What Research Really Says About Birth Control with guest Dr. Mariza Snyder

Our previous episode with women’s hormone expert Dr. Mariza Snyder was so jam-packed with great information that we invited her back! This time on the Brainy Moms podcast, we’re talking about birth control, periods, perimenopause, PCOS, and menopause. This latest episode is equally full of valuable information, statistics, new research, and personal stories. Whether you’ve been thinking about getting your daughter on the pill, if and when you should take hormones for perimenopause, or just want to understand how women’s hormones affect every aspect of our lives, tune in for this in-depth discussion Dr. Amy and Sandy had with a leading hormone expert. Dr. Mariza is passionate about helping women understand what’s happening in their bodies—from their first period to their last and beyond—and she even shares insights on the types of experts to see. (HINT: It’s not an OB/GYN!) Grab a pen and paper because you’re going to want to take notes!

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Transcript

DR. AMY: Hi, smart moms and dads. We are so excited to welcome you back for another episode of the Brainy Moms podcast, brought to you today by LearningRx Brain Training Centers. I'm your host, Dr. Amy Moore, and I am joined by my co-host, Sandy Zamalis. And Sandy and I are really happy to welcome back another, let's, let me re slurp the hair. All good. Try that again. Sandy and I are super excited to welcome back our guest, Dr. Mariza, and y'all I'm dying here. We're going to do this one more time. Sandy and I are super excited to have another conversation with Dr. Mariza Snyder. We had Dr. Mariza on a couple of months ago to talk about women's hormones and what we didn't get to talk about when she was here was birth control. And so we invited her back to have a conversation just about birth control. Let me tell you a little bit about her. So Dr. Mariza is a functional practitioner, women's hormone expert, and an author. For the past 15 years, she has lectured at wellness centers, conferences, and corporations on hormone health, metabolic health, nutrition, and detoxification. She's been featured on Dr. Oz, Oprah magazine, Fox News Health, MindBodyGreen, and others. Dr. Marisa is also the host of her own podcast called “Energized with Dr. Mariza.” We are so happy to have you back. Welcome. 

MARIZA: Thank you so much for having me. I'm so excited for this conversation. 

SANDY: So last time we talked about hormones and perimenopause and we really wanted to talk about birth control today, because, like we talked about before we even started the show today, we all have a horror story about birth control. And as parents, it is probably one of those hard conversations you've got to have if you've got teenage girls. So we're just going to dive right in, Dr. Mariza. Where do you want to start? 

MARIZA: Yeah. I mean, I would love, I'd love to share if you're open to, I'd love to share my horror story and just how it all went so wrong, you know. I grew up, I was, I'm born in 1979. So I'm an ‘80s baby. And I was in school in the ‘90s. I graduated high school in ‘98, and back then I felt like every magazine was touting the benefits of birth control, like getting rid of a bad boyfriend, fixing your hair, mood swings, acne. I mean, it was, they were promising the world to all of us in high school and also in college. I remember just at every glamor magazine, Self magazine, anything that was on the shelves really felt like there was so much kind of, just marketing and propaganda around getting on the pill. And so it was a very normal thing that it happened. And me, like so many other girls, you know, when I was in puberty, no one tells you that they're going to be for a couple of years, definitely around the 14- to 16-year-old age where it's going to look like polycystic ovarian syndrome. It's going to be inconsistent. And that's really the name of the game. But my parents didn't tell me this. If anything, my parents were like, “Don't get pregnant.” That was the conversation. You know, someone could sneeze on you and it would be over. Like don't ruin … my mom got pregnant out right after high school and they was kind of like “don't let that happen to you.” And so, and that was the only conversation. So when my cycles were off and I probably had POS looking kind of like where I wouldn't have a cycle for a month and then it would come back and I didn't know how inconsistent cycles could be. And so the top track around that irregular menstrual cycle wasn't that, “Oh, this is typical as the ovaries are coming online during puberty. You're gonna have some mixed messages between the brain and the ovaries and you know, follicular stimulating hormone is gonna really crank up,” you know and “Let your ovaries know they need to be more consistent.” And so because of that, the solution was birth control. And so I remember getting on birth control and I thought that it was normalizing my cycle. I didn't know that it was turning it all off. And then once, I remember it was being such a big pain in the butt, taking it every single day at the same time. So I remember my doctor telling me, she's like, “You know, there's this Depo-Provera shot that you can do that you only have to do quarterly.” And I thought, sign me up. Not once did she talk about the extreme symptoms of the Depo-Provera shot, which is just horrific. I mean, the horror stories on of little girls on that shot are just mind blowing. And I was very much that girl. I lasted, I barely lasted a year on that shot. And I remember it's tense, insane, depression, anxiety, mood swings, weight gain, exhaustion, brain fog. I mean, honestly, I mean, you could have said I was in perimenopause at the time. It was so extreme and I just felt like I was out of my body to a point where I finally stopped taking the shot. It took me almost an entire year. I was 21 years old when I finally got my cycle back. And so, I remember, and that was it. I swore I would never ever get on birth control ever again. I believe the stat is that only 50 percent of girls stay on the pill or any kind of hormonal birth control. You know, 50 percent get off of it within a year of use. Cause the symptoms are just so insane and intense. So that's my story. And honestly, I was like, never again. So at the age of 21, the young age of 21, I committed and now I'm 44 and I have never been on birth control again. 

DR. AMY: Wow. 

SANDY: Wow. I have a similar story. Mine ended up in a really scary place for sure. And now I didn't have the Depo-Provera. I was just regular birth control pills as a teen and just ended up in such a deep depression that I had to be hospitalized for a while. So like, it was really scary to me as a parent when I had to have a conversation with my daughter. Because not only did I, I didn't want to. I didn't want to do what like you were saying your mom did like we all want our kids to be safe and, you know, understand their choices and all that kind of stuff. But I was terrified. I was absolutely terrified as a parent that my daughter would have a similar experience that I had. I was hoping that it was better, but I feel like anytime you mess with hormones, and I'm sure you're going to tell us more about that, but anytime you mess with your hormones, you're, you know, you get what you sow, you sow what you reap, you know, you're messing with your body and things are just going to go awry. So, I can't wait to hear more just in general about how birth, what birth control does to your body. 

