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Have you ever considered if there is a connection between subfertility, infertility and perimenopause or menopause?
Well, recent research suggests that women who have experienced infertility may be at a higher risk of entering perimenopause earlier than age-matched peers.
And this is certainly something I see with increasing frequency in clinic as a medical professional specialising in supporting women through perimenopause and menopause.
Too often women have endured physically and emotionally gruelling journeys with numerous tests and hospital visits but rarely been informed that their infertility may impact risk of earlier perimenopause or menopause later down the line.
I appreciate that the job of the fertility clinician is not to foretell of the doom and gloom of menopause in the face of hope for conception. But I feel there is a need for women experiencing infertility, subfertility or assisted conception to be given as much information as possible, when the time is right, for them to make informed and empowered decisions about their future health and well-being.
Premature Ovarian Insufficiency (POI) previously termed “Premature or Early Menopause” is common problem impacting 1 in 100 women under the age of 40 and 1 in 1000 under the age of 30. It is characterised by irregular periods or periods stopping as ovarian reserve declines dramatically and prematurely. The causes of this can be genetic, autoimmune, caused by medical treatments or “unexplained”.
HRT is an imperative part of treatment for this group of women. As with low ovarian function, comes low levels of ovarian oestrogen, which is critical for normal function of most cells and in particular maintaining healthy bone mineral density, cardiovascular, metabolic, cognitive and emotional health.
In this example, the connection between infertility and menopause is clear and the treatment priorities are unambiguous.
However, the same logic may need to be applied more broadly to other forms of non-POI infertility, subfertility and perimenopause.
Perimenopause is the ill-defined period of time prior to menopause, that is characterised by symptoms of progressive decline in ovarian oestrogen as a result of ovarian ageing and reduction in ovarian follicular reserve over time. There are over 34 recognised symptoms. The most common of which include irregular periods; hot flushes and night sweats; sleep disruption, vaginal dryness, mood swings, brain fog, anxiety, and low libido.
Ovarian ageing and decline in function, appears to accelerate from our mid 30s. Which is why is its widely understood that natural conception prior to 35 is more likely to be successful. It therefore stands to reason that symptoms of perimenopause may start in women of the similar age.
Yes, many symptoms of perimenopause can mimic those of being stressed, which is a common experience when trying to conceive. But many of them may also be due to the biological changes underlying the difficulty in conceiving: low ovarian reserve.
Navigating the journey though perimenopause into menopause in the context of an earlier fertility problems can be really hard and in my opinion is unnecessary hardship.
The first line treatment for perimenopause and menopause is Hormone Replacement Therapy (HRT), to improve declining natural oestrogen and testosterone levels. For most women progesterone is required too to protect the womb lining from thickening.
HRT is largely safe for most women and as mentioned above, research indicates that not only is it safe, but also protective and important for future health. If you recognise any of the symptoms of perimenopause and in particular if you have a history of difficulty conceiving or need for fertility treatment, it is likely you will benefit from HRT. So consider speaking to a clinician to explore your options.
Alongside HRT, engaging in regular physical exercise, maintaining a healthy diet, and managing stress levels can help alleviate symptoms. Psychotherapeutic support including CBT/ACT can be useful for symptom relief (insomnia/flushes/anxiety/mood), but also provide an invaluable opportunity to create a toolkit of options to move through this stage positively and with purpose.
If HRT is not an option, then certain antidepressant medications (SSRIs), have shown effectiveness in reducing hot flushes, mood swings, anxiety and insomnia. Lubricants and moisturizers can provide relief from vaginal dryness and discomfort.
Perimenopause is a time of transition that can be incredibly challenging. Being alert to the possibility of it happening early is important so that women can proactively seek appropriate medical support to not only improve their wellbeing, but also safeguard future physical, emotional and cognitive health and ultimately improve longevity.
This is something I am really passionate about and in order to effect change, I am conducting research to understand patient and clinician understanding and attitudes on the subject. Please help by anonymously completing this Google Form and please share widely to others to improve the power of this data.
About the Author:
Dr Fionnuala Barton is a GP, Women's Health Doctor, and educator. She is passionate about improving awareness of health issues impacting women with particular interest in early recognition and proactive management of perimenopause and menopause, including premature menopause (POI). POI can occur at any age and is a common cause of infertility. Women experiencing subfertility may also be at increased risk of earlier perimenopause or menopause and Dr Barton is hoping to shine a spotlight on this frequently ignored link. www.themenopausemedic.com
Follow Fionnuala on Instagram: @themenopausemedic