'I’ve come to terms with the fertility issues of premature menopause'
Niamh Connellan, a nurse originally from County Clare, who was in her 20s when she realised her symptoms meant menopause. Picture: Moya Nolan
Niamh Connellan was 27 when she found out her ovaries were as small as those of a woman in her late 50s — a woman who had completed the menopause.
The ultrasound also picked up that the lining of her cervix was thin, while a check on her egg reserve brought another brutal truth.
“My levels were so low, there was no way, even with IVF, that I could use my own eggs. Egg-freezing wasn’t an option – I’d need donor eggs.”
For Connellan, now 36, the first red flag that something might be amiss was when her period didn’t arrive after she came off the contraceptive pill in 2012 when she was 24.
“I was told it could take a year after stopping the combined pill for it to come back, but 18 months later, it hadn’t. By then I was in Australia and I thought I’d get it checked when I came back home,” says the now Dublin-based nurse.
Wondering if her no-show periods might be due to stress, a thyroid problem or polycystic ovary syndrome (“you mightn’t get periods for a few years but you might still be having a cycle”), she finally attended a Well Woman clinic in 2015.
“The doctor did some blood work — particularly hormonal, oestrogen, progesterone. I wasn’t nervous. I was relieved it was being looked at, that I was going to get answers.”
When the results came in, the doctor wanted a repeat test. “She thought the hormones might have been off due to the time in my cycle. She gave me a 10-day course of progesterone to induce a bleed and told me to wait a week for it to come – but it didn’t. So she did the second blood test.”
The results indicated premature ovarian insufficiency.
Dr Karen Soffe, GP and menopause specialist, explains that this — also known as premature menopause — is when a woman’s ovaries reduce production of oestrogen at an age below 40. “It’s different to ‘early menopause’, which is when a woman’s periods stop between the age of 40 and 45,” Soffe explains.
Connellan says her premature ovarian insufficiency is the idiopathic form. “Meaning we don’t know what caused it. There’s no genetic reason, nothing surgical.”
She recalls not knowing what to think at the time. “I kind of panicked. But I also thought, ‘I’m going to meet someone, I’m going to have children, I’ll be fine — there are probably treatments available’.”
She was referred to an endocrinologist who ruled out Turner’s syndrome, a congenital condition — short stature and reduced ovary function are the two most common features. Subsequent referral to a gynaecologist reaffirmed what she had already been told — she would need donor eggs if she wanted a family.
“At 27, I wasn’t planning children anytime soon. I did feel a bit of loss but then there was the option of donor eggs if I wanted to go that route. So I wasn’t overly concerned. What I didn’t know were the future ramifications for my cardiac and bone health. For this, I was told I’d need to start HRT, and I’d be on it until at least 50, the age of natural menopause. So I was started on a tablet form of HRT.”
While absent menstruation had been her only menopausal symptom, Connellan now began having cold flashes. “I was freezing all the time. And later I had fatigue – and aches and pains.” It didn’t end there — within three months of starting HRT, she also began experiencing gastric problems — medication resolved these — and “horrendous migraines” until a neurologist realised these were due to the HRT type she was on.
“I was referred to another endocrinologist who straightaway switched me to HRT patches and a lower dose.”
By 2019, she was suffering from depression, anxiety and panic attacks. “I was never offered any psychological help from 2015 to 2019. But working in a hospital, we have an employee-assistance programme and six free therapy sessions a year, so I was lucky. At this stage, I was in bits, crying for no reason – if you asked what was wrong, I couldn’t tell you.”
While the first anti-depressant made her “more agitated”, a different one settled things and now she is on the lowest possible dose. Premature menopause has undoubtedly taken a toll on her life and health.
“I’ve come to terms with the fertility issues — all my family are having kids and I’m OK with being the favourite auntie. It’s the other health concerns that preoccupy me – the constant pain, tiredness. The need to deal with doctors who fob me off, who say ‘you can’t have cardiac issues – you’re only in your 30s’. I’ve ended up with a thyroid problem, arthritis and fibromyalgia.”
Soffe says the incidence of premature menopause is largely unknown — Ireland does not keep a register. “The reported incidence is between one and three percent but we’re probably grossly underestimating it. Many women with premature ovarian insufficiency mightn’t have symptoms. The flushing and sweating of a standard menopause might be absent – just the periods stop.”
She has seen it in two distinct groups. “In one group, it happens for a specific reason — a medical issue has caused it, for example, in survivors of childhood leukaemia. Or someone has had an ovary removed due to ovarian cancer.
“In the other group, we don’t know why it happens — there might be family history, and there’s some evidence that it might be linked with autoimmune disorder.”
Why it is under-diagnosed is due to several factors, she says. “A woman might have a child in her 20s. Then her periods stop, she doesn’t tell anyone, and it might be years later when someone asks ‘When was your last period?’ We’re also manipulating periods a lot more today. Some women might have used the coil for years, where they wouldn’t be expecting to have periods.”
Soffe says women who have previously required fertility treatment, or who have had previous surgery on their ovaries, should be regularly asked ‘are you having periods?’
She says the key is protecting women’s bone and cardiac health. “We do a bone density scan on anyone diagnosed with premature ovarian insufficiency. Their oestrogen also needs to be replaced in some way, either by HRT or the combined oral contraceptive pill, at least up to standard menopause age.” Many younger women, she says, prefer the contraceptive pill approach because “it makes them more like their peers”.
Soffe emphasises what a devastating diagnosis premature menopause is. “There’s a big difference between someone who has it, and who has completed their family at 36 — and someone who hasn’t. They’re going to require fertility support and consider egg donation. The psychological impact is huge and there’s very little psychological support full-stop — there’s a nationwide shortage of psychologists.”
Connellan urges women to talk about premature menopause. There is support, she says. “I only recently found out about the Daisy Network support group, where people of a similar age can speak to each other. You find out your issues are not just yours — and you’re not on your own.”
Read More
