaring lights. Without the glaring lights. Yes. Everything yes. I know. I know. I can't do. I can't

even do it. My brain's like, don't do that. Please don't do that. That's good. And then I'm in my room. And once I'm in my room, like obviously blackout curtains, all those things are set up already. And that's what's so great about a lot of these kind of that sleep hygiene is that once you set, like blackout curtains, making sure that you've got kind of amber lighting or dim lighting, like once that is done, you can pretty much just set that up for every day. But I love reading. Reading, you know, just moving the eye across the page helps to re-regulate me. I'm just in bed. I'm either journaling. I have a gratitude practice. And also before that, the little bit of rewind is that I'm usually getting up at 6 o'clock in the morning or 5.45. So I'm laying out my clothes. I have my water ready.

I've got the keys at the door. I've got my shoes at the door. So I am really setting up my future self for success. Sometimes it's a protein coffee in the fridge or sometimes it's like a little protein snack ready to go so that I can grab it and head to the gym. But that's usually what I'm doing. So really setting yourself up for success for the next day and really honoring your body and your brain and your sleep that night. I think it's so mission critical.

Throughout my day, I would say that connection with the women that I love is so important. I know so often when we're dealing with these symptoms and we're doing. dealing with the chaos of this transition, again, that messy middle, we can go inward. And this is not the time to go inward. I know that there are days, I know on my migraine days, when I have a migraine, it feels like no one understands or no one gets the level of debilitating pain that I'm in. But I know that there's millions of women dealing with migraines everywhere. 80% of migraine patients are women.

And so that's when I'm usually like every day connecting to friends and having conversations and talking to my book besties and walking with my friends. And so I really build in as much connection as possible. I think that that has been such a beautiful through line to feeling more regulated and to feeling more connected. You know, I think the research is so clear on this as well, that community and connection, like spending time with people in real life doing the things that you love, I don't know if there's anything more important than that.

So building in community and connection with my friends is so important as well. And I think every woman should really tap in to those, that community and to their friends. And then the last thing I would recommend for women is carving out a lone time for you. Not time where you are doing emails or responding on social media. I mean, this is your time. Ideally outside in nature, but just carving out time for you to feel centered. A friend of mine, a dear friend of mine who helps women with nervous system regulation. She says, you know, so often we're looking at the computer right in front of us or a screen

right in front of us. And she's like, if you could just even look five feet out, five feet out outside, allow your brain to just daydream and wonder a couple of times a day, kind of similar to your exercise snacks. Like that helps to re-regulate that stress response system and helps to kind of calm things down and just get you back to homeostasis. So it's these little things like that, punctuating your day with rituals of self-care, even again, one minute or two minutes can help you feel more resourced in your body. Yeah. This is like these many moments where we're activating the parasympathic branch,

the nervous system to your point. Like just even looking out into a horizon or, you know, expanding, you know, your vision is going to reduce your heart rate. You know, it's like it's just a beautiful response that we don't even have to will ourselves. You know, we just literally have to look up to your point and extend our vision. and we get this amazing heart re-response. We have a rapid fire icebreaker. All right, so true or false, your birth control might be sabotaging your sleep.

True. Interesting. True or false, hormones affect your sex drive more than your mindset. Sex drive more than your mindset. God, I would say that's a yes and. But yeah, sex drive is significantly affected. true or false you can gain weight from stress even if your diet doesn't change yes true true or false your morning coffee is wrecking your hormones

depends it can yes feel free to expand yeah absolutely I think it depends a lot on what is your stress resilience and capacity to begin with or what is the state of your metabolic health so I've looked at you know continuous glucose monitor data for years now and some women can have an espresso, nothing, no change. Other women can have an espresso and major blood sugar spike. It just really depends on your, how you're waking up, your cortisol awakening response, your circadian rhythm, optimization, all of those things are at play. Your sleep, yep. Yeah, everything. True or false, most women are mis-sagnosed during perimenopause. True. Let's go, if you don't mind, but I think the birth control one,

I think is really interesting. And if you can just say a little bit of about hormone replacement therapy as well. Women who are transitioning into perimenopause, they realize, okay, I've got a lot of these symptoms related to paramedopause. Maybe it's a regular period, heavy period. You know, they are noticing sleep disruptions. They go to their OBGYN, and the OBGYN recommends birth control. What are your thoughts on that? And there's lots of different types of birth control. Is one okay versus another? Break that down for us. Let's just define what birth control is very quickly. It is contraception.

