778: The Fatigue Problem No One Is Solving for Women Over 40 (And The Labs I Order First)

You’re exhausted by 2 or 3 PM. Your workouts suddenly wipe you out. Your hair is shedding, your brain feels foggy, and even climbing a flight of stairs leaves you more winded than it used to. Then you finally ask for help and hear: “Your labs are normal.” In this solo episode, Dr. Mariza breaks down one of the most commonly missed contributors to persistent fatigue in women: iron deficiency, even before anemia develops. She explains newly released American Society of Hematology ferritin thresholds and why women who were previously told their iron was “normal” may deserve a closer look. But iron is only one part of the conversation. Dr. Mariza walks through the bigger clinical picture she considers when a woman says, “I don’t feel like myself anymore,” including thyroid function, mitochondrial energy production, blood sugar, sleep, nutrition, stress physiology, and HPA-axis regulation. Most importantly, she explains why fatigue is a symptom, not a diagnosis and why neither stress, aging, nor perimenopause should automatically become the explanation for everything you’re experiencing. Listen now to learn what may be hiding behind your exhaustion and how to have a more productive conversation with your healthcare provider. IN THIS EPISODE Why iron deficiency can exist before you become anemic The new ferritin thresholds women should know about Why a lab’s reference range and a diagnostic threshold are not always the same thing Why heavy perimenopausal periods can increase your risk of depleted iron stores The fatigue, brain fog, headaches, hair shedding, and exercise intolerance that can overlap with perimenopause How iron, thyroid hormones, nutrition, blood sugar, sleep, and recovery influence mitochondrial energy production Why “adrenal fatigue” oversimplifies what may actually be happening with the HPA axis How under-fueling, over-training, poor sleep, circadian disruption, illness, and caffeine can add to the body’s total stress load The questions to ask when you know something has changed but your labs keep coming back “normal” QUOTES “You can be iron deficient before you ever become anemic.” “Two things can be true at once.” “I don’t want mitochondrial dysfunction to become another vague label we give an exhausted woman.” RESOURCES MENTIONED Find inspiration, connection, and meaningful reads. Join the Book Club now! https://drmariza.com/bookclub Order my newest book: The Perimenopause Revolution http://drmariza.com/book Stop surviving and start thriving, join Midlife on Fire Collective now https://drmariza.com/trial RELATED EPISODES  769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 664: The Hidden Reason You’re Exhausted: How to Fix Cortisol and Boost Stress Resilience in Perimenopause 661: When “Normal” Isn’t Normal: How to Be Heard (and Taken Seriously) at the Doctor’s Office 755: What If Your Body Isn’t Broken, Just Undernourished? The Missing Link Between Nutrients, Hormones & Energy with Ryan Woodbury

What happens when the woman who has always been able to handle everything suddenly realizes her body won’t let her operate that way anymore? In this episode, Dr. Mariza sits down with functional diagnostic nutritionist, medical exercise specialist, bestselling author, and women’s health educator Jenn Pike for a deeply personal conversation about the capacity shift that can happen in perimenopause. Jenn shares the subtle signs she noticed in her late 30s: alcohol suddenly disrupting her sleep, slower workout recovery, increased soreness, less patience, and a shorter emotional fuse. Eventually, she realized she wasn’t simply stressed. Her body needed her to operate differently. They unpack what happened when Jenn stopped forcing intense workouts, began respecting her changing energy, reduced her workload, asked for help, and started saying no, even when disappointing people felt uncomfortable. But this conversation goes even deeper into the identity so many high-functioning women carry: “I’ve got this. I don’t need help.” Listen now to discover why perimenopause may be an invitation to protect your energy, trust your body, and stop treating exhaustion as the price of a full life. JENN PIKE Jenn Pike is a functional diagnostic nutritionist, medical exercise specialist, bestselling author, and women’s health educator who has spent years helping women in perimenopause and menopause better understand their hormones and bodies. She is also the host of The Simplicity Sessions podcast. In this conversation, Jenn shares her own experience of entering perimenopause in her late 30s and how it forced her to rethink exercise, work, motherhood, boundaries, identity, and the belief that she always had to be the one who could handle everything. IN THIS EPISODE The subtle perimenopause signs Jenn started noticing before age 40 Why intense workouts stopped feeling good and how she changed her training What overstimulation and a shorter emotional fuse revealed about her capacity How overcommitment and constantly