If you’re trying to start a family, you are probably vaguely aware of the onset of menopause as you consider your timing. It’s like a huge “end” sign in the race to have children. For most women, menopause occurs between 45 and 55 (on average at 51), but some women find that it appears much earlier than expected, which could potentially throw a wrench into your family planning preferences.

What is early menopause?

Doctors distinguish between early menopause, which happens between the ages of 40 and 45, and premature menopause, also called premature ovarian failure (POF) or premature ovarian insufficiency (POI), which occurs before the age of forty.

Studies have found that around 5% of women experience early menopause, and another 1% experience premature menopause.

What causes early menopause?

For many women, early or premature menopause is idiopathic, which means that there’s no known medical cause. That said, there are a number of issues that can lead to early menopause or POI:

Chemotherapy and radiotherapy often bring on menopause because the treatment can damage your ovaries and stop them from ovulating. In these situations, it’s possible for your body to recover and begin ovulating again, although you might still struggle to get pregnant because of other ways that the treatment impacted your reproductive organs.

Genetic and chromosomal disorders, like Turner’s syndrome, can affect the ovaries from birth and bring on early or premature menopause.

Autoimmune diseases like diabetes, rheumatoid arthritis, and thyroid diseases are signs that your immune system has malfunctioned in some way and is attacking your body instead of the disease. In these cases, your immune system could also attack your ovaries and prevent them from working properly.

Infections, like mumps, malaria, and tuberculosis, can damage the ovaries, but this is very rare. HIV and AIDS that are not controlled properly with medication can also bring on menopause.

Surgery to remove the ovaries inevitably causes menopause.

Smoking can speed up the degeneration of follicles (premature eggs). A woman is born with one million follicles on average, and these slowly dwindle over time. Follicles aren’t just used up through ovulation and menstruation; they go through a process called atresia, which means that the egg follicles simply degenerate and die. If you smoke, you speed up this process.

A Danish study found that there’s a link between your mother’s age at menopause, and your own ovarian reserve, which means the number of eggs that remain in your body. If you have a family history of early menopause, you’re likely to have a lower ovarian reserve than average, have trouble conceiving at a younger age than average, and experience menopause yourself at an earlier age than average.

What is perimenopause?

It’s rare for menopause to occur completely overnight (in fact, that would only happen if your ovaries were surgically removed). Women go through a period called perimenopause, which is when you’re still ovulating, but far less frequently. During this time, your periods become irregular and spaced further apart.

Perimenopause can last as long as six years or more, and during this time it is still possible to get pregnant, but it’s far more difficult.. One study found that between 2.2% and 14.2% of the women involved conceived naturally and gave birth to a healthy baby.

If your periods become noticeably longer or shorter than usual, or stop entirely for three cycles, you could be entering perimenopause. You might also see some of the symptoms of menopause, such as hot flashes, vaginal dryness, insomnia, headaches, anxiety, and joint pains.

How does early menopause affect your fertility planning?

Once you’ve gone through menopause, you won’t be able to conceive naturally, but you can still successfully start a family by using IVF with either donor eggs, or your own eggs that you froze at an earlier point in life.

You might have heard about hormone replacement therapy, or HRT, which is often recommended for women who experience early menopause. However, HRT is only prescribed to address various other health issues associated with menopause, like osteoporosis and an increased risk of cancer, in addition to managing its symptoms. It doesn’t improve your fertility.

If you:

• Have a family history of early menopause;
• Are suffering from an autoimmune disorder, infection, or genetic disorder that can bring on early menopause;
• Have been advised to begin treatment or surgery that can impact your fertility;

it’s wise to consider freezing your eggs as soon as possible.

When you freeze your eggs in your 20s or 30s, egg quality is higher, which improves your chances of success when you use them later to get pregnant via IVF. Egg quality can drop well before menopause, which means that even if you do get pregnant during perimenopause, you’ll have a higher risk of miscarriage and of the egg failing to divide properly, resulting in the wrong number of chromosomes in each cell in the embryo.

The chances of going through early or premature menopause is something that you should bear in mind when you think about your path to growing a family. We hope that whatever you choose, your journey to parenthood is smooth and successful.