MARIZA: Absolutely. Well, I would love to get into it for sure. And I'll talk a little bit about some of the research I know around birth control and the brain in the body. And also that there's other options. I mean, I've, I know, you know, probably, I don't know if it's TMI or not, but if a woman asks me all the time, well, what do I do? I'm like, it's called condoms. That's what you do. Like, I'm like, there's other options, especially for young people where, you know, the concern around STDs are very, very prevalent and very real. And so birth control doesn't prevent any of that. That's for sure. But yeah, I want to first talk about our menstrual cycle and how critical it is to our, not only to our reproductive system, but to our entire body. I believe that our menstrual cycle is our fifth vital sign. And I'm not the only one who believes that. You know, I know that the American Board of Obstetrics and Gynecology believe the same that they, we've begun to realize how critical it is to have these reproductive hormones online. We know that estradiol, which is the main hormone being created during our menstrual cycle and progesterone, along with testosterone, have a profound impact on every single organ system of the body. No wonder girls are struggling with mental health issues when they're put on the pill, or even, you know, as I think about so much of my demographic, women in perimenopause, which is the second puberty, except that we're not ascending into ovulation, we're on the descent. And what does that look like? And it's gotten so clear that as those hormones are, are less are being produced and are declining in the body, that it is driving our physiology into a default inflammatory state. And so you can imagine being on hormonal birth control and turning off what I call the “main event,” which is ovulation, that drives and propels not only a reproductive system, but so many other systems in the body that that does put us at greater risk. And so that's what I want to speak into is what hormonal birth control is doing is we're putting synthetic progestins and synthetic estrogen into our bodies. And as a result, we're basically turning off the cycle, our menstrual cycle, our fifth vital sign. And we are now looking deeper into the long-lasting implications of turning that important system off for, you know, short periods of time and for some extended periods of time, you know, over a decade's worth of time. And so I just want you to know that, you know, by suppressing what is considered, what I like to say is I think the menstrual cycle is really at the epicenter of a woman's physiology. Like it's really driving our metabolic system. It's driving a lot of our other hormones. It has a profound impact on how our body's physiology is working because a lot of what we're here on earth to do in our biology is to extend the human race, like is to continue to continue having babies. And so by turning that system off, you know, we're beginning to understand that it has profound implications. And when we turn that off with medication and synthetic medication, we know that there are adverse side effects. And so we know that the pill increases risks of migraines, blood clots, heart attacks, stroke, liver conditions, depression, and suicide. But also women can experience weight gain, low libido, brain fog, mood swings, vaginal dryness, and most definitely nutrient deficiencies like B vitamins, vitamin C, vitamin D, and magnesium. So those are just some things that we want to just put on the radar that as a result of going on the pill, we are going to see some of those changes happening by turning off a very critical piece of our physiology. 

DR. AMY: Yeah, that's staggering to think about because, you know, when you when you think, “Okay, I'm going to go get on the pill just so the egg isn't released every month,” you don't think about the systemic impact of putting synthetic hormones in your body beyond, “Okay, it's just not going to release an egg.” 

MARIZA: Right. Right. And well, that's what we were told. No wonder that's what we thought. You know, that's so, that's what I was told that there weren't any real side effects. “Maybe you'll gain a little weight. Maybe you'll feel a little moody at first, but like it's all good.” But it's not all good. And I also want to say that, I mean, I know that birth control has helped women maintain jobs. It has helped us skyrocket our careers. We have more women going and graduating more than men graduating from college and grad school and becoming doctors. Like I, you know, we can see that some of the, in terms of us creating autonomy and freedom, it has offered us that. But then at what cost, you know, in terms of our physiology? Girls are having, women are having a harder time getting pregnant. Infertility is on the rise. Just bringing, trying to get your cycle back can take months, if not up to a year, maybe even longer for some. And for some women, it just doesn't ever come back. We see, you know, premature ovarian insufficiency. And so these are just the realities of what a medication can do when you're turning off, again, what I consider to be one of the most vital physiological systems in a woman's body.

DR. AMY: So then how do you respond to the argument or to what's commonly believed that getting on the pill will help regulate your cycle and will help you have less severe cramps? 

MARIZA: Mm. And I'm not saying that it's not gonna help. I mean, yeah, if you don't have a lot of prostaglandins popping up, you know, you're gonna have less cramps. But we now know, at least I think where many people stand is that that's a lie. It's not regulating your cycle. It is not doing anything like that. You know, if you have a bleed during being on hormonal birth control, that is a pill bleed. That is not a physiological, there's no shedding of the endometrium happening there because you have your hormones dropping. It is consistent dosing of synthetic hormones every single day. And the intention for that is to shut our hormone system, our menstrual cycle system off. That is the full out intention. And so telling women that it is regulating their hormones, to me feels like gaslighting and it feels like medical negligence.

DR. AMY: Wow. 

MARIZA: That's, I mean, let's just be straight up. Call it what it is! We're turning it off. You know, we're turning the faucet off and, and women deserve to know this. I, you know, if I would have known, I don't know if I even would have known what the implications of that meant when I was younger, unless someone really explained, I mean, I never would have guessed in a million years, I would have lost my period for a year after I got off the depo or that I would have had such extreme symptoms. You know, that wasn't clear to me and it definitely wasn't clear that it was going to take that long for my body to come back online. And so if I think of these types of the conversation of what the implications are, you know, what to be expected regarding, you know, symptoms and long-term usage, what that can look like, that to me  is really about, you know, educating women. Informed consent. Just really laying it out of what it looks like and what you, what you can expect over time. And same with women, whether it's younger girls or it's women in perimenopause where, you know. Again, perimenopause is literally defined as a default state of hormone chaos. That is what is happening. There is, you cannot balance hormones in perimenopause, like, good luck. You know, you can do the best you can mitigating it. You're talking about declining hormones and physiological changes because of that. That really isn't setting us up to win. And so I'm a big fan of, you know, the consideration of bioidentical hormones that are actually real, that are binding to receptor sites that are helping us mitigate some of those changes in perimenopause. I don't think a, you know, a synthetic hormone pill that is higher levels of synthetic hormones is the answer for women in the perimenopause continuum either. And so again, I just think it's really about educating women and giving them the kind of the options that they have and then allowing them to make that decision for themselves.