It basically shuts down our ovulatory cycle and our hormones, a part of that ovulatory cycle. So if you were to test a woman on hormonal birth control, you're going to see that their hormones are at a very low state because they are being suppressed. So that is a process of suppression. In perimenopause, yes, there's going to be women who have very, very heavy periods and, you know, flooding. And, you know, in those particular instances, I think birth control can be really helpful because that is extremely disruptive, and it can really mess with your quality of life. Also, women who are struggling with very, very, very severe, like things like PMDD, maybe, you know, birth control can be supportive.

However, for a majority of us, there's a lot of players here besides hormones disrupting and getting to the root cause of what is going on, I think is always important. And just silencing those hormones with birth control pill, I don't think is always the most helpful response. Currently, it's technically the gold standard of care for women in pari menopause. Now, with a lot of combination pills, we're looking at these are synthetic hormones. So synthetic estrogens and a progestin, right? And progestins don't have the same impact as progesterone on the brain.

Again, I talked about perimenopause being a neuroendocrine transition. We know the brain is vastly impacted. We know the brain is massively reorganizing. And so, yeah, it may be addressing some of the menstrual cycle changes because, again, we're just shutting that down, but it is not addressing the brain fog, the sleep issues. the mood swings, the irritability, the low stress tolerance, all of the cacophony of brain-related symptoms. And so in that case, we'll see providers recommending oral micronized progesterone on top of hormonal birth control, particularly like a progestion-driven IUD. But again,

not that they can't be supportive to some degree, but I also think that it can be a bit lazy when we aren't looking at the full spectrum, the comprehensive, you know, like the whole body experience of perimenopause into menopause. And so when we are, we're shutting a lot of those systems down, you know, I will say that, you know, Dr. Sarah Hill, who wrote, you know, love has done a lot of research on our brains being on the pill and on, you know, on synthetic hormones. And we know that it does impact the brain. and not necessarily in a great and significantly positive way. And so, yes, I've had women with the pill on its own right drive mood swings and drive more stress and drive, you know, anxiousness and, you know, cause sleep issues.

And so it really depends on the woman. I think that's so important to really listen to your body and know that, okay, being on birth control, how is it impacting my overall quality of life? Is it affecting my brain? and then if that is true, kind of renegotiate a protocol that works for you. I am a big proponent of bioidentical hormone replacement therapy. I love the real deal. And what's the difference between kind of hormonal birth control versus bioidentical? Yes.

So bioidentical hormone replacement therapy is identical to the molecules of progesterone and estradiol that we make inside of our body. Yes, it's made into labs. I don't want you to think that these are still exogenous hormones. hormones, but they are in the exact molecular structure as the hormones that we use in our body. And so they're able to bind to these receptor sites, you know, for estrogen, the alpha and beta receptor sites and also for progesterone too. And so my recommendation is we should be bringing in hormone replacement therapy in perimenopause, so sooner than menopause, to mitigate some of these symptoms, but that we should be giving women the real deal and going from there.

And again, every woman's going to be different. There's no one-size-fits-all when it comes to building out a plan and a protocol. And if anything in perimenopause, you, the one guarantee I can promise is you're going to shift and change throughout the journey. And so your dosage, application, all of that's going to change as well. But I just want women to know that there is an option of bioidentical hormones available. I think that should be the first thing we try before we just put a woman on the pill. Can HRT work without kind of in parallel exercise, nutrition, sleep, abstaining from alcohol?

That's a big one. Yeah, abstainting from alcohol. We didn't even talk about that. You and I both feel very strongly. Strongly about this. Yeah. Yeah. Yeah.

Yeah. It's a no-go. It just really, yeah. The dad is clear. And that's where I, it's interesting, you know, when I observe women and you hear them talk and be like, I'm doing all the things and they're having two glasses of wine a night. I'm like, that, that is sabotaging your efforts in the biggest way. I just, I feel like the role of alcohol, we've got a paper in review right now that is going to be very eye-opening for women. Yeah, alcohol has that to go.

