101. Dr. Mariza Snyder: Why 80% of Perimenopause Symptoms Are Brain Related and Doctors Keep Missing It

Did you know, 80% of perimenopause symptoms are brain-related, but it takes 4-6 doctor visits to get a diagnosis? In this episode of Extend, Dr. Mariza Snyder reveals why perimenopause has been medicine's best-kept secret and how women can reclaim their health during this critical transition. We discuss why perimenopause is called "the silent shift," the protective power of hormone replacement therapy, and why suffering through this transition is completely optional. Dr. Mariza also shares her personal hormone protocol and why she believes women deserve the gold standard of care during this pivotal decade. Dr. Mariza Snyder is a hormone and metabolic health expert specializing in perimenopause and menopause care. She's the author of "The Perimenopause Revolution" and host of the "Energized with Dr. Mariza" podcast. With nearly 15 years of experience helping women navigate hormonal transitions, she advocates for preventative hormone replacement therapy and comprehensive biomarker tracking. We Also Discuss: 04:54 - Why 80% of Perimenopause Symptoms Are Brain-Related 07:49 - The "Silent Shift" That Happens Years Before Missing Periods 11:21 - Why Standard Blood Work Keeps Women Suffering in Silence 12:57 - The Biomarkers Every Woman Should Track Starting at 35 30:49 - What Women Can Do to Start Managing Perimenopause 39:45 - How Hormone Replacement Therapy Acts as Your "Protective Shield" 55:21 - The Truth About Breast Cancer Risk and HRT 1:01:21 - Advanced Cancer Screening Strategies for Women 1:05:24 - Why Sleep Consistency Can Change Your Life in 10 Days 1:06:23 - The Mindset Shifts That Make Perimenopause Empowering Thank You for Our Sponsors: NextHealth: Your destination for cutting-edge health optimization from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ https://www.instagram.com/nexthealth/https://www.instagram.com/darshanshahmd Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Mariza Snyder: Instagram: https://www.instagram.com/drmariza/ Website: https://drmariza.com/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Dr. Snyder, thank you so much for joining me on Extend.

• 0:51Speaker 01

  Dr. Shah, it's so good to be here.

• 0:53Dr. Darshan Shah?

  Yeah, this is so amazing that we were introduced by so many people, and they're like, "You have to have her on." And now that I get to know you a little bit more and your book, like, I'm so excited to dive into this with you.

• 1:05Speaker 01

  Yeah, thank you for letting me just spread the word about this profound transition. And I love your platform. I love what you're doing. I love that you are transforming health.

• 1:14Dr. Darshan Shah?

  Thank you so much. You know, when we started this podcast, we said that half the guests have to be women because there's so much that's not talked about for women. And I think perimenopause is definitely the one topic that women, until just recently, like, literally the last few years, have been told not to talk about.

• 1:35Speaker 01

  Yeah, no, it's been very much an area of dismissal for women. And women just thinking, "Okay, well, maybe it is just stress, or I'm being a mom, or maybe I'm just making it up." You know, so many of the symptoms of perimenopause are subjective. And when it comes to women's health, often when we come in with subjective symptoms, we aren't connecting the dots between those symptoms and it being perimenopause. In fact, in the US alone, it takes between four and six office visits for your primary doctor or even your OB-GYN to connect the dots between your symptoms and it being perimenopause.

• 2:07Dr. Darshan Shah?

  That's just mind blowing to me because it's not like perimenopause just started happening 10 years ago.

• 2:13Speaker 01

  No.

• 2:14Dr. Darshan Shah?

  This has been going on since the beginning of humanity.

• 2:16Speaker 01

  It's an inevitability.

• 2:17Dr. Darshan Shah?

  Right.

• 2:18Speaker 01

  If you live long enough, yes, it's gonna happen.

• 2:20Dr. Darshan Shah?

  I mean, and do you think some of that is a combination of maybe, you know, women were traditionally, you know, taught to suffer in silence with this? Combined with our medical system, just, you know, there's no silo for perimenopause, right? There's no silo for hormone health in Western medicine. It's either endocrinology, which is like a hormone, like a disease of the hormone system, or it's just a bunch of different silos based on the system that is being affected. Like if you have headaches, you go see a neurologist. If you have gut issues, you go see a GI doctor. Why do you think, why do you think it's been so ignored?

• 2:56Speaker 01

  Hmm, that is such a good question. I would say that we were paying attention to menopause. We kind of knew what menopause was mainly because we had medications for menopause. So we had, oh, hot flashes, night sweats, maybe some sleep issues, vaginal dryness, low libido. Okay, here's Primorin.

• 3:14Dr. Darshan Shah?

  So we had, we had a medication for the symptoms.

• 3:16Speaker 01

  Yeah, for the symptoms. And we kind of knew, you know, kind of when women go through menopause, it's that one day in time where they haven't had a period for 12 months and you're in menopause. And then we had a medication or a solution for menopause symptoms to manage those symptoms. But we didn't have anything for perimenopause. And here's the thing is that perimenopause into menopause is really a continuum. There's no, you go from one and then you reset to the other, right? You just keep going and I call it the silent shift. Because a lot of the changes that happen in perimenopause are your blood pressure is creeping up. Your blood glucose levels are going up. You are losing muscle mass, you're losing bone mass. And we don't feel these things.

• 3:59Speaker 01

  And so we didn't really have a quote unquote, you know, medication or solution for this profound transition where women are coming out of their childbearing years into menopause and post-menopause.

• 4:11Dr. Darshan Shah?

  Yeah, that makes total sense. And to your point, like, you know, your sugar goes up, your blood pressure goes up. Now you're being given medications for hypertension. You're giving medications for hyperglycemia, but you're not really getting to the root of the problem.

• 4:23Speaker 01

  No, you're not getting to the root of the problem.

• 4:25Dr. Darshan Shah?

  Yeah, that's the, and I think that's part of the issue. What about this kind of societal?

• 4:31Dr. Darshan Shah?

  Imperative to just not really talk about it.

• 4:34Speaker 01

  Yeah, I think two things are happening here that you had mentioned earlier that we just suffer through it. That is, and you'll go to your doctor's office, you know, one of the, one of the doctors I was just interviewing, that's a dear friend of mine, we were talking about the end of her perimenopausal journey. And she said what was the most destabilizing for her journey was the brain-related symptoms. And 80% of perimenopausal symptoms are brain-related. Brain fog, lack of word recall, sleep issues, even hot flashes and night sweats are brain-related symptoms.

• 5:06Dr. Darshan Shah?

  So 80%?

• 5:07Speaker 01

  80%. Irritability is the most common symptom. Mood swings, rage, depression, anxiety, these, these can all be triggered by erratic declining hormones in perimenopause. So she goes to her doctor, she's in late, late peri, she's not able to think properly. Her brain, this is a high-functioning doctor for many, many years, 30 years in practice. And all of a sudden, she even wonders, am I going to be able to finish this book? You know, and her sleep was so just messed up. She wasn't able to get to sleep, she was waking up at 3 o'clock in the morning. So she goes to her doctor and her doctor is on sabbatical. So she gets another doctor who's in her 60s and basically she's like, listen, this, she wanted hormones, she's like, this isn't indicated for hormones.

• 5:49Speaker 01

  When it comes to sleep, I don't have anything for you and you just need to suffer through it. Like, that's what I've been doing. I'm suffering through it. You can suffer through it. I've got these cheats that you can implement that can help you a little bit, but like, I'm not, I'm not prescribing hormones for you. And I asked her, I was like, how did it feel to be one of your patients who have had that experience and then have come to you because of that dismissal? You know, how did it feel to have to really advocate for your health when this is what you have been doing for 30 years? And, you know, she was like, I, it was really wonderful to be able to have that experience, um, to know what my patients felt when they were getting dismissed, when they walked away with more questions than answered.

• 6:31Speaker 01

  But, um, but more importantly, she's like, it was really disheartening to know that I was have to, I was gonna have to keep going to bat for myself. And finding someone who was finally gonna prescribe a solution for me that I knew that was gonna be effective.

• 6:42Dr. Darshan Shah?

  Wow, so, so sad. I, I'm sure that is pretty much the rule rather than the exception still, right?

• 6:50Speaker 01

  Yeah, I think we, we tend to, we've been told, women have been told to just blame ourselves.

• 6:55Dr. Darshan Shah?

  Yeah.

• 6:56Speaker 01

  You know, it's your fault that you are gaining weight. It's your fault that your brain isn't working. It's your fault that you can't show up to work the way that you used to. And so what I think ultimately happens is that women, what we do best is we overextend. We over-effort. We over-try. And that can lead to a lot more burnout and a lot more symptoms. It also, it feels so, again, disheartening and it can feel like you're losing hope about what you can do for your body. And we know that when we're in that state of hopelessness or that things are feeling insurmountable, that it tends to exacerbate symptoms as well. So we kind of end up in this, like a roller coaster of symptoms, kind of driven by not getting the care that we deserve.

• 7:35Dr. Darshan Shah?

  Sure, sure. Does perimenopause sneak up on women? Does it hit them like really hard or is it a spectrum in between?

• 7:44Speaker 01

  I love this question. This is actually why I wrote the book, The Perimenopause Revolution, because there is no one day where perimenopause announces itself. It's like, I'm here. Or there's no one test, right? There's no one test that's gonna, if anything, because what is, how we define perimenopause is this erratic decline in hormones. One day they're gonna be up, the next they could, they could be down. So I could catch you on a good day when I'm running labs and everything looks good. And let's be honest, those reference ranges for estradiol and progesterone are pretty wide, are pretty big. And so we can easily tell women it's normal. I would say that when you're stepping into early perimenopause, a lot of the symptoms are very subtle.

• 8:23Dr. Darshan Shah?

  Uh huh.

• 8:24Speaker 01

  I, what women will tell me is they will notice that they don't have as much bandwidth as they used to have. Like before, maybe even a year prior, they could handle the household, the career, the family, all of the to-do list and do it effortlessly. And they could multitask, like ninjas. And all of a sudden, they're having to try harder. They're having to effort harder. They'll also notice that closer to their cycle, they're feeling more irritable, maybe day five and day four versus it was only day two, maybe three. Three days. So their their PMS symptoms begin to extend. You know, they're noticing cyclical changes, but more so brain related. Their stress resilience isn't what it is. They feel more irritable. Maybe they're noticing their workout recovery isn't the same.

