Maggie McKay (Host): Welcome to the Live Greater podcast series, information for a Healthier You from the University of Maryland Medical System. This episode is part of our menopause and perimenopause series focused on education, empowerment, and personalized care. I'm your host, Maggie McKay. Joining us today is Dr. Carmen Farrior, OB-GYN at University of Maryland St. Joseph Medical Group, to discuss perimenopause. What now? Thank you so much for being here, Dr. Farrior.

Carmen L. Farrior, MD: Thank you for having me.

Host: So first things first, what is perimenopause and how is it different from menopause? Because I have to say, I remember years, decades ago actually, on Oprah, she had a guest and they said, "Menopause is like 14 years and there's three stages to it." And I'm like, "Oh my goodness." So, let's just start with that, perimenopause.

Carmen L. Farrior, MD: I would say it's kind of like the start of the journey of the retirement of your ovaries, so to speak. During this time period, your hormones are fluctuating a lot, and you also notice that your periods are going to be really irregular. So, that's the first clue that women are entering perimenopause. It usually happens like early 40s for most women.

Host: And how is it different from menopause?

Carmen L. Farrior, MD: Menopause means that you have not had your period for an entire year. So, perimenopause ends a year after your final menstrual period. And we have a retrospective diagnosis. We don't know how long we're going to make it, so that's why we count for the full year. You may make it seven months and your hormones fluctuate and you start having cycles again. So, menopause is a full year of no bleeding.

Host: What are the most common signs of perimenopause? And which ones surprise women the most?

Carmen L. Farrior, MD: The most common signs will be the menstrual irregularities where your periods become unpredictable. Some women may have had cycles like clockwork every 28 days. Now, all of a sudden, it's 30 days, it's 35 days, it's 26 days, God forbid. And they may also notice that the amount of blood that they're losing is variable. So, a lot of women may notice that sometimes their periods are really scanty, sometimes they're really heavy. And so, those are things that are frustrating because you're trying to plan your life and you're noticing these things. Women can also have some hot flashes. That usually happens more so when they are getting closer to menopause. But they may notice those hot flashes, which are things that they will remember to report in most cases. If you're 42 and you're having hot flashes, you'll probably want to talk to your provider about it.

Host: Why do so many women feel blindsided by perimenopause, even if they've heard of menopause?

Carmen L. Farrior, MD: Partially, the providers are at fault for that, and there've been a lot of stigma over the years about something that's natural for women to happen, that we do have a set stage for the lifecycle of our ovaries. And a lot of the times we have not done a good job of explaining this to women, especially after the Women's Health Initiative study about 2001 where there were no hormonal treatments and pretty much everybody stopped everything when that study came out. So, we just kind of stopped talking about it. Before that point in time, women just got treated. They may have been on contraception, and they transitioned right to hormonal therapy, so they weren't having a lot of symptoms.

Host: How early can perimenopause start? And when should someone talk to their doctor instead of brushing symptoms off as stress or aging?

Carmen L. Farrior, MD: It can start even in your 30s. So, there are a lot of women who have some of the symptoms: hot flashes, irritability, night sweats, irregular periods. And they become frustrated by these symptoms and they're not really sure what's happening. And we also normalize everything in society. So, women, we're kind of taught to tough it out, it's just what happens. It happens to me. So, you just have to go through things. And people don't always realize that there are treatments out there that we may be able to help alleviate some of your symptoms. So, the early 30s, it is very frustrating for women. And it doesn't mean they're necessarily going to lose their fertility in early 30s, because perimenopause can last, for some women, two years; for some women, over 10 years. So, it's just the fact that your hormones are just going up and down and you just not feeling like yourself.

Host: Ten years?

Carmen L. Farrior, MD: Yes, unfortunately. Particularly in women of color, they have longer transition periods.

Host: And that's just perimenopause.

Carmen L. Farrior, MD: Yes, perimenopause where your hormones are changing. Menopause is for life. Post-menopause, I should say. So once we stop having our cycles, we spend the rest of our life in post-menopause, dealing with those consequences of having low estrogen state.

Host: So lucky being women. Just kidding.

Carmen L. Farrior, MD: It is manageable. There are a lot of things out there we can do about it. We're not powerless.

Host: Totally. Yeah. And like you said earlier, it's so true how, like when I was growing up, it was like anything medical that women go through, it was like, "That's just the way it is. Get through it." And that's how you had to deal with it. But now, there are options today, like you said, for managing, let's just start with perimenopause symptoms. What are those options?

Carmen L. Farrior, MD: The first thing I would say before I go into full options is be sure that you're intentional about your appointments. A lot of the times, as providers, we feel powerless or not useful because our patients may come in and they come for routine appointments, but then they have all these other problems that are very important and we can't take the time to go through them appropriately.

So if you feel like you have concerns about menopause, don't wait until your routine exam, schedule a separate appointment to do a menopause consult, perimenopause consult, whatever you want to do, but schedule a separate appointment so that we know that you have a serious issue, and that we also have the time to address your issue.

In terms of perimenopause, there are treatments out there. We try to focus on what the problem is. So if a woman's having a lot of menstrual irregularities, we'd be looking at some type of hormonal treatment, whether it is birth control pills, the patch, progesterone, IUD. If they're having mood issues, we look at different type of mood treatments or cognitive therapies to try to help them with some of those things.

Host: Dr. Farrior, if a listener is thinking, "Okay, what now?" What are the first one or two steps you recommend that they take?

Carmen L. Farrior, MD: When my patient first starts to transition to perimenopause, I kind of see that as another vital sign that they're getting ready to go through a transition in their life. And so, I want women to use that time to do a checklist to make sure that they're on track to be able to have their best postmenopausal life.

So, is my diet good? Am I exercising appropriately? Is my BMI, is my weight in order? Is my cholesterol doing well? Is my blood pressure good? Because these are things that estrogen protects and helps us with. And as we age, we're more likely to have problems with those things. So, I see it as an opportunity for us to kind of like get our ducks in order.

Host: In closing, is there anything else you'd like women to know about perimenopause?

Carmen L. Farrior, MD: Perimenopause is natural. There's nothing wrong with you. There are treatments out there that can help you. You may have to do something. I know sometimes we feel paralyzed that we actually have to take another medication, but if that medication's going to get us to the other side, make life more tolerable for us, then don't be afraid. There's a lot of studies out there with good medications that are safe and tolerable, so just don't be afraid to talk about it. You can get something done.

Host: Well, thank you so much for sharing your expertise. This is invaluable information that a lot of times we don't hear about. You know, like, people just don't discuss it, much more now today, thankfully, than years ago. But still, I think, it's good to have it out in the open like that. So, thank you so much

Carmen L. Farrior, MD: Thank you.

Host: Again, that's Dr. Carmen Farrior. Listen to more at umms.org/podcast, YouTube or your favorite podcast platform. I'm Maggie McKay. Thank you for listening to Live Greater, a Health and Wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.