It just, there's no place. There really isn't. So say a bit more about that. Yeah. So as we were talking, as you were going to show in your paper, and I know that with the data, I've seen the data. Yeah. You know, when women have just a glass of wine the night before with dinner. my gosh, I see a significant drop in heart rate variability and resting heart rate and sleep quality,

deep sleep. It all just tanks. So we know that there is nothing healthy or beneficial when it comes to alcohol in the brain. And the body has to work so hard to prioritize processing and detoxifying that poison out of the system before it can do anything else. So I just want to make that clear. So if you're noticing that you don't have the same capacity after drinking that glass of wine like you did in your 20s. I mean, not that it was beneficial then either. Yeah. You're more resilient or robust. You know, you can maybe get away with it. Still wasn't ever good for you, right? It never was good for me. But the second. And it hurts you later in life, most likely. Yes, for sure. Yeah. Absolutely. It's a reality. Yeah. Accelerates your aging. I mean, that's the thing I mean, we didn't really

connect into is that how much of how we lived our lives in our 20s and our 30s is really adding up to. It bears its head later on. Later on. Yeah. It'll come for you. Also, you know, someone listening to this in their 40s, they're like, well, there's nothing I can do about what I did. That's not true either. Yeah. Yeah. Yeah. So what can I do moving forward, you know, now from this place? So I understand that. But yeah, if you're noticing that you're waking up groggy or off, not a hangover, but just off. Like, you're not fully 100% in full function. It's time to put the wine aside. Like give yourself just a 30 day break. See how you feel. Look at your biometrics. And based on that data, for example, I have a dear friend and a patient of mine

who is 36 years old, ran her labs and had her take her labs to her practitioner, ran her labs and she is pre-diabetic. She has metabolic syndrome. She has, her progesterone is tanked. And even her lipoprotein little A is like 150 milligrams per decilator, like scary numbers. Oh, my God. She has, she's two little boys under age of five, and she is just like so many women, surviving, surviving as a working mom, doing the best she can, taking on most of the mental and physical load of being a mother, and just has not felt well in a while. And I remember calling her and saying, hey, are you okay with me really laying this out? Because I'm very worried. Like you've got metabolic syndrome, you're pre-diabetic and your cardiovascular lab.

are scary. Period. Like, we have to do a massive lifestyle shift. We got to make you a different person. And the thing she said to me is she's like, don't take away the alcohol. Like, don't, I can't have alcohol out of my life forever. And I responded. I was like, you know I'm pulling it. Like, that's part of the protocol, at least for the next 60 days. And here's what's going to happen in the next 60 days when we remove the alcohol and make these big shifts is you are going to be unrecognizable. And once you get to that place of being unrecognizable because you feel so much better and you are well more resourced and you've got energy in the tank and you can take care of your boys in a way that you haven't been able to take care of them, tell me then if you're willing

to bring alcohol back because I have a feeling it's going to be a no. So you start to feel good and tell me you're okay with bringing the stuff back that helps you, that just, that enables you to feel like crap. Yeah. And I, you know, it's, it's one of those things where I know, you know, alcohol can serve a purpose, right? Yeah, no. And, you know, but at the same time, it's not a long-term strategy. No, no, no. It's a long-term strategy towards brain inflammation. Yeah. You know, it's a long-term strategy towards poor mitochondrial function. It's a long-term strategy towards poor sleep and blood sugar regulation, that's what it's a long-term strategy for. Yeah.

Like we have, again, discernment, being intentional, that's what this is all about in this phase. Everything is up for review in perimenopause. And that is okay. I just need women to know that and need them to know that we get to create a new way of operating in the second half of our lives. and that ensures that you are feeling alive and that you're stepping fully into yourself. And it sounds like it's going to require like shifts. Major shifts.

Major shifts. Yeah. I think the conversation, you probably are giving everyone a pseudonym, but the client that you just talked to in terms of the 60 days, is, did you, is this a recent conversation? Is she through her 60 days? No, this is literally last week. So that's like, because I feel like a lot of folks would be able to identify this. You know, you're, you're approaching 40, you know, you go out with friends, you're

barbecuing on the weekends, like alcohol is just a feature of your life. But we know from the data, we both know that that is the biggest saboteur, likely. Lack of exercise, of course. But when you think about the impact alcohol has on sleep, hormones, and just your capacity to exercise, like, everything, it has to go, right? Right. So how do you, how do the women you talk to? Like, how do they get over that hump? Because they're using alcohol for a reason. Yep. Absolutely. Which makes it hard to stop. But it's getting in the way of the quadry of life.

Yeah. It's a meaningful conversation. One really figuring and figuring out and identifying the why behind the alcohol. Is it stress relieving? Is it social? what is it that is driving you to have, you know, glasses of wine or whatever alcohol you're consuming throughout the week and the weekend? And then, okay, now that I'm clear on what the motivation is, you know, what can we swap in to still do the same thing? Like, you can still be social with a mocktail. You can still, we can create an adaptogenic drink, like maybe a holy basil tea or a magnesium macktail that can help kind of calm the nervous system before bed. Like we can build that in. And so I think it's really about the swap.