SANDY: So let's go to the parent discussion. If you're a parent and you have teenage daughters, and I know you're a big proponent of that informed consent. What are questions parents should be asking, especially if they're allowed to be in this process with their child to help figure out if it's the right choice for them? What do they need to know about how it affects their teenager developmentally? What questions should they be asking their doctor? Because, you know, I think we all have that very skewed version of, you know, a simplistic version of what birth control does and helps with. So what are the other sides of that?

MARIZA: Yeah, I mean, I think, so there's a couple different kinds of pills or hormonal birth control that are that that are worthy of discussion. You know, obviously, the kind of the biggest heavy hitter, the one that a lot of us were put on originally was the combination pill and you're getting hit with both synthetic hormones, synthetic estrogen and progestins. And then you've got the mini pill, which as I don't know if you guys know, the mini pill has just been approved without the need of prescription. And the thing about the mini pill, and so it's usually recommended for women who are breastfeeding, who are not looking to get pregnant with the next baby already, or someone who's looking to regulate their cycle, versus someone who wants to use it, especially younger girls who want to use it for birth control, like do not get pregnant, because if it's not taken consistently, if it's not taking within the same hour every single day, it becomes less potent and less effective. And so, I believe 13 percent of girls who start using the mini pill, which is often like in a lower level of progestins, and progestin only, 13 percent of girls will get pregnant in the first year of using the mini pill. And so, just, but that's a pill that is available without the need of a prescription. And so looking at looking through your options. The other option, I think that is the most attractive to a lot of moms and girls is probably the I U D. Whether it's the Mirena or, you know, the copper and what I will say about the IUD in terms of its effectiveness is that it does contain a little bit of a progestin. But the interesting thing about this particular IUD is that in some cases, girls could still have an ovulatory cycle, but for the most part, not. But your better chance of having an ovulatory cycle would be with an IUD. And so if there was a lesser evil, so to speak, that would potentially be it. So I would, I was a mom, I would say, lay it out, lay it out for me. Like, sell me on it, you know, and explain to me the risks of each of these. I have a whole episode that goes through the meticulously every single one, what is in it, what are the side effects, what are the potential risks over time, and, you know, kind of what are the lesser of the evils and the Merina IUD definitely is the lesser of those. And I would also be asking my doctor of why are we even thinking about putting my daughter on this? Is it symptom driven? Because then let's dig into the root cause. You know, again, birth control is a band aid. What I consider to be a terrible band aid. But like, is is it PCOS? Polycystic ovarian syndrome? If 33 percent of our teenagers are pre-diabetic, are we dealing with something like that? The pill isn't going to fix prediabetes. And or is my daughter, are there nutrient deficiencies that I need to consider? Is it stress that, that are, that is, you know, we know that a lot of things have a profound impact on the cycle. Or is she just at an age where it's inconsistent because it's meant to be inconsistent? Like that's the conversation as well. And then talking about the symptoms and the options and then, you know, asking them if they understand the, you know, the research around starting girls on the pill before the age of 21, 22. And the profound impact it can have on the development of the brain, the development of their physiology, their microbiome, their nutrient deficiencies, creating those, and even their metabolic health. Like, what kind of profound changes are worth looking at, you know, if we're starting her at an age where it's going to shift her development and growth? 

DR. AMY: Okay. So we still need to like break those myths, right? Like debunk those myths that, you know, we need to regulate the cycle that, you know, getting on the pill is the only way to get rid of acne without going on Accutane and all of these other things, right? Well, I love how you talk about let's get to the root cause. Right? And then work on fixing that rather than using birth control pill as the fix. When I was a teenager, I had very heavy periods and very, very, very severe cramps to where I missed a day of school every month because the cramps were so bad. So I know I'm not the only one who as a teenager suffers through that. And so the easy fix, according to my doctor, was to put me on the pill and it helped. So if that is not what you recommend, because of all of these side effects, obviously, all of these, this systemic impact to the body and the brain, what can we say to teenagers who are suffering, right? Like, what, like, what are your recommendations to help them with manage those cramps and the heavy bleeding? 

MARIZA: Absolutely. And I think important. It's like kind of looking at it can be a moving target in puberty and perimenopause testing hormones. I mean, it really is. Like in some doctors would argue, why are we even testing hormones in puberty and perimenopause because it's so erratic. But then when we look at symptoms like that, where heavy bleeding and cramping, you know, we know that it could be an issue of estrogen dominance, where we just maybe the liver is just not enough metabolizing the excess estrogen quick enough. So, so I would, based on the symptoms, I would really start to dig in. And there's some great books out there. One of my best friends, Nicole Jardim has a book called “Fix Your Period.” I'm pretty sure it's called, “Fix Your Period” and a lot of her demographic. It's very obvious what the book is about. And I'm pretty sure that's exactly what it's called. And it's, it's really talking about girls, like how we can help women and girls, young girls and young women address some of the most common symptoms of, you know, of their periods and of an inconsistent or, you know, a symptom-driven menstrual cycle. And so one of the areas we would be looking at is the liver and the gut, particularly around estrogen dominance, if we're seeing kind of those more estrogen-dominant symptoms. Or maybe it is blood sugar deregulation. Again, we're looking at blood sugar levels as well. Or maybe it's nutrient deficiencies. Like so often zinc and B vitamins, um, can be a game changer. I mean, how many teenagers are getting the right kind of nutrition? I, you know, I really couldn't speak to that. I don't think it's amazing. You know, I remember being a teenager. It wasn't good. It was a lot of ultra-processed foods. And so looking at, you know, what are the nutritional pieces? What's the gut piece? What's the liver piece? How can we help to balance blood sugar? Are there nutrient deficiencies to address? Stress incidents? Because here's the thing, if, I don't know if it got better over time and how long you were on it, but what I learned is when I got, when my period came back online, you I had the same problems that that I did then. The pill didn't make it better. And if in anything, because I kept doing the same thing for more years and I had this pill that band-aided and kind of hid things behind the scenes. My menstrual cycle, my reproductive system wasn't any happier because of it, if anything, I was driving more inflammation because I really didn't get clear on what was going on. I was still not eating super great. My liver was still super unhappy. And so those are the things that I would be looking out for. You know, what are the symptoms educating and then getting some resources to actually address that. The root cause. And so for often, I always think it's the gut and liver. It's blood sugar, it's stress and it's nutrient deficiencies. Those are the those are the big five. And there are so many amazing resources out there today that are like, okay, if this are these the symptoms, let's start here and then we can move to the next step. 

