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Chances are that you or someone you know has experienced infertility. It’s estimated that about 1 in 9 women in the United States have difficulty achieving pregnancy or carrying a pregnancy to term.
Now a study of nearly 700 women, published August 1 in the journal Menopause, suggests that infertility may have an effect on women’s health later in life, including the severity of their menopause symptoms.
“When we looked at individual symptoms reported, the categories of symptoms with increased reporting or severity among women with infertility included depressive mood, irritability, and sleep problems,” says the lead author, Victoria Fitz, MD, an ob-gyn fellow at Massachusetts General Hospital in Boston.
“If our findings are confirmed in other studies, it would suggest that providers should consider history of infertility as a risk factor for depressive mood and sleep problems in midlife, and possibly initiate screening for these conditions earlier or with greater frequency,” says Dr. Fitz.
Women’s Reproductive History May Influence Menopause
A woman’s reproductive history is one of many factors that may influence when menopause begins, as well as the prevalence of menopause symptoms, according to the authors.
For example, the National Institutes of Health cites evidence that pregnancy and breastfeeding may lower the risk of early menopause. For women who experience infertility, though, research suggests they may go through menopause earlier. Menopause before age 45 is associated with a risk of early death, cognitive decline, osteoporosis, and heart disease.
Women who report infertility were also more likely to experience decreased libido and vaginal dryness in menopause, according to an earlier study.
Stressful life events are also associated with reports of more menopause symptoms, the authors wrote — infertility being one such event. One previous study, for instance, found that infertility causes as much stress as a cancer diagnosis.
Infertility Linked to Depression, Sleep Problems, and Irritability
For this study, investigators set out to specifically evaluate the effect of a lifetime history of infertility on the experience of menopause symptoms in midlife. The women were enrolled in the study when they were in their thirties and were followed for an average of 18 years.
About one-third (36.6 percent) of the 695 participants reported an experience of infertility, higher than the national average for infertility overall.
After adjusting for other factors that might influence menopause symptoms, researchers in this new study concluded that women with a history of infertility had a higher relative risk of sleep problems, depressive mood, and irritability.
Although previous studies have shown an association between infertility and depression, this is the first study to show that a prior history of infertility was associated with depressive symptoms specifically in midlife, wrote the authors. “It is important for women and providers to be aware of the association of history of infertility and depressive mood, because it suggests that history of infertility could be used to trigger increased screening for depressive symptoms during midlife years,” says Fitz.
Treatment for Depression During Menopause
Fortunately, though, there are multiple treatments available, says Julia Riddle, MD, an assistant professor at the Center for Women’s Mood Disorders and a psychiatrist and clinical researcher with a focus in reproductive mental health at the University of North Carolina School of Medicine in Chapel Hill.
“Assessing and appreciating the mood impact of infertility — or its concurrence in the case that it is not a cause-effect relationship — is vital. There are treatments — medical evaluation, modalities of therapy, sleep interventions, community support, and, when necessary, [medication] — that help to alleviate symptoms,” says Dr. Riddle, who was not involved in the current study.
It’s important for all providers who treat women and people with female reproductive symptoms to be aware of what it means to go through life’s multiple reproductive transitions, she adds.
Why Might Infertility Make Depression in Midlife More Likely?
Although the analysis was not designed to identify the cause of the association, the authors did offer a few possible reasons for the connection. “We theorize that the association may be related to hormone levels, such as estrogen. However, if that were the case, we would have expected to see an association with outcomes such as hot flushes [or flashes] and vaginal dryness, which we did not identify,” says Fitz.
“The other proposed theory is that infertility is a negative life event or stressor, and there is evidence that negative life events can impact the experience of menopausal symptoms,” she says.
Researchers Found No Connection Between Infertility and Hot Flashes, Vaginal Dryness, or Anxiety
“Many patients with infertility have questions about the implications of this diagnosis on other health outcomes and later reproductive health,” says Fitz.
On the positive side, this study didn’t find that infertility made a difference in the age of menopause, and it didn’t make menopausal symptoms including hot flashes, vaginal dryness, or anxiety more likely, though these findings need to be tested in other studies, she says.
What to Do if You Have Symptoms of Depression
If you’re experiencing symptoms of depression, speak with your healthcare provider, says Riddle. “More specifically, schedule a special appointment or message your provider in advance that you want to discuss mood symptoms and make it clear if this is new in the setting of menstrual changes,” she says.
Give your physician a heads-up to help them prepare and make sure there will be time during the visit to address your concerns, says Riddle.
“For mood changes during reproductive transitions such as perimenopause, seek out reproductive psychiatrists, psychologists, or clinicians with specialized training if possible. These mood changes are real, and we need to keep paying attention to them. There are treatments. People do get better. Depression is not a foregone conclusion,” she says.
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