What Is Perimenopause Really? - Ep. 73 - I AM YOU

What Is Perimenopause Really? - Ep. 73 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health. In this Ask the Heart Doctor-style episode, Dr. Alvarez reframes perimenopause as more than irregular periods, hot flashes, or poor sleep. What if perimenopause is not the beginning of the end of your hormones, but the beginning of your cardiovascular risk? And what if the symptoms women often dismiss — waking up at 3 a.m., feeling more anxious or irritable, fatigue, palpitations, blood pressure changes, or cholesterol shifts — are actually the body’s early warning signs? Dr. Alvarez explains that perimenopause can begin in the late 30s or early 40s, sometimes even earlier, and that estrogen does not simply decline — it fluctuates. These fluctuations affect the brain, nervous system, blood vessels, inflammation, sleep, metabolism, and cardiovascular health. With clarity and urgency, she breaks down: • Why perimenopause is not the same as menopause  • How fluctuating estrogen affects sleep, cortisol timing, heart rate, and the autonomic nervous system  • Why waking up around 3 a.m. may be more than stress or poor sleep hygiene  • How hormonal instability can affect blood vessels, nitric oxide, inflammation, and vascular tone  • Why blood pressure, cholesterol, insulin resistance, and body composition can begin changing before menopause  • Why women should not wait until something is “wrong” to evaluate their cardiovascular risk  • What a proper cardiometabolic profile should include, such as fasting glucose, hemoglobin A1c, fasting insulin, advanced lipid testing, blood pressure patterns, visceral fat, muscle mass, and hormone patterns This episode is a direct call-to-action: perimenopause is not something to ignore or simply push through. It is a critical window for prevention. If your body feels different, listen to it. Becoming the CEO of your own health starts with recognizing the signals early, asking better questions, and taking your cardiovascular future seriously. Visit NitzaMD.com  Follow @NitzaMD on Instagram and Facebook

You’re Not Crazy — You’re Not Being Understood - Ep. 72 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health. In this episode, Dr. Alvarez addresses a common experience for women entering perimenopause: feeling tired, anxious, disconnected, forgetful, or simply “not like yourself” — only to be told that it is stress, aging, or all in your head. These symptoms are not random, and women are not overreacting. During perimenopause, estrogen does not simply decline. It fluctuates unpredictably, affecting the brain, blood vessels, metabolism, inflammation, and cardiovascular system. This can contribute to brain fog, fatigue, mood changes, anxiety, and heart palpitations. Dr. Alvarez explains why women need to understand the connection between hormonal changes and heart health — and why waiting until something appears on a standard test may mean missing an important opportunity for prevention. With clarity and urgency, she breaks down:  • Why perimenopause can begin in a woman’s late 30s or early 40s — sometimes even earlier  • Why estrogen fluctuations can affect the brain, heart, blood vessels, and immune system  • Why symptoms such as fatigue, anxiety, brain fog, and palpitations are not simply signs of stress or aging  • Why up to 42% of perimenopausal women may experience palpitations  • How hormonal changes can increase inflammation and contribute to cardiovascular risk  • Why standard lab results may not capture what is happening during this transition  • Which cardiometabolic markers women should discuss with their doctors, including glucose, insulin, hemoglobin A1c, blood pressure, lipid profiles, ApoB, and lipoprotein(a)  • Why body composition matters beyond weight and BMI — including waist circumference, visceral fat, body fat percentage, and lean muscle mass  • Why hormonal and thyroid markers should also be considered as part of a more comprehensive evaluation This episode is a reminder that prevention begins before a heart attack, before permanent damage, and before something abnormal appears on a test. It begins when your body starts signaling that something has changed. You do not need to wait for something to go wrong to take your health seriously. Listen to your body, ask the right questions, and step into your role as the CEO of your own health. Visit NitzaMD.com Follow @NitzaMD on Instagram and Facebook

Why You Keep Waking Up at 3AM (It’s Not Just Stress) - Ep. 71 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health. In this episode, Dr. Alvarez explains why repeatedly waking up around 3:00 AM may not be random — and why it should not automatically be dismissed as stress, anxiety, or normal aging. For many women, especially during perimenopause, disrupted sleep can be an early signal that hormonal changes are affecting the nervous system, circadian rhythm, and cardiovascular health. Dr. Alvarez shares the example of a 48-year-old woman who falls asleep without difficulty but wakes up at the same time each night with a racing mind and a noticeably stronger heartbeat. Although she had been advised to try meditation, magnesium, and better sleep hygiene, the deeper issue was a change in her physiology. With clarity and urgency, Dr. Alvarez breaks down: * Why fluctuating estrogen levels can disrupt sleep cycles, temperature regulation, and the body’s nighttime stress response * How changes in cortisol, norepinephrine, and the autonomic nervous system can trigger early-morning awakenings * Why waking up feeling warm, restless, or unusually aware of your heartbeat is not necessarily random * How declining estrogen levels can increase inflammation and make the blood vessels and nervous system more reactive * Why poor sleep recovery can contribute over time to higher blood pressure, insulin resistance, and blood vessel dysfunction * Why sleep disruption during perimenopause should be evaluated alongside hormones, sleep patterns, and cardiovascular risk markers Dr. Alvarez also addresses several common myths: waking up at night is not always “just stress,” it should not automatically be accepted as normal aging, and women do not have to wait until a serious problem appears on a test before taking action. This episode is a call to listen closely when your body starts whispering. If you consistently wake up at the same time each night, do not dismiss the pattern. Becoming the CEO of your own health starts with recognizing the signal, asking the right questions, and taking prevention seriously before symptoms become larger problems. Visit NitzaMD.com  Follow @NitzaMD on Instagram and Facebook