DR. AMY: All right, so this one is going to be more difficult to answer. Teens have a hard time with future-oriented thinking. 

MARIZA: Oh, for sure. 

DR. AMY: Right. And so, it's very difficult to convince them, right, that the long-term impact on your body includes A, B, C, and D. And so it almost comes down to starting these discussions early, like in earlier adolescence to kind of create this safe environment to talk openly, you know, with your mom about your body and so that your mom or dad are allowed to speak into your health, right, in all areas as opposed to waiting until your 16 year old comes to you and says, “I want to go on the pill.”

MARIZA: Yes, like she's made up her mind. She's like, “I'm clear.” Yeah, “I am clear, Mom. I know the pill. I talked to my friends.” Yeah. Yes. And I, this is, this is where we really need to bridge the gap. There is, I interviewed an amazing, Holly, I want to say Holly Briggs. She has a book out as well on the menstrual cycle and she created an app called Teena. And you can actually start the app with your parents. It can all, it can just be on your parents’ phone even before the, your period. And it really walks girls through with their family, their parents, what are all the changes and the things to expect and the shifts that are going to happen, right? Because what your period looks like at 11 is going to be very different than when it really hits the fan at like 14, 15, 16, or when you're thinking about other, you know, other things, other extracurricular activities, you're looking to do, I think having to having a resource like that, where the conversation is happening. There's, you know, they're learning how to track their cycle. They're learning about what it means to have a menstrual cycle, the different phases of their cycle, right? The follicular phase versus the luteal phase. But really our cycle kind of breaks down into four different phases and then they can really start to listen to their body and even kind of start like, “Oh, like, Oh, I must be, this must be ovulation. Like this is what it feels like to be an ovulation. This is what it feels like to be an early luteal. Ooh, this is what I'm experiencing in my late luteal, heading into my period. This is what early follicular looks like. And then what mid follicular looks like.” So they get a really great sense of body literacy. I think that is so critically important. So what I love so much about this resource was that not only was it came from a very positive and beautiful perspective, but it could be managed by the adult because you can imagine an 11 year old like, “mmhm” and just done in a way that was so respectful, but was really creating beautiful body literacy around what's happening. So that girls knew that this was a superpower and that, you know, that they get to tend to and take care of. Versus something that they just, I'm like, just shut it off. I remember being 18 and just like, “Shut it off, shut it off. Like, I don't want it.” And cause I just didn't know how important it was. No one had told me how critical the system was. I was like, it doesn't, I'm not trying to get pregnant right now. That was my attitude. And shut it off. Like, and I mean. Like, I just, I kind of knew intuitively that that's what was gonna happen. I'm like, because, but I was so naive to think that it was, I could, like, I could just turn it back on, you know, because I just didn't know. And so, I think that's a really important piece of it, is the superpowers around it. I mean, obviously, you know, cycle syncing is so, is so big on TikTok and Instagram, and what does it look like when you're In your high follicular fame, you feel like a rock star. And you know, what does it feel like? You know, it's like, you get to own these parts of you that are okay. But what does it mean to be more inward during late luteal? And that being so okay about being selfish, about tending to yourself. You know, I didn't learn this until my mid-thirties. I was like,” Oh, this isn't something I should beat myself up about. This is something I get to embrace and I get to be, be about me right now.” Like, and so, I think that's the kind of conversation that we get to have. We get to create a new legacy for our girlscoming in and changing the dialogue around, you know, how much our menstrual cycle really is influencing our behavior, our mood, our motivation, our creativity. And how we just show up in the world. Like every single day your hormones change and that changes your microbiome, that changes your brain chemistry, it changes your mood, it changes your metabolism, it changes everything, like every day you are a different person than the day before, because your hormones are doing different things, they're binding to different receptor sites. And I think there's something to be really in like, it's very empowering, when we own it and know it, versus feeling like it's like taking a hold of us, and kind of, you know, without permission. 

DR. AMY: Yeah, so that app is Tina T E E N and N A. Yes. 

MARIZA: Yes. T E E N A. 

DR. AMY: What a neat resource. Super cool.

MARIZA: I got to check it out and I was mind blown. I was like,” Oh, what I wouldn't give to have had this as a teenager.” You know, I remember my period starting. I was roller skating with my boyfriend, my little 11-year-old boyfriend. I was in summer camp and we were roller skating to Janet Jackson. And, um, and I was wearing these jean shorts and I started my period in these jean shorts at the roller skating rink. And, you know, I was just up, just mortified at 11, almost 12. And I just like all of it, like all of it was just so messy and I didn't know what to expect. And I just wish I would have known so much more about how precious and how beautiful and how dynamic and amazing my body was, opposed to just thinking it was this burden that I needed to like deal with.

DR. AMY: All right, so we're going to take a break and let Sandy read a learning success story from our sponsor LearningRx. And when we come back I want to talk about the moms. Because if you are a mom of a teen girl, you may be in perimenopause or nearing perimenopause. And so you've got some birth control decisions that you need to make as well. So when we come back. 

SANDY: Austin was struggling so much in his junior year of high school that he worried he wouldn't fulfill his dream of getting into the agricultural program in college. He would study for hours only to get poor grades. His mother, who was a teacher at his school, tried everything she could to help, but nothing stuck. Then, his family found LearningRx. The LearningRx team created a brain training program tailored to Austin's unique needs and goals. The next school year, Austin could focus more, keep up with taking notes, and remember what he studied. But best of all, Austin was accepted into the agricultural program at the college of his choice. While your child may or may not achieve these same results, LearningRx would be happy to work with you to get answers about your child's struggles with learning. Get started at LearningRx.com or head to our show notes for links to more helpful resources. 