• 9:06Speaker 01

  And body composition changes are beginning to happen, but more so, again, it's brain related. And then by the time we're in early peri, I would say, I would say for my patients, forty two, forty three. Show me a sign, make it impossible for me to miss. This is where women really notice the mood changes, really notice the brain changes, the brain fog. I would say I catch women peri menopause in the wild. Where I'll have a friend who's like trying to remember the word and they don't know what the word is. Even my son, who's almost five, will, I'll say, you know, the thing over there and he'll be like, the Lego? You know, and so he completes my sentences all the time. Or I'll walk into a room like with intention and not know why I walked in there once I get there.

• 9:47Speaker 01

  Like that is what women will start to notice and they'll be like, this is not, this is not normal. The number one symptom that I hear from my patients the most is I don't feel like myself anymore. And this is usually in those those early forties to mid forties. The cycle changes, regular cycles are typically still happening at this point. But women will notice maybe a shorter cycle or a heavier bleed or lighter bleed. So they'll notice cycle changes if they're paying attention, but again, nothing overt and obvious. But then when we get into late peri menopause, and this is where I feel like the medical system was like, this is peri menopause. This is where we are missing periods up to sixty days. And that's when we're like, this is peri menopause, this is like, but now we know that women have been suffering or struggling

• 10:29Speaker 01

  with more brain related symptoms or even more subtle symptoms for maybe three to five years prior till they get to that point where they're finally skipping periods. And that's where I see the hot flashes, the night sweats, the low libido, the vaginal changes. That's really in the late peri menopause because now we're in a low estrogen state.

• 10:46Dr. Darshan Shah?

  Got it, got it. So in the early perimenopause time, you know, some of the symptoms you mentioned, like I just can't multitask as much, or I'm struggling to get through more things. They're kind of hard to pinpoint for women. I think there's like a struggle period there, right? And so I think about my own wife, like that time period is kind of like, what's going on? You know, and I wish there was some biomarker or blood test that you could say, ah, this is what's happening. And so is there a way to look at maybe hormone levels, or Dutch testing, or even just markers of metabolic health that might be off? Like, are you looking for any objective measurement of early perimenopause? Is there something like that?

• 11:27Speaker 01

  I am. But it is a lot of subjective. Like, clinical diagnosis is often based on symptoms. So three things that I'm looking at, one, I'm looking at your age. You know, if you are 41, 40 years old, or 42, and you're like, I don't feel like myself, and the symptoms are adding up, I'm, you know, I'm going to call it perimenopause. And it could be other things as well. It could also be stress. It could also be, you know, low thyroid function. It could be a number of things. I always say a lot of women come into perimenopause, you know, with some other health concerns. Maybe they've had polycystic ovarian syndrome for most of their life. And so that's very much a viable, you know, kind of factor going in. Maybe they had children late. Maybe they were like me and had a little boy at 41 years old, you know, in our postpartum, until they get into perimenopause.

• 12:12Speaker 01

  So all of these need to be taken into consideration. So I say, symptoms, age, and tracking your menstrual cycle.

• 12:19Dr. Darshan Shah?

  Got it.

• 12:20Speaker 01

  That monthly report card can give me so much information and give you so much information. Most importantly, track your symptoms around your cycle. So do you feel amazing in that follicular phase? But then, you know, five days into the luteal phase, something shifts? Instead of it being only three days, you know, three days before your period? So those are the types of things I'm looking out for. In terms of looking at biomarkers, I do want to look at everything. And ideally, if I can get a timeline of those labs, so I understand your baseline and your normals, I want to get that as early as your 30s. So that I know, what is your normal fasting blood glucose? What is your normal fasting? Insulin, what's your normal CRP, your highly sensitive CRP? What is your normal triglyceride THDL ratio?

• 13:03Speaker 01

  I want to know those numbers going in, like what is the state of your metabolic health and your cellular energy? Is that, is that going to start to shift in perimenopause? And what I will notice is women who are very, very early peri, things still look pretty good. Their, you know, metabolic markers are good, they're still metabolically healthy. But as we move through that perimenopause transition, that's when I see things beginning to shift. So I will see more insulin resistance, I will see blood pressure starting to climb. I will notice that their lipid markers are going into an unfavorable range. I will also notice vitamin D levels begin to drop. Thyroid panels begin to go into unfavorable range. And so the more data I can have on you heading into perimenopause, the more that I can begin to see those changes. And they can even still be subtle.

• 13:48Speaker 01

  So that's what I would be looking at as they enter perimenopause.

• 13:52Dr. Darshan Shah?

  Yeah, we're huge advocates of, you know, regular biomarker testing here. So we do what's called a baseline and next out, and we do that every three to four months on all of our patients, men and women. And it can show early perimenopause happening just by fasting insulin going up, like you're saying, you know? And, and it's more than just the hormone levels, it's also other markers that even inflammation sometimes can go up.

• 14:13Speaker 01

  Absolutely.

• 14:14Dr. Darshan Shah?

  In perimenopause too, right? So I think it's super important to be really more proactive about checking biomarkers. And also having someone like yourself that can review them with you as well.

• 14:25Speaker 01

  Yeah, we live in a world of bioobservability that we can know so much about our bodies. And women were first the, the first biohackers, I believe, because we really had to know our cycles.

• 14:34Dr. Darshan Shah?

  Yes.

• 14:35Speaker 01

  To understand ovulation. I always say that ovulation is the main event, right? We can't have progesterone on the back end in the luteal phase if we don't have good ovulatory cycles. And so that kind of information alone, if, if you're feeling flat in that luteal phase, if you're noticing your PMS symptoms are more severe, it could be that you're having an ovulatory cycles at this point. And that progesterone just didn't show up in that cycle. And, and as a result, you're noticing those changes. Also, I do love looking at hormones. I like looking at, like I said, a full thyroid panel. I also want to look for anemia. Especially in perimenopause, is that contributing to her fatigue?

• 15:09Dr. Darshan Shah?

  Right.

• 15:09Speaker 01

  And to her burnout? And I want to look at testosterone, estradiol, cortisol, melatonin, and progesterone. And again, it's about reading the tea leaves, I find, when it comes to those levels. But when I have a comprehensive look at everything, I can really start to put the pieces together.

• 15:24Dr. Darshan Shah?

  Yeah, makes total sense. And how are you looking at cortisol? Is that being looked at, um, or using the four times a day salivary testing?

• 15:31Speaker 01

  Ideally.

• 15:32Dr. Darshan Shah?

  Yeah.

• 15:32Speaker 01

  Let's say if I can't get that salivary testing, I will at least look at the AM, the AM cortisol. Yeah. But ideally, I would love to look at that salivary testing because majority of women in perimenopause, including myself, have had deregulated cortisol levels, um, moving into that phase, especially if you didn't realize what was happening.

• 15:51Dr. Darshan Shah?

  Right.

• 15:56Dr. Darshan Shah?

  Hi, Dr. Shaw here. I want to take a minute to talk to you about cellular health. So in my clinics, I've actually seen 30-year-old people with cells that look like they're pushing retirement. And I've also seen 60-year-olds with cells that look like they're 40 years old. So what's the difference? It's really about how fast their telomeres are breaking down. Your cells, you see, are like phones, and they have limited cellphone battery. Poor sleep, stress, processed foods, all of these things can drain that battery way faster than it should. So this is the reason why I partnered with IM8. IM8 powers that cellular battery. It's not just another multivitamin. It's a comprehensive 92-ingredient formula designed specifically for cellular health and longevity.

• 16:41Dr. Darshan Shah?

  I'm talking 900mg of vitamin C. That's like 20 oranges worth of DNA protection. The clinical dose of CoQ10 that you need to power your cellular engine. You also get zinc, selenium, vitamin E, alpha-lipoic acid. All of these work synergistically for cellular repair and protecting your telomeres. So instead of taking a handful of pills every day and all these supplements, IM8 actually gives you everything that you need in one scientifically formulated system. And this isn't just a theory anymore. IM8 had partnered with Oxford University, the International Space Station, San Francisco Research Institute, and they've done studies, and they've gotten this NSF certified to truly power your health. Most people are aging twice as fast as they should, unfortunately.

• 17:27Dr. Darshan Shah?

  You don't have to be one of them. Try IM-8. I actually have a discount secured for you. If you go to drshah.com/ima or go to im8health.com/discount/drsah and you can get 20% off with my discount code, Dr. Shah. You can also find the link below.

• 17:48Dr. Darshan Shah?

  I think also, like you mentioned earlier, it's so helpful to have the early biomarkers as well. So you have something to compare to, right? So maybe you're not in perimenopause yet, or maybe you're even 35 years old or 30. And still, it's worth having a set of biomarkers done so you know what your normal is prior to going through this.

• 18:07Speaker 01

  Absolutely. I think that type of information, knowing your normals, it allows you to advocate more thoroughly, more effectively for your health.

• 18:16Dr. Darshan Shah?

  Yes.

• 18:17Speaker 01

  And I think that's so important.

• 18:18Dr. Darshan Shah?

  Yeah, you can bring that to your doctor and be like, look, this is not normal for me. This is where my normal is. What's going on? I think that's really powerful to have that data.

• 18:26Speaker 01

  Yeah, I always have, I have my lab data and I have a timeline. I actually have an Excel spreadsheet of my labs that I track and I track my symptoms. You know, when I, I tell my patients if they're going into their primary or their OB-GYN or seeing someone else, what they're looking, what they're doing is treat that meeting like it's one of the most important meetings that you have, that you are advocating for yourself. Bring it on paper. So have your labs on paper, have your most disruptive symptoms on paper. Connect them to how it's impacting your life. I feel like doctors can really move the needle for you in a meaningful way when they can see how it's impacting your lifestyle and your quality of life. And then I also recommend knowing the labs that you want to run, you know? And I, I talk about this in the book.

