Written By Kate Organ
As more and more women choose to start their families later in life it can often mean that women swing from fertility issues, pregnancy and then directly into perimenopausal symptoms. Here’s my story below and reasons why the perimenopause should be addressed in this group of women.
The menopause signifies the end of a women’s natural reproductive life. Over our reproductive lives the egg store within the ovaries decline and eventually empties resulting in the menopause. The failing ability of the ovaries to produce hormones during this decline are linked to the symptoms we experience in the perimenopause, leading up to the menopause.
Egg reserves The number of eggs we have as we age diminishes
At birth: 1-2 million oocytes
Puberty: 300,000 - 500,000 oocytes
Around age 37: approx. 25,000 oocytes
Around age 51 (average age of menopause in the UK) 1000 oocytes
Infertility and diminished egg reserve
The majority of women seeking assisted help with their fertility have been trying to have a baby naturally for at least 12 months. There are many reasons for infertility. Here I discuss ovulatory issues and diminished egg reserve which is diagnosed by measuring follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH )in the blood. There may also be other symptoms related to our menstrual cycle that suggest a diminished egg reserve including:
late, erratic or absent menstrual cycles
shorter menstrual cycles
heavy menstrual flow
Some of these sound familiar don’t they? Essentially perimenopausal symptoms are as a result of a reduction in ovarian function (reduced hormone production and number of eggs) and hence is also a diminishing egg reserve.
This topic is very personal to me following 4 unsuccessful rounds of IVF covering the ages of 34-39 due to secondary infertility as a result of a bilateral fallopian tube blockage (the result of an infection from my caesarean). I wished my healthcare professionals explained to me that my diminishing egg reserve, quantity and quality had the greatest impact on my IVF success rates rather than it all being about my fallopian tubes. However it may not have effected the outcome. The great news is that at age 39 we had a successful donor egg IVF transfer from the most altruistic fabulous lady who I hope to thank will all my heart one day. During my donor round of IVF at age 39, I vividly remember feeling soo good for those few months when I was using high dose transdermal oestrogen. In hindsight, I now know I was perimenopausal before my treatment, which actually probably started around age 38. For those few months while I was using oestrogen my body didn’t ache, I had so much energy, I was mentally more alert, there was no fatigue. It wasn’t until after the birth of our daughter and my oestrogen levels dropped significantly (and didn’t normalise) that I started to experience more prominent symptoms of the perimenopause. Initially I brushed these away with thoughts of the effects of breast feeding and hormone levels, expected fatigue from having a young child. I went on for three more years without treatment feeling exhausted, sweating at night, having problematic urinary and vaginal issues, heavy periods and increasing migraines….
And so we’ve all heard those symptoms before. My question is how can we address the perimenopause & infertility of women in their late thirties and early 40’s? Well actually there is no reason why you can’t take HRT when you are trying to conceive, the doses of the body-identical hormones oestrogen and progesterone are much lower compared to the oral contraceptive pill and so do not prevent pregnancy, are safe in pregnancy and actually may even increase fertility having restored your hormone levels.
What can you do if you think you are perimenopausal and want fertility treatment
Ask your fertility professional to assess you for menopausal symptoms or take the menopausal symptom questionnaire on my website www.menopausespecialists.com
Seek help from a professional who understands both fertility and the perimenopause
How’s does IVF effect the menopause There is some emerging evidence from research looking at this subject suggesting that women who undergo IVF can have an earlier onset of the menopause and that they may have more prominent urinary and vaginal symptoms. This suggests that we should be informing IVF patents of this possible correlation and helping them to recognise early symptoms and seek help.