14 Oct Perimenopause vs Menopause: Understanding Your Hormone Changes and What Actually Works with Mariza Snyder
Have you been told your symptoms are just part of getting older? That the sleepless nights, unexplained weight gain, mood swings, and exhaustion are simply something to accept? If your doctor has handed you an antidepressant or birth control pills and said “it’s just menopause,” you’re not alone—and you deserve better answers.
As someone who’s walked through this transition myself and now coaches thousands of midlife women, I’ve become fascinated with understanding what’s actually happening in our bodies during perimenopause and menopause. The confusion, the conflicting information, the feeling that your body has betrayed you—it’s real, and it’s not your fault.
That’s why I brought back integrative physician Dr. Mariza Snyder to dive deep into what she calls “The Perimenopause Revolution.” Dr. Mariza is not only an expert in this field but also a midlife woman navigating this journey herself. This conversation is for every woman who’s been dismissed, confused, or told to just accept declining health as inevitable.
Understanding the Hormone Confusion: Perimenopause vs Menopause
Let’s start with the basics, because even the terminology can be confusing. For years, everything was just lumped together as “menopause,” but understanding the distinctions matters for getting the right support.
Menopause is actually just one day—the day you mark after not having a period for 12 consecutive months. That’s it. One moment in time. Everything after that is technically the second half of your life, though many call it post-menopause.
Perimenopause is the transition phase where your ovaries are going offline, and it’s characterized by erratically declining hormones. This phase can last up to 10 years and is where most women experience the symptoms that disrupt their lives. By age 35, women only have about 10,000 eggs left, winding down to just a few hundred by menopause. As your ovaries recognize this dwindling supply, communication between your ovaries and brain becomes disrupted—like a game of telephone where messages get garbled.
What many people don’t realize is there’s also a “waiting room” phase that nobody talks about. You could be nine months without a period, then suddenly have one again, technically restarting the clock. Dr. Mariza’s perspective is powerful: once you’re in that waiting room and struggling with symptoms, you deserve support—you don’t have to wait for some arbitrary timeline.
The Hormone Dance: What’s Actually Happening in Your Body
To understand what goes wrong in perimenopause, it helps to know what normal looks like. In your reproductive years with a healthy 28-day cycle, here’s the basic pattern:
Days 1-5: Low hormone state across the board—estrogen, progesterone, and testosterone are all at baseline. This is why you might feel off in the first few days of your period.
Days 5-11: Estrogen starts rising, and you begin feeling more like yourself. By day 11, estrogen peaks, and this is when most women feel their best—the version of you everyone wants to be around.
Mid-cycle: Testosterone also peaks alongside estrogen in that follicular phase. Then ovulation occurs, triggered by a surge in luteinizing hormone.
Days 14-21 (Luteal phase): After ovulation, your corpus luteum releases progesterone, which rises significantly. In a healthy cycle, the ratio of progesterone to estrogen should be anywhere from 100:1 to 500:1. This is when you should feel balanced, with good mental and emotional resilience.
Days 22-28: Everything tanks—both estrogen and progesterone drop, triggering your period.
The key point? Ovulation is the main event. It always was. You only get progesterone if you ovulate, and progesterone is crucial for sleep, mood stability, and metabolic rate.
When Things Start Going Wrong: The Perimenopause Shift
In perimenopause, progesterone is typically the first hormone to decline. Why? Because you start having months where you don’t ovulate at all, or ovulation is suboptimal. Without ovulation, there’s no corpus luteum to produce progesterone.
This is why early perimenopause symptoms often show up in the luteal phase of your cycle:
- Intensified PMS that lasts longer (4-5 days instead of 2-3)
- Lower stress tolerance
- Sleep disruptions (hello, 3 AM wake-ups)
- Mood swings and irritability
- Brain fog and difficulty multitasking
- Slower workout recovery
- Cycle changes (shorter cycles, heavier bleeding)
When progesterone drops but estrogen remains relatively higher, this creates what’s called “estrogen dominance”—though this term is often misunderstood. It doesn’t necessarily mean you have too much estrogen; it means you have too much estrogen relative to progesterone. This imbalance can cause fibrocystic breasts, bloating, heavier periods, and even migraines.
As perimenopause progresses into late stages, estrogen also becomes erratic—sometimes spiking high, sometimes plummeting. Those months where you don’t have a period at all? Your endometrium has been building up for 60 or 90 days, leading to those “crime scene” heavy bleeds when your period finally arrives.
