Fertility and early menopause: Health Practitioners’ perspectives

A diagnosis of spontaneous early menopause or Premature Ovarian Insufficiency (POI), or medically-induced early menopause, often has significant implications for a woman’s fertility. Depending on several factors, including age and medical history, early menopause (EM) can result in the loss of fertility. This can have a considerable emotional impact on women, their partners, and family (see Personal and emotional impact of early menopause on women) and Emotional impact of early menopause and fertility loss (women’s experiences)).

Spontaneous EM or POI and fertility

The health practitioners we interviewed emphasised the importance of offering women referrals to fertility specialists soon after a diagnosis of EM is made. Several also noted that they offer women referrals for psychological support due to the significant impact of EM on fertility, relationships and identity (see Psychological therapies and support for early menopause). As general practitioner Dr Ee explained, ‘the most common difficulty for [women diagnosed with EM] is the end of their fertility and some of them might never have had children…’ Dr G, a clinical psychologist, added: ‘there’s all the grief … around not being able to have children, [it] is a very personal thing that you might not necessarily want to divulge to everybody.’

In endocrinologist Dr W’s experience, it is important to discuss fertility with women diagnosed with EM during the first consultation.

Professor Kulkarni, a psychiatrist specialised in women’s mental health, discussed the ‘grief’ that some women can experience in relation to the loss of fertility due to EM.

Health practitioners spoke of the need for care and sensitivity when explaining the impact of EM on fertility to women diagnosed with spontaneous EM or POI. As Dr Baber, an obstetrician-gynaecologist, explained, ‘some of them will conceive spontaneously. The trouble is we don’t know who they will be … I send them to my fertility colleagues … it gives them a chance to go away, consider the things that I have said, get a second opinion, talk about what sort of options are available.’

Fertility specialist Dr K offered her thoughts on monitoring ovarian function in women diagnosed with POI.

For obstetrician-gynaecologist Dr C, it is important to be cautious when discussing infertility with women diagnosed with spontaneous EM or POI.

A few health practitioners remarked that while adolescent women, for example under the age of 18, may not need an immediate referral to fertility specialist, it is important to begin discussing fertility options early. Dr D, an endocrinologist, commented, ‘you can’t really talk to a 16 year old about fertility … you do need to just plant the seed that fertility will be looked at along the way.’

Health practitioners commented that the impact of loss of fertility on women can vary according to their individual circumstances, including prior knowledge of EM, whether they are in a relationship, and whether they already have children (see Personal and emotional impact of early menopause on women ).

Dr D, an endocrinologist, explained that the impact of fertility loss depends on different factors in women’s personal life.

Dr Ee, a general practitioner, offered her thoughts on how the impact of fertility loss can vary between women.

Medically-induced EM and fertility

Health practitioners emphasised the importance of early referrals to fertility specialists for women diagnosed with medical conditions that can affect their fertility, for example endometriosis and certain cancers.

Obstetrician-gynaecologist Dr C reflected on the ‘pressure’ that women with medically-induced EM can experience.

Several health practitioners shared their experiences of collaborating with different specialists to ensure that women diagnosed with cancer have access to fertility preservation services if they wish to (see Referrals and coordination of care for early menopause). Fertility specialist Dr K explained: ‘we will negotiate with their oncologist for enough time … we can take ovarian tissue, and then we can also … try and protect [their] ovaries during the chemo … we’ll negotiate with [oncologists] on the patient’s behalf…’

Ms Lewis, a breast care nurse, noted that the impact of fertility related to EM after cancer treatment is ‘a loss that [women] have to grieve’. She added that women diagnosed with cancer may react to fertility loss differently depending on whether they have children: ‘if they [have] completed their families and it’s not possible for them to have more children then I think that’s easier for them to accept than if they haven’t had a child.’ (see Personal and emotional impact of early menopause on women)

Dr S, a medical oncologist, shared her experience of offering fertility preservation to women diagnosed with oestrogen-positive cancer.

Breast surgeon Dr Baker explained the options for fertility preservation for women according to their age and cancer diagnosis.

Barriers to accessing fertility services

The costs of fertility services such as in vitro fertilisation (IVF), and the difficulties that women living in regional areas can experience when accessing fertility specialists, was noted by a few health practitioners. Breast surgeon Dr Baker who worked in a metropolitan centre said: ‘The IVF program … [has] financial barriers.’ She added that she sometimes sees women living in regional areas who ‘haven’t been offered … goserelin for ovarian protection [and] haven’t had a discussion [with their oncologists] and it just needs to be standard for younger women.’

Endocrinologist Dr D discussed the cost of IVF and the need to work closely with fertility specialists.

Further information

Talking Points (Health Practitioners)

Talking Points (Women)

Other resources