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Fertility and premature menopause
All you need to know
While most people will experience menopause around the age of 51, when it happens earlier than this it is known as premature and early menopause. Premature menopause is diagnosed when menopause happens before the age of 40, and early menopause refers to menopause occurring before age 45. 1
Premature menopause is estimated to affect 1% of women under 40, and 0.1% of women under 30. In a few exceptional cases women may become menopausal in their 30s, or even younger. 1
If you are diagnosed with premature or early menopause, it might catch you unaware and completely unprepared. In this article, we will go over the causes, symptoms, diagnosis and the available options for fertility treatment.
In most cases, menopause does not start suddenly with no warning, but follows a period of time where women experience menstrual and ovulation irregularities and disturbances and difficulty conceiving. When this happens before the age of 40, it is often referred to as Premature Ovarian Insufficiency or Premature Ovarian Failure.
What is menopause?
Menopause is a natural biological process that marks the end of a woman's reproductive years, and the end of their periods and fertility. Most women will go through the menopause between the ages of 45 and 55, with the average age around 51 years.
During menopause, the ovaries gradually produce fewer hormones, specifically oestrogen and progesterone, which regulate the menstrual cycle and support female fertility. As hormone levels fluctuate and decline, it is common for women to experience physical and emotional changes that can cause stress and discomfort.
What is the difference between premature menopause, early menopause and POI?
Premature menopause, also known as premature ovarian insufficiency, and early menopause are terms used to describe different conditions where a woman’s ovaries stop producing regular hormone levels long before the usual time of menopause. While they share similarities, there are important distinctions between these conditions.
Premature menopause is diagnosed when menopause occurs before age 40 and affects 1% of women under the age of 40 years. 3 In premature menopause, the ovaries stop working properly and don’t produce enough of the hormones oestrogen and progesterone. This can cause symptoms similar to natural menopause such as hot flashes, night sweats, mood changes, vaginal dryness, and decreased fertility.
Treatment for premature menopause often includes hormone replacement therapy (HRT) to help the symptoms, prevent osteoporosis, and reduce the risk of cardiovascular disease.
Before premature menopause the ovaries stop producing adequate levels of hormones and inconsistently release eggs during periods. 3 This period of time is often referred to as POI.
The exact cause is often unknown, but it could be genetic or caused by autoimmune disorders or conditions such as ovarian tumours, endometriosis or previous ovarian surgery. Quite often it runs in families and a woman going through premature menopause discovers other female relatives experienced early menopause.
Early menopause happens between the ages of 40 and 45 and affects 5% of women before the age of 45. 1 Early menopause can occur naturally, as a result of genetic and inherited conditions or following conditions that affect ovarian function. 4 It can also be caused by certain treatments such as chemotherapy, radiotherapy or surgery to remove the ovaries. 4 Similar to premature menopause, there is a decline in ovarian function (POI) and hormone production before early menopause and the symptoms are similar to natural menopause and premature menopause.
Treatment options for early menopause may include hormone replacement therapy (HRT) to manage symptoms and promote overall health.
What causes early and premature menopause?
Early and premature menopause can be caused by different factors including genetic, autoimmune, environmental, and medical and surgical causes. Some common causes:
Genetics play a role in the age a woman will go through menopause. If there is a family history of early menopause, this can increase the likelihood of it. 4 Certain genetic disorders, such as Turner syndrome and Fragile X syndrome, are also associated with an increased risk of early menopause. There is the possibility to screen for Fragile X in young women from families with a history of early menopause.
Some autoimmune conditions can lead to premature ovarian failure or early menopause. These include autoimmune oophoritis, where the body's immune system mistakenly attacks the ovaries. Hashimoto's thyroiditis, an autoimmune disorder that affects the thyroid gland can also impact the ovaries. 4
Chemotherapy and radiotherapy treatments for cancer can damage the ovaries leading to a decline in hormone production and early menopause.
Surgical removal of one or both ovaries, called bilateral oophorectomy, causes immediate menopause at any age. 4 If only one ovary is removed, menopause can still happen earlier than expected. Surgery that removes ovarian cysts and endometriosis can also cause reduced ovarian function and POI, depending on the extent of the surgery.
Some studies suggest that certain environmental factors and lifestyle choices may influence the timing of menopause. Factors such as smoking, exposure to certain chemicals and toxins, and a lower body mass index (BMI) have been associated with earlier onset of menopause. However, the exact mechanisms and extent of their influence are not yet understood.
