Interruptions in fertility, hormonal dysfunction, absence of menstruation… premature or primary ovarian insufficiency (POI), more commonly known as premature menopause, affects 1% of women under 40 years old. 

What are the mechanisms and causes of this phenomenon? Is there any treatment to delay or reverse its symptoms, synonymous with infertility? But, above all, does this condition that affects women in the prime of life exclude any possibility of conception? How does medically assisted reproduction offer hope, through egg donation or ovarian self-preservation? 

In summary, is it reasonable to consider pregnancy despite primary ovarian insufficiency? 

Focus on premature menopause and advancements in Assisted Reproduction that allow us to cope with it.

What is the meaning of premature menopause?

Menopause occurs when the ovaries stop producing eggs, leading to a decrease in estrogen levels, the hormone that regulates the reproductive cycle. It typically affects women between the ages of 45 and 55, with an average age of 51. However, premature menopause or premature ovarian insufficiency occurs in women under 40 years old.

To counteract hormonal imbalance, prevent the risk of osteoporosis, and control hot flashes, hormonal treatment is often recommended. In the form of contraceptive pills or HRT (hormone replacement therapy), this medical approach aims to stabilize estrogen levels.

The origins of premature menopause

Any factor that can damage the ovaries or alter estrogen production can lead to premature menopause. Other possible causes include:

• Genetic causes: In the absence of obvious medical reasons, premature menopause may have a genetic origin. Evidence suggests that the age of onset of menopause may be hereditary. Asking about family history can provide clues about the onset of this condition.
• Lifestyle: Certain behaviors can influence the onset of menopause. Smoking, for example, alters estrogen levels and may contribute to premature menopause. Studies indicate that women who smoke tend to experience menopause earlier, on average 1 to 2 years before non-smokers.
• Body mass index: Since estrogen is stored in adipose tissue, women with a lower body mass index have fewer estrogen reserves. This can lead to faster depletion and contribute to the early onset of menopause. A vegetarian diet, lack of exercise, and insufficient exposure to sunlight may also influence premature menopause.
• Chromosomal causes: Certain chromosomal abnormalities, such as Turner syndrome, pure gonadal dysgenesis, or fragile X syndrome, can lead to premature menopause.
• Autoimmune diseases: In autoimmune diseases, such as thyroid disorders or rheumatoid arthritis, the immune system attacks a part of the body, causing inflammation that can affect the ovaries.
• Epilepsy: People with epilepsy, a brain-related seizure disorder, are more likely to experience premature ovarian insufficiency, leading to menopause. The hormonal changes resulting from this condition may also influence seizures in people with epilepsy.

Signs of premature menopause

The early onset of menopause may manifest as irregular menstrual cycles. Its symptoms are very similar to those of natural menopause. These include:

• Heavy bleeding
• Prolonged periods lasting more than a week
• Longer intervals between menstrual periods. 

Additionally, mood changes, fluctuations in sexual desire, vaginal dryness, sleep disturbances, hot flashes, night sweats, and difficulty controlling the bladder may also be observed.

Treatment for premature menopause

Typically, premature menopause does not require specific treatment. However, there are options available to help alleviate symptoms or related conditions. In cases of menopause associated with premature ovarian insufficiency, treatment is usually recommended, as it occurs at a young age. It is essential to consider that decreased estrogen levels can contribute to issues like heart disease, osteoporosis, depression, etc.

Hormone replacement therapy is one of the most common approaches to treating premature menopause and helps alleviate many common symptoms. However, this strategy may increase the risk of heart disease or breast cancer. It is crucial to discuss the benefits and risks of this hormonal therapy with an expert.

Practical tips for better coping with premature menopause

While premature menopause cannot be prevented, certain measures can help alleviate its symptoms. Maintaining a healthy diet and exercising regularly helps control symptoms. If you are a smoker, consider quitting, as smoking can worsen some symptoms.

When it comes to using natural products to manage menopause symptoms, results vary. Some people prefer vitamins and herbal supplements over conventional medications. Consult your doctor for specific recommendations for your situation.

Premature menopause and pregnancy.

Currently, although available treatments can help alleviate menopause symptoms, there is no guaranteed way to reverse premature menopause. However, scientific research continues to find ways to help women in this situation conceive.

Infertility is often one of the most concerning issues associated with premature menopause. However, Assisted Reproduction (AR) techniques offer personalized solutions to the desire for pregnancy. First, in-depth examinations, such as a fertility test that evaluates ovarian reserve and a blood test performed on the third day of the menstrual cycle, help understand the reasons for infertility.

Secondly, an ultrasound combined with a count of the number of follicles provides an overview of the patient's oocyte potential (immature eggs).

Treatment to conceive in cases of premature menopause

Despite premature menopause, the uterus remains functional and is perfectly capable of hosting an embryo. Therefore, doctors may recommend In Vitro Fertilization (IVF) with egg donation to patients considering getting pregnant.

The donor undergoes a complete clinical examination, including blood tests to determine her blood type, Rh factor, and exclude any presence of infectious agents such as hepatitis B and C viruses, HIV, cytomegalovirus, HTLV 1 or 2 viruses, as well as bacteria responsible for syphilis. A thorough gynecological examination is conducted to confirm the absence of cysts, fibroids, polyps, or other anomalies in the reproductive system. A karyotype is performed to map the chromosomes and avoid any risk of malformation in the child. Once the donor's profile is established, it is registered to facilitate matching with the recipient. IVF with simple or intracytoplasmic injection (ICSI) is commonly recommended for postmenopausal women who wish to become pregnant after the age of 40 and is also suitable for young women suffering from primary ovarian insufficiency.

On the other hand, women who have preserved their fertility have the option to become mothers with their own eggs, even in cases of premature menopause. This technique involves increasing the chances of success by preserving reproductive cells through freezing, thus pushing the limits of fertility over time.

If you are facing the challenges of premature menopause and wish to explore the possibilities of motherhood, our team is here to guide you. Whether you are considering assisted reproduction, IVF with egg donation, or using the eggs you preserved, at NatuVitro we are committed to providing personalized solutions. Contact us today to schedule a consultation and make your dream of becoming a mother come true.