Maggie McKay (Host): Welcome to the Live Greater podcast series. Information for a healthier you from the University of Maryland Medical System. This is one episode in a larger series exploring menopause and perimenopause with expert guidance to help women feel informed, prepared, and empowered. 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, recognizing and managing early onset menopause. Thank you so much for being here today, Dr. Farrior.

Carmen L. Farrior, MD: Thank you.

Host: So what exactly is early onset menopause and how is it different from the menopause most people expect in their late forties or fifties?

Carmen L. Farrior, MD: So menopause normally happens somewhere between the age of 45 and 55, and the average age in North America is about 52 years old. So if you are between 40 and 45 when you go through menopause, that's considered to be early menopause. And then we have women that are under the age of 40 that are in premature menopause or primary ovarian insufficiency when they stop having their cycles early.

Host: What are the early signs and symptoms that women often miss or dismiss as "stress, burnout, or something else"?

Carmen L. Farrior, MD: The changing your menstrual flow, the menstrual irregularities, skipping your cycles. We tend to think we're stressed out. I'm studying. I got a lot on my plate, it may be stressful at the job, and so when you're starting to skip cycles, it's better to do a check-in if it's something that's been persistent or recurrent with your provider so that they can do some evaluation and catch some things early.

Host: Why can early menopause be so hard to recognize or diagnose even, even by women who know their bodies well?

Carmen L. Farrior, MD: We tend to focus on so many different things, and if you're 38 years old and your cycles have not shown up, people don't necessarily realize, we are just not paying attention. Some of it is denial. We, think about things that we pretend like it's not there. It's not there at all, and there's so many other different things on the provider side that we may not be thinking about it either, that we may feel that there's some other issue that's going on.

Maybe she had been on contraception for a while and there was some delay in her cycle coming back. Maybe it's some other problem that's going on that we think about like her thyroid can affect the menstrual cycles. And so the other thing is that this can be intermittent, so you may have sporadic flows of where everything's back to normal again.

 And so if we test the hormones, everything's going to be normal if you're menstruating again, so there's not like one test for it.

Host: And what health risks or quality of life issues can come with early menopause if it goes untreated?

Carmen L. Farrior, MD: That is a great question because it's so difficult to get the stigma of hormone therapy out of the treatment of these women who have primary ovarian insufficiency and premature menopause. So we really consider them being true hormone replacement therapy because we are supposed to have menopause around 52 years old.

And if you're 38, 39, 40, you're missing your estrogen for so many years. Estrogen helps with osteoporosis and it helps with cognitive function as well as our heart and cardiovascular disease. So it's very important for women in that age group to have hormone replacement therapy.

Host: Is there any downside to hormone replacement therapy, no matter what your age?

Carmen L. Farrior, MD: Starting with that age group, there is no downside because they are supposed to be on hormone therapy. And so the studies that were done back in 2001, that women's health initiative that came out included people that were 80 years old that had been on hormone replacement therapy for decades. So over the years, we've done a lot more research and studies to dial down into the different patient populations.

But in that particular age group, if they don't replace their estrogen, they're going to end up having early osteoporosis where if you fall and you break a bone, particular hip, that's life altering. They have higher risk for cardiovascular disease. And higher risk for dementia. So it's very important.

And in the older ages, we really have to look at the patient and see how old she is, how long has she been in menopause, and what her other medical factors are to give her a real risk assessment. But I don't think there's a lot of risk with being on hormone replacement therapy when we choose the right dosage in the right patient.

Host: That's reassuring. What treatment or management options are available today and how personalized is menopause care?

Carmen L. Farrior, MD: There are different types of treatments and I want to start with what not to do. The pellets, the injections that people may go to some providers and get where insurance doesn't cover it, is not anything that any of the major health organizations that take care of women recommend. Those things are not FDA-approved.

You don't know how much you're getting and we don't know how they're necessarily affecting your body, so please stay away from those things. There are tons of FDA approved treatments out there from patches to gels to pills that can be used to help people treat their symptoms. And we also go by what the symptom is in the older populations.

If you have an early menopause, you may have some vaginal issues, vaginal dryness. We can give local therapy that doesn't go systemically, so there are a lot of different treatments out there that can help.

Host: What's the most important thing you want women experiencing symptoms to know and what should they ask their doctor first?

Carmen L. Farrior, MD: The most important thing to know is that there is treatment out there for you that is safe and effective. You may have to spend some time finding the right recipe for yourself and not to get discouraged if the first thing you try doesn't work. We as providers are not going to know that it didn't work if you don't follow-up to say, Hey, I didn't like that side effect. I want to try something different. Just don't get discouraged and go and do some of those things where you're getting super physiological, very high doses of hormone therapy that can be harmful to you, that gets advertised as natural because it is not safe.

Host: Good to know. Anything else in closing you'd like people to know?

Carmen L. Farrior, MD: I want women to know that your bodies are perfect the way they are, and we go through changes in cycles that we're supposed to go through as we age. It's natural for you to age, and our ovaries have a life cycle. And it's okay. It doesn't mean anything is wrong with you once you get to your transitional period.

It just means that you're going through a new phase in life. And we as providers, we're going to be here to try to help you get through it.

Host: Well, thank you so much for sharing your expertise. This information is so invaluable to women and we really appreciate you taking the time.

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

Host: Absolutely. Again, that's Dr. Carmen Farrior. Listen to more at umms.org/podcast, YouTube, or your favorite podcast platform. I'm your host, 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.