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The truth about IVF – and what can really cause early menopause
Trinny Woodall recently opened up about going through early menopause after having IVF treatments – we consulted experts to get the facts
At 43, Trinny Woodall began feeling lacklustre, as if she had “lost my mojo”. Having first been prescribed antidepressants, it was only after consulting a hormone doctor, that a different conclusion was drawn: early menopause, which the cosmetics entrepreneur was told had been triggered by the 16 rounds of IVF she’d gone through in order to conceive her daughter Lyla, now 19. “That’s about 16 years off your cycle,” Dr Erika Schwartz, author of The Hormone Solution, told Woodall – as in, “with each round you produce 10 to 12 eggs, and that’s what you [naturally] produce in a year,” she told The Shift podcast. “I’d never been told that… But it was interesting that my mother went [through menopause] at 57 and there I was [going through it] at 43.”
The average age for women going through menopause in the UK is 50 to 52. The term “early menopause”, used to denote those who are affected by the condition between 40 and 45, occurs in about five per cent of women. Premature ovarian insufficiency, or very early menopause, which happens before a woman turns 40, affects around 1 per cent.
Does IVF cause early menopause?
IVF is when eggs are removed from women’s ovaries and fertilised by sperm in a lab. Once fertilised, the egg becomes an embryo, and is returned to the woman’s womb in order to develop. According to the HFEA, 69,000 IVF cycles were carried out for 53,000 patients in 2019, with success rates at 32 per cent for under-35s, dropping to four per cent for over-44s.
While the likes of Woodall and Kourtney Kardashian have suggested that IVF can trigger early menopause, studies have yet to provide a causal link. The guidebook Assisted Reproductive Techniques, published in 2019, concludes that “all procedures involved in the IVF treatment process are generally safe and do not put the woman at risk of premature ovarian failure”. Prof Tim Child, chair of the Human Embryo Fertility Authority’s scientific and clinical advances advisory committee, says: “There’s no evidence that IVF brings forward the menopause,” adding: “The reduction in egg number during a woman’s life is mainly due to eggs degenerating rather than them being ovulated.”
While you might assume that IVF, which harvests multiple eggs, would result in the loss of more eggs than a natural cycle, this is not the case. Each woman develops a number of eggs every month, while normally one of these eggs progresses to maturity and ovulation while the others regress and die off. Ovarian stimulation in IVF keeps a number of these early eggs, so there is no additional impact on a woman’s egg reserve.
Dr Stephanie Kuku, honorary senior research fellow at UCL Institute of Women’s Health and clinical scientist at biotech firm Conceivable Life Sciences, reiterates that “there is absolutely no evidence” that IVF causes early menopause. Of Woodall, she says that “if you need 16 cycles of IVF to have a baby, then IVF is just a confounding factor” – which is to say that if your ovarian reserve is low enough to require multiple rounds of IVF to begin with, that is more likely to be the cause of early menopause than fertility treatment.
Still, IVF can cause other health complaints. “Harvesting your eggs for either IVF or an egg-freezing procedure can have various psychological and physical side effects,” says Dr Hannah Allen, GP and medical director at Béa Fertility. “At its most severe, the hormone injections required to stimulate egg production can bring on Ovarian hyperstimulation syndrome (OHSS), which is when the ovaries start to swell and become painful.” Psychologically, too, hormone injections can have a major impact on mood, and “make you feel bloated, tired, and can cause headaches”.
Evans notes that “the age at which we’re having children is on the up, so we’re seeing increasing numbers of women going through IVF. This makes it statistically more likely that there will be more women who go through IVF and also experience early menopause.” That correlation, however, does not equate to causation.
What are the symptoms of early menopause?
Menopause describes the condition in which a woman’s ovarian supply diminishes, ovulation – which formerly happened once a month – becomes irregular, and levels of the reproductive hormones oestrogen and progesterone drop. The fall in oestrogen levels causes the majority of symptoms commonly associated with menopause and early menopause, such as hot flushes, relaxation of pelvic muscles, brain fog, weight gain and difficulty sleeping.
Kardashian’s belief that “the medication they’ve been giving me, they’ve put me into menopause” appears to have been more of a reflection of the menopause-like symptoms she was experiencing, rather than the condition itself, as she is now pregnant.
Menopause symptoms affect more than 75 per cent of women, and can last for up to seven years, according to the British Menopause Society, with one in three experiencing symptoms beyond that time. There’s no evidence that IVF can cause early menopause, but other medications and conditions may play a part.
What really causes early menopause?
“The greatest predictor of early menopause is family history,” Kuku says, with some twin and family studies showing genetics can be responsible up to 65 per cent of the time.
Female twins are also up to four times more likely to go through early menopause than other women, according to a study of twins born in Britain and Australia.
The European Menopause and Andropause Society (EMAS) says that “there should be early monitoring of women with a family history of early menopause, who are a child of a multiple pregnancy, or who have had early menarche [when menstruation begins], especially those who have had no children.”
Weight and smoking
EMAS suggests that stopping smoking (the habit can lower oestrogen levels) and maintaining a healthy weight can be preventative measures in the case of early menopause. “Being underweight is highly causal to premature ovarian failure,” Kuku says (adding that “women who are overweight and obese actually go into menopause later, because fat cells produce oestrogen”). A 2017 study of 80,000 women found that those with a BMI below 18.5 were 30 per cent more likely to experience early menopause.
Cancer treatments
“The most common medical factor that triggers early menopause is cancer treatment, such as hormone therapy, some chemotherapies or pelvic radiotherapy,” says Evans. The drugs and radiation used can damage the ovaries, while some hormonal treatments, like those used for fibroids or endometriosis, can inhibit ovarian function and trigger symptoms of menopause.
Surgical menopause
The menopause can be brought on surgically by an oophorectomy – the removal of the ovaries – which is typically used to treat ovarian cancer. This is sometimes carried out alongside a hysterectomy, where the uterus is removed. Patients are advised to consider whether the benefits of the surgery they require mitigate the downsides of going through menopause sooner than they naturally would have.
Knock-on effects
Woodall has herself noted the impact of perimenopause and menopause on her skin, which she says can become dry and prone to breakouts, lose firmness, radiance and mark easily as a result of halted ovulation and low levels of reproductive hormones in the blood.
There are more serious consequences. A 2015 Mayo Clinic paper agreed that “the long-term consequences of premature or early menopause include adverse effects on cognition, mood, cardiovascular, bone, and sexual health, as well as an increased risk of early mortality.”
One study, published in the journal Maturitas, concluded that “regardless of the cause, women who experience hormonal menopause and oestrogen deficiency before reaching the median age of natural menopause are at increased risk for morbidity and mortality.”
Fortunately, HRT can replace some of the lost hormones. This can help reduce the symptoms and side effects, although this may not be safe for women who have had breast cancer. In such cases, talk through the options with your GP.