DR. AMY: I love hearing those success stories. Thanks for sharing that with us, Sandy. Okay, so we are talking to Dr. Mariza Snyder about birth control. And so, let's shift now and talk about moms. 

MARIZA: Yes. Oh my goodness. So let's—I'm that mom. I'm actually, as we've talked about before, I don't have a teenager yet. Oh my goodness. I'm in potty training mode right now. And that's where we're at. But I'm in perimenopause and, and so these changes are happening, you know, in somewhat now they feel somewhat dramatic. And so I can really speak into not only in the lived experience, but what are options for us? You know, you would expect if you go to your OBGYN, that you are at the grocery store asking for milk. But instead, really, you're at the hardware store asking for milk. They're, you know, the amount of hours they get for perimenopause and menopause care, I believe, is about an hour of education and that the real focus is obstetrics, as I talked to you guys about, and then surgery. And so a lot of doctors are not equipped. And when they're looking at okay, when we start to see symptoms of perimenopause and menopause, the things that they're usually recommending is going to be birth control pills to regulate their cycle to manage some of those symptoms and then potentially depending on the state of mental health for that patient, they may recommend some type of mood-altering medication, like an anti-anxiety or anti-depression. Because in perimenopause, a stat that a lot of people don't know, but 79% of women will experience a lack of emotional resilience and some pretty intense mood changes. And the recommendation, the standard recommendation is, “Well, let's just put 'em on an SSRI or some type of medication to manage that,” when what we know is happening is that it's these really potent and profound hormones are declining and that is having a huge impact on our neurological system because there's a lot of receptor sites that progesterone and estradiol are binding to.

DR. AMY: Yeah. And so we typically just go and take the advice of our doctor who, you know, with that one hour of training that they got in medical school, know exactly how to inform us of what we should be looking for. Right? Yeah. 

MARIZA: And so I want to open the door for one, what it is, you know, I feel like over just up until two decades ago, we really weren't even owning the term and so many women, you know, it can be so hard. Again, I think perimenopause can feel like a bit of a moving target too, mainly because our hormones are. And so just kind of speak into some numbers really quickly. One: average menopause is 51.6 years old in the U S. And even in other other countries as well. Natural menopause can be anywhere between the ages of 45 and 55. You know, premature menopause is under the age of 40. And so, and that could be for a number of surgical or medical reasons or, you know, it could even sometimes a result of being on birth control for too, too, too long can, can ultimately end result in that ovarian insufficiency. And then when it comes to perimenopause, it is the transition, the 4- to 14-year transition before menopause. And if menopause is a moving like that, then menopause is really just the one day that you haven't had a period for 12 consecutive months. And so, depending on where that is for you, and you can kind of determine that by when your mom overall like it's kind of sometimes can be around when your mom was in menopause. Then you start to go, then you start to kind of reverse engineer perimenopause. And so for some women perimenopause absolutely starts in their 30s, as you know as early as you know, early/mid 30s. And so it's, you really kind of figuring out what that transition is. And then where women really begin to experience symptoms of menopause is between the ages of 39 and 44, like somewhere in that five-year gap, the majority of women will start to notice changes. Now the first hormone to take a dive to start to decline is going to be progesterone. And so usually, you know, my recommendation is there's a lot of things that we can do to mitigate stress and to support our metabolic health to support our sleep. But, you know, instead of the idea around, again, a progestin, a synthetic progesterone or synthetic estrogen, I'm really of the mindset of a bioidentical option. Kind of a lower-dose bioidentical option that can help. And so for me, I'm on micronized oral progesterone in the luteal phase of my cycle. I cycle progesterone like it's cycled in my cycle and it has been profoundly helpful. And then, you know, as time goes by and if symptoms continue to become more debilitating, again versus going on the pill, my recommendation would be to look at an estradiol patch or something that's actually really binding to receptors. Now, don't get me wrong, bioidenticals are not, they're not estradiol, they're not progesterone, but they are identical to those and so they will bind to receptor sites in a way that can be, that can profoundly support. And so I am a big proponent of topping off hormones in perimenopause, if indeed the reason why we end up in a kind of default inflammatory state where our risk factor for stroke and heart attack and Alzheimer's and osteoporosis climb steeply after the age of 50. And that 90 percent of us by the time we're 45 years old have one or two or multiple markers of metabolic dysfunction and the elephant of the room is declining reproductive hormones, I say “Amen!” to getting some of that back. You know, and so we're, we're beginning to realize after we've kind of debunked a lot of what happened in the Women's Health Initiative study that this, that there's a generation of women that have been left out of the opportunity of bioidentical hormones, and that they really could have had a profound impact. And so, instead, when those got taken off the market for women, we leaned on birth control as an option. And what we're beginning to realize is that we've made a grave mistake and that we really should be replacing or supplementing women with the hormones that they're losing in the process. And so I'm actually right now in the process, I'm getting mammograms and I'm getting all the things checked out because I am at a point where progesterone is just not cutting it. And I am stepping into an estradiol patch. And so I'm kind of just doing all my due diligence to get on the kind of when you'll know when you may need some of that, I can talk about the symptoms. But for me, it's the, we have the biggest, what we call the biggest estrogen estradiol peak about 12 days prior to ovulation. And I just want everyone to think about how good you feel 3 days before ovulation if you are cycling, right? And, and it's all good. And you're supposed to feel kind of super womanesque like what I feel like in the luteal phase compared to the luteal phase. I mean, they are, they are—the discrepancy is massive. But what I really began to notice, and I keep a journal, so I keep a journal of my symptoms, I keep a journal of my cycle, I track my cycle, because I'm really trying to pinpoint, because labs are hard to nail this. Is my estradiol levels not where they need to be? And what I've noticed is that I'm having kind of late luteal symptoms in my late follicular phase. So when I'm supposed to be having this robust, amazing estradiol peak, it's not. It's inconsistent. And that's, that's the journey of perimenopause is that that peak starts to disappear. We don't have enough estrogen to carry us through ovulation. And then we kind of—and that's the intention of perimenopause. And so, I'm a big proponent of, you know, supplementing and topping off women when symptoms arise. And to also note that whether you have symptoms, minor or severe during perimenopause, at the end of the day, your physiology is changing. Like who you were prior  to perimenopause and who you are in menopause, your body has shifted and changed. Your physiology has changed. I'm going to tell you, not for the better. Like you are not in a more optimal health state because you are now in menopause. You're not in a more optimal health state because you lost those critical reproductive hormones. And I think that really speaks and lends to what's birth control doing? It's putting us in a default declined state before we really need to be there, I, you know, ride it to until wheels fall off is my call. And so I'm getting on a bioidentical hormones, you know, as an end of one experiment for myself at 44. And let me tell you, I will be on them till the end of days, you know? And so, cause why would I take away something that so critically allows me to thrive? I don't want a greater risk of cardiovascular or neurodegeneration just by default for doing nothing during this critical transition. And that's ultimately what's happening to so many of us. And so I think owning the reality and really normalizing what this transition really is, is so critical because we keep gaslighting women and talking about how this is, “Oh, it's normal. Oh, it's fine. Oh, you're just so it's just getting older.” I'm like, like, this is putting us in a default state of less optimal health. You know, I think that a new research article just came out. And although women live longer than men, we all know that, 25 percent of our lifetime, that last 25 percent we are more likely to be dealing with health challenges. And so, even if I'm living longer than my male counterpart, you know, I want those years to be robust and full of vitality and abundance and having a good health span. And so, you know, what can I do to mitigate the fact that by the time I'm in menopause, I'm more at risk for some pretty serious chronic conditions? And that, you know, I am at greater risk of having the last two decades of my life being in a place of not great health. And so those are just, that's kind of the reality that I think we're finally waking up to. And, you know, what can we do to really mitigate in that transitional period, that's what I'm most interested in for women.