• 19:07Speaker 01

  I've got so many guides where this is a reference ranges, functional reference ranges. But here's, I want you to take this list, just cut this paper out and take this list to your doctor and advocate for these labs. And then I also recommend if you're having a hard time getting what you want or saying what you need, you bring someone else with you who can really help support that. Because that's going to really move the needle in you getting the care that you deserve and the support that you deserve. And it's also worth asking your doctor, do you take care of women? Women in perimenopause and menopause. Do you deliver perimenopause and menopause care? And you know, what are some of the solutions that you offer? I think it's a worthy conversation. By the time we're in peri, we're about halfway through life.

• 19:49Dr. Darshan Shah?

  Yeah.

• 19:49Speaker 01

  And so I think that it becomes really important for us to get clear on what matters to us. And at the epicenter of that is feeling revitalized, feeling energized. And if you don't have a good team working with you to get that done, you're just not going to feel your very best in that second part of your life.

• 20:05Dr. Darshan Shah?

  Yeah, yeah. And to your point, many doctors do not treat perimenopause. Even OB GYNs sometimes don't treat perimenopause. They don't really feel there's an indication for treating it, so they don't treat it. Is that correct?

• 20:18Speaker 01

  Yeah, absolutely. And I mean, OB GYNs, it's really a surgical residency. If you think about it, I mean, thank goodness they're here delivering our beautiful boys and girls to us. Thank goodness they're catching things and supporting, you know, surgical interventions with endometriosis and fibroids. And so you think about a lot of it is a surgical residency. I think on average, only right now in terms of for OB GYNs, 30% of OB GYNs get any type of menopause and perimenopause care.

• 20:44Dr. Darshan Shah?

  Only 30%?

• 20:45Speaker 01

  And that's changed in the last five years. Five years ago, it was only 20%. So it has jumped 10% in the last five years. But if you ask, a lot of residents do not feel equipped to treat women in perimenopause and menopause currently today.

• 21:01Dr. Darshan Shah?

  But it's so disempowering to like, think, okay, I'm having these symptoms. I want to talk to my OB GYN about it. I can imagine, you know, being a woman, like thinking you're going to the doctor, they're going to help you with this, and they don't even evaluate it or treat it. And then it's like, what do you do then, you know? And like, to your point, this is amazing. You could give them a set of labs you want them to run, but they still probably won't do anything about it.

• 21:28Speaker 01

  Yeah, they're going to be within normal range or, you know, they're, you know, unless it's in that red zone. You know, we're pathology driven in the healthcare system. It's very reactive. And so we're often not going to get to the root cause of what is going on.

• 21:40Dr. Darshan Shah?

  Right.

• 21:41Speaker 01

  And that's when I think it's important to ask that question. And it's, I know that my, I have an amazing OB GYN. I know how far I can go with her. And I know what she's going to be able to provide and what she's not going to provide. And so I'm not disillusioned by the experience. And I know that if I'm looking for someone who's going to really support me in this peri-menopause and menopause journey, looking at how, connecting the dots between my symptoms today and my health outcomes later, or just looking into my future health and how this is going to play out for me in terms of longevity and health span, I know that I'm going to need someone who has a much more functional perspective.

• 22:17Dr. Darshan Shah?

  Yeah, and I think this all goes to every woman and man. You need to become the CEO of your own health. You need to take control of your healthcare journey and outsource it to the Western medical system because no one's going to care more about your own health than you do, right?

• 22:34Speaker 01

  No one's going to know it.

• 22:35Dr. Darshan Shah?

  Exactly, no one's going to know it. They're not going to be advocating for themselves, they're not going to be following it. And I think there's this mindset that I grew up with, you know, even being a doctor.

• 22:44Speaker 01

  Me too.

• 22:44Dr. Darshan Shah?

  That, right?

• 22:45Speaker 01

  Yeah.

• 22:45Dr. Darshan Shah?

  Yeah, you grow up and you're like, your doctor will just take care of it. And if they say nothing's wrong, nothing's wrong and don't pursue it and don't even ask any questions, right? And so I think so many people have been done a disservice there with just that mindset. And I think we're entering a new era where people are becoming more curious about their own health, they're checking their own biomarkers, they're, you know, advocating for themselves by reading books like yours and really going that extra mile to push for their own health. And I think everyone needs to do that. It's so important.

• 23:18Speaker 01

  Yeah, I think each and everyone, all of us have family members.

• 23:21Dr. Darshan Shah?

  Yeah.

• 23:21Speaker 01

  I have a sister who had a stroke two years ago. She's two years younger than me. I have uncles that have had bypasses, family members with prediabetes. I mean, we see this in our families and we see that it's not even that far down the road.

• 23:33Dr. Darshan Shah?

  Your sister had a stroke and she's two years younger than you. Wow, was it from a blockage or was it from something else?

• 23:39Speaker 01

  Lifestyle.

• 23:40Dr. Darshan Shah?

  Lifestyle.

• 23:41Speaker 01

  Unfortunately, yeah. And yeah, so it's, it was, it was a wake up call for all of us. You know, and I was first to the scene to take care of her, help her manage her care when she was going through. I called all of my cardiology friends who are more longevity doctors about what we could do. Cause I knew that the hospital can only do, they can only do so much for her. I mean, the way that we've been treating strokes, it, it's been the same for almost 20 years. And so, you know, I wanted to know what else could we do for her?

• 24:04Dr. Darshan Shah?

  Yeah.

• 24:04Speaker 01

  And that was just a big take, a big moment for me where I have, my younger sister is going through something I, I didn't imagine she would. Well, I never hoped she'd have anything like that happen to her, but I at least thought she had another 20, 30 plus years before that was indicated. And we all, we all have family members where we are supporting them in the journey. We've got maybe aging parents, we're in that sandwich generation and we are seeing what is happening to our family. And it's not the path that we want for ourselves. And we, we, when we reverse engineer, when we started to see those subtle symptoms. For a lot of our, our parents or our aunts or uncles or maybe siblings, maybe it was in their 50s. Maybe it was in their early 60s. You know, I, my mother is such an example of how to thrive.

• 24:50Speaker 01

  She's 64 years old. She'll be running a half marathon next weekend.

• 24:53Dr. Darshan Shah?

  Wow.

• 24:54Speaker 01

  She, she's training for another marathon in Loma Linda. She lives right outside of Loma Linda, one of the blue zone areas.

• 25:00Dr. Darshan Shah?

  That's, yeah, Loma Linda's a blue zone, right?

• 25:02Speaker 01

  Yeah. And she's competitive tennis player and she could shot put my son into the air if she wanted to. She can run with him. She can get on the floor with him. And I have another one of my best friends. She has a little boy, almost my son's age and her mama, same age as my mom, actually maybe a year younger. And doesn't feel confident to be left alone with him because she can't get on the floor with him.

• 25:24Dr. Darshan Shah?

  Oh, no.

• 25:25Speaker 01

  She's not able to do the things and it's, you look at that path.

• 25:28Dr. Darshan Shah?

  Yeah.

• 25:29Speaker 01

  You know, when the subtle symptoms for my mother, my best friend's mother started to show up probably in her 40s.

• 25:35Dr. Darshan Shah?

  Really?

• 25:35Speaker 01

  Maybe even in her 50s. And now here we are at early 60s, really struggling with her quality of life.

• 25:41Dr. Darshan Shah?

  And why can't she do that? Like what's, what's going on?

• 25:43Speaker 01

  Cardiovascular disease, prediabetes, chronic pain, rheumatoid arthritis, but a mismanagement of care.

• 25:50Dr. Darshan Shah?

  It's a, it's a total constellation of diseases that. You know, we have names for each one of these diseases, but they're all one thing.

• 25:58Speaker 01

  It's all cardiometabolic health.

• 26:00Dr. Darshan Shah?

  Exactly. It's all cardiometabolic health. And it affects your immune system. That's where you get autoimmune disease. And I resonate with this because that's what happened to me 10 years ago. I had cardiometabolic disease. I had diabetes. I had autoimmune condition. I had all of this. And it was all really part of one process that was occurring. And I was treated, being treated by five different doctors with 10 different medications, right?

• 26:24Speaker 01

  And not getting better.

• 26:25Dr. Darshan Shah?

  And not getting better. And then I discovered functional medicine and found out what the root cause was, fixed it, everything went away.

• 26:31Speaker 01

  Yeah, that's incredible.

• 26:32Dr. Darshan Shah?

  And it's such an important point that we feel that these are just little things that happen along the journey of life and health. But the reality is, it's not little things that are happening along the way that need to be treated with a different prescription. There's root causes to all of this that can be fixed and you can eliminate it.

• 26:51Speaker 01

  Absolutely. No, there are root causes. And I just, I think about the quality of life that my mother has versus the quality of life that my best friend's mother has. And it is so, the disparity is so great. And I'm choosing my mother. I'm choosing that direction.

• 27:07Dr. Darshan Shah?

  Absolutely.

• 27:08Speaker 01

  Yes. And so, you know, we get to feel phenomenal in our 60s. My mom doesn't take any medications. Her blood glucose levels, she is a part of the 7% that is metabolically healthy.

• 27:19Dr. Darshan Shah?

  Yeah.

• 27:20Speaker 01

  I just looked at her labs two weeks ago and I was like, high five, mom. Like, do you know how many 64-year-olds are metabolically healthy?

• 27:27Dr. Darshan Shah?

  I know.

• 27:27Speaker 01

  A very small percentage, right? It's like 1%. And I was just so, I was celebrating her so big.

• 27:33Dr. Darshan Shah?

  Amazing.

• 27:33Speaker 01

  Because she shows up for her, but she also, she is the epicenter of her family. And she is such an example of what it can look like when we really prioritize ourselves.

• 27:42Dr. Darshan Shah?

  Yeah. And you know, you talk longevity, like, I would say even though your friend's mom and your mom are the same age, your mom has already lived an extra 10 years, right? Because she's been healthy the last 10 years.

• 27:52Speaker 01

  Yes, right.

• 27:53Dr. Darshan Shah?

  Your friend's mom hasn't.

• 27:54Speaker 01

  No.

• 27:54Dr. Darshan Shah?

  She hasn't been picking up kids and all these things. It's, longevity is really putting those years back in to where your years are living right now.

