Menopause is defined as the complete absence of periods for 12 months and as we know, the menopause is when a woman ceases to be fertile. The average age at which this occurs in the US is 51, but women can start being menopausal at age 40 to 50. But, in fact, what most of us think of as the menopause, or being menopausal, is actually the period of transition between the normal fertile years and the menopause itself. This is known as the perimenopause, meaning ‘around menopause’ or premenopause, which is the time that fertility starts to decline – although there may be few symptoms.

None of these stages have a clear demarcation and a woman’s journey through normal fertility towards premenopause, through perimenopause and finally to post-menopause, is a process rather than an easily definable event. Learning to recognise premenopause symptoms and understanding the significance of hormonal levels, the ovarian reserve and endometrial thickness for premenopausal women can therefore be crucial in terms of fertility.

What are the symptoms of premenopause?

During the premenopause you will still have your periods, although they may be starting to become irregular, and you will probably feel that you are still fertile. There may be minor hormonal alterations but you will not observe any major changes in your body. Some authorities consider that this stage can start as long as 8 to 10 years before the real menopause and so is likely to happen when you’re 38 or later.

Although for a fortunate few there are only minor or no symptoms as you enter the transition into the perimenopause, if you are among the majority of women you will experience at least some of the well-known symptoms.

• Irregular periods result from the gradual reduction in oestrogen levels causing unpredictable ovulation. The length of time between periods may become shorter or longer and the blood flow may be unusually light or heavy. Periods could be skipped altogether.
• Hot flushes are sometimes just a general warmth but they can also be a real soaking of sweat. These can happen during the night, when they are known as night sweats. They can cause sleep disruption or sleep may be disrupted in any case, possibly because of hormonal fluctuations.
• A decline in libido can come as a result of the drop in oestrogen levels, as well as vaginal dryness for the same cause. These can be connected to each other, since the drop in oestrogen causes a reduction in lubrication and elasticity in the vaginal tissues, making intercourse potentially painful.
• Mood swings and irritability or anxiety are common symptoms. These are possibly associated with disrupted sleep but could also be connected to fluctuating hormone levels.
• The natural result of the irregular periods and lowering oestrogen levels means an inevitable decline in fertility. During this time, it is still possible to conceive and so unless you are trying to become pregnant, contraception is still necessary through premenopause, perimenopause and all the way through to final menopause.

How will the premenopause impact on your fertility?

Once you are in your 30s, you will be aware of the potential for declining fertility, especially after the age of 35 for most women. If you have any reason to suspect that you are in a premenopausal stage, for example if you have a family history of early menopause, there are a number of tests that can be arranged. The results of these should provide you with peace of mind, if you intend to start or complete your family in the near future. Alternatively, they could alert you to the fact that premenopausal symptoms have already begun and action needs to be taken. Here are some of the ways you can check your fertility status:

Endometrial thickness in premenopausal women

The endometrium is the lining of the womb which, during the fertile years, changes quite significantly according to the time of the month. Oestrogen and progesterone trigger the cycles of growth and the shedding of the endometrium during menstruation. Measurement is carried out by ultrasound scan, and during the premenopausal stage it should vary between 2–4 mm during menstruation, to a high of up to 16 mm at the point of ovulation. At menopause and after, the thickness is stable at around 5 mm.

Blood tests for hormonal levels

A blood test can establish your levels of progesterone, which the ovaries produce just after the release of an egg. The timing of this test depends on whether or not your periods are regular. If they are irregular, your blood can also be tested for the gonadotropins Luteinising and Follicle Stimulating Hormone. These are hormones which stimulate your ovaries to produce eggs.

Checking the ovarian reserve

When girls are born, their ovaries contain all the eggs they will ever have. Counting them is near impossible since at this stage they are the size of a grain of sand, but the number is around 300,000. This number diminishes throughout the premenopausal years. A test that can estimate the reserve is used by fertility clinics to indicate how well a woman may respond to ovarian stimulating hormones, but it can also be a good indication of the likelihood of success for someone trying to become pregnant, or a woman who is considering freezing her eggs.

Booking an appointment with IVI

Living in a world where it has become the norm to delay parenthood for economic, social, relationship or career reasons, premenopausal women inevitably have a new set of problems to face. Detecting the premenopause may not be the most pressing issue on the agenda in a busy schedule, but it is time-specific and so worth checking before the body clock starts to ring alarm bells.

If you would like to know more about how to check your fertility status, the possibilities of fertility treatments or what options may be available for preserving your fertility, do get in touch with us at IVI. It’s easy to book an appointment using our online contact form, or just pick up the phone and call us on +34 960 451 185 from outside the UK, or on 0800 52 00 161 if you’re in the UK.