being needed contributed to burnout Why Jenn had to dramatically rethink how much she could put on her calendar Learning to ask for help, delegate, and disappoint people without falling apart Why perimenopause can bring your deepest patterns around productivity and self-worth back up for review How Jenn moved from being “smart” to feeling wiser, calmer, and more trusting of herself QUOTES “The nutrient is actually doing less, and figuring out how to do less better.” “I taught people to expect that of me.” “I don't have to be that person to be loved.” RESOURCES MENTIONED Order my newest book: The Perimenopause Revolution: https://drmariza.com/book Join my brand new Substack: for the woman everyone depends on who is wondering why everything feels harder in midlife >> https://drmariza.substack.com/ The Simplicity Sessions Podcast: https://jennpike.com/podcast/ Jenn Pike Website https://jennpike.com/ Jenn Pike Instagram RELATED EPISODES  776: What Changes When Your Body Can’t Keep Pushing Like It Used To? With Dr. Taz Bhatia 775: Wide Awake at 3 A.M.? What’s Really Disrupting Your Sleep in Midlife with Morgan Adams 774: Training for Your Grandma Self: How to Build a Body That Lasts 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza

What if perimenopause isn’t simply changing your hormones, but revealing everything your body has been compensating for for years? In this episode, Dr. Mariza sits down with integrative medicine physician and women’s health expert Dr. Taz Bhatia for an incredibly personal conversation about what happens when the strategies that helped high-functioning women push through for decades suddenly stop working. Dr. Taz shares how her own perimenopause began with incredibly heavy periods, fatigue, anemia, hair loss, mood changes, and unexpected weight gain. But one of her biggest surprises came later: as progesterone and estrogen declined, her blood sugar, insulin, cholesterol, A1C, and liver enzymes began creeping upward, revealing just how interconnected hormones and metabolic health really are. They also explore the emotional transformation of midlife: letting go of people-pleasing, protecting your energy, releasing the need to be the “good girl,” and becoming clearer about who you are and what deserves your attention. Listen now to rethink perimenopause as an opportunity to understand your body, protect your health, and step powerfully into what comes next. DR. TAZ BHATIA Dr. Taz Bhatia is a board-certified integrative medicine physician, women’s health expert, and bestselling author of several books, including The Hormone Shift. Her work explores the connections between hormones, metabolism, stress, nutrition, and whole-body health. Through her Whole Plus clinics and podcast, Dr. Taz advocates for a more collaborative approach to women’s health that looks beyond symptoms to cognitive, metabolic, cardiovascular, bone, mental, and hormonal health. IN THIS EPISODE How extremely heavy periods became Dr. Taz’s first undeniable sign of perimenopause Why weight gain in midlife isn’t necessarily something women simply have to accept How estrogen and progesterone shifts can intersect with blood sugar, insulin, cholesterol, and visceral fat Why the “silent” cardiometabolic changes of menopause deserve more attention Why your body may stop tolerating the stress, sleep debt, and depletion you once pushed through How perimenopause helped Dr. Taz stop people-pleasing and build stronger boundaries Why knowing your own patterns and tracking changes can help you advocate for yourself How midlife can become an opportunity to redefine your identity, purpose, and power QUOTES Perimenopause is really where women come into their own.” “These are not my battles. This is not my fight.” “We gotta redefine what fine is.” RESOURCES MENTIONED Find inspiration, connection, and meaningful reads: Join my Soulful Shelf Book Club (no cost) here: https://drmariza.com/bookclub Join my brand-new Substack: for the woman everyone depends on who is wondering why everything feels harder in midlife: https://drmariza.substack.com/ The Hormone Shift by Dr. Taz Bhatia: https://amzn.to/4xJ5VfK The Superwoman Rx by Dr. Taz Bhatia: https://amzn.to/4hHkZpn Dr. Taz Website: https://doctortaz.com/ Dr. Taz Instagram Hol+ Wellness Podcast RELATED EPISODES  775: Wide Awake at 3 A.M.? What’s Really Disrupting Your Sleep in Midlife with Morgan Adams 774: Training for Your Grandma Self: How to Build a Body That Lasts 771: Beyond Hot Flashes: The 103 Symptoms of Perimenopause No One Talks About with Andrea Donsky 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza

If you keep waking up at 2:00, 3:00, or 4:00 AM and can’t fall back asleep, your hormones may only be one piece of the puzzle. In this episode, Dr. Mariza sits down with sleep expert Morgan Adams to unpack why sleep can suddenly fall apart in midlife and what you can actually do about it. Morgan explains three major forces affecting women’s sleep: declining estrogen and progesterone, rising anxiety and depression, and the enormous demands of being part of the “sandwich generation,” often juggling a career, children, and aging parents simultaneously. They dig into one of the biggest complaints among midlife women: middle-of-the-night wake-ups. From blood sugar dysregulation and overheating to overlooked breathing issues, Morgan reveals why repeatedly waking at the same time deserves a closer look. You’ll also learn what not to do when you wake up, the cognitive trick that may interrupt 3 AM rumination, why your wearable can’t replace a sleep study, and whether sleeping separately from your partner could actually protect your health and your relationship. Listen now for practical strategies to finally get the deeper, more restorative sleep your body needs. MORGAN ADAMS Morgan Adams is a sleep coach who helps women struggling with insomnia and disrupted sleep improve their sleep using evidence-based behavioral strategies. Her work includes cognitive behavioral therapy for insomnia (CBT-I) principles and practical approaches to middle-of-the-night wake-ups, rumination, evening routines, and sleep optimization. In the episode, she also offers listeners a guide specifically for 3 AM wake-ups and an opportunity to connect with her about insomnia support. IN THIS EPISODE Why sleep can suddenly fall apart for women in midlife What “revenge bedtime procrastination” is and why busy women do it The surprising reasons you may keep waking up around 3 AM How blood sugar dysregulation may contribute to nighttime wake-ups Why overheating may be disrupting your sleep even without night sweats The overlooked breathing problems that can leave healthy women exhausted What to do when your brain starts spiraling in the middle of the night Why a “sleep divorce” might actually become a sleep alliance QUOTES“My big thing is mindfulness snacks.” “Sleeping separately doesn’t mean the marriage has failed.” “It’s not a template. It’s really an individualized kind of puzzle that you kinda have to put together for yourself.” RESOURCES MENTIONED Find inspiration, connection, and meaningful reads. Join the Book Club now! Awake Again at 3am by Morgan Adams Morgan Adams Website Morgan Adams Instagram RELATED EPISODES  774: Training for Your Grandma Self: How to Build a Body That Lasts 771: Beyond Hot Flashes: The 103 Symptoms of Perimenopause No One Talks About with Andrea Donsky 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman

What if one of the biggest questions of perimenopause isn’t simply “How do I feel better right now?” but “Who do I want to be 20, 30, or 40 years from now?” In this deeply personal conversation, Dr. Mariza sits down with women’s health expert Dr. Stephanie Estima to talk about the side of midlife that rarely makes it into conversations about hormones. They explore what happens when the high-functioning woman who has always been able to handle everything begins to notice that her capacity has changed. Stephanie shares how she can no longer work the same 10- or 12-hour days she once could, why movement has become essential for her mental clarity, and how perimenopause has made her more discerning about where she puts her energy. But this conversation goes much deeper than symptoms. From female friendship and motherhood to living according to your values, Stephanie and Mariza ask what it actually means to build a life and body capable of carrying you through the second half of your life. You’ll also hear Stephanie’s non-negotiables for longevity, including strength, mobility, joint health, pelvic floor health, and the small habits that compound over decades. Listen now and start training for the woman you still want to become. DR. STEPHANIE ESTIMA Dr. Stephanie Estima is a women’s health expert, chiropractor, bestselling author of The Betty Body, and host of the Better with Dr. Stephanie podcast. Her work focuses on helping women understand their bodies, optimize health and performance, and build strength and resilience throughout the different stages of life. In this conversation, Stephanie gets especially personal about her own experience of midlife, motherhood, changing capacity, friendship, fitness, and becoming increasingly comfortable being fully herself. IN THIS EPISODE Why your mental and work capacity can feel different in perimenopause The emotional reality of motherhood as your children grow up Why female friendship and connection matter more in midlife The powerful realization that your mid-40s may represent your halfway point How to tell if your calendar actually reflects what you say you value Why strength training is one of Stephanie’s longevity non-negotiables The overlooked role of mobility and joint health as you age Why pelvic floor health deserves your attention long before older age QUOTES“I think I have, like, lactic acid of the soul.” “I really do need people.” “Are you living in alignment with the things that you say are important to you?” RESOURCES MENTIONED Order my newest book: The Perimenopause Revolution Stop surviving and start thriving, join Midlife on Fire Collective now The Betty Body by Dr. Stephanie Estima Better with Dr. Stephanie Podcast Stephanie Estima Website Stephanie Estima Facebook Stephanie Estima Instagram RELATED EPISODES  773: What’s Really Driving How Fast You Age? The Science of Biological Aging with Nikolina Lauc 771: Beyond Hot Flashes: The 103 Symptoms of Perimenopause No One Talks About with Andrea Donsky 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman

What if perimenopause isn’t only changing your hormones, but also changing how your body is aging underneath the surface? In this episode, Dr. Mariza sits down with Nikolina Lauc, CEO and co-founder of GlycanAge, to explore emerging research on immune aging, chronic low-grade inflammation, and the menopause transition. Nikolina shares research showing just how dramatically markers of “inflammaging” can shift when estrogen declines. In one hormone-blocking study, women gained 9.1 years on GlycanAge markers within six months, while research following twins found the rate of immune aging accelerated during the transition from perimenopause to menopause. They unpack why this inflammation may be happening even when your traditional labs look normal, what glycans can reveal about how your immune system is functioning, and why biological age is more complex than a single number. They also explore the research around HRT, exercise, weight loss, fasting, GLP-1 medications, nutrition, and why the same intervention doesn’t work the same way for every woman. Listen now to discover what may be happening beneath the surface in perimenopause and how better data could help you become more proactive about how you age. NIKOLINA LAUC Nikolina Lauc is the CEO and co-founder of GlycanAge, a longevity biotechnology company focused on glycans, immune aging, chronic inflammation, and biological age. GlycanAge’s research focuses specifically on “inflammaging,” the chronic, low-grade systemic inflammation associated with aging. Its work examines glycan structures on antibodies to better understand whether the immune system is behaving in a more pro-inflammatory or anti-inflammatory way. IN THIS EPISODE What biological age actually means and why there isn’t one universal biological-age number How chronic low-grade inflammation can develop without obvious symptoms Why immune-aging markers may accelerate during the menopause transition How declining estrogen influences inflammation and immune function Why your hormone and traditional inflammatory labs can look normal while something is shifting What glycans can reveal about your immune system and inflammaging What the research suggests about HRT, exercise, weight loss, fasting, and GLP-1s Why interventions for healthy aging need to be personalized QUOTES “There’s never going to be one biological age.” “Not everybody experiences perimenopause in the same way.” “There’s no universal diet.” RESOURCES MENTIONED Use Code ENERGIZED and Get 10% Off on your GlycanAge Single Order or Subscription https://www.glycanage.com/dashboard/shop GlycanAge Website GlycanAge Instagram GlycanAge LinkedIn RELATED EPISODES  771: Beyond Hot Flashes: The 103 Symptoms of Perimenopause No One Talks About with Andrea Donsky 770: The Heart Disease Risk Factor Most Women Aren’t Watching: What Your Blood Sugar and Insulin Can Reveal with Dr. Philip Ovadia 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman

Have you ever looked at the same life you were managing a year ago and wondered, “Why does everything suddenly feel so hard?” You’re still ambitious. You’re still capable. You’re still the woman everyone depends on. But the stress you once brushed off gets under your skin. Your brain doesn’t feel as sharp. Sleep is changing. Your patience is shorter. And keeping all those plates spinning suddenly requires far more energy. In this solo episode, Dr. Mariza explores what happens when the profound hormonal and neurological changes of perimenopause collide with decades of over-functioning. She introduces what she calls the midlife capacity gap: the disconnect between the enormous load many women are carrying and the biological capacity they currently have to sustain it. You’ll learn why simply pushing harder may widen that gap, how Dr. Mariza is redefining resilience, and why supporting your hormones, brain, metabolism, muscle, and sleep is only part of the conversation. Because the goal isn’t to make your life smaller. It’s to build a body capable of sustaining the life you actually want while becoming far more discerning about what deserves your energy. Listen now to rethink what resilience looks like in midlife and start protecting your capacity for what truly matters. IN THIS EPISODE Why high-functioning women can feel blindsided by perimenopause What happens when the woman who always handles everything suddenly has less capacity How estrogen and progesterone shifts can affect your brain, sleep, mood, and stress response What over-functioning looks like and why it often gets rewarded The midlife capacity gap between the load you carry and your biological capacity Why pushing harder and becoming more disciplined may not be the answer How to redefine