• 28:02Speaker 01

  Well, and I think a lot of, you know, we think about heart disease as a man's disease, you know, but more women than men die of heart disease and stroke. Also, women spend, although we live longer, I think for women it's like 81 years on average and men it's like 76 to 78, but we live longer. And yet 20% more of our lives are spent in debilitating health. What's important to note about that, one, it is every time I hear that stat, every time I share that, I am heartbroken because I know how much these women have given to their communities, to their families, to everyone around them. You know, I was brought up being self-sacrificing.

• 28:35Dr. Darshan Shah?

  Yeah.

• 28:35Speaker 01

  You know, and how much, and then all of a sudden it's time to take care of us and we're already struggling. And that moment, that that transition of perimenopause is really the window of vulnerability, but also the window of opportunity. It is not in our 60s and our 50s where we want to really be making these changes, although now is the new later, always, always. But it's in this transition where we're starting to notice these symptoms. These symptoms are signals. They're telling our body that we need a new level of support and care. And I think the more that not only the medical system begins to pay attention to this, but mostly us as women, as we're navigating this transition in probably one of the busiest seasons of our lives, I want to just put, I recognize that.

• 29:18Dr. Darshan Shah?

  Yeah.

• 29:19Speaker 01

  But then when we start to notice these symptoms, the brain fog, the moodiness, the weight resistance, the body composition changes, the just not feeling like ourselves. I don't want women to wait until menopause or post-menopause. I want you to act now because in this window of opportunity, there is so much that we can do to future-proof our health.

• 29:41Dr. Darshan Shah?

  Yeah, so true. And you know, you said, you know, women give so much of themselves to raise kids and manage busy families and all of this stuff. And then when perimenopause comes, it's usually, I mean, I think for some women it's still a really busy part of their life, right?

• 29:56Speaker 01

  Yeah, I feel that, yeah.

• 29:57Dr. Darshan Shah?

  You know, I think our kids are 11 and seven and it's so busy. And right now my wife's going through perimenopause and it's like, It's the business doesn't stop right now, right?

• 30:09Speaker 01

  No.

• 30:09Dr. Darshan Shah?

  But the, but there needs to be kind of the shift in mindset to some level of self-care, like what you're saying.

• 30:16Speaker 01

  Absolutely. I was being interviewed earlier and I was walking someone through my morning routine. You know, my son, he's almost five.

• 30:22Dr. Darshan Shah?

  Yeah.

• 30:22Speaker 01

  He's going to farm camp and he wants, he wants to see mama the first moment he wakes up. And so I know that I have a window before my son wakes up and I am fully in the morning routine of his routine.

• 30:35Dr. Darshan Shah?

  Yes.

• 30:35Speaker 01

  And so this morning I got up at 6:00 AM.

• 30:37Dr. Darshan Shah?

  Mm-hmm.

• 30:37Speaker 01

  I did my 30-minute weight training and I did it from the house today because I didn't want to leave the house. I wanted him to see me when I woke up. Um, I did my electrolyte water. I did my green juice. Um, I really took care of me. I grounded outside in my backyard and I just took a moment to be with me. You know, I, I had my, my water, my coffee, and then I heard the little steps. I heard those little steps coming down the stairs and, but I got that 45 minutes to attune to me, take care of me before my whole morning became his.

• 31:07Dr. Darshan Shah?

  Yeah.

• 31:07Speaker 01

  You know, and I think those are the things that really move the needle. Like, how do we bookend our days, the nighttime and the morning that are for us? If the day is going to happen to you, I always say that perimenopause is the messy middle.

• 31:19Dr. Darshan Shah?

  Uh huh.

• 31:19Speaker 01

  But then your day is the messy middle in the messy middle, right? Where anything can happen. What you, what's really sacred is that bookend where you can honor your sleep routine, you can honor your morning routine to set yourself up for success. And that's, that's what I do. Like, I'm in a car for six hours today, give or take.

• 31:35Dr. Darshan Shah?

  Yeah.

• 31:35Speaker 01

  You know, and I'm getting squats in everywhere I can and I'm moving my body, but I make sure that I anchor into those routines.

• 31:41Dr. Darshan Shah?

  That's so powerful because I think, it's so funny, the last podcast I just did, we just talked about this, is you get that morning routine in, you, you've made a major win for the day. And it's also, I think, mentally beneficial to have the win time for yourself because no matter what happens in that messy middle, you at least know that you had a win in the morning for yourself. You feel good about, you got your workout in, you got your me time in for a little while, 45 minutes.

• 32:07Speaker 01

  I mean, I'll take it any day of the week.

• 32:10Dr. Darshan Shah?

  I love it. So, okay, say you're a woman listening to this podcast and you're saying, you know, I think I might be in perimenopause. I'm 39, 40 years old. I do have headaches every once in a while. I have, you know, my, I feel sluggish. What should I do besides taking a, besides, you know, of course, reading your book?

• 32:31Speaker 01

  Obviously, reading the book.

• 32:33Dr. Darshan Shah?

  And then talking to your doctor. But what are some of the things that you can do to start managing this time of your life?

• 32:39Speaker 01

  I would say number one, really collecting that data, whether it is, you know, tracking your cycle, tracking your symptoms, understanding what's going on, maybe even getting a continuous glucose monitor to track your blood glucose to see if that's the energy issue, or even a whoop. I love looking at my body score. I love looking at my HRV, my heart rate variability, just understanding my biometrics over, over the course of 24 hours and over the course of a month. So just collecting data on yourself, being the objective observer of what is going on. But then I would start by looking at your day. You know, what, how does your morning look? Is it, is it controlled chaos in the morning? One of my favorite quotes by Louise

• 33:22Speaker 01

  Hay is how you live your day is how you start your, like how you start your morning is how you live your day, and how you live your day is how you live your life. And that was such a defining moment for me because there was a time where my morning was chaos. And then it, I was, was I surprised that the rest of my day looked just like my morning? And so taking a look and seeing what are some subtle things that we can do? I always tell women, start with balancing your blood sugar. That's probably one of the biggest things we can do. And that's with meals. So prioritizing protein and fiber and healthy fats, doing your best to eliminate the refined grains, the added sugar, the ultra-processed foods as best as possible, and then moving as much as possible throughout your day. Yes, it's good that I got the 30-minute weight training workout in today, but I know

• 34:04Speaker 01

  that if I'm gonna sit for six hours today, that it's gonna pretty much negate the 30-minute workout. So I want women to be moving their body as much as possible. The 10 squats after a meeting, or even the 20 squats after a meeting, walking up and down your stairs after a podcast. I did a 60 squat buy-in into this podcast. I was behind that pillar and I did 60 squats.

• 34:28Dr. Darshan Shah?

  You're amazing.

• 34:28Speaker 01

  I call it the 60. Well, it's usually when I'm in my Nikes, when I'm in my, my workout clothes, it's jump squats. But when I'm in a little dress and some heels, it's squats. And so I did my 60 squat buy-in and I'm gonna do another 60 squats before I get in the car.

• 34:41Dr. Darshan Shah?

  That's a great idea.

• 34:42Speaker 01

  And so I have three minutes. I always have three minutes to knock out 60 squats.

• 34:46Dr. Darshan Shah?

  Yeah.

• 34:47Speaker 01

  Or 60 jump squats. Then the next thing I would tell my beautiful patient is to prioritize your sleep like it is a million dollar meeting, because it is. So whether that is having a good sleep routine or nailing your sleep consistency. So I think that sleep consistency is probably one of the most powerful things that you can do to support your circadian rhythm, support your mitochondria, and support your sleep. And so I, you know, I always benchmark, try to be in bed by 10 and be up between 6 and 7. Like whatever that sleep consistency is for you, but this is seven days a week.

• 35:22Dr. Darshan Shah?

  Yeah.

• 35:22Speaker 01

  You know, there's no social jet lag here. We want to make sure that that's consistent. And then, you know, having a routine that supports that. Gone are the days where we can just race into bed and fall asleep. Like we really gotta set the...

• 35:34Dr. Darshan Shah?

  Doesn't happen anymore.

• 35:35Speaker 01

  No, it doesn't happen. Like, oh gosh, where did the twenties and my thirties go?

• 35:38Dr. Darshan Shah?

  Yeah.

• 35:38Speaker 01

  And so being really intentional about that routine in the evening. And then the other thing that I recommend in the evening as well is set your future self up for success. So if you are getting up early in the morning and you are trying to get to the gym or you're trying to do that workout, have your workout clothes set out. Have your emotional support, I call it my emotional support water. Have that at the door. Have the keys at the door. Have the socks with the shoes at the door. Have your protein coffee or whatever you're doing, your little snack before, so that it's all ready, that there's no excuses.

• 36:07Dr. Darshan Shah?

  Ready to go.

• 36:08Speaker 01

  That you're ready to go. And there's something to be said about kind of easing your mind and creating peace when everything's ready the night before.

• 36:14Dr. Darshan Shah?

  For sure.

• 36:15Speaker 01

  You're not racing around trying to find all of your things so that you can get out the door. So those are the things that I always tell.

• 36:20Dr. Darshan Shah?

  I think it helps you sleep better too, because then you know you're set up for the next day. You're not stressed out about it. There's not one less stress you're carrying to bed with you.

• 36:27Speaker 01

  Absolutely, yes. And then if I had just, if I had to just choose one habit, just one, it would be movement after meals. Movement after meals. I've tracked so much continuous glucose data over the years, and that is the biggest longevity hack that I can bring to the table. And even better still, walking with friends or family after meals, or... Voicemailing your bestie after a meal while you're walking. Like, there's so many wonderful longevity hacks stacked into that beautiful 15-minute walk. And if you can't get outside because your son or your daughter wants to do Legos, or they want you to work in the workbook, that's when you bring in the jump squats. That's when you walk up and down your stairs. But movement after meals, hands down, it can bring you back into metabolic comia stasis.

• 37:10Dr. Darshan Shah?

  Yeah, so many powerful, seemingly simple things there, but people just don't do them, right? I mean, moving after meals is super simple. It's just you just gotta get used to doing it. And, you know, going to bed at the same time every night, just make it happen.