The Standard Medical Response: Why It’s Not Enough
Here’s where many women get frustrated with the healthcare system. The typical response to perimenopause symptoms? An antidepressant and hormonal birth control.
Dr. Mariza calls this “lazy medicine,” and I have to agree. After the Women’s Health Initiative study scared everyone away from hormone therapy about 22 years ago, doctors were left with limited tools. So they turned to what they had: birth control pills to regulate bleeding and antidepressants for mood symptoms.
But here’s what you need to know: Combination birth control contains synthetic hormones that stop ovulation entirely, putting you in a constant low hormone state. It’s essentially a flat line—no natural hormone fluctuations at all. And while this might control heavy bleeding, it doesn’t address sleep issues, cognitive changes, energy levels, or many other perimenopause symptoms.
Even more concerning: hormonal birth control actually contains higher doses of hormones than bioidentical HRT, yet one is handed out readily while the other is often withheld. The synthetic progestins in birth control also have more concerning data around certain health risks compared to bioidentical hormones.
Meanwhile, 61 million women in the United States are currently on antidepressants or anti-anxiety medications. Many of these prescriptions are written for women experiencing the mental health impacts of hormone changes—yet the root cause (declining estrogen and progesterone) often goes unaddressed.
Why Estrogen Matters More Than You Think
Here’s something crucial to understand: Estrogen is the CEO of your brain. Perimenopause is actually a neuroendocrine transition where your brain undergoes vast changes.
For 20 to 35 years, estrogen has shown up rhythmically every single day. Suddenly, in perimenopause, estrogen becomes erratic—sometimes over-showing up, sometimes not showing up at all. Your brain is desperately trying to adapt to this chaos, which is why mental health and cognitive symptoms emerge.
When estrogen finally bottoms out in menopause (and let’s call it what it is—they don’t “level out,” they bottom out), every system in your body feels the impact. Yet many doctors still dismiss this as “just aging” rather than recognizing it as a treatable hormone deficiency.
The Metabolic Connection You Can’t Ignore
One of the most important takeaways from my conversation with Dr. Mariza is this: Your reproductive system is metabolically driven. What throws off your hormones in your 20s and 30s—and what makes perimenopause symptoms worse—is often an underlying metabolic issue.
Your cellular energy impacts everything you think and everything you do. When your cells can’t efficiently process glucose or fat into energy (ATP), your entire body struggles. This affects:
- Hormone production and balance
- Sleep quality
- Mental clarity and mood
- Physical energy and recovery
- Weight management
- Inflammation levels
Only 7% of American adults have good metabolic health. If you’re struggling with perimenopause symptoms, blood sugar dysregulation and insulin resistance could be major contributing factors.
Dr. Mariza recommends looking at your fasting blood sugar and considering a continuous glucose monitor (CGM) to understand your patterns throughout the day. While the medical establishment considers an A1C under 5.7 “normal,” functional medicine practitioners prefer to see it between 4.9 and 5.2.
The Power of Circadian Rhythm Optimization
Here’s something you can start addressing today: your relationship with light.
We are diurnal, sunlight-driven beings. Our hormones—including insulin, ghrelin, leptin, and cortisol—run on biological rhythms that sync with light exposure. When this rhythm is disrupted, everything can be disrupted, including insulin sensitivity, sleep quality, and energy levels.
My husband is a perfect case study. He was naturally a night owl who stayed up late using blue light and slept in during the mornings. After learning about circadian rhythm optimization, he made specific changes:
- Getting outside within 30 minutes of sunrise to get natural light in his eyes
- Spending 45 minutes in actual sunlight during the day
- Switching to amber light bulbs at night (that mimic firelight)
- Wearing blue light blockers when using screens in the evening
- Avoiding bright LED lights after sunset
The result? His testosterone levels shot up naturally, his energy improved, and his sleep quality transformed—all within about a month. This isn’t just for men; these same principles apply to women navigating hormone changes.
Before Adding Hormones: Become a Good Host
If you’re considering hormone replacement therapy (and we’ll talk about that), Dr. Mariza emphasizes an important concept: you need to be a good host for hormones.
Hormones are powerful chemical messengers that bind to receptor sites throughout your body. But you also have to metabolize and eliminate them properly. If your liver is sluggish or you have poor gut health, those hormones can cause side effects rather than relief.
