Diagnosed, Dismissed, and Determined: How Premature Menopause Became My Mission
by Marissa Fontanez, DNP, FAIHM, MSCP
In the United States, the first COVID case emerged in Washington state, where I worked as a primary care/urgent care doctor. It was a time of intersecting crises – the pandemic, the Black Lives Matter movement, and devastating forest fires. Working long shifts leading a COVID clinic while living alone with my cat, I felt the weight of isolation and stress mounting as months passed without seeing friends or family.
When I started “feeling off,” I initially attributed it to workplace stress and the state of the world. Being single, I decided to stop taking birth control pills for the first time in over 15 years. After four months without menstruation, my symptoms worsened. At 34, I knew this would lead to news I wasn’t prepared to face.
Despite my medical background, I found myself in the unfamiliar position of being a patient, scheduling an appointment with a colleague. While she initially dismissed my concerns, I had to advocate for myself, guiding her through the labs I knew were necessary. Though she suspected nothing was wrong, my medical and personal intuition pointed to Premature Ovarian Insufficiency (POI) or Premature Menopause – a condition at that time known to be rare, affecting less than 1% of women under 40 worldwide.
The diagnosis shocked me, especially given my history of heavy, painful, regular menstruation. My first thought was about fertility – I was single and only 34 years old. Seeking answers, I consulted a fertility specialist who delivered the news without empathy: my ovaries “were those of a 60-year-old” with no visible follicles. While they prescribed HRT, I received no education, no dose adjustment, nor any discussion of follow-up care.
Unlike natural menopause, where HRT is optional, women with premature menopause require hormone replacement to protect their long-term health. Without it, life expectancy lowers, and the risks of heart disease, osteoporosis, and cognitive decline increase significantly – yet this crucial information wasn’t discussed during my diagnosis. What’s more, the dosing requirements for premature menopause should be much higher than that for natural menopause, as younger women need more hormones for protection. My persistent symptoms were a clear sign that my prescribed dose was too low, but none of my doctors recognized this.
Even as a medical professional, nothing prepared me for this experience. For once, I wanted to be the patient – to receive support, guidance, and answers. Instead, I faced a brutal three months of symptoms: deep depression, mood swings, insomnia, weight gain, severe brain fog threatening my career, noticeable hair loss, joint pain, body aches, hot flashes, dry skin, and complete loss of libido.
After consulting eight different doctors without finding adequate care, I realized I needed to become my own advocate and doctor. I pursued training as a menopause specialist and immersed myself deeply in any available research, discovering valuable resources in the UK, including specific guidelines and support organizations, such as The Daisy Network, that weren’t available in the USA.
True to my nature of fully committing to my passions, premature menopause became more than just my diagnosis – it became my mission.
I began volunteering to help other women access resources and shared my story on Instagram. This platform quickly grew into a vital educational resource, connecting me with countless women facing similar struggles. Recognizing the enormous gap in care, I established my own telehealth company focused specifically on helping women with premature ovarian insufficiency and diminished ovarian reserve address their hormonal and fertility concerns.
After a year of building this practice, I joined forces with a nationwide telehealth menopause company as a nurse practitioner to extend my reach and help more women on a larger scale. Leveraging my personal experience and professional expertise, I developed instructor-led courses on premature menopause and created clinical protocols that now educate their healthcare providers on how to properly care for women with this condition.
My journey’s ending is bittersweet. Through my background in integrative medicine and menopause care, I worked with a supportive fertility doctor and, surprisingly, was able to create a viable egg. While it fertilized, it didn’t survive. Still, this experience gave me the closure I needed to embrace a child-free life – a decision I’ve come to accept and thrive in. I also finally uncovered the cause of my diagnosis and developed a hormone regimen that has now eliminated my symptoms. Though proud of these achievements, it saddens me that I had to be both doctor and patient to find these answers.
As I write this in 2025, we’ve made significant progress in discussing menopause openly in the media, increasing awareness and resources. In recognition of my diagnosis, I was recently featured in the Vagina Museum in London, England as part of their March 2025 exhibit “Menopause: What’s Changed” – a milestone that highlights how far the conversation around menopause has evolved. Importantly, premature menopause is no longer considered such a rare disorder, affecting around 3.5% of women and rising, and this year marked a crucial milestone with the first update to clinical guidelines since 2015.
Through collaboration between UK medical organizations and international partners, these comprehensive guidelines are now accessible to healthcare providers worldwide. Yet much work remains, particularly regarding premature menopause. While media attention focuses on women 40 and older, we must continue educating both healthcare providers and women that menopause can occur AT ANY AGE!
About Marissa Fontanez, DNP, FAIHM, MSCP
Dr. Marissa Fontanez embodies the spirit of lifelong learning, transforming her journey as a first-generation college graduate into a dynamic career at the intersection of healthcare and education. As the founder of Atabey X Designs and a Learning Experience Designer, she brings over a decade of multifaceted expertise to the transformation of complex healthcare knowledge into accessible, impactful learning experiences. She is dedicated to improving women’s reproductive health and is a staunch advocate for broader menopause education and awareness across the age span.
MARCH 2025
