By stopping ovulation before age 40, early menopause, or premature ovarian failure (OIP), can affect female fertility. How to explain the appearance of this sydrome? What are the possible treatment options? Some explanations.
Early menopause: what is it?
The term menopause describes the cessation of ovarian function. If it occurs on average at 51 years, menopause is said to be early if it appears before 45 years. In some women (1.9%), stopping ovulation may occur before age 40, sometimes much sooner. This is called premature ovarian failure (PDI).
What are the symptoms of early menopause?
The first sign of premature ovarian failure is the disruption of menstrual cycles, which can be variable among women.
- For some, the diagnosis is made after the appearance of a secondary amenorrhea (an absence of menstrual periods of more than 3 months in a woman who has already had her period). In the absence of resumption of ovulation, this amenorrhea may become definitive. However, recovery of ovarian activity remains possible in about one in two women, with a return of menstruation sometimes several years after diagnosis. Moreover, estrogen production, ovulation and natural pregnancy are likely in 5 to 10% of them.
- For others, menstruation varies in frequency and intensity (oligomenorrhea).
Other symptoms, due to estrogen deficiency and similar to those experienced by women whose menopause is later, may appear. The manifestations of this climacteric syndrome:
- vasomotor disorders, (flushing, sweating, palpitations …)
- mood disorders, (irritability, …)
- vaginal dryness,
- urinary disorders: urinary burns, urgency (urge for which we cannot hold back),
- a decrease in desire and disorders of sexuality,
- a weight variation,
- More rarely, depression, or even disorders of attention and memory.
How to explain an early menopause?
In the vast majority of cases, the origins of premature ovarian failure are not found. However, certain family antecedents, pathologies and iatrogenic causes (related to a medical treatment) are systematically sought by the practitioner, namely:
- an autoimmune disease ( hypothyroidism , hypoparathyroidism, celiac disease , type 1 diabetes, rheumatoid arthritis, Graves’ or Addison’s disease),
- a history of chemotherapy, radiotherapy or ovarian surgery,
- family history of IOP,
- Family history suggesting premutations of the FMR1 gene (FRAXA region of the X chromosome associated with Fragile X syndrome in particular).
What are the consequences of an IOP?
The most important early menopausal effect in women of child-bearing age is usually infertility. However, in the longer term, the IOP has other health implications. Thus, it can promote bone fragility and fractures due to osteoporosis, as well as cardiovascular diseases. In addition, about 3% of women with PDI are likely to develop autoimmune adrenal insufficiency, which, if not detected, can be serious.
How is the diagnosis of early menopause established?
In the face of a suspicion of IOP, several examinations are carried out in the first intention, namely:
- a pregnancy test,
- Serologies to evaluate the levels of prolactin, FSH and oestradiol.
Once premature ovarian failure is confirmed, the practitioner can recommend the following:
- a karyotype to identify possible abnormalities in the number or structure of the X chromosome (Turner syndrome, triple X, X deletion, ring X chromosome …),
- A search for premutations of the FMR1 gene to detect ovarian failure related to premutation of the FRAXA region.
What are the treatments for Primary Ovarian Failure?
In case of early menopause, several treatments may be considered, especially in case of desire for children.
Treatment of infertility
Although spontaneous pregnancies are possible, they are very rare as the ovulation capacity of women with IBO is reduced. Moreover, this is the main problem faced by specialists in infertility: there is no treatment whose effectiveness is proven to restore ovulation in case of early menopause. However, two courses of therapy can be dug according to the profile of the patients:
- a gonadotropin-based combination with estrogen, which would appear to significantly improve the ovulation rate.
- IVF with oocyte donation.
Treatment of hormonal deficiency
Beyond infertility, it is essential, in the face of early menopause, to prevent the effects of estrogen deficiency. Hormone treatment mimicking oestradiol-based ovulation (oral or dermal) and progesterone is recommended during the first 12 days of the month.