• 37:26Speaker 01

  Make it happen. Set an alarm. I always tell people, set an alarm. And if you're a, you know, a night owl, my husband's a night owl. I'm like, okay, well, just start to move yourself down 15 minutes. But set an alarm and, and treat it like that's, that's your million-dollar meeting. That is when you get into bed. Just honor it. And I, I'll tell you, if sleep is an issue, which it is for 67% of midlife women, it is a massive percentage, and it is a driver of hyperinsulinemia. It is a driver of cardiometabolic issues. Sleep is such a cornerstone of everything, that if you would just honor that sleep consistency, I'm telling you, it will change your life in less than 10 days.

• 38:03Dr. Darshan Shah?

  Wow, that's awesome. Now, let's talk about a little bit, you know, you're seeing your doctor, you're checking your markers, you're checking your hormone levels. Are there hormone treatments that are available during this time of, of, sorry, I know this is a loaded question, but I have to put it out there. What can you do?

• 38:22Speaker 01

  Yes, please. Yes, I love this question. Thank you so much for asking. I have an estradiol patch on right now, obviously, and I cycle oral micronized progesterone. And I will be honest, I have, I was diagnosed with Haji-Muros thyroiditis years ago. And although my antibodies are in control, my thyroid got a little bit of, you got a little bit of a hit, so I do take thyroid medication. And so I'm fully transparent in my hormone protocol, because there is so much that we can do to support women. Again, perimenopause is all about hormones. Can other factors be playing, like playing out at the same time? Absolutely. But we know what's really triggering those. Symptoms or exacerbating those symptoms or bringing them up for review is the hormones, is the erratic decline in hormones.

• 39:04Speaker 01

  And so progesterone is a beautiful option for women who are experiencing mood changes, anxiety, potentially even depression and sleep issues. And I'm a big, big believer of supporting you with hormones.

• 39:16Dr. Darshan Shah?

  Yeah.

• 39:17Speaker 01

  You know, progesterone is such a power player when it comes to just creating calm and peace. And it can really disrupt us, especially in that late luteal or that luteal phase. That's half of our cycle. That's half of our

• 39:28Dr. Darshan Shah?

  Yeah.

• 39:28Speaker 01

  life, you know, where we could be losing that progesterone. And then, you know, I find that symptoms do dictate estrogen. There's a lot of back and forth about when to bring on estrogen for perimenopause. Because early peri, if progesterone is dropping, we can have unopposed estrogen.

• 39:45Dr. Darshan Shah?

  Yes.

• 39:45Speaker 01

  So that's where it becomes really important to track those symptoms and track your cycle. You know, for me, even my follicular phase isn't what it used to be. Like it's shifting. So that estradiol peak at day 11, she's not always peaking anymore for me. You know, I fall a little flat. And so for me, it's made a lot of sense to bring on estradiol. But for another woman, it may not be indicated for another couple of years. And so again, it's really driven by those symptoms, more so than it will be always driven by labs. Although I always say tests don't guess. Like I want both. I want to take both into consideration. But I never want to withhold hormones because a woman's estrogen level is just, just barely above that okay, normal. But she's feeling not normal.

• 40:25Dr. Darshan Shah?

  Yeah. You know, I'm seeing some devices out that are going to be launched pretty soon that you can test hormone levels at home.

• 40:32Speaker 01

  Yes.

• 40:32Dr. Darshan Shah?

  That's going to be a game changer.

• 40:33Speaker 01

  It is going to be a game changer. Yeah, I'm really excited about that too.

• 40:36Dr. Darshan Shah?

  Yeah, they can really, day by day, even, even direct your dosing and, and, and kind of modify what's happening, right?

• 40:44Speaker 01

  Yeah, well, peri is, I mean, hormones are not a one size fits all.

• 40:47Dr. Darshan Shah?

  Right.

• 40:47Speaker 01

  Particularly in perimenopause. Darshan, I would say that I am a different woman every day. Depending on what's going on with my hormones. And you know, even my hormone protocol a year ago is different than it is today. Because I am, I mean, that's the one thing I can guarantee for you and Perry is that you are going to be changing.

• 41:05Dr. Darshan Shah?

  Yeah.

• 41:05Speaker 01

  Yeah.

• 41:06Dr. Darshan Shah?

  That's only guarantees that things are not going to be the same the next day.

• 41:09Speaker 01

  Exactly.

• 41:10Dr. Darshan Shah?

  So can we dive a little bit into the forms of hormones that are available and how women should think about it? I know estrogen, estrogen, for example, there's creams, there's patches, there's different kinds of patches. Can you tell us kind of how you think through that?

• 41:24Speaker 01

  Absolutely. Yeah. I mean, one of the things that we've learned is that transdermal is really one of the safest ways. You know, in terms of mitigating any cardiovascular concerns or particularly stroke. And so not taking it orally, we kind of mitigate even migraines with aura. And things that we used to think were contraindicated, we were finding with transdermal application, it is amazing. I think for a lot of women, the patch is great. I know for me, as a mom who holds my son a lot, creams and sprays on my inner arm. I'm going to estranize my child on accident, you know? And so for a lot of women that are still holding kids and hugging kids, you know, using a patch is a very viable option. And then it depends on the dosage, you know, a lot of doctors are going to start with the lowest dose and just to kind of mitigate symptoms. But I'm a big fan of prevention as well.

• 42:09Speaker 01

  Estrogen is such a powerful preventative hormone for insulin sensitivity, for immune system modulation. I mean, estrogen is the CEO of the brain, like in terms of even brain related symptoms. And so I want to go a little bit past or looking past just mitigating hot flashes and night sweats and vaginal dryness. I want to be able to ensure that we're protecting your bone and your muscle and your metabolic health. And so that's always a consideration when it comes to HRT. So creams, you know, usually those are compounded, creams and gels. Patches are going to be kind of FDA approved, what you're going to get from your typical doctor. And they're going to usually be covered by insurance.

• 42:45Dr. Darshan Shah?

  Right.

• 42:45Speaker 01

  When it comes to progesterone, usually the one, the hormone or the, the application that I prefer is going to be oral micronized progesterone, especially for the brain related symptoms and the sleep issues. But again, you have to know that Prometrium is suspended in peanut oil and does have dyes. And so if you're sensitive, you may want to go the compounded. Especially if you're having severe sleep issues and extended release progesterone that's compounded can be really beneficial for those 3 a.m. wakeups. In terms of creams, there's a lot of controversy in terms of effectiveness. We know that progesterone molecules are pretty big and so absorption can be a challenge. But some women will, I've seen some of my patients who have have progesterone creams and serums.

• 43:28Speaker 01

  They will use them for anxiousness or feeling irritable during the day, but then they will step in with the oral micronized progesterone.

• 43:36Dr. Darshan Shah?

  Got it.

• 43:37Speaker 01

  In perimenopause, it makes a lot of sense to cycle progesterone, not necessarily use it continuously. So it's really a matter of figuring out what works best for you. If the sleep issues are so severe and you're in late perimenopause, is continuous use very much a viable option where you're taking it every single day? Absolutely, especially if you are sleeping better. So it's a matter of looking at all of these things, your symptoms, you know, what application works for you. As you get started, looking and testing and also, you know, having an honest conversation of what is actually feeling effective and then going from there. And so I find that it's constantly a tailoring of figuring out what works best. So I hope I kind of covered a little bit.

• 44:18Dr. Darshan Shah?

  No, that's fantastic. In fact, you know, I think this is where a lot of women get really tripped up on the information that's out there. There's so many different forms. There's so many different controversies out there about using compounded versus not compounded. There's different patches and let's talk about that, like the bias patch. How do you think about the estrogen forms?

• 44:39Speaker 01

  I'm not a big fan of the bias.

• 44:40Dr. Darshan Shah?

  Many doctors are not, but it's incredible that it's still being sold in massive quantities out there.

• 44:46Speaker 01

  I'm not a fan of the estrogen being a primary and just hoping that E2 is going to convert. Yeah, no. So no, I'm a big fan of estradiol as the primary. And yeah, not all patches are going to work for women. Some women are really big performance athletes and they just come right off. You know, depending on the different type of patch, I mean, we try one, you try one out and see what happens and see how you're doing. And if it's not working, then we try a different one and we play with dosage. I mean, it can really be, I don't want, I don't say this in the, in the. In the sense that I want women to feel discouraged. I just want you to know that you hopefully you're working with a provider or a practitioner who is willing to be open minded and work with you during this time. As a hormone practitioner myself and someone who's been working with women in perimenopause and menopause

• 45:31Speaker 01

  for almost fifteen years, I'm still working out, you know, what is best for me? What's the right dosage, when to take my progesterone? And yeah, there's a, you know, I know there's a lot of controversy around it only needs to be FDA approved. But then we think about testosterone, a lot of these doctors are like no compounded hormones. And yet they're, they are recommending compounded testosterone because it's the only option, right? It's not FDA approved. And it's really, I mean, a lot of it's done off label. We're recommending off label testosterone cream, but it must be compounded. And so it's interesting that the dialogue in, in the hormone space about what is appropriate or what's, what's effective and what's not. And again, it's really about the patient.

• 46:12Dr. Darshan Shah?

  Yeah.

• 46:13Speaker 01

  Always.

• 46:13Dr. Darshan Shah?

  And are you prescribing vaginal estrogen for most of your patients?

• 46:17Speaker 01

  Yeah, I love vaginal estrogen. Like I'm, I'm rooting for the black, the black box warning to get taken off. I think, you know, almost ninety-five percent of women will have genital urinary symptoms of menopause.

• 46:28Dr. Darshan Shah?

  Right.

• 46:29Speaker 01

  They'll experience UTIs or they'll experience incontinence or vaginal dryness or vaginal atrophy or even painful intercourse, and that is not acceptable. And so I love that we have a local solution and it should be a solution that every woman is, is offered. You know, even women who, who have had, you know, potentially, potentially even cancer. Like it depends on what the situation is, like you, every woman needs to be looked at. But it breaks my heart that so many women are being denied vaginal estrogen.

• 46:55Dr. Darshan Shah?

  Why are they being denied?

• 46:57Speaker 01

  I think it's fear. It's a lot of fear.

• 46:59Dr. Darshan Shah?

  Yeah.

