TTC, perimenopause and early menopause – your straight-talking guide

You’ve been trying for what feels like forever – but nothing happens. Your periods are playing up, and your anxiety levels have skyrocketed. Your temper’s all over, you’re crying at nothing and to top it all off, teenage acne is back with avengence this month. But that’s just the TTC journey… isn’t it?

If this all sounds familiar, it’s very possible that there’s nothing untoward going on. But – depending on your age and genetics – there’s a chance you might actually be entering the life stage called ‘perimenopause’. So let’s take a closer look at what perimenopause, menopause and early menopause, and how it all affects your chances of conception.

What is perimenopause?

The time before your menopause when you start to experience changes to your cycle – and other menopausal symptoms (there’s a list coming up). It’s all caused by hormonal changes leading to menopause: your last period.

What is menopause?

Lots of people misunderstand menopause, because unfortunately we just don’t talk about it enough. Medically speaking, menopause is actually your last ever period. Doctors will only confirm it 12-24 months after the fact if your period doesn’t arrive again. In fact, they diagnose based on symptoms if you’re over the age of 45, though they will do tests if you’re younger.

When do most women experience menopause?

According to the NHS, the average age for a woman to reach the menopause is 51. Sadly around 1 in 100 women experience the menopause before 40 years of age – what’s called early menopause.

Why does early menopause happen?

Early menopause can happen for a number of reasons:

• Because the ovaries stop working ‘naturally’ – this is called premature ovarian failure (POF), or primary ovarian insufficiency (POI).
• As a result of cancer treatments – following radiotherapy and chemotherapy.
• Following a hysterectomy – if you have had to have surgery to remove the womb and ovaries.

In this article, we’ll be dealing with the ‘natural’ early menopause. In the other cases, you’ll be informed and advised by your medical team.

How common is POI – ‘natural’ early menopause?

According to the Daisy Network, the organisation for women experiencing Premature Ovarian Insufficiency (POI), approximately one in every 100 women under the age of 40, one in 1,000 women under 30 and one in 10,000 under 20 experience POI.

Spotting the signs

Perimenopause is the time before your menopause when menopausal symptoms start appearing. It can last months – or even years. All too often, perimenopause as a precursor to early menopause can go undiagnosed by both women and their GPs because symptoms can easily be missed or attributed to other things.

Lifestyle changes, stress at work, changing family dynamics such as caring for older family members, the ups and downs of TTC, and even depression can get the blame – when the reality is that it’s all your hormones’ fault.

Symptoms of perimenopause and menopause

The British Menopause Society list the most commonly experienced symptoms as:

• Hot flushes – this feels like a sudden tide of heat coming over you.
• Night sweats – basically hot flushes, but at night.
• Sleeping problems – difficulty dropping off, or waking up in the night.
• Changing periods – lighter or heavier, more or less frequent.
• Mood changes – feeling low or down, or just ‘out of sorts’.
• Stress, anxiety and anger – can vary from full-blown panic attacks to flashes of temper.
• Weight gain – especially around your middle.
• Low energy – like the PMT energy slump’s evil sister.
• Brain fog – forgetting things, struggling to focus
• Joint aches – aches can be anywhere, and are often worst in the morning.
• Loss of libido – that’s changes to your sex drive (you just don’t fancy it).
• Vaginal dryness and painful sex – intimacy without lube is off the cards, and can be sore if you don’t take it slowly.
• Urinary changes – do you need to pee more often, or have you noticed changes in control.
• Headaches – like PMT headaches.
• Skin changes – your skin can be drier or greasier, with many women experiencing acne or sensitive skin for the first time.

However, there are actually over 30 symptoms associated with menopause, including tingling skin, weird sensations in your tongue, brittle nails, changes to your body odour… the list goes on.

What about perimenopause and TTC?

Perimenopause might feel like the end of the road when it comes to TTC. However, it isn’t all bad: conception is possible. It isn’t easy, but it can still happen naturally – as mums from Cherie Booth to Halle Berry and Susan Sarandon prove.

It’s important to check in with your GP – and make the most of every cycle. Irregularity might make timing trickier, so look into LH tracking so you’re aware of ovulation and never miss a chance. And egg quality might be decreasing too, so it’s a good idea to lay the best possible foundations by looking into making lifestyle changes like improving nutrition for yourself and your partner if they are male.

Higher chances of multiples

You might have heard that twins are more common as you get older? It’s a thing – your body is trying hard to help you conceive, often releasing more than one egg in a cycle. However, it’s worth being aware that the risk of miscarriage also higher – sadly it increases sharply post-40, rising to over 50% by the age of 45 according the BMJ.

What to do if you suspect perimenopause

If you are under 45, have a lot of symptoms, or you’ve gone more than 3 months without a period, it’s time to act. Get an appointment with your GP, and bring up the topic of early menopause yourself.

Don’t forget that GPs are generalists – not specialists – and only study menopause briefly. So it’s worth doing your research before your appointment so you can discuss the possibility and push for tests. Come equipped with a diary of your cycle and symptoms, and don’t be fobbed off with ‘just wait and see’.

What about early menopause and TTC?

If you have an early menopause diagnosis, you’ll need to seek specialist medical advice. Though you won’t be able to conceive naturally, you may be able to have a baby with help, for example through IVF using donor eggs. And there are always other options to create a loving family: adoption and fostering might end up your route to happiness if you have love to give and a home to share.

Useful resources:

• Early menopause on NHS Direct.
• Daisy Network – support for women experiencing Premature Ovarian Insufficiency (POI).
• Tommy’s on Premature ovarian insufficiency and getting pregnant
• The Fertility Network UK – free confidential advice.
• Women’s Health Concern (WHC) – the patient arm of the British Menopause Society (BMS).