8th June 2012 | by Dr. Stephen Hudson
I’m 34 and single but want to have kids at some point in the future. My mom went into premature menopause at age 37. Is premature menopause hereditary? Should I be concerned about my fertility?
Written by our medical expert Stephen Hudson, M.D.
The short answer to your question is “yes”. You may be at risk for premature menopause, and are right to be concerned about your fertility.
I think a brief explanation of ovarian biology would do well to start. All women are born with a finite number of eggs. An average female is born with about 2 – 3 million eggs – and from birth onwards, eggs are “dying” every day. At the time a girl has her first period, referred to as “menarche”, on average she will have between 200 and 400,000 eggs remaining. This is from the initial reservoir of almost 3 million! And so it goes on, so that by the age of 37 years in an average woman there may be only 25,000 eggs remaining.
Ovarian reserve (a term that refers to the number of eggs in the ovary) is, however, quite variable from one woman to another. This is reflected in nature, with the “normal” range of menopause being between 40 and 60 years, with the average age at 50 years. Menopause, also referred to as the “change in life” coincides with ovarian failure. At this time, apart from loss of reproductive function, a woman will experience signs and symptoms of low estrogen levels, such as hot flushes, vaginal dryness and mood disturbances.
One of many reasons why a woman may not get pregnant in any one cycle is related to egg quality. If for instance a woman releases an abnormal egg (which occurs relatively infrequently at the age of 20, but much more frequently at the age of 40 years), the egg will either not fertilize at all, or if it does fertilize and implant in the uterus, will usually result in a miscarriage. Again this is reflected in nature: the chance of a miscarriage in a woman aged 20 years may be 5 – 10 %, but the chance of a miscarriage in a woman aged 40 years is around 30 %.
There are a number of factors that may affect a woman’s ovarian reserve and make her susceptible to premature ovarian failure (POF) or premature ovarian aging (POA).
It may be genetic. So in your case, you may have inherited a genetic factor from your Mother which would put you at risk. There are a variety of genetic causes for POF which your doctor can explain more fully.
A DNA test will determine if you are at risk for POF. You could discuss this test with your doctor, and perhaps request either having the test done, or referral to a genetic counselor. Because the risk of having the mutation is low, most provinces in Canada will not fund the cost of this test.
The next thing to discuss is how to assess your “ovarian reserve” to determine what risk you may be at. Ovarian reserve can be assessed in a variety of ways:
1. Medical history. The length of a woman’s menstrual cycles may provide information. A cycle length of anywhere between 21 and 35 days is generally regarded as “normal” with 28 days being the average. If a person starts having shorter than usual cycles (for instance, if she has usually had 28 day cycles, and now has noticed her cycles are changing to 25 days – this may be a sign of premature ovarian aging.) Other changes, such as missing an occasional period, or symptoms such as occasional hot flashes would also be important.
2. Ultrasound. A vaginal ultrasound done early on the menstrual cycle – best done just after a period – allows the ovaries to be carefully examined. This ultrasound would preferably be done by a reproductive endocrinologist, to perform an “antral follicle count” (AFC). The follicles are the tiny cysts which contain eggs – and this AFC is a good indicator of ovarian reserve.
3. Blood tests. For more information on blood tests used to measure fertility and ovarian reserve, see our question on testing your fertility in the Testing and Preservation section.
This may be more information than you expected, and may be difficult to interpret. I would suggest that you consider requesting a referral to a Fertility Clinic so that you can be assessed.
If indeed you are at risk for premature ovarian failure, there are now options for fertility preservation. Perhaps the most exciting new technology in Human Reproduction is vitrification. The human egg (oocyte) is the largest and most sophisticated cell in the human body. It has also been the most difficult cell to successfully freeze. Now, with Vitrification, this can be done. It is not a guarantee, but does provide an option not previously available. Read more about fertility preservation in our Testing and Preservation section.
There is also new evidence that certain supplements may help protect eggs from the aging process. All cells require fuel (energy) to survive. Eggs require a lot of energy! In all cells, available energy is converted into “usable” energy by a specialized apparatus in the cell known as the mitochondria. There is now some evidence from animal studies that a diet supplemented by extra amounts of a vitamin-like substance known as Coenzyme Q10 may be good for preserving egg quality. CoEnzyme Q10 supplements can be purchased from most pharmacies and health food stores. Although we are not sure of the “best” dosage, at this time the recommended dosage for women wishing to protect their eggs appears to be 600 mg daily (300 mg twice daily).
I hope this information is helpful.
I have always wanted kids, but find myself single in my late 30s. I may also suffer a condition (that is in part genetic) that would affect my fertility. I have worried, and to some extent, continue to worry about my ability to have kids in the future. BUT just reading Dr. Hudson’s informative response makes me feel like things could be ok in the end. Thanks for that.