• 46:59Speaker 01

  We think that it's going to be systemic. We think it's going to cause cancer and a lot of this has been debunked. And yet here we are, I don't think we're going to see, I mean, with as much noise and education is out there right now, how long it will take to translate into bedside, into the office. It's going to take probably another, I would say, give or take seven to ten years.

• 47:17Dr. Darshan Shah?

  And that's optimistic in my

• 47:19Speaker 01

  Yeah.

• 47:20Dr. Darshan Shah?

  I was gonna say, like, you know, the, the, everything in medicine right now, like, by the time it gets taught in medical school and then taught in residency, so even if it's taught in medical school, when you go to residency and you, you're working for a doctor that has been trained prior and tells you no, you know, then you, you unlearn everything that could potentially be good information. So I find it takes decades for the first, and I'm hoping in this new era that we're living in where people are getting more self-educated through listening to podcasts and reading books like your, yours, that it goes faster, but it's just, it's just so mind blowing how long it takes for the medical establishment to change their mindset.

• 48:00Speaker 01

  Yeah, no, it, it does take a long time. I am being a little bit optimistic, given the noise that it's creating. And I hope a whole chapter on HRT inside of the book, because I want women to at least know the basics, to feel enough hormone literate that they can have the conversation.

• 48:13Dr. Darshan Shah?

  That's the key.

• 48:13Speaker 01

  That's really the key. So that you can ask your doctor, are you even prescribing HRT for women in perimenopause and menopause?

• 48:19Dr. Darshan Shah?

  Exactly.

• 48:19Speaker 01

  Do you feel comfortable prescribing? Because we have gone two, two decades of doctors not prescribing.

• 48:25Dr. Darshan Shah?

  Two decades, right.

• 48:26Speaker 01

  Yeah. And so you're talking about how long it's gonna take. We're already two decades out, you know, of not prescribing or doctors not feeling confident prescribing hormone replacement therapy. And so, yeah, we have a lot of work in front of us to support women. And, you know, again, it's, it's a yes and, it's, it's the hormones and it's the lifestyle, you know? And I would never deny a woman hormones because a lifestyle isn't locked and loaded. You know, I, I jokingly say that estrogen isn't gonna lift the weights for you, but estrogen could get you in the gym.

• 48:53Dr. Darshan Shah?

  Yeah.

• 48:54Speaker 01

  You know, could get you that motivation to just get back in the gym again, or that testosterone could be the thing that has you motivated and confident and just feeling like yourself, not so flat, that you are like, you know what, I'm gonna take that walk. I'm gonna, I'm gonna do those jump squats. I'm gonna lift those weights. And I think that is such a big part of, of this conversation is letting women have as many tools in the toolbox to help them feel like themselves again, so that they feel motivated and confident to start really attuning to themselves and taking care of themselves.

• 49:25Dr. Darshan Shah?

  For sure. And then between Vaginal estrogen and estrogen patch. Being on vaginal estrogen doesn't replace the patch.

• 49:33Speaker 01

  No, it does not.

• 49:34Dr. Darshan Shah?

  And I think it's very, you know, it's a very important point for people to hear because I think sometimes they get the vaginal estrogen and they think.

• 49:40Speaker 01

  I'm good.

• 49:41Dr. Darshan Shah?

  I'm good. And I've seen that so many times.

• 49:43Speaker 01

  Yeah, no vaginal estrogen is localized.

• 49:46Dr. Darshan Shah?

  Local only.

• 49:46Speaker 01

  It's local only to the vaginal tissue.

• 49:49Dr. Darshan Shah?

  Right.

• 49:49Speaker 01

  Which is very important for your quality of life, but it's not going to protect your cardiovascular health. It's not going to protect your bones. It's not going to stop the hot flashes and night sweats from happening. It's not going to protect your brain and your muscles and your metabolic health. And so it's important to note that if you want that level of support, you are going to need a systemic estrogen.

• 50:08Dr. Darshan Shah?

  Right. So you need both.

• 50:09Speaker 01

  You need both.

• 50:10Dr. Darshan Shah?

  You need both.

• 50:10Speaker 01

  And for some women, some women could just be on an estrogen patch or estrogen cream and be okay for a while. But I find that as we get older, we're then we're going to need the vaginal estrogen too.

• 50:21Dr. Darshan Shah?

  Yeah, you need both, right?

• 50:22Speaker 01

  Yeah.

• 50:22Dr. Darshan Shah?

  And then let's talk about testosterone real quick and how that fits into the puzzle. When in the journey is testosterone an option?

• 50:29Speaker 01

  And every, every doctor's different here. I'll be honest with you, I'm still looking a lot at the main reproductive hormones. And I'm also looking at testosterone as well. I mean, if I see low testosterone levels, I will consider bringing it on or recommend it. But I really do want to dial the estrogen and progesterone.

• 50:45Dr. Darshan Shah?

  Right.

• 50:46Speaker 01

  So I know that some women are on testosterone earlier, well, before they're on progesterone and estrogen. I typically like to work with lifestyle recommendations to see if I can boost testosterone. Especially if it's really like low way earlier than I would expect it to be. Like, you know, I want to look at the lifestyle. I want to look at toxin load. I want to look at how much, how much to go food you're eating. What are your vitamin D levels? Are you moving your body or working out? Like, are there ways that we can increase that naturally? And if not, then I'll, I'll look at that as well.

• 51:14Dr. Darshan Shah?

  Yeah, I think, you know, that testosterone for women, first of all, what is, what is considered low in your mind as far as the life?

• 51:21Speaker 01

  I would say under 15.

• 51:22Dr. Darshan Shah?

  Under 15, right? Okay, that's, that's kind of what I used to use under 15. I'm like, oh, this is really pretty low.

• 51:27Speaker 01

  And, and they've got the symptoms to match.

• 51:29Dr. Darshan Shah?

  Yeah, exactly. Okay, great. And then I think, like you said, sometimes light cell interventions make all the difference. This is getting people moving can make all the difference there too. So I think as you're going through the perimenopause journey, and every woman is different, every doctor is different. But to your point, the testosterone can probably be managed with life cell interventions while you're frigging the estrogen progesterone out.

• 51:50Speaker 01

  And a lot of my patients don't necessarily want to go on testosterone therapy yet. They, they do want to try it life, they want to try the lifestyle interventions first because it's always there.

• 51:58Dr. Darshan Shah?

  Yeah.

• 51:59Speaker 01

  It's always on the table.

• 52:00Dr. Darshan Shah?

  It's always on the table, right?

• 52:01Speaker 01

  So we can always, we can always try in three months, we can retest levels and see how you're doing and really just see how you're feeling, you know, in terms of symptoms and go from there. And so I, I want women to know that there's a lot that we can do, especially if you're in your thirties or your early forties and you're like, I don't know if I, so I have so many patients, even friends I talk to, they're like, do I really have to get on testosterone? Because that's the thing that they're hearing a lot about and not necessarily. Not to say that I, I don't love it. I think it can be really profound and especially off label.

• 52:29Dr. Darshan Shah?

  Yeah.

• 52:33Dr. Darshan Shah?

  Let's take a quick break to talk about something that I see people are using to completely change how they approach their health data. So at Next Health, we're seeing tons of patients every day. These are people that have struggled with fatigue, losing weight or brain fog. And they're going to the doctor and they're getting their annual blood work. But most of that annual blood work is coming back normal. The problem is they're only getting about 10 or 15 different biomarkers checked by their normal physician. And what they're doing instead now is they're taking their health in their own hands and getting their blood work through a company called Function Health. I love it when people come in with their Function Health results because they have over 160 different biomarkers. Now normally this would cost about $10,000 out there if you did it with your insurance.

• 53:18Dr. Darshan Shah?

  But to get your hormones, inflammation, toxins and nutrient levels checked all under one platform and even have access to scans, you can do this all now with Function Health for about $500 a year. And what I love most is that Function Health doesn't try to sell people supplements or pharmaceuticals or anything. They're just giving you the data. So doctors like us can look at the data and interpret it for you and help guide you with a health plan. It only costs $4.99 a year. That's just a dollar 37 a day. And it's a really cost effective way for you to get a lot of your own health data into your own hands. And like I said, doctors love it because now you have a ton of data that you can come to us to and review with you. You can learn more by using Function Health and going to functionhealth.com/drschah.

• 54:02Dr. Darshan Shah?

  And if you're the first thousand people, you get a hundred dollar credit towards your membership by going to functionhealth.com/drschah or just using my gift code for you, DrShah100.

• 54:16Dr. Darshan Shah?

  Let's talk about a woman's journey through hormone replacement therapy versus not having hormone replacement therapy. How does a woman who is on hormone replacement therapy with a good practitioner like yourself that is used to managing hormones, how does she kind of go through the next five years of perimenopause versus someone who doesn't?

• 54:36Speaker 01

  I feel like the disparity is so great.

• 54:39Dr. Darshan Shah?

  It's massive, huh?

• 54:40Speaker 01

  It's so massive. You know, I always say that suffering is optional. You can decide how you want to feel. And women who go through perimenopause into early menopause with hormones, they feel more resilient, they feel more energized. Again, I'm watching biomarkers, I'm keeping an eye on all of this. They're still within that metabolically healthy range and they feel more like themselves again. So that's a big part of it. As, you know, how are you feeling heading into menopause? But also when we look at DEXA scans, bone density looks a lot, you know, looks well and they're building lean muscle. You know, this can be such a beautiful helper. Women who go through perimenopause into early menopause without HRT, I mean, for some, they can still be doing okay.

• 55:22Speaker 01

  And I think that that is the greatest myth is they're like, I feel fine, I feel good, you know? And more so, my concern is, well, how are you going to feel in your late 50s? How are you going to feel in your early 60s if we didn't have this hormone protection this entire decade in that window of opportunity? But I will say that even between my non-hormone users and my hormone users, that my hormone users do feel like they navigate it with a lot more ease and grace.

• 55:48Dr. Darshan Shah?

  Yeah. And I want to talk about that woman that is fine being in perimenopause, doesn't feel a lot of symptoms. She's just like, I don't know what everyone is so worried about, I'm fine. Would you still recommend that woman be on some hormone replacement therapy?

• 56:03Speaker 01

  I mean, from a preventative perspective, yes.

• 56:06Dr. Darshan Shah?