However, it's important to remember that in many cases, the cause of early or premature menopause is unknown. The underlying factors can be complex, and different women may have different experiences.
What are the symptoms of premature menopause?
One of the first signs are changes to the menstrual cycle. Periods may become irregular, shorter, longer, lighter, or heavier. Eventually, periods stop altogether, however a woman must have had no periods for a year to meet the definition of menopause. It is not unusual for sporadic ovulation to start again even after several months which can lead to unexpected periods, and sometimes unexpected pregnancy.
Sudden and intense feelings of heat that may be accompanied by flushing of the face, neck, and chest. Hot flashes can be followed by sweating and a rapid heartbeat often disrupting sleep at night.
Lower levels of oestrogen can cause vaginal dryness, itching and discomfort during sexual intercourse, and an increased risk of urinary tract infections. It can also impact libido and a decrease in sexual desire and changes in arousal and orgasm.
Hormonal changes can cause mood swings, irritability, anxiety, and depression. Some women may experience increased feelings of sadness or loss. Often women report mild memory loss and a sense of confusion described often as “brain fog”.
Insomnia, difficulty falling asleep, and disrupted sleep patterns are common symptoms. Night sweats can also contribute to sleep disturbances. Many women also experience general fatigue, decreased energy levels, and a sense of overall exhaustion.
Early and premature menopause often coincide with decreased fertility or infertility. Understandably, this can cause a great amount of stress. 4
How is early and premature menopause diagnosed?
A GP or fertility specialist should be able to make a diagnosis of early and premature menopause based on your symptoms, family history, and blood tests to check your hormone levels. 4
Consultation with a doctorYou'll discuss any changes in your menstrual cycle, such as irregular periods, what symptoms you have, and any relevant medical or surgical history.
Physical examinationTo assess your general health, evaluate symptoms and check for signs associated with hormonal changes in breasts and genitals.
Blood testThis measures your hormone levels including follicle-stimulating hormone (FSH), luteinising hormone (LH) and oestrogen (oestradiol).
Ultrasound scanYou'll have a scan of your uterus and ovaries to review their size and structure.
Additional testsTests to check thyroid function, prolactin levels or autoimmune markers can rule out other potential causes of irregular periods.
Premature menopause and fertility
Early and premature menopause do not necessarily mean you are completely infertile. Some women may still ovulate, albeit irregularly, which can make spontaneous pregnancies possible. 5 to 10% of women with premature menopause can become pregnant naturally when their ovaries do function in between irregular periods. However, the chances of conception decrease significantly with age.
Can I still get pregnant after being diagnosed with premature menopause or early menopause?
While the chances of getting pregnant naturally after being diagnosed with premature or early menopause are lower, it is still possible to become pregnant through assisted reproductive technologies, such as in vitro fertilisation (IVF). Realistically, only women who still have some ovarian function, sporadic ovulation and that are in their early 40s or younger have some chances with IVF. Egg quality decreases as women age, which with reduced number of eggs can make conception over 40 very difficult even with IVF.
If you have premature menopause and cannot conceive naturally then donor eggs from a young and healthy donor can be a successful option. IVF with donor eggs is when a woman undergoes fertility treatment using eggs from another woman, known as an egg donor who donates those eggs altruistically to help women who can not conceive.
At Apricity we are proud of our 86% cumulative clinical pregnancy rate for three embryo transfer events from one cohort of donor eggs. Our egg donation services have enabled many families to have genetically-related children using donor eggs. Egg donors are screened thoroughly for medical conditions and are selected to match as closely as possible the women who receive their eggs. Donated eggs can then be used in a fresh or frozen embryo transfer in an IVF cycle.
Being diagnosed with premature or early menopause can feel life-changing, with difficult decisions to make, whether you are planning to start your family or not. Support exists, from hormone replacement therapy for symptom management to fertility treatment including egg donation that gives a higher chance of success.
Finding support after a diagnosis of premature menopause or POI
The Daisy NetworkA charity organisation providing lots of support for women affected by premature ovarian insufficiency and early menopause. www.daisynetwork.org- Becky Kearns @definingmumShares her story of being diagnosed with premature menopause at 28, and becoming a mum of three through egg donation.
- Paths to ParenthubThis network offers community support, guidance and comprehensive resources on egg donation and is a great source of inspiration.
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