Like once I'm clear on what the motivation is and, you know, I understand why you're doing it, then we can create rituals and we can create mottails and all kinds of things to swap it out so that you're still having the experience without the deteriorous effects of it. And now, I mean, there hasn't been a bar restaurant I've gone in in the last few years that doesn't have a non-alcoholic option. Yeah, there tend to be sugar forward. Yeah, some of them. I bring my own mottail in my Stanley at this point because I don't want to spike my blood glucose, especially in the evening when I'm already relatively more insulin resistant. There's no sugar kind of champagne alternatives, no sugar wine alternatives.

You know, there's some really good alternatives that can make you feel like a part of it. What would you say, you know, for the friends who make you feel bad, you know, for having a mocktail? I would say that it just doesn't support my brain. I don't feel good in the morning. I usually attach it to function. Like I just, I don't show up the way that I want. But what I say most importantly is that alcohol is going to drive my migraines. And I just can't afford to have a migraine.

And that just hard stop shuts the conversation down. When you explain to friends and family that alcohol is going to have a significantly negative effect on you and how you show up as an individual or as a mom or even as a friend, then they understand. They get it. They stop pressuring you around that. They get that you are supporting your health and you are mitigating symptoms. And that would be, I mean, gosh, it would be horrible of them to be like, but still, you know. Some people do really feel a lot of that social pressure. You know, it can be hard, you know, especially when that's just been a feature of your life. And, you know, those changes are a mirror sometimes. And I think people feel judged without even, you know, like, you just have to make people know that this isn't about them in any way.

Totally. Or like for me, I remember I was, I was a bartender. Like I grew up in alcohol culture, in mixology culture, in the Bay Area, San Francisco Bay Area. And I used to think that kind of a buzzed or. a little like a couple drinks version of me was a like a happier or a more gregarious version. And so I remember when I was starting to think about, you know, just taking alcohol out of my life. And I had to really grapple with like, I am I going to be just as fun, you know, at the party or at the restaurant or, you know, at the gathering without alcohol. And so the only way, and yes, absolutely, 100%. Like who I am is who I am. But experiment. And that's why I think it's first, it's the experimenting. Like, give yourself 30 days.

You know, start with seven and see how you do. And then go to 14 and then go to a whole month and see how you feel. And ideally track those biometrics. Watch your heart rate variability. Watch your sleep quality. Watch all of these things shift and change. I promise you, you will be a different human if you put down the alcohol for 30 days. And then from that place, that place of feeling more resource, more energized,

your brain firing all cylinders, then make the decision if you really need to bring alcohol back into your life. You need to keep me posted on what those 60 days look like. Is she going to make it? I think so. I think she's committed to the 60 days. And then we get to have that, yeah, reassess that conversation. I love that.

That's so exciting. Well, this has been such a fun conversation. Where can people buy your book? Yes. So the Perry Menopause Revolution, which is literally the book I wanted when I was going through this. It's a rallying cry. It's a movement. It's so good. It's such a beautiful gift. It is my love letter to every woman who is going through this transition. Yeah. And feeling alone. I'm going to walk you through all of it, including a five-week reset plan. It's got so many amazing bonuses,

exercise snack routines, workout routines, so many recipes to live, like eat metabolically healthy foods. And you're not even like there's a meal plan, but you don't need that. Once you know the foods and you know the cooking strategies. Like, you are good to go. Just plug it in. Yes. You just, this is your life moving forward. And like so much more. Community, self-care, nighttime routines, morning routines. I mean, I build it out for you in such a way that it almost feels like I do it for you. I love that. If we're only that easy. I try to get you as close as possible. Good. It sounds like it's very close. I cannot wait to read it. And I'm so grateful for you for so many reasons, but, you know, just all the work that

you've done and educating women and leveling us up in the most important ways. Your work is so inspiring. So thank you. Thank you. Thank you. Thank you. If you enjoyed this episode of the WOOP podcast, please leave a rating or review. Check us out on social. At Woop at Will Ahmed. If you have a question was answered on the podcast, email us, podcastuptu.com. Call us 508-434349.52. If you think about joining Whoop, you can visit Whoop.com, sign up for a free 30-day trial membership. New members to use the code Will, W-I-L-L, to get a $60 credit on Whoop accessories when you enter the code at checkout. That's a wrap, folks. Thank you all for listening.

We'll catch you next week on the Whoop podcast. As always, stay healthy and stay in the green.