  Yeah, I agree. I fully agree with you. And it's kind of a rhetorical question because I do see that sometimes that I have a patient 45, 42 years old, I think. I'm thinking about one particular patient right now who's a hard-charging CEO, executive. She's like, I'm fine, I don't need all that stuff. And... I'm like, well, wait a minute, like, let's talk about prevention then. At least think about the preventative aspects here. And I think there's a case to be made.

• 56:32Speaker 01

  How long does she want to be high charging?

• 56:34Dr. Darshan Shah?

  Exactly.

• 56:35Speaker 01

  Like, because that comes at a cost.

• 56:36Dr. Darshan Shah?

  Yeah.

• 56:37Speaker 01

  Like, you're burning, you're gonna burn out at some point. And if you don't have the protective shield there to carry you through, she probably just has, still has probably good hormone levels at that age. Just know that that level of charging ahead, high functioning, is gonna come at a cost. At some point, it's gonna catch up. And if we don't have the preventative, you know, tools in place.

• 56:59Dr. Darshan Shah?

  I like what you said earlier, protective.

• 57:01Speaker 01

  Protective.

• 57:02Dr. Darshan Shah?

  Right.

• 57:02Speaker 01

  It's your protective shield.

• 57:03Dr. Darshan Shah?

  Shield, right.

• 57:04Speaker 01

  And that's why perimenopause is so destabilizing, because all of a sudden, women have been doing it all.

• 57:09Dr. Darshan Shah?

  Yeah.

• 57:10Speaker 01

  And doing it all pretty effortlessly until we lose that protective shield.

• 57:14Dr. Darshan Shah?

  Yeah.

• 57:14Speaker 01

  And then all of a sudden, it starts to fall apart.

• 57:16Dr. Darshan Shah?

  And this is a mindset that practitioners need to get their head wrapped around. Like, hormone replacement therapy, in my mind, we're coming to a place where it's not just for symptoms.

• 57:26Speaker 01

  No.

• 57:26Dr. Darshan Shah?

  It's something that we really need to look at as a truly protective preventative therapy for women.

• 57:34Speaker 01

  Yes.

• 57:34Dr. Darshan Shah?

  And it's kind of like, you know, we have no problem slinging around Crestor at everyone that has a low, that has a high cholesterol as a protective, you know, I'm doing air quotes, protective mechanism. Yeah, and that's a pharmaceutical agent. It's not even a bioidentical hormone that our body naturally makes since, you know, since childhood.

• 57:54Speaker 01

  Yes, it's puberty.

• 57:54Dr. Darshan Shah?

  Yeah, since puberty, right, exactly. It's like, why are we so hesitant to give women hormones? But all the other pharmaceuticals for prevention are okay.

• 58:04Speaker 01

  Yeah, well, aren't even, are they even preventative?

• 58:06Dr. Darshan Shah?

  Right.

• 58:06Speaker 01

  I mean.

• 58:07Dr. Darshan Shah?

  And that's another argument, right, exactly. Right.

• 58:10Speaker 01

  Yeah, I mean, the fear mongering that has happened because of the Women's Health Initiative is just, oh my gosh, it's devastating. That what has happened, that has set women back and set their longevity and their health span back. And I'm hoping that conversations like this, we really turn the tide on what women deserve in terms of preventative health. And even still, I mean, I can't tell you how many women come to me whose doctors, you know, they're in their 60s, and their doctors are taking them off their hormones.

• 58:33Dr. Darshan Shah?

  I know.

• 58:33Speaker 01

  Because they're out there, they're at that age where they don't need them anymore. I'm, I just don't understand at all. I'm like, what? And you have to understand that the second, within a year of you being off those hormones, you've lost, well, even less than that, you've lost all the protective benefit.

• 58:49Dr. Darshan Shah?

  Oh, in one year.

• 58:51Speaker 01

  In one year, or less. And women need to understand that. Then that conversation isn't happening. So whatever bone protection you had, whatever cardiovascular protection or brain protection you had, the moment you stop taking those hormones, you begin to lose that protection. So I always tell my patients, ride them until the wheels fall off, all the way to the end.

• 59:13Dr. Darshan Shah?

  I love that. So Marissa, what if you have a woman that comes to you, or there's a woman listening to this podcast who's 55 years old, she's in menopause, fully in menopause, but was never given the option of hormone replacement therapy. What should her next step be?

• 59:29Speaker 01

  I would say first, let's take a look at your symptoms. Let's also take a look at your labs. I want to do, you know, a cardiovascular workup. I just want to make sure she's good.

• 59:37Dr. Darshan Shah?

  Yeah.

• 59:38Speaker 01

  You know, even at 55, she's still within the window. Like even at 65, she's still within the window. Like there's no real contraindication. No, not really. I mean, I would say what we know from the Women's Health Initiative is after 20 years, we see a slight, a tiny risk for a stroke and cardiovascular disease. But it's so slight, and again, this is with oral estrogen. This wasn't even with transdermal estrogen.

• 1:00:00Dr. Darshan Shah?

  Yeah.

• 1:00:00Speaker 01

  And so I would say that there really isn't a window. I still want to look at everything. I want to make sure that she's good to go, that she is a healthy host for hormones.

• 1:00:08Dr. Darshan Shah?

  Right.

• 1:00:08Speaker 01

  But at 55, particularly, you know, depending on what her symptoms are, no, it's hormone replacement therapy, 100%.

• 1:00:16Dr. Darshan Shah?

  I think even if you unfortunately were seeing a doctor that was not going to even talk to you about it, and has the Women's Health Initiative messaging of it's going to cause breast cancer, you know, echoed out at you, I think it's time to reevaluate and just look at the real science that we have now that shows that hormone replacement therapy is still very safe, and it should be something you go find a practitioner to evaluate your work.

• 1:00:41Speaker 01

  Absolutely, yeah. As far as I'm concerned, she's on all systems go for HRT. And she does deserve that full workup so that she understands what's going on with her body. A lot has changed, even in, even in those last, those five years, you know, when she went into menopause. I want to make sure that she's clear on her cardiovascular status and her metabolic status. And even, I'd love to, you know, for her, again, it's not indicated, not until 65, but I'd love to see what her bone density is. Because at this point, she could have lost a lot of her bone by the time she's 55.

• 1:01:09Dr. Darshan Shah?

  And no one should wait until they're 65 to check their bone density. Then you can get a DEXA scan on your own, you know, you can just Google DEXA scan near me.

• 1:01:17Speaker 01

  Yeah, exactly.

• 1:01:17Dr. Darshan Shah?

  And you can find one, it's 50 bucks, and just go get it done and know where your bone density is.

• 1:01:21Speaker 01

  And I would say 40 years old is when I want that done.

• 1:01:24Dr. Darshan Shah?

  Yeah, yeah, exactly. And let's talk about as we get older. So the 55-year-old woman, no hormone replacement therapy, up to 65, you said, is probably still okay. And even after, okay, if someone is on hormones or hasn't had hormones, is there a way to kind of, I, I think the biggest negative aspect of hormone replacement therapy that people worry about is cancer, right? Specifically breast cancer, is that correct?

• 1:01:48Speaker 01

  That's correct, yeah, yeah.

• 1:01:49Dr. Darshan Shah?

  And so maybe, like you said, with oral estrogen, there might be a slightly increased risks later on. But is there a way for women to be proactively like screening and making sure that this is not an issue, they can still do hormone replacement therapy?

• 1:02:02Speaker 01

  In terms of their cardiovascular health and their breast health?

• 1:02:05Dr. Darshan Shah?

  Exactly.

• 1:02:05Speaker 01

  Yeah, absolutely. I think we should be screening as early as our 40s for both. And I think if you have a good primary doctor, there are screening for, I mean, I had a breast cancer scare last year, and I was fine. But I'm, I'm really grateful that, you know, we're, I'm, I'm looking at that. When I go to my primary doctor, who's a, who's a good friend, you know, we're looking at colon cancer, and we're looking at cervical cancer, and we're looking at breast cancer. That is their list. And then I've got my list.

• 1:02:29Dr. Darshan Shah?

  Exactly. I love it, I love it. What's your list add to that?

• 1:02:33Speaker 01

  I want, I want all the biomarkers, you know? I want, I usually like to do an ultrasound on my thyroid every five years or so, just to make sure we're good there. And I'm, you know, anything that's coming up for me. But mostly, I'm fighting for the biomarkers, you know? And then, you know, and also a cardiovascular referral, so that I'm looking in more depth, especially with the health history of my family.

• 1:02:52Dr. Darshan Shah?

  Yeah, I love this concept of like that they have a list and then you can have your own separate list now. And you really, one of the things I advocate at Next Health is obviously, number one, checking your biomarkers much more frequently. We like to do them every three to four months.

• 1:03:06Speaker 01

  And I love that. That is so proactive.

• 1:03:08Dr. Darshan Shah?

  So proactive.

• 1:03:09Speaker 01

  You know, if I could, always, if I could get three to four month data, oh, I love it, but at least twice a year.

• 1:03:16Dr. Darshan Shah?

  Yeah. And look, that amount of data is not right for everybody, but if you're someone that is data driven and is good about learning about your health, I think it can be very helpful. But the cancer list especially, like the cancer list has not moved in decades. And there's so much incredible technology out there now to look for cancer much earlier and less invasively. And there's an argument to be made, we should be doing everything much sooner as well, because people are getting cancer a lot younger as well. Can I dive into a little bit about how you think about breast cancer screening? And what's MRI versus mammogram versus other modalities? What are your thoughts around that?

• 1:03:54Speaker 01

  Hmm, that's a good question. I mean, obviously, the gold standard for us is going to be the mammogram. I love looking at, I had my MRI done earlier this year. And I think it's, there's no one diagnostic tool that I think is better or more superior than the other. And I think whether it's even thermography, if you want to just preventively, just looking at that, and maybe it can indicate if there's inflammation or anything going on, particularly in the breast tissue. But I would say MRI, if you can afford it. Again, it's, I want to make sure that it's cost available as well. Ultrasound, mammogram, just even self screenings, I think can be really helpful every single month. And then I would be also looking at, I mean, there's, there's other technology out there as well that just isn't as readily available right now.