SANDY:  I think that, at least in my case, I live kind of in what I would call rural America. So it's really, really hard to find caregivers, practitioners who will help with this topic.

MARIZA: Yeah. 

SANDY: My choices are super limited. So if there are parents out there listening to this, what kind of professionals should we be looking for to help us with these things? What kind of tests should we be asking for? Because going to your regular OBGYN, you're just going to get the checklist, unless that's someone who is specializing in that extra care that you're describing, right? You're just going to get the regular checklist of wellness check and out the door you'll go. So who should we be looking for? I think with the internet and just, you know, our options are much wider now. Am I right? In terms of like reaching out to.

MARIZA: Yes. And so to your point, only 4 percent of women in menopause are on hormone replacement therapy in the States.

DR. AMY: 4 percent?

SANDY: That's crazy. 

MARIZA: 50 million women are in menopause in this country. Another 20 million women are in the perimenopausal waiting room, over a billion worldwide. We know we have to shift the conversation. We have to shift the level of care. We cannot, even in the workplace, we've got to shift how we take care of women in the workplace and menopause. I mean, it really is, you know, profoundly impacting our society at large. And so, yeah, you're right. Depending on where you live, there's a good chance that you're not going to have somebody who is going to be open, who's read the newest research, who totally understands the implications of not putting women or topping women on hormones, and obviously it's an individualized decision and options that needs to be discussed, like we've really got to do our own research too of understanding what our options are. And I also want women to know that majority of bioidentical hormones are FDA approved and available at a pharmacy for very low cost. My Prometrium, my micronized progesterone, is $11 a month. That's doable. Right? And so I just want to speak into that. My estradiol patch is going to be, you know, $20 something. Those are not astronomical prices. I know compounding can get a lot more expensive. Get in where you fit in, but who you're looking for. So you're looking for a menopause specialist. You're looking for a functional doctor, maybe a naturopathic doctor. You're looking for an anti-aging doctor. Those are popping up. Where anti-aging clinics where you can get, you know, IVs, hormone therapy, you know, a lot of different, more, more of a kind of biohacking of tool set of really manage the supporting your health span. And then the other doctor you're looking for is trying to remember the name. I think I may have nailed them all, but you know, ultimately, you know, not anti-aging. There's another word for that kind of facility where you'll see those types of offerings. But the great thing about it, too, is that there are practitioners that are online. You know, you can, you can get a script from a doctor, the doctor, one of my best friends is the one who's taking care of me, and she's in Texas. And so I'm doing everything online through her are really over the phone. And so, you know, I'm not working with someone locally because I've got I've got her taking care of me. And so just know that it doesn't have to be local. I know I can imagine how nice it would be to have somebody local or to have someone you can talk to like face to face, but I mean, a Zoom works too. And so I just want you to know that the options are there. More people are waking up to what is necessary for women. And it may be that you're going to be finding someone where it is an online consultation versus an in-person consultation. 

DR. AMY: So you're not just an N-of-one on this call. I actually have a functional medicine physician. I take Prometrium. I wear an estradiol patch. But I went into surgical menopause at menopause at 37. So I had a complete hysterectomy at 37. And probably as a result of my messed-up hormone supplementation for my, like, the early part of my life, right? So age 15 went on birth control, went on birth control in between babies, had P.C.O.S. You know, just uncontrolled. Let's just slap band-aids on it. I had a pill baby, by the way. 

MARIZA: It can happen. I mean, that's why, you know, I mean, obviously when you're, you're, you have a partner that's longstanding condoms, you know, or condoms aren't the thing, but I mean, that was the thing I leaned on for so long, too. But I can, oh my gosh, I'm, you know, that I'm just sending you so much love and extra grace just because that journey. Yeah. Had to feel so hard and so insurmountable at times. 

DR. AMY: Yeah. Iin my mid-thirties, they had just come out with the 90-day pill and knowing, you know, how you teach that it's important to have periods. I'm sure that you just shook your head at the 90-day pill. But I thought for someone who really had heavy periods, how great that I only have to have four a year. And so, but I ended up getting pregnant on the 90-day pill and didn't know until I was about 10 weeks along. So we used to joke that my kid was going to be born with a pack of birth control pills in his hand. Luckily he turned out fine. 