Why am I always tired even when I sleep? - Ep. 70 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health. In this Ask the Heart Doctor-style episode, Dr. Alvarez tackles one of the most overlooked symptoms women experience during perimenopause and menopause: feeling exhausted even after a full night of sleep. If you go to bed early, sleep through the night, and still wake up tired, this episode reframes fatigue as more than stress, aging, or “just being busy.” Dr. Alvarez explains that persistent fatigue can be a signal of deeper changes happening in the body — especially involving hormones, inflammation, oxygen delivery, sleep quality, and cardiovascular stress.   With clarity and urgency, she breaks down: * Why sleep time and sleep quality are not the same * How declining estrogen can disrupt deep, restorative sleep * Why inflammation increases during perimenopause and menopause * How sleep apnea can show up differently in women * Why snoring, brain fog, morning headaches, insomnia, and fatigue may be signs of sleep-disordered breathing * How poor sleep can affect blood pressure, insulin resistance, weight gain, palpitations, stroke risk, and heart disease * Why wearable devices like Oura Ring, Whoop, or Apple Watch may help women gather useful sleep data * When a formal sleep study may be needed * What labs and evaluations to ask about, including hormone status, thyroid panel, cortisol, and sleep quality testing Dr. Alvarez also challenges common myths, including the belief that sleep apnea only affects overweight men, or that fatigue is simply part of getting older. Instead, she explains that fatigue may be a physiology signal — your body’s way of showing that something is changing before disease develops. This episode is a direct call-to-action for women who feel tired but dismissed: don’t stop at “I’m just tired.” Ask why your body is not restoring. Becoming the CEO of your own health starts with listening to your body, asking better questions, and getting the right evaluation before symptoms become disease. Visit NitzaMD.com  Follow @NitzaMD on Instagram and Facebook

Why do I feel off but my tests are normal? - Ep. 69 - I AM YOU

I AM YOU is hosted by Dr. Nitza I. Alvarez, MD, FACC — board-certified cardiologist, Women’s Heart Specialist, and bestselling author. Each episode shares real stories and expert insights to help women protect the heart that carries them through every stage of life — and step into their power as the CEO of their own health. In this episode, Dr. Alvarez addresses one of the most common and frustrating experiences women face during perimenopause: feeling “off” even when their labs come back normal. If you’ve ever been told “everything looks fine,” “it’s just stress,” or “this is just aging” — while still feeling tired, anxious, foggy, wired, or not like yourself — this episode reframes those symptoms as signals worth taking seriously. Dr. Alvarez explains why normal lab results do not always tell the full story, especially during perimenopause, when estrogen levels can fluctuate dramatically from one day to the next. These hormonal shifts can affect the brain, blood vessels, metabolism, nervous system, inflammation, cholesterol, sleep, and cardiovascular risk. With clarity and urgency, she breaks down: * Why estrogen is more than a reproductive hormone — and how it affects the brain, blood vessels, metabolism, and heart * Why perimenopause can make women feel anxious, foggy, tired, wired, and unlike themselves * Why “normal labs” may miss hormonal fluctuation and early physiologic changes * Why perimenopause can begin in the late 30s and 40s * What women should consider evaluating beyond basic labs, including: * Hormonal patterns, including estradiol, progesterone, testosterone, free testosterone, thyroid markers, and cortisol * Cardiometabolic markers such as fasting glucose, hemoglobin A1c, fasting insulin, and insulin resistance * Advanced lipid markers including LDL, HDL, triglycerides, non-HDL cholesterol, ApoB, and lipoprotein(a) * Blood pressure and vascular health, including ambulatory blood pressure monitoring when appropriate * Body composition, including waist circumference, visceral fat, body fat percentage, and lean muscle mass * Inflammation markers such as high-sensitivity C-reactive protein, homocysteine, and ferritin Dr. Alvarez also shares why these symptoms matter from a prevention standpoint. Perimenopause is not just about symptoms — it can be a critical window to detect early cardiovascular risk before it becomes disease. This episode is a direct call-to-action for women who have been dismissed, minimized, or told to ignore what their body is signaling. Becoming the CEO of your own health starts with asking better questions, understanding what should be evaluated, and taking symptoms seriously before they become something more. Visit NitzaMD.com  Follow @NitzaMD on Instagram and Facebook