resilience around adapting, recovering, restoring, and thriving The question Dr. Mariza wants you asking: “Is this actually mine to carry?” QUOTES “Perimenopause doesn’t arrive in a vacuum.” “Endurance is not resilience.” “Doing less isn’t the same as caring less.” RESOURCES MENTIONED Order my newest book: The Perimenopause Revolution Stop surviving and start thriving, join Midlife on Fire Collective now The High Functioning Woman on Substack RELATED EPISODES  771: Beyond Hot Flashes: The 103 Symptoms of Perimenopause No One Talks About with Andrea Donsky 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 764: Why Your Nervous System Feels Dysregulated (Even When You’re Doing Everything Right) with Roseann Capanna-Hodge 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman

What if the symptoms disrupting your life are connected to perimenopause, even if you’ve never had a hot flash? Andrea Donsky spent 14 years in perimenopause and 11 of them with no idea what was happening to her body. Now, as a seven-time published menopause researcher, nutritionist, and bestselling author of Nourishing Menopause, she’s helping women put language to experiences that have been overlooked for far too long. In this episode, Andrea joins Dr. Mariza to unpack her research into 103+ reported symptoms of perimenopause and menopause and why hot flashes aren’t even among the most common. Fatigue ranks #1, while nine of the top 10 symptoms are cognitive or mental-health related. They also discuss why women are still being dismissed by healthcare providers, the foundational role of nutrition, blood sugar, sleep, movement, and stress management, and why perimenopause deserves to be viewed as an opportunity to protect your long-term health. Most importantly, you’ll learn why this transition rarely looks the same from one woman to the next and why having the right vocabulary can completely change how you advocate for yourself. Listen now to better understand what your changing body may be trying to tell you and the tools that can help you feel like yourself again. ANDREA DONSKY Andrea Donsky is a nutritionist, menopause researcher, bestselling author, and co-founder of We Are Morphus. She has worked in health and wellness for 26 years and has spent nearly a decade focused specifically on perimenopause and menopause. Her research explores women’s real-world experiences during the menopause transition, including more than 100 reported symptoms and women’s experiences seeking care. She is the author of Nourishing Menopause, a research-backed guide combining nutrition, lifestyle, holistic health, and conventional approaches to help women feel their best through this transition. IN THIS EPISODE Why Andrea spent 11 years in perimenopause without realizing it The 103+ symptoms women have reported during perimenopause and menopause Why fatigue is the #1 reported symptom, not hot flashes The surprising dominance of brain, cognitive, and mental-health symptoms Why 40% of women in Andrea’s research reported feeling dismissed by healthcare providers How nutrition, blood sugar, sleep, movement, and stress support women through this transition Why HRT can be one valuable tool alongside foundational lifestyle strategies How perimenopause can become a window of opportunity for protecting long-term health QUOTES “I was in perimenopause for 14 years total, 11 of which I had no idea.” “We know that there’s 103 different symptoms of perimenopause and menopause.” “The number one symptom across the board is fatigue.” RESOURCES MENTIONED Use code DRMARIZA and get 10% off on your Womeness Order Nourishing Menopause by Andrea Donsky Sign up now to receive your bonus: "The Nourishing Menopause Bonuses" Andrea Donsky Website Andrea Donsky Instagram Andrea Donsky Youtube RELATED EPISODES  770: The Heart Disease Risk Factor Most Women Aren’t Watching: What Your Blood Sugar and Insulin Can Reveal with Dr. Philip Ovadia 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 768: Why Your Period Gets So Weird in Perimenopause + What Actually Helps with Kaya and Yasmin Purohit 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman

What if the cholesterol numbers you’ve been watching aren’t telling you the whole story about your heart? In this episode, Dr. Mariza sits down with cardiothoracic surgeon Dr. Philip Ovadia to explore why he believes metabolic dysfunction and insulin resistance deserve far more attention when assessing cardiovascular risk, especially for women entering perimenopause and menopause. Dr. Ovadia shares what he’s learned after 25 years in heart surgery, including why he’s now routinely operating on patients in their 40s and even 30s. They break down the metabolic warning signs that can appear decades before advanced heart disease, from rising blood pressure and waist circumference to fasting insulin, glucose, triglycerides, and HDL. You’ll also hear their discussion about cholesterol and advanced lipid testing, how changing hormones can affect women’s cardiometabolic health, and why resistance training, real food, muscle, sleep, and