Emotional impact of early menopause and fertility loss

For most women, early menopause (EM) means losing fertility. Women with spontaneous EM / POI have a lifetime chance of spontaneously conceiving of 1-5%, and women who experience surgical menopause (removal of the ovaries) become infertile. Women who undergo other treatments such as chemotherapy, stem cell / bone marrow transplants, radiotherapy, hysterectomy, or ovarian surgeries may experience EM and become infertile. Alternative possibilities for having a child following EM include fertility preservation (usually offered to women diagnosed with cancer or facing surgical menopause), IVF using a donor egg, surrogacy, adoption, or becoming a foster carer (see IVF, fertility preservation and other paths to parenthood).

Fertility loss, the desire for a child, and family circumstances

About half the women we spoke with had wanted to have their own ‘biological’ child, or more children than they had currently, but could not as a result of EM. Others had either had children they wanted before experiencing EM, or they were childless but hadn’t felt a strong desire to have children, or were reconciled with not being able to have children.

Experiencing EM before having children

For women who had wanted children but had not had them before EM, fertility loss could be deeply distressing. Several felt it had impacted on their sense of identity as a woman. They spoke about ‘always’ having wanted to have children; a few said motherhood had been their ‘purpose’ in life.

For Alex, losing her fertility as a result of a radical hysterectomy for ovarian cancer prompted ‘an existential crisis.’ 

Ella recalled the thoughts about fertility, mortality, and loss of choice she had when she was first diagnosed with spontaneous early menopause. 

Women in this situation described EM as triggering a fundamental rethink of their path in life. Sonia said, ‘[infertility] brings up a whole lot of emotions and shifts in perspective that one has to make about one’s life and one’s future.’

Kirsty described having to ‘reframe’ her ‘journey’ after not being able to have children as a result of spontaneous EM. 

A few women who experienced involuntary childlessness as a result of EM described feeling distress about what their infertility meant for close personal relationships. Some described feelings of a loss of sense of worth in romantic partnerships, including Kate who was undergoing ovarian suppression therapy following breast cancer. She reflected, ‘it’s hard for me knowing that I’ve gone through this journey with someone who just doesn’t deserve to have someone so broken, because we’re still pretty young and there’s all these things that have been taken away from us. … the children part of it has been very, very hard.’

Sylvia, who experienced early menopause after having a radical hysterectomy for uterine cancer, recounted telling her new partner that if he wanted to end the relationship she would ‘completely understand.’ 

Others felt sadness at not being able to give their parents grandchildren, including Lorena: ‘my dad, he wanted so badly [to have] grandchildren – I could see how sad and disappointed he was.’

Experiencing EM while still planning to have more children

A few women who experienced EM while still planning to have more children also talked about infertility as upsetting. Louise, who was trying to have a second child via IVF using a donor egg, said learning about EM was ‘just gut-wrenching… being told that you couldn’t have your own baby, that that’s taken away.’

However, women in this situation also described being aware that, as Anna said, it would be ‘so much harder’ for women who did not have any children.

Melinda didn’t fully grasp why her fertility specialist had called her daughter a ‘miracle baby’ until a couple of years after her birth when she was diagnosed with spontaneous EM. She reflected on what it was like not being able to have a second child. 
Experiencing EM without wanting a child or more children

Women who had the number of children they wanted, or who had reconciled with not having children were less distressed about fertility loss. Tracey experienced surgical menopause and commented that ‘not being able to have kids wasn’t an issue for me. I understand that is, absolutely, for some people but for me, it wasn’t on my agenda.’ Apart from the symptoms and long-term health risks of EM, some women who didn’t plan to have children or had children saw the end of their fertility as bringing freedom from menstrual periods or concern about an unwanted pregnancy (see Women’s experiences of symptoms of early menopause – Part 2).

A couple indicated that co-existing health conditions meant that trying to become a mother through IVF, adoption or fostering seemed difficult.

Vicki had Turner Syndrome and was contemplating having a hysterectomy for endometriosis. Although she enjoyed spending time with children, she was ‘ambivalent’ about having her own because of other health conditions. 

Some women who had not wanted children or had the number of children they wanted nonetheless had other concerns about losing their fertility, including worries about spontaneous EM being genetic, and frustrations over health practitioners’ assumptions that fertility was ‘only’ about childbearing capacity.

Jessica reflected on how and when she might talk to her daughter about the possibility she would experience early menopause. 

Yen-Yi was undergoing ovarian suppression therapy as part of breast cancer treatment. She had never wanted children, and felt that fertility was more than the capacity to have a child. 

Infertility and social expectations

Many women said what they saw as social expectations or ‘pressure’ for women to become mothers could sharpen the pain of fertility loss. As Lorena observed, ‘this thing that society puts in our mind that woman are made to be mums, this is terrible.’ They described being asked if they had children or having to explain why not, having people suggest other ‘solutions’ or ways to have a child (see IVF, fertility preservation and other paths to parenthood), others assuming they had not had children because they were ‘career-oriented’, or feeling excluded around women who had children (see Impact of early menopause on relationships). Most women who had wanted children but not been able to have them because of EM found these experiences ‘insensitive’, ‘upsetting’, or ‘intrusive.’ Kirsty was hesitant about attending her upcoming school reunion because ‘by the 120th person asking me if I have children, that’s not going to be good for my mental health.’

Sonia described what it was like receiving ‘suggestions’ about ways to have children when people around her learned she was struggling with infertility.

Natalie reflected on why it was so ‘automatic’ for people to make conversation by asking one another if they have children, and how she responded to this question.

Fertility loss and EM in the context of cancer

Women who had experienced EM in relation to cancer treatment talked about comparing fertility loss with surviving cancer. For most, survival outweighed fertility loss in the initial stages of diagnosis and treatment, but for some women who had not yet had children or wanted more children, the balance between these two priorities changed over time. Alex, for example, described coming to feel that life as an infertile woman had no ‘meaning’. For other women, survival remained paramount.

Kate and her husband went through IVF before starting chemotherapy for breast cancer and had some embryos frozen. She discussed the trade-off she felt she faced between surviving breast cancer and having her own child.

Fiona had already finished having children when she was diagnosed with breast cancer. When deciding whether to have a bilateral oophorectomy to further reduce her risk of recurrence, ‘survivability’ easily trumped fertility loss.

Further information:

Talking Points (Women)

Talking Points (Health Practitioners)

Other Resources