Scott Webb (Host): Menopause is a part of life for women and between hot flashes and mood changes, dealing with menopause in the various stages may be a little easier if we involve medical professionals. And I'm joined today by just such a medical professional who can help patients through menopause. I'm pleased to welcome Dr. Edward Ferris. He's the Chair of the Department of Obstetrics and Gynecology and the Medical Director of the Women's Institute. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Doctor, thanks so much for your time today. We're going to talk about menopause and perimenopause, the signs, symptoms, treatment options, duration, all that good stuff. So a real comprehensive podcast today, and it's great to have your expertise.

And let's just start here. What is menopause?

Edward Ferris, MD, FACOG: So menopause is just a normal part of aging for women in which they get to a point in their life where their ovaries start to fail and their hormone production starts to decline and eventually their periods will stop. And the textbook definition for menopause, is once your periods have stopped for at least 12 months, then that's when we consider you to be in menopause.

Host: Yeah. And I'm wondering, you know, I don't know if it's the same for all females, of course, but is there a general age or can you put a timeline on when generally speaking menopause begins for females?

Edward Ferris, MD, FACOG: Yeah, so the average age for menopause is approximately age 51. But, it is not uncommon for women to start to have symptoms or go through menopause in their mid to late 40s, or maybe as late as their mid to late 50s. Every once in a while a patient will go through menopause in their early 40s, or actually their late 30s, but that would definitely be the exception and not the rule.

I would say most patients, it's late 40s, early 50s is the typical age when women start to experience menopause.

Host: Okay. And when you say late forties, early fifties, are there any determiners for that? Is it family history or, you know, like how does that work?

Edward Ferris, MD, FACOG: Yeah, I would say that family history is kind of a soft way of predicting menopause. I mean, a lot of tend to inherit the characteristics of their other females in their family. So their mothers, grandmothers, sisters, but truly everyone's their own individual. And so menopause, happens for everybody in due course, just based on their own health and, physiology.

Host: Right. So it could be some family history, obviously, but, everybody is different perhaps. And, you know, one of the things that I've heard about and my wife has gone through menopause. So I've had some personal experience with this is some of the symptoms that come along with it, the mood changes, hot flashes, you know, me not being able to have the heat on in the car in the winter, you know, things like that. So, what are some of the common symptoms?

Edward Ferris, MD, FACOG: So by far and away, the one that's the most common is once your menstrual cycles start to dissipate. So, we define menopause as the absence of menses for 12 months. And leading up to that, there'll be variation in your menstrual cycles. Most women will start to skip a cycle here and there, and then two months at a time, three months at a time, until eventually their periods stop.

Along the way, there's a lot of other symptoms that would go along with menopause. And they, again, these vary a lot from person to person. Some women experience all of these and some experience none of these other than their period stopping. But the typical symptoms are things like hot flashes, night sweats, mood swings, sometimes they'll notice a little thinning of the hair, decreased libido, sometimes their metabolism starts to slow down and so they'll complain of some issues with inability to lose weight, or gaining weight and then there's also vaginal symptoms.

So a lot of women who are going through menopause start to notice vaginal dryness or discomfort with intercourse. So those would probably be the most common things that we encounter.

Host: Yeah, the most common symptoms and wondering, are there different stages of menopause? Like we're going to talk about perimenopause, but are there different stages within menopause and maybe are the symptoms different throughout the stages?

Edward Ferris, MD, FACOG: Yeah, menopause is kind of a continuum and there's some synonymous terms is when we talk about menopause. So menopause and postmenopause, I would say are probably synonymous terms. Women who are premenopausal or women who are still having periods, their periods have not yet stopped; their periods might be irregular and they might start to experience just very mild symptoms like we discussed earlier. So pre or perimenopause, that's kind of a, certain period of time and then menopause or post menopause, is a second period of time.

Host: All right. So there are some stages for sure. And just wondering, we think about managing the symptoms. I feel like that's what it is. It's really just managing the symptoms. There's no magic wand, you know, to make them go away. So, how do you help patients to manage the symptoms?

