Premature Menopause and Early Menopause

Diagnosis and Fertility Treatment for Women at Different Stages of Menopause

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What Is Early Menopause?

The average age at which women typically experience menopause is around age 51. Early menopause, also referred to as premature menopause, premature ovarian failure (POF) and primary ovarian insufficiency (POI), occurs when a woman experiences menopause prior to turning age 40 yeas. It can occur naturally as a result of genetic abnormalities that affect the ovaries, with family history playing a role. Between 10 and 20 percent of women who experience early menopause have a family history of early menopause. But in many cases, it is the result of a health condition. For example, early menopause is highly associated with thyroid disease, or surgical removal of ovaries. Women who have undergone chemotherapy or radiation treatments may also experience early menopause. Table 1 below summarizes the major known causes of early or premature menopause.


Premature and early menopause diagnosis and treatment discussed by Dr. Norber Gleicher.


Major Known Causes of Early Menopause
TypeCause
POF
  • Autoimmune disorders
  • Chromosomal abnormality of the X chromosome, like FMR1 premuattion range genotype and Turner Syndrome)
Surgical causes
  • Oophorectomy (surgeries that involve removal of ovaries)
  • Surgical damagest to the ovaries
Other therapeutic (iatrogenic) causes
  • Radiation therapy
  • Chemotherapy
  • Tamoxifen
Other
  • There is some evidence that women wiht a family history of early menopause experience early menopause themselves.
  • Viral infectons during fetal development that affect ovarian development.

Early Menopause and Diminished Ovarian Reserve – CHR's Expertise

At CHR, early menopause has been a major focus of research and clinical care. Early menopause is the end stage of usually a lengthy process of early premature ovarian aging (POA). Our preference, of course, is to see patients before they have reached the end stage of POF because at an earlier POA stage we can, still, be much more successful with fertility treatments for women moving toward early menopause. The secret of diagnosing POA early enough is the recognition that even a relatively young woman can have diminished ovarian reserve (DOR) for her specific age group!

CHR, therefore, for a good number of years, has focused on research and treatment of DOR, a condition that has been widely ignored by many, if not most, fertility centers. As a consequence, many women with POA are often overlooked even in very competent fertility centers. Through contributions to the medical literature and expertise in patient care, CHR has developed a worldwide reputation as "the fertility center of last resort." More than half of new patients now come to CHR with a diagnosis of DOR, many from all over the United States, Canada and overseas. CHR has also been pushing the boundaries of our understanding of ovarian reserve. A glimpse of the latest scientific findings is available on our ovarian reserve page.

DOR exists in practically all women above age 40 years. In those women the DOR is "physiologic," which means that the condition is expected due to age. In women with POA, DOR occurs at younger ages, and is usually unexpected. Therefore, it is often much more difficult to diagnose.

If you suffer from early pre-menopause, we may be still able to help you. Please fill out the email consultation form as the first step. Once a woman has reached the end stage of POF, even physicians at CHR can offer only experimental treatments, with much more limited chances of success.

How Is Early Menopause Diagnosed?

It is here very important to be accurate in terminology: Diagnosis of POA needs to be clearly differentiated from diagnosis of POF.

POA is usually completely asymptomatic, though some women may report changes in menstrual patterm especially shortening of their menstrual cycles. In contrast, there are a number of symptoms associated with POF, many of which mirror those experienced by women who are entering natural menopause. Those include irregular or missed periods, hot flashes, vaginal dryness, bladder irritability, incontinence, dry skin, dry eyes, dry mouth, problems with sleep, decreased sexual desire, and emotional shifts such as irritability, feelings of depression, or mood swings.

Women who are experiencing symptoms of early menopause, or who have had fewer than nine periods in a year or missed more than three consecutive periods, should talk with their doctor about early menopause. A blood test will likely be ordered to rule out other possibilities, such as pregnancy. Your doctor may also test your levels of estrogen, with abnormally lower levels often being a potent indicator of POF.

The decisive test for early menopause, icluding POF, is the level of follicle stimulating hormone (FSH), elevated levels (above 40mIU/mL) of which indicate early menopause.

POA, in contrast, is characterized by elevated FSH levels but below 40.9mIU/mL. A few years ago, researchers at CHR determined age-specific FSH level thresholds to detect POA in timely manner. The bottom portion of Figure 1 on the right shows the curve of age-specific normal FSH level. The top portion demonstrates normal age-specific AMH (anti-Müllerian hormone) levels. Women at abnormally high FSH and/or abnormally low AMH levels for their age by definition suffer from POA, and at a higher risk of entering early menopause.

For more information on age-specific levels of FHS, please refer to our high FSH page. With age-specific levels, we are able to diagnose even the earliest stages of early menopause in a timely manner, which is crucial in providing the best possible fertility treatments to women with risk towards early menopause.

Can I Get Pregnant with Early Menopause?

The chance to conceive is directly related to the number of follicles/eggs left in ovaries. In other words, while women in the relatively early stages in the process toward early menopause, i.e., those with POA, have fewer follilces and eggs than they should have at their age, they usually still have enough for a good chance of pregnancy. In contrast, POF patients, i.e., those who are alrady in early menopause, often are donw to small enough numbers of follicles and eggs, to prevent them from having a reaslistic chance at pregnancy with use of their own eggs.

Treatment Options

With POA, women usually still haveta reasonable likelihood of achieveing pregnancy with use of their own eggs. Supplementation with dehydroepiandrosterone (DHEA), a mild male hormone treatment introduced into fertility care by CHR physicians, has played a crucial role in revolutionizing treatment of younger POA (early pre-menopause) and older DOR patients. DHEA helps to rejuvenate ovarian function. As reported in 2007, DHEA supplementation prior to IVF cycles more than doubled pregnancy rates [Barad et al. J Assist Reprod Genet 2007;24(12):629-34]. Our published data have shown that DHEA supplementation improves pregnancy rates, improves egg and embryo quality and reduces chromosomal abnormalities. For more details, please refer to the DHEA page.

DHEA supplementation with POF is still under investigation but appears much less successful. In contrast to women with POA, women in early menopause in most cases still requires egg donation.

In vitro fertilization (IVF) with egg donation is a very effective treatment option for women with early menopause who want to conceive. Eggs are retrieved from a young donor with normal ovarian reserve, and fertilized outside of her body using the partner's (or donor's) sperm. After a few days, embryos are transferred into the recipient's uterus. Because egg donation from young egg donors circumvents the problems of poor egg quality and small number of eggs, pregnancy chances are much higher. Indeed, recipients have the pregnancy chances and miscarriage risks of women at the egg donors' age. Cumulative pregnancy rates from a single donor IVF cycle at CHR, therefore, have been consistently in the high 80s to low 90s.

To determine which fertility treatment option is right for you, please contact us.

Next Step

The first step is easy, simply complete the early menopause contact form to determine what fertility treatment is best for you.

Last Updated: November 21, 2012