Early Menopause explained

Today, October 18th, marks world menopause day – a day to raise awareness of the menopause and the support available for improving health and wellbeing

When we think of the menopause though, we automatically think about women in their late forties and early fifties, but the reality is that many women have experienced early menopause. We turned to the team at Clinica Tambre to help us understand in more detail what this means.

What age is considered early menopause?

It is considered an early menopause when the periods stop before the age of 40 years old.

Is there an “average” menopause age?

The average menopause age may be different between countries. There could be differences specially between developed and developing countries but in general, the menopause occurs between 45 and 55 years old on average.

 Is early menopause hereditary?

Some particular cases of early menopause can be related to genetic disorders such as Turner Syndrome or X- Fragile associated primary ovarian insufficiency ( X- Fragile permutation).

The Turner syndrome is an alteration in the karyotype in which the woman has just one X chromosome instead of 2. Its symptoms include short height, wide neck, low-set ears and others. Typically, there is a reduced production of sex hormones which lead in many cases to infertility, lack of or delayed puberty and early menopause.

The X- Fragile associated primary ovarian insufficiency is a genetic disorder caused by changes the FMR1 gene. Carriers of the X- fragile premutation have an increased risk of developing premature ovarian insufficiency which may lead to fertility problems and early menopause.

How do you know if you are experiencing early menopause? (What are the symptoms?)

The main symptoms are caused by the lack or decreased production of female hormones and are the same that may occur in a menopause at a normal age. Those symptoms include: menstrual cycle changes, specially irregular cycles or amenorrhea (absence of periods),hot flushes, sweats, insomnia, mood alterations or vaginal dryness.

What should you do if you are experiencing any of these symptoms?

You should go to your doctor and explain your symptoms so that a physical examination can be performed and some specific test can be requested.

What tests will your doctor run?

In case you have typical menopause symptoms, your doctor will request some test to confirm the diagnosis. Those tests will check the hormonal levels. The most important ones are FSH, LH, estradiol and TSH. It is important to discard any thyroid issue as some alterations in the TSH levels may also be related with irregular periods and some other menopause symptoms.

In addition, FSH, LH and estradiol should be also requested. When the ovaries are not working properly, there is a decrease in the estradiol production so the estradiol level in a blood sample may be low (below 30 pg/ml). In contrast and due to the feedback loop the hormones are involved in, an increased FSH and LH level may be found in the blood tests results.

If tests show that you are experiencing early menopause, what happens next? Are you referred to a fertility doctor?

It would be highly advisable to be referred to a Fertility specialist to request all the tests needed to make a proper diagnosis, and to have your fertility options explained.

How does early menopause affect fertility?

When a woman is in menopause, the ovaries do not produce the hormones they should and therefore, they do not release eggs either as there is no ovulation.

This makes it very difficult to get pregnant naturally or even with IVF. In contrast, these women may be able to get pregnant with donor eggs as the uterus is not so affected by the menopause. It is also possible to use hormonal treatments so the uterus is in the best possible condition for pregnancy in spite of the ovaries.

Once early menopause starts, how quickly and at what rate is your egg reserve depleting?

It is not possible to know so far how quick a woman’s ovarian reserve decreases but once the symptoms related to early menopause appear it is very likely that the amount of eggs remaining in the ovaries is already low.

Is it possible to “catch it” early? If diagnosed early enough, can you freeze your eggs?

Some women that have a familial background of early menopause ( especially if the mother experienced early menopause), are normally concerned about it and may go to a fertility clinic soon to try to maximize their chances of freezing their eggs which is the ideal treatment to preserve their fertility in case they do not want to get pregnant at that moment.

In addition and considering that most patients do not have any familial background, it is very important that the general Gynaecologists pay attention to the antral follicular count (the follicles that may be seen in the ovaries in a vaginal ultrasound) when they perform a routine vaginal scan, to give advice to young women that have a low count and refer them to a Fertility specialist to request an AMH to check the ovarian reserve. If both AMH and antral follicular count show a decreased ovarian reserve and even if the woman does not have any typical menopause symptoms, egg freezing could be a good option before the ovarian reserve decreases even more.

If you have been diagnosed with early menopause, what are your next steps in terms of your journey to motherhood?

The first step is visiting a fertility specialist who can explain to you the best fertility treatment in your case. As mentioned before, due to lack of ovarian function, it is recommended to have egg donation treatment to ensure that women can become pregnant.

Have you been diagnosed with early menopause? We would love to hear from you. Drop us a line at mystory@ivfbabble.com

Read more from Clinica Tambre here

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