MARIZA: Yeah. Cause you're like, what does that do? We're taking the pill for so many weeks, you know, because when you're, you know, it's a 90-day pill, you kind of just got to wait for it to wear off, you know.

DR. AMY: Well, right. Like you don't get your period. You don't realize you're pregnant. 

MARIZA: But it's a massive dose of, yeah, I was very much an eye roll. Cause they were trying to find a solution to the Depo-Provera at the time they were, cause that was massively failing. I knew so many clinics who wouldn't even, were like, we will not do it, you know? And so that became like a, a better option. I remember. Yeah. I was like, how was it that, why didn't we just take it off the market? 

SANDY: This is a different question. I've had a couple of friends and maybe you can talk about this. We've talked about progesterone and estrogen, but what about testosterone because I've had a couple of friends that have gotten like, I guess the seeds or whatever, yeah.

MARIZA: Pellets.

SANDY: Yeah, pellets, and have touted them, you know, they scare me to death. Let's talk about that a little bit. When is that something that you should look into and what are the side effects of that? 

MARIZA: Yes, testosterone is all the rage right now. And really, the queen bee should still be estradiol. I really truly believe that. Cause it's not testosterone that is putting us at greater risk for Alzheimer's, cardiovascular disease, osteoporosis, and urinal, I mean like urinary issues. Like, it is estradiol hands down that is going to, you know, that, the drop in estradiol just, you in our insulin resistance, metabolic dysfunction, all of it is what's going to put us at greater risk. But it is true that testosterone is the most biologically harm biologically active hormone in a woman's body. And, you know, we start to decline to death testosterone at the same time we decline on progesterone. So those that's going to happen in your thirties. If anything, testosterone is going to start declining in your late twenties. Very precipitously and relatively consistently, unlike estradiol, which is just a hot mess rollercoaster. But testosterone and progesterone, you'll see, have the same similar trajectory downward. By the time you're 50, you have a half of what, well, by the time you're 50, progesterone doesn't even, she's gone, like she ain't coming back. But testosterone, she can, she can study out and women can actually have a decent amount post menopause. Always worth testing. But there's something about testosterone that, like, makes you feel extra good, you know? And so my recommendation around testosterone, a lot of women are getting on testosterone earlier than even progesterone or estradiol. It can interfere with estradiol receptors, and so if you do end up going on an estradiol patch, just note that if you were on testosterone first, it actually can mess with kind of your receptors receiving that estradiol, and that could not always work in your favor. So a consideration, sometimes the recommendation is get on the estradiol first, do things naturally to boost testosterone, get on that estradiol patch first, let it do its thing and then do a little bit of that testosterone. I have a lot of friends of mine in the functional space that are a full body “No” to the pellets. And the reason for that is that we end up we can actually end up overdosing. They last for six months at a time. And so it can it's a lot you don't have a lot more wiggle room in terms of modification on that dose. And so more the recommendation is a cream or a gel, you know, something that is, that is topical that you have more control over. And so a lot of friends of mine have seen more nightmares than they would love with a pellet testosterone. But yes, there's a lot of women who love it until they don't. And so that that can be it's .. I find you love it until you don't. And so my general consensus is better safer than sorry, and working with something that's a lot more flexible, that would be my goal. I've been even given I've been given inject injectable testosterone and I've done that. And it wouldn't normally be my recommendations. That's not what I'm going to do again. And honestly, I didn't notice a difference. I didn't notice a difference. I don't think it was the fact that I didn't have robust testosterone levels was the reason why I was feeling the way that I was. I honestly feel it was a lack of estradiol. We just missed the mark. And so just from my own personal experience, so that would be my that would be my kind of from my experience and the experience of talking to so many other friends of mine, that when it comes to testosterone, because it can have multiple implications if not done properly, that I would love it to be more, more safely managed, you know. But that and then again, we don't have an FDA-approved solution for testosterone and we really fail women in that department. And so I do believe that a lot of women can benefit from it, but I just don't want women to forget that estradiol really is the main event. She's the one really running the show. And testosterone is very much an optimizer. And it's a metabolic optimizer. And so I do, there's absolutely room for it. And I think that a lot of women are going to need all three. But like be looking at the main two first and then be thinking about, because I feel like testosterone can be more of a band aid to the, and then it doesn't address those longstanding concerns, because you can feel super hot for a second. But then, again, if pedestrian and estradiol are falling and they're not being addressed, you're still going to feel pretty crappy. 

SANDY: Yeah. I think the, you know, consensus of my friends who have done it, it's just that increase in sex drive. That's all I really hear about. Right. It's just like, “Oh, there I am.”

MARIZA: Yeah. Finding yourself again. Finding yourself again, the confidence and more what I'm most interested in testosterone. I know that's not the reason why women are doing it is, it's the metabolic support and it's. The maintaining good muscle mass because those are the things that really put us at greater risk later down the road. And so I love the idea of optimizing growth hormone and testosterone, but just not, just not at the sacrifice of the other two. And then the other thing I wanted to just say, when we're talking about surgical menopause or premature menopause due to whether it's cancer or it's medications or it's surgery, that if it's before the age of 45, and I would even still argue after the age of 45, that hormone replacement is 100 percent necessary and non-negotiable. So I just wanted to speak to that because I know so many women are having hysterectomies for a number of reasons and that it's not being offered as the option. And progesterone isn't being offered either, like, well, you don't have a uterus, so you don't need it. I'm just like, have you, have you tried to sleep without it? Have you tried to have a discussion with your partner without it? Have you tried to like, be okay without it? Like, if you do not know what it does besides protect the uterus from cancer with, you know, unopposed estrogen, like it's doing so much more than that. Like, let's talk about it. And so yes, please, to all three, you know, if you end up in having a hysterectomy or you go into menopause earlier than your body was naturally expecting. Your body expects, demands, requires those hormones to be in circulation and to be doing their job. And I just know so many women are getting subpart care around that. So I just wanted to just speak into that real quick. 

DR. AMY: Yeah. I woke up with an estrogen patch from my hysterectomy. 

MARIZA: Just on your booty or something?

DR. AMY: And I was like, well, excuse me. I don't remember even having the conversation. But I'm glad that, you know, I'm glad that my doctor had the foresight. Yeah. For sure. 