• 1:04:39Speaker 01

  So, yeah, but those would be my, my recommendations. Like, I'm probably going to do, especially with my breast cancer scare, I will probably do MRI every, every couple of years, if not every year.

• 1:04:49Dr. Darshan Shah?

  Yeah. And I think, you know, to your point, like every woman is so different and you have to go based on what is the density of your breasts? Are you on hormone replacement therapy or not? There's a lot of, and hormone replacement therapy could be argued to be protective against having cancer as well.

• 1:05:03Speaker 01

  Yes, it can.

• 1:05:03Dr. Darshan Shah?

  So I think, I think it's a positive to be in hormone replacement therapy. But I used to be a breast surgeon. I did breast cancer surgery and breast reconstruction. And I just remember thinking all the time, like, why are we finding these cancers so late, you know? And I think there's something To be said that we really need to look at on an N of one basis, how do we update our cancer screening protocol for each individual woman in their particular risk versus like this population based?

• 1:05:30Speaker 01

  Average.

• 1:05:31Dr. Darshan Shah?

  We can only do mammograms on everybody because that's what the population can afford to do, you know? And I think if you're a woman listening to this, really look into MRIs. I think MRIs are becoming more available. They are still very expensive, but you can get a full body MRI and look at your breasts in that as well.

• 1:05:47Speaker 01

  For like $400 to $500 now at this point.

• 1:05:49Dr. Darshan Shah?

  Yeah, it's getting much less.

• 1:05:50Speaker 01

  Much cheaper.

• 1:05:51Dr. Darshan Shah?

  Much more affordable. And I would argue that, you know, diagnosing a cancer as stage one is much better than finding it as stage three or four. That's really expensive.

• 1:05:59Speaker 01

  Yeah, it's very expensive. And it's not only financially expensive, but it is quality of life.

• 1:06:03Dr. Darshan Shah?

  Absolutely.

• 1:06:04Speaker 01

  Yeah.

• 1:06:04Dr. Darshan Shah?

  Absolutely.

• 1:06:05Speaker 01

  I mean, I think a lot of us, again, as we talked about in the beginning, is that we think we're just got to tough it out and we need to survive this. And that is so far from the truth. Like you get to have a gold standard of care. You get to have a team that supports you. You get to have the lifestyle strategies that move the needle for you in a meaningful way so that you are thriving through this. And that those signals, those symptoms, what you're dealing with, if anything, it is just a beautiful reminder. It's your body's way of telling you that it's time for a new level of support and care.

• 1:06:33Dr. Darshan Shah?

  Great. What about mindset number two?

• 1:06:34Speaker 01

  Okay, I would say mindset number two is don't fear HRT. Don't fear the longevity strategies. Like you, again, you deserve all the tools in the toolbox and you deserve to find a provider and a practitioner who is willing to work with you on the hormone replacement journey.

• 1:06:49Dr. Darshan Shah?

  Yep, I love that. Okay, so number three, I want to add, don't think that hormone replacement therapy is going to lead to breast cancer. I think that's a major fear that has been ingrained in people's brains the last couple of decades from the Women's Health Initiative. And I think we have preventative strategies, which is hormone replacement therapy can be preventative, and we have great screening and just accelerate your screening, maybe.

• 1:07:11Speaker 01

  Oh, absolutely. Yeah, and earlier.

• 1:07:12Dr. Darshan Shah?

  Yeah.

• 1:07:13Speaker 01

  Yeah, accelerate your screening and earlier. I mean, I think it's about you get to be proactive about your health. You know, when you were talking about becoming a CEO of your health, I always say, no one's coming to save us. And so often for women, you're the one taking your kids to the doctor's office, you're the one checking on your husband's or your partner's biomarkers. You are really the epicenter of everybody else's health. Well, guess what? You're the epicenter of your health too.

• 1:07:36Dr. Darshan Shah?

  Yes.

• 1:07:37Speaker 01

  And so the more that you can take ownership of that, like that is a superpower.

• 1:07:42Dr. Darshan Shah?

  Right.

• 1:07:42Speaker 01

  That gives you agency.

• 1:07:43Dr. Darshan Shah?

  Exactly. Okay. Number four. What you you do number four.

• 1:07:47Speaker 01

  Okay, okay, okay. Number four. I say number four. I'm trying to think about all the things that I say and mindset. That even one shift, one habit shift, whether it's a conversation about HRT, or it is moving after a meal, or it's sleep consistency, or it's tracking your blood glucose. So that you're getting that data, that one shift, it doesn't have to be an overhaul. It doesn't have to be full burnout mode. Like, it doesn't have to be perfection. One shift can make all the difference.

• 1:08:16Dr. Darshan Shah?

  Yeah, absolutely. And also on that point, getting into a place, like you mentioned a lot earlier in this conversation, where you have forty five minutes to yourself every morning to have a routine where you can do some of these things, and the benefits of that will stack up over time.

• 1:08:31Speaker 01

  Mm hmm. Compounding interest.

• 1:08:32Dr. Darshan Shah?

  Exactly. And I will say number five on my end is also just becoming the CEO of your own health and following your own biomarkers and learning what are the important ones, why they're important, how you can affect them, and what's the optimal range, not just disease range.

• 1:08:47Speaker 01

  Absolutely. And that information is available. Like, it is, it's available in the book. It's available on your, on your Instagram, on my Instagram. Like, you know, someone asked me, what are your six top biomarkers that you want people to know, right? And, and, and these are the, these numbers, they give you power. And the beautiful thing is, is when you're tracking them three to four months, every three to four months, you can move those numbers back into optimal range. I want people to know that, that, you know, a, let's say, a triglyceride level of one eighty five milligrams per deciliter, that doesn't have to be your normal. You can get it back down under eighty milligrams per deciliter. I want you to know that there is so much power in that knowledge. And the more that you understand your biometrics and your lab numbers, that's when you get to move the needle.

• 1:09:31Speaker 01

  Like, I, I just got my labs back yesterday, and I was, I was just tickled when my, my fasting insulin was a four.

• 1:09:38Dr. Darshan Shah?

  Oh, that's amazing. Yeah.

• 1:09:39Speaker 01

  And I was so tickled, my, my fasting blood glucose was eighty.

• 1:09:43Dr. Darshan Shah?

  Beautiful.

• 1:09:43Speaker 01

  And my lip, my lipoprotein little A was forty. I was just, you should have seen the happy dance I was doing, you know?

• 1:09:51Dr. Darshan Shah?

  It's all good.

• 1:09:52Speaker 01

  You get to see this. Yeah, you get to and you get to be like, okay, what I'm doing is working. What I've done in the last 90 days is working and I'm going to keep doubling down on that. If you're not loving the biomarkers, you can be like, okay, what am I, what, what was the last 90 days like? What can shift? And that's why I, again, I love the continuous glucose monitors as well because in real time, you can influence your cellular energy. That's powerful.

• 1:10:16Dr. Darshan Shah?

  Yeah, I love that. I love that. This has been such an incredible conversation. This book is coming out soon.

• 1:10:22Speaker 01

  Yes, it is.

• 1:10:22Dr. Darshan Shah?

  The perimenopause revolution.

• 1:10:24Speaker 01

  Yes.

• 1:10:24Dr. Darshan Shah?

  Can it be pre-ordered?

• 1:10:25Speaker 01

  It can be pre-ordered.

• 1:10:26Dr. Darshan Shah?

  Okay.

• 1:10:27Speaker 01

  This is my movement, my mission, the rally cry for women to feel so good in their bodies. Yes, I have amazing pre-order bonuses, including exercise snack videos, intermediate and beginner workout videos. I've got lab ranges, how to track your cycle and your symptoms. So your perimenopause tracker, metabolically healthy meals, meal plans. So while you're waiting for this book, I give it all to you.

• 1:10:51Dr. Darshan Shah?

  Oh, so you can pre-order and then you get all this.

• 1:10:53Speaker 01

  And get all those bonuses.

• 1:10:54Dr. Darshan Shah?

  Where can we pre-order it?

• 1:10:55Speaker 01

  drmariza.com/book. That'll take you to the bonus page and you can buy it anywhere books are sold, Amazon. I just finished the audio version, so it'll be available on audio as well. I'm so excited for that because I'm a big audio.

• 1:11:08Dr. Darshan Shah?

  Did you read it yourself?

• 1:11:09Speaker 01

  I did.

• 1:11:09Dr. Darshan Shah?

  Oh, wow. Fantastic.

• 1:11:10Speaker 01

  I was in the studio for four days. Yes.

• 1:11:11Dr. Darshan Shah?

  Yeah. And for anyone listening and not watching this, there is a massive smile in your face while you're talking about this. You can feel the passion as you talk about it. And so I'm sure that's going to come out in the audiobook too.

• 1:11:25Speaker 01

  Yes, I was very, yeah, it was, it's, it's an undertaking, but it's such a beautiful honor to get to read your own book.

• 1:11:31Dr. Darshan Shah?

  Oh, for sure.

• 1:11:32Speaker 01

  And I'm so excited because I, as a, as a, as a busy mama, I listen to a lot of my content on audible, on Audible.

• 1:11:37Dr. Darshan Shah?

  Yeah.

• 1:11:38Speaker 01

  And on podcasts. And that's where I, I get. And then I, I like having both. I like having the audiobook and I like having the hardcover. I like having both.

• 1:11:45Dr. Darshan Shah?

  I do the same thing. I have both. Well, this was a fantastic convo. Thank you so much for this. It's such an honor to have you on and I learned so much today.

• 1:11:54Speaker 01

  Thank you for having me.

• 1:11:55Dr. Darshan Shah?

  Yeah. Where else can people find you? Your social media?

• 1:11:58Speaker 01

  I'm so excited. I just invited you to come on to my show, Energized with Dr. Marisa. And this is really, I mean, the conversation we just had, we can just translate it over to Energized, @DrMarisa, D R M A R I Z A on Instagram, where you'll find a lot of levity around perimenopause and metabolic health. Just, just a lot of humor, because sometimes we need a little bit of that to get through this transition. And drmariza.com is where you'll find the book and all the other things.

• 1:12:22Dr. Darshan Shah?

  I love it. Thank you so much.

• 1:12:23Speaker 01

  Thank you.

• 1:12:27Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.