blood sugar stability matter. Plus, Dr. Ovadia explains how continuous glucose monitors can provide real-time insight into your metabolic health and the heart imaging he recommends women discuss with their healthcare providers. Listen now to discover the metabolic clues your body may be giving you today and how to start protecting your heart for decades to come. DR. PHILIP OVADIA Dr. Philip Ovadia is a board-certified cardiothoracic surgeon, founder of Ovadia Heart Health Center, and author of Stay Off My Operating Table and Stay Off My Kitchen Table. After performing thousands of heart surgeries, Dr. Ovadia shifted part of his work toward prevention, helping patients identify and address metabolic dysfunction before it progresses to advanced cardiovascular disease. His virtual practice focuses on improving metabolic health as a strategy for reducing heart disease risk. IN THIS EPISODE Why Dr. Ovadia believes insulin resistance deserves more attention in heart disease prevention The five basic metabolic markers he wants women tracking Why your personal blood pressure baseline matters in midlife What fasting insulin can reveal before blood sugar becomes obviously abnormal Why cholesterol alone may not give you the complete picture of cardiovascular risk How muscle and resistance training support metabolic and heart health What a continuous glucose monitor can teach you about food, energy, and blood sugar When Dr. Ovadia recommends considering coronary artery calcium imaging QUOTES “It's never too early to start thinking about this, but it's also never too late.” “Cholesterol is not the main thing driving heart disease.” “Low-fat diets, they simply don't work.” RESOURCES MENTIONED Order my newest book: The Perimenopause Revolution http://drmariza.com/book Stop surviving and start thriving, join Midlife on Fire Collective now https://drmariza.com/trial Stay Off My Operating Table by Dr. Philip Ovadia Dr. Ovadia Website Dr. Ovadia Facebook Dr. Ovadia Instagram Dr. Ovadia Youtube RELATED EPISODES 769: Is It Perimenopause or Something Else? How to Finally Connect the Dots with Dr. Mariza 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman 650: Unlock Your Health: The Ultimate Biomarker & Lab Blueprint to Thrive in Midlife and Beyond

Is this perimenopause… or is something else going on? It’s one of the most common questions Dr. Mariza hears from women in their late 30s and early 40s, especially when their periods are still regular and they’ve never experienced a hot flash. In this solo episode, Dr. Mariza breaks down why early perimenopause can be so difficult to recognize and the less obvious signs that often appear first, including exhaustion, anxiety, irritability, brain fog, sleep changes, worsening PMS, migraines, and changes in stress tolerance. She shares three important clues for identifying a possible perimenopause pattern: looking for clusters of symptoms, noticing changes from your normal baseline, and tracking how symptoms change throughout your cycle. But hormones aren’t always the entire story. Dr. Mariza also explains why thyroid dysfunction, low iron, metabolic issues, nutrient deficiencies, sleep problems, and other conditions deserve investigation, even when perimenopause is part of the picture. Plus, you’ll learn how to track your symptoms and walk into your next healthcare appointment prepared to ask better questions. Listen now to connect the dots, understand what your body is telling you, and get clearer on your next steps. IN THIS EPISODE Why so many women over 35 aren’t sure whether they’re in perimenopause The early perimenopause symptoms women often mistake for stress or burnout Why you can be in perimenopause while still having regular periods The three clues Dr. Mariza uses to recognize a perimenopause pattern Why tracking changes from your personal baseline matters How your menstrual cycle can reveal patterns in mood, sleep, migraines, and energy What else to investigate, including thyroid, iron, metabolic health, and sleep How to advocate for yourself when your labs look “normal” but you don’t feel like yourself QUOTES “Stop looking at the one symptom that proves you’re in perimenopause. Start looking at the collection of clues and patterns that your body is exposing.” “Perimenopause doesn’t usually show up with a giant flashing sign.” “Hormones may be a huge part of the picture without being the entire picture.” RESOURCES MENTIONED Order my newest book: The Perimenopause Revolution http://drmariza.com/book Comprehensive Perimenopause Lab Guide Stop surviving and start thriving, join Midlife on Fire Collective now https://drmariza.com/trial RELATED EPISODES  768: Why Your Period Gets So Weird in Perimenopause + What Actually Helps with Kaya and Yasmin Purohit 764: Why Your Nervous System Feels Dysregulated (Even When You’re Doing Everything Right) with Roseann Capanna-Hodge 750: The Underlying Cellular Cause of Midlife Fatigue, Brain Fog & Low Motivation with Andrew Salzman 650: Unlock Your Health: The Ultimate Biomarker & Lab Blueprint to Thrive in Midlife and Beyond