Before jumping to HRT or other interventions, consider:
Blood work basics:
- Inflammation markers (high-sensitivity CRP)
- Vitamin D levels
- Uric acid
- Fasting insulin
- Fasting glucose
Lifestyle foundations:
- Blood sugar balance and metabolic health
- Circadian rhythm alignment
- Gut health support
- Liver detoxification pathways
- Stress management and nervous system regulation
- Consistent movement
These aren’t sexy interventions, but they’re the foundation that makes everything else work better. You can implement them at home, starting today, without expensive testing or prescriptions.
When Hormone Replacement Makes Sense (And When It Doesn’t)
The conversation around HRT has become polarized, with some doctors refusing to prescribe it and others suggesting everyone should be on it. The truth is more nuanced.
HRT is not a magic bullet. It won’t fix poor lifestyle habits, chronic inflammation, or metabolic dysfunction. But for many women, especially those who’ve optimized their foundations and are still struggling, bioidentical hormones can provide significant relief.
The key is working with a knowledgeable practitioner who understands:
- Your individual hormone levels and symptoms
- Your metabolic health status
- Your ability to detoxify hormones
- Proper dosing and delivery methods
- How to monitor and adjust based on your response
This is NOT something to DIY by ordering from random websites. Whether you’re considering HRT, peptides like GLP-1s, or even supplements for blood sugar control, working with a clinician who can run labs, monitor your progress, and make adjustments is essential.
Remember: this is your body, your health, and you only get one chance. Advocating for yourself is crucial, but so is working with qualified professionals who can guide you safely.
The Perimenopause Revolution: Taking Your Power Back
Dr. Mariza wrote “The Perimenopause Revolution” because she was blindsided by perimenopause herself. Like many women today, she had babies later in life and found herself moving directly from postpartum into perimenopause with almost no runway between.
The book’s core message is powerful: You deserve agency over your health, and you can have it.
Right now, the medical system is far behind in how we care for women in perimenopause. You’re likely going to have to advocate for yourself, which means getting educated. The book provides everything you need to have informed conversations with your healthcare providers and to implement daily strategies that move the needle.
This isn’t about complicated protocols or expensive supplements. It’s about:
- Understanding what’s happening in your body
- Optimizing circadian rhythms
- Balancing blood sugar
- Moving your body intentionally
- Regulating your nervous system
- Building supportive community
- Knowing enough about HRT to have the conversation
The throughline of everything is metabolic health—the quality of your cellular energy. When you secure that foundation, you have resilience for this transition and for the second half of your life.
Your Action Steps: Where to Start Today
If this resonates with you, here’s how to begin taking control:
- Get educated: Grab Dr. Mariza’s book “The Perimenopause Revolution” at drmarisa.com/book (there are bonuses including symptom trackers and lab ranges)
- Start with your doctor: Request basic blood work including fasting insulin, fasting glucose, A1C, vitamin D, and inflammatory markers
- Optimize your circadian rhythm: Get morning sunlight, minimize blue light at night, and create a consistent sleep schedule
- Focus on blood sugar balance: Consider a CGM to understand your patterns, and work on eating to stabilize glucose levels
- Find your community: Connect with other women navigating this journey. You’re not crazy, and you’re not alone
- Advocate for yourself: If your doctor dismisses your symptoms, find a practitioner who specializes in perimenopause and hormone health
The Bottom Line
Perimenopause and menopause are not diseases to suffer through—they’re transitions that deserve proper support. You don’t have to accept exhaustion, brain fog, weight gain, and mood swings as your new normal.
Yes, hormones are changing. Yes, your body is different than it was at 25. But with the right knowledge, support, and interventions, you can thrive in midlife. This isn’t about anti-aging or fighting your body—it’s about optimizing for this stage of life and stepping powerfully into your second act.
The narrative that women are meant to suffer needs to end. Every symptom you’re experiencing is your body communicating with you. When you learn to listen and respond with proper support, transformation is possible.
You deserve to feel energized, clear-headed, strong, and confident at every age. The perimenopause revolution is about claiming that truth and refusing to accept anything less.
📒 Get Dr. Mariza Snyder’s book “The Perimenopause Revolution” at https://drmariza.com/book for comprehensive strategies and exclusive bonuses.
The contents of the Midlife Conversations podcast is for educational and informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider. Some episodes of Midlife Conversations may be sponsored by products or services discussed during the show. The host may receive compensation for such advertisements or if you purchase products through affiliate links mentioned on this podcast.
