Normally, the process of the gradual decline of ovarian activity in the female body occurs after about the age of 45. It begins with a period called perimenopause, which occurs four to five years before menopause itself. The first sign of perimenopause is the absence and irregularity of menstruation, followed by hot flashes, sweating and mood changes. In this period, spontaneous conception is already very unlikely. Menopause is the final "full stop" after the fertile period, which means the absence of menstrual cycles for twelve consecutive months.
When the menopause surprises
If the above-mentioned symptoms of perimenopause appear before the age of forty, doctors usually conclude that menopause is premature, which, according to statistics, affects approximately one in twenty women. The causes can be multiple - from heredity to autoimmune disease, chemotherapy, radiotherapy, surgical removal of the ovaries to thyroid disease. The problem with premature menopause occurs when a woman wants to get pregnant. "If you are at risk of premature menopause or have a family history of this diagnosis, I recommend that you do not postpone your reproductive plans and see a specialist to discuss the available options," says Hana Višňová, MD, head of the IVF clinic CUBE, and continues. However, this procedure is only suitable up to the age of approximately 35. Oocytes lose their original quality during a woman's lifetime and the number of genetically defective oocytes increases," explains Višňová, adding: "In some types of diseases, such as oncological or immunological diseases, the doctor may also choose cryopreservation of ovarian tissue."
Caution should also be taken with hormonal contraceptives
Unless you have a family history of premature menopause or are being treated for a specific diagnosis, predicting its onset may not be easy. For example, symptoms of premature menopause can be masked by the use of hormonal contraceptives, which give a false sense of regularity to "menstrual cycles". The basic examinations carried out as part of gynaecological examinations cannot be overestimated. "Today, the main diagnostic tools used are the determination of the number of antral follicles (AFC) by ultrasound or the examination of the level of antimüllerian hormone (AMH). However, without a comprehensive assessment by a specialist, these values are of limited predictive value. Even results that are within the normal range do not mean that you can postpone pregnancy until an older age," points out Višňová.
Don't rely on experimental therapies
The good news is that even with a diagnosis of premature menopause, it is possible to achieve pregnancy. Most often through IVF therapy with donated eggs. However, despite the high cumulative success rate of this method, a wait-and-see strategy is not advisable: "It is important to remember that older age also means higher risks of pregnancy complications," reminds Višňová. She also advises against relying on various experimental procedures, including PRP therapy using blood plasma. "It is possible that in the future, thanks to PRP injected into the ovaries, it may be possible to obtain oocytes even in women who would otherwise be indicated for a donor programme. However, this is still an experimental therapy, which many experts are reluctant to use. Only long-term independent research will provide answers to the questions of whether PRP ovarian rejuvenation is effective and safe at all," adds Višňová.
