Infertility and endometriosis linked to higher risk of earlier menopause

Women with primary infertility are more likely to enter menopause sooner, a long-term study has concluded.

US researchers have examined how the timing of menopause is associated with various types of primary infertility (when a woman who has not been pregnant before has trouble conceiving), using patient records spanning nearly two decades. The analysis has revealed that women with a history of primary infertility entered menopause sooner, with some being at an increased risk of experiencing early menopause (menopause before the age of 45).

'This study shows that women with primary infertility, specifically those with unexplained infertility or a history of endometriosis, were at risk for early menopause,' said Dr Stephanie Faubion, director of the Mayo Clinic Office of Women's Health and medical director for the Menopause Society, who was not involved in this research.

This study, published in Menopause, relied on the Mayo Primary Infertility Cohort, which consists of 1001 women diagnosed with primary infertility between 1980 and 1999 in Olmsted County, Minnesota and a control group of 1001 age-matched women from the same area. After excluding individuals based on factors such as unknown menopausal status or age at menopause, the study cohort was formed of 461 women with primary infertility and 530 control individuals.

The results suggest accelerated onset of menopause in women with primary infertility, who, on average, entered menopause one year younger than controls. Individuals with unexplained infertility or endometriosis were also at increased risk of early menopause. Women with endometriosis and unexplained infertility entered menopause on average 2.75 years and 1.45 years earlier, respectively. However, there was no statistical association between primary infertility and premature menopause onset (menopause before the age of 40).

The statistical analyses controlled for various factors already known to impact age at menopause, such as body mass index (BMI), smoking or contraception use. Unlike previous studies that were limited to self-reported data or individuals who were undergoing IVF, this work directly relied on medical records spanning over 20 years.

However, the authors highlighted several limitations to their work. For instance, they noted that their study cohort was restricted to a single geographic area and primarily comprised educated white women with normal BMIs. 

The results suggest that shared biological mechanisms may underpin certain forms of infertility and early or accelerated menopause onset. The findings could also be relevant for the care of women with primary infertility, as studies show that women who experience early menopause have higher risks of certain health problems such as cardiovascular disease, osteoporosis and neurocognitive disorders.

'Given that early menopause is linked to adverse long-term health consequences, these women may benefit from counselling that they are at risk of early menopause,' said Dr Faubion. 'This will allow them to monitor for early menopause and to seek treatment with hormone therapy, if indicated.'