Edward Ferris, MD, FACOG: Yeah, so I think it's important for women to understand that, you know, menopause is a normal physiologic process. So it's not in and of itself, an indication of any sort of harmful condition to them. It really boils down to their quality of life. So if you have symptoms like we discussed earlier, but they're tolerable, they're manageable, you don't necessarily have to do anything.

Most of the time, any woman who has a mild symptoms, they'll just kind of dissipate over time. And so, a lot of those women can go without any kind of treatment. But if they have symptoms that are affecting their quality of life, very disruptive, and they're very conscious of those symptoms and they feel like they need relief; that's when we can start talking about treatment options. And treatment options can range from non-medical things, so just lifestyle choices. Good sleep hygiene, good exercise, eating rights, stress reduction, meditation, stuff like that. Or, if that just doesn't completely help, then we do have medications available that can sometimes mitigate the symptoms of menopause.

Host: Sure. And so we've been focusing here on menopause and we touched a little bit on perimenopause. So I want to do that. I want to sort of bookend menopause. So let's start with perimenopause and just give us a sense. Is that just basically like pre menopause?

Edward Ferris, MD, FACOG: Yeah, so it's basically before your periods have stopped for that full year, you may have symptoms of varying degrees of severity leading up to that, as your periods start to dissipate and you start to get those vasomotor symptoms. And so again, if you're really having a hard time with those symptoms, then we can talk about hormone replacement or maybe depending on their age, sometimes just putting them on a low dose birth control pill.

And then if their symptoms progress, we can adjust that dose. For certain women who can't take hormones, there are other options. A lot of antidepressants work for menopausal symptoms. A lot of times we will reach for those types of medications. And then some women prefer to try to do something that does not require a prescription medication.

And so there are some anecdotal evidence about certain types of supplements; black cohosh and soy based supplements that sometimes can help as well.

Host: All right. So we've got the stages, right? We've got perimenopause or pre menopause and menopause. So let's talk about post menopause. And I'm sure there's a celebration involved somewhere in there, but when you get to that post menopausal stage, you know, do females know that? Do they just, they can, they just feel it one day and they're like, I'm done. I'm done. I'm finally done. How does that work?

Edward Ferris, MD, FACOG: I guess to a degree, I mean, it varies a lot. There's no one person that follows a typical pattern. I think once your periods have stopped for that 12 months or a full year and then we just really look at symptoms. If they had a lot of symptoms and now the symptoms have dissipated quite a bit to the point where they're really not a factor; I would say that that's someone who's postmenopausal. So it really kind of just depends on how they feel. And at that point, they probably wouldn't require any sort of treatment for menopause, but there are some other health issues for postmenopausal women that need to be considered. So postmenopausal women are definitely at risk for bone loss.

That's probably the main thing is osteoporosis, osteopenia. And so, using calcium and vitamin D, continuing to do weight bearing exercises, and then talking to your physician about the timing of a DEXA scan, which looks at your bone density. Those are all important things to consider after menopause.

Host: Right, so just because you're post menopausal, you're not out of the woods yet, right? Because we're all people and we all have things, right, to speak with our providers about, be treated for. Wondering, when someone is post menopausal and they're no longer menstruating, do they still need to get cervical screenings and PAP smears and all that sort of stuff?

Edward Ferris, MD, FACOG: Yeah, they actually do. I mean, we still recommend a yearly pelvic exam, periodic PAP smears. We don't do PAP really on anybody every single year anymore. But we do continue to do PAP smears up till age 65, depending on an individual patient's history, of whether or not they've had abnormal PAPs. But as a general rule, we stop doing PAPs at age 65.

There's still breast health concerns that we monitor and other just general health concerns with blood pressure and things like that. The other really important thing for post menopausal women to be cognizant of is if they have any postmenopausal bleeding. So once you've had that period of time where your periods have stopped for 12 months, if you suddenly start bleeding again, that's never considered normal and it should always prompt the patient to seek attention, because that can be an early warning sign of something like uterine cancer or endometrial cancer.