MARIZA: And that should have been a conversation though. At 30, at 30, at 37, listen, your body really wants it and expects it and needs it, you know, but then also I'm hoping that Prometrium was on the docket right after that, or did you have to ask for it?

DR. AMY:  I started Prometrium two weeks ago. Oh, okay. And I'm 53. So I did a complete hormone panel and my DHA was super low and, like, so I'm doing some DHEA supplementation. But yes, so, I think that I'm getting there. I mean, the estradiol has never been in question, right? Like, I've been on it since 37.

MARIZA: Yeah. And I, I just, and I know it's a worthy, we're beginning to realize very, we've been knowing, but that we hope that the standard of care is that, that the kind of the standard of care is no uterus, no progesterone. And it's, it's, I just think it's, I mean, I just think it's mind blowing that they're like, “No, we don't, you don't need it anymore. You're good”. And then, and we're finding that that is not, that's not true. 

DR. AMY: All right. Yeah. What did you not get to say Dr. Mariza that you want to leave our listeners with today, either with for birth control for teenagers or hormone replacement for perimenopause? 

MARIZA: Yes, so the thing for birth control for teenagers is there is an app called Natural Cycles, and it is as effective as the combination pill. So it is 98 percent effective with good use, 92 percent effective with inconsistent use, and it literally starts to work immediately. It's an app that literally tracks when you're ovulating or when you're at risk and very easy to use. Maybe harder to use for teenagers. I get that. But definitely for women in their twenties, thirties and beyond, if they're not looking to get pregnant and they're looking for an FDA-approved device, which is literally just an app that will track you and let you know, “Today's the day to wear the condom,” you know, versus, “Today is not the day to do it.” So it is again, it's as effective as the combination, more effective than the mini pill. And so I just wanted to speak into that, that there are non-hormonal options that are as effective as the hormone, if not more than some of the hormone option, hormonal birth control options on the market. So that's the thing I wanted to share. 

DR. AMY: Yes. So when you were talking about the mini pill real quick, you said 13 percent of girls who go on the mini pill get pregnant, and so that makes it 87 percent effective. So, that's not super effective.

MARIZA: No, it's not. 

DR. AMY: When you look at the other options, like, aren't condoms 99 percent effective?

MARIZA: Yeah, 98 to 99% effective. 

DR. AMY: And now the app. 

MARIZA: Yes. Natural Cycles. Yeah. I mean, that is the that is the thing. So yeah, because of an estimated 13, 15 percent of women who use the mini pill will get pregnant in one year of use, it's not typically recommended as contraception, but for treating hormone issues. That is, that is what your doctor is going to tell you. But because it is the liability around birth control particular around blood clot stroke and cardiovascular disease in women, that was the only pill that that was okay to get released without prescription because it's not a dangerous amount of synthetic hormones to put someone at risk. Now, does the mini pill have symptoms or side effects? Yes. 100 percent irregular menstrual bleeding, acne, breast tenderness, decreased to no sex drive, depression, headaches and migraines, nausea and ovarian cysts. So those are the typical symptoms of or side effects of where I've taken the mini pill. But it's less harsh than the combo which puts you at deeper risk for cardio like cardiovascular issues and stuff like that. I mean, ideally, you know, if it was my, I mean, if it was my daughter, I would've started the conversation a long time ago and really educated about it and you know, I don't know.  I would, I would really struggle knowing, especially at a young age, the changes that it would have on her physiology that we're still not even clear about because gosh forbid we look at that. And so that's where I would land. I know it's a hard decision. It's a difficult decision. And then even from for older women in perimenopause too, super difficult decision. You don't want to be struggling. You're trying to raise a family. You're maybe caretaking for your parents. You're in the middle of your career. I mean, can you have any more balls in the air than you do right now? You know, and now you feel like you're losing yourself and your mind and your symptoms are insane? And, yeah, you're just like, “Anything to stop this. I've got life to live. I got people to take care of.” I get it. And, and it's, again, this is just a, just a deep example of how we continue to fail women at every age. And how we're just not setting us up for success, given the fact that we're not even honoring the superpower, the beauty of that we are bringing life into this world. That's what all of this is about. And I would think that that would matter. That would matter enough for us. We are the person, we're the default study participant. We're the one that matters. We're the ones that are bringing children into this world. How did we get the shaft? I don't know. And that's what I think is mind blowing to me. Like at every turn, I'm just like, really? Really? Like, come on, we can do so much better than this. And so, yeah, I mean, that's why I'm so grateful we're having this conversation. And yeah, there are doctors and books and amazing resources out there. You know, Dr. Mary Claire Haver is coming out with a new book called “The New Menopause.” And then another book that I think is really powerful for women is “Estrogen Matters” for this demographic. And you know, “The Definitive Guide of Menopause and Perimenopause, like there are great resources out there. And I think that first step is just getting educated because unfortunately most of your doctors are not.

DR. AMY: And the other book you mentioned was “Fix Your Period.” 

MARIZA: Yeah, “Fix Your Period” by Nicole Jardim. Yeah, and “The Fifth Vital Sign” by Lisa Hendrickson-Jack is an amazing book, too. Just really speaking into, what your cycle really is and why it is so critical. You know, I think we, you know, the more that we understand and we're really owning what are, what the menstrual cycle is, what the reproductive system is for women. And that is empowering us more and more to take ownership of our health and to normalize these massive transitions that happen to women. 

SANDY: We love your passion, Dr. Mariza. 

DR. AMY: Yes. Thank you for the work that you're doing. It's so important. Dr. Mariza Snyder, appreciate you being with us again. Listeners, if you would like to learn more about Dr. Mariza's work, you can visit her at drmariza.com. Dr. D R M A R I Z A, drmariza.com. Her podcast is “Energized with Dr. Mariza.” So catch some of this really cool stuff there too. She interviews experts on related topics as well. So thank you so much for listening today. If you liked our show, we would love it if you would follow us on Instagram or Facebook at The Brainy Moms. Do it now before you forget, please. If you'd rather watch us, we're on YouTube at The Brainy Moms. Look, this is all the smart stuff that we have for you today, so we'll catch you next time.