Many women in the United States are choosing to postpone having children until later in life. Although the birth rate is flat or going down in most age groups, births among women ages 40 to 44 years old has been rising since the early 1980s, and this age group accounted for 114,730 of the 3.8 million babies born in 2017, according to the birth statistics from the Centers for Disease Control and Prevention (CDC).
For women who want to have a child in their forties, plans for a family can be derailed by early menopause, and may only be possible through a donor egg.
Treatment Shows Promise for Helping Women in Early Menopause
New findings presented in a small study published March 30, 2021, in the journal Menopause might restore those dreams. Researchers administered platelet-rich plasma and gonadotropins near the ovarian follicles to bring back ovarian function and menstruation in women who had gone through early menopause.
“This could provide another treatment scenario for women in early menopause and those of impending ovarian failure and give them a better opportunity to conceive using their own eggs,” says Chao-Chin Hsu, MD, PhD, a physician in the department of obstetrics and gynecology at the National Taiwan University Hospital in Taipei, and a coauthor of the study.
What Is Early Menopause? Who Experiences It?
The medical definition of menopause is no period for a year, according to Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Rochester, Minnesota, and the medical director of the North American Menopause Society. Dr. Faubion was not involved in the research.
There are two age cutoffs for early menopause, she explains. “If you experience menopause before age 40, that is considered premature menopause. The incidence of that is probably about probably 1 to 2 percent,” says Faubion. It may be underreported, because sometimes premature menopause may be “covered up” when young women go on birth control pills, she adds. Menopause is only official when there’s no period and no hormonal treatments such as an oral contraceptive pill or progestin-containing IUD, as these hormones may mask symptoms.
Early Menopause vs. Typical Menopause: The Age Ranges
“Menopause at 40 to 45 years of age is called early menopause, and that occurs in about 5 to 7 percent of the population, so it’s safe to say that at least 7 percent of women are going to go through menopause early or prematurely,” says Faubion. Reaching menopause at age 46 or older is considered normal, she says.
What Are the Signs of Early Menopause?
There can be other signs of early menopause besides not bleeding for a year, says Faubion. “A lot of these women have what is called premature ovarian insufficiency (POI),” she says. POI used to be called premature ovarian failure, but it’s not called “failure” anymore because a lot of these women will have spontaneous periods periodically,” says Faubion. There’s about a 5 to 10 percent spontaneous pregnancy rate in that group of women in POI, she says.
“In premature ovarian insufficiency a woman may have spotty periods or have a menstrual cycle every three months or so. If we really did the investigations, we would see that the anti-Müllerian hormone (AMH), which is an indicator of how many viable follicles a woman has, would be quite low,” says Faubion.
Hot Flashes, Other Menopausal Symptoms, May Be Less Common With POI
Oddly enough, women who have POI may not have many menopause symptoms, she notes. “In my experience and in a lot of my colleagues’ experience, these women don’t have a ton of hot flashes or other symptoms; often they're just going to have missed periods,” says Faubion, adding that an inability to conceive (or infertility) could be another clue.
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11 in 12 Who Had Experienced Early Menopause Resumed Their Period
There were 12 women with early menopause included in the study, with an average age of 44. All the women had stopped bleeding for at least a year, and menopausal status was confirmed by blood samples. Women who experienced early menopause because of surgical removal of ovarian tissue, and cancer patients who received chemotherapy or radiation, were excluded.
Investigators injected platelet-rich plasma and gonadotropins into the ovaries of study participants to find out if ovarian function could be restored. After the treatment, 11 of the 12 study participants regained ovulatory function and resumed menstruation, says Dr. Hsu.
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Six of the participants were able to undergo egg retrieval followed by ICSI, which stands for intracytoplasmic sperm injection, a procedure where the selected sperm is directly injected into the egg. One participant achieved clinical pregnancy, defined as a pregnancy that is confirmed by ultrasound as well as a fetal heartbeat.
Use of Platelet Rich Plasma to Help Fertility Is Still Years Away
“There's not nearly enough evidence to recommend this treatment more globally right now. This is years away,” says Faubion. This type of procedure is currently only available to women who are in clinical trials, she adds.
Right now, it’s unclear how the platelet-rich plasma works, says Faubion. According to the authors, it’s a preparation that contains about a “10 times higher concentration of growth factors and active metabolites, and has been used in clinical situations which require rapid tissue repair.” Gonadotropins were also administered, to stimulate the ovaries, she adds.
“There’s a long history of trying this for different things, but we don’t have enough data to say if this is going to be viable,” says Faubion.
Speculation about potential costs of the procedure is premature, says Faubion. “It’s way too early to know,” she says. The average cost of donor eggs can vary from $10,450 to over $45,000, according to CNY Fertility, a fertility clinic with locations in New York, Colorado, and Canada.
Platelet Rich Plasma Could Be Used to Improve Menopause Symptoms
Several bothersome symptoms are common for women in early menopause, including hot flashes, sweating, and genitourinary syndrome due to the dramatic decrease of ovarian hormones, says Hsu. Genitourinary syndrome includes genital symptoms such as dryness, burning and irritation, sexual symptoms such as lack of lubrication, discomfort or pain, and urinary symptoms such as urgency and UTIs.
“Our study showed the regain of follicle growth with elevated serum estradiol level (ovarian hormone) in most menopausal women who received our treatment,” he says. That may mean that the treatment could be used to relieve the symptoms and signs of early menopause, says Hsu.
Treatment Could Help Reverse Age-Related Risks of Early Menopause
There are many negative health consequences linked to early menopause, says Faubion.
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“There’s all kinds of evidence to suggest that these women are at higher risk of heart disease, osteoporosis and fracture, cognitive impairment and dementia, and a whole host of other things, including early death,” she says.
There Are Health Benefits to Ovarian Function Beyond Fertility
Restoring ovarian function and making a woman whole again is about more than preserving fertility, says Faubion. “Early loss of ovarian function has even been linked to telomere shortening, a marker of accelerated aging. If we could reverse that, it may reverse all those chronic conditions that are linked to losing ovarian function.”
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To find out if the treatment could have a lasting effect on long-term adverse health outcomes, a larger study that followed women for several years would be needed, says Faubion. “My guess is that giving platelet rich plasma over a short time is not going to fix these health issues long term,” she adds.
Larger Studies on Early Menopause Causes Are Needed
Studies that examine the use of platelet-rich plasma in a larger population where women are grouped according to the cause of their early menopause would be an important next step, says Faubion. “When possible, we need to define why these women experienced early menopause. For example, was it caused by cancer treatment, autoimmune disease, or a virus?”
Then investigators could explore if the treatment works to restore ovarian function for women in all those groups, or just in some specific populations, she says. “We don’t know that yet,” she adds.
Women With Signs of Early Menopause Need to See a Doctor
Any woman who is under the age of 45 and is skipping a lot of periods should see her provider, because it could be that ovarian function isn’t what it should be, says Faubion. “Again, this isn’t just about fertility or having a baby — the question is, is this affecting your long-term health?” she says.
Even if you aren’t experiencing hot flashes or other menopause symptoms and you feel okay, it’s not normal to have irregular menstruation if you’re under 45, and particularly if you’re under 40, says Faubion. “It’s definitely something you should talk with your doctor about,” she adds.