Host: Yeah, I see what you mean. And just thinking in general about whether it's getting close to perimenopause or menopause itself; I'm assuming, especially since knowing what you do, being an OBGYN, I'm assuming that you recommend that females have a healthcare provider, have a gynecologist and speak with them about these things, heading again towards perimenopause and ultimately menopause, right?

Edward Ferris, MD, FACOG: Yeah, I mean, I think it's important to address the gynecologic needs of every patient and you know, most gynecologists will work closely with their primary care doc, just to, you know, maintain general health with colonoscopy screening, breast cancer screening, osteoporosis, cholesterol, blood pressure. Those types of issues, smoking cessation, mental health issues, all of those things require, you know, everyone on the team to contribute to.

Host: Yeah, it's a team for sure. And, you know, we talked about perimenopause, menopause, postmenopause. Wondering if there are ever times during this process where there are severe symptoms, you know, and really sort of dramatic intervention is needed on your part. And if so, what does that look like?

Edward Ferris, MD, FACOG: So patients that are very, very symptomatic, symptoms, hot flashes, night sweats, mood swings, vaginal symptoms that are really disruptive and affecting their quality of life, that's when we would start to talk about the use of hormone replacement. It's really the most effective way of dealing with those symptoms.

 There are certain patients that are not candidates for hormone replacement, so we do have to assess their risk factors. So things like breast cancer, any history of stroke, any history of liver dysfunction, or any sort of history involving blood clots like a pulmonary embolus or a DVT, those are the reasons why we would avoid the use of hormone replacement. But in the absence of those, hormone replacement can be very, very effective in reducing or eliminating menopausal symptoms.

Host: Yeah, and wondering what are some of the benefits, from your perspective, about being open and honest with your provider about menopause?

Edward Ferris, MD, FACOG: I think it is important. I mean, and hopefully your physician, when you're at that age range will ask you about symptoms, but if not, it's perfectly expected and valuable for the patient to initiate that conversation. And I think, for women who are struggling with their symptoms, you know, there is treatment, very effective treatment available to them.

And so there's no reason to hide what's going on because again, it kind of boils down to their quality of life. If their quality of life is being affected by their menopausal symptoms, then I think that topic should be discussed, options put on the table for them so they understand what they're dealing with and what they can do about it.

And sometimes it's just as simple as, when we talked about earlier about the vaginal symptoms, you know, if you're having intimacy issues with your partner because of dryness, there are very, very effective ways of dealing with that. But we have to talk about it in an open and honest way to come to a shared decision about how to deal with them.

Host: Right. Yeah. It's just a part of life. It's just what happens and they don't need to suffer, speak with their providers, gynecologists, whomever. Just give you a chance here at the end, final thoughts, takeaways, when we think about the, you know, this continuum here from perimenopause all the way through post menopause and all that that implies. What are your final thoughts and takeaways for listeners?

Edward Ferris, MD, FACOG: The take home point should be several things. Number one, if you're having symptoms that are affecting your quality of life, feel free and be courageous enough to bring those up so they can be addressed. Number two realize that after menopause, there are certain disease states that become more common, such as the osteoporosis thing. And so, that should be addressed. I think it's very important for women to understand that bleeding after menopause is never considered normal and always needs to be evaluated. And that, even though they're not having periods anymore, we still need to do a gynecologic exam periodically during those menopausal years just to make sure that nothing has changed and that, they're still healthy and will live a long and productive life.

Host: For sure. Well, Doctor, I really appreciate your time and your expertise today. Really educational. I know I had a lot of questions for you, but, listeners would have those questions and I got to ask them for them today. So thanks for your time and expertise and you stay well.

Edward Ferris, MD, FACOG: Yeah. It was my pleasure. Thank you so much.

Host: And for more information about SUMA's gynecology and menopause care, visit sumahealth.org/women.

And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.