Lately, the only thing consistent about your menstrual cycle is that it’s inconsistent. At night, you find yourself checking the thermostat after a hot flash, or you wake up in a dreadful sweat.
Perimenopause is here, and you’re coming to terms with it.
But what does this mean for your fertility?
If you’re in midlife and still hoping to grow your family, UNC OB-GYN Rachel Urrutia, MD, says it might still be possible—but your path to pregnancy could be longer and more challenging. Here, she shares more about perimenopause and fertility.
What is perimenopause, and what does it mean for my fertility?
Perimenopause refers to the years leading up to menopause when a woman’s ovaries begin to show signs of aging. Periods become less frequent, ovulation may become erratic and estrogen levels will begin to decline. This typically starts when a woman is in her 40s, although some women begin perimenopause in their 30s.
“Fertility is declining every year of a woman’s reproductive life,” Dr. Urrutia says. “The average age of menopause is 51. A lot of people in their late 30s or early 40s may start experiencing some of those early symptoms of perimenopause.”
Symptoms of perimenopause can include:
- Irregular periods
- PMS-like symptoms
- Mood swings
- Hot flashes
- Night sweats
- Sleep disturbances or trouble sleeping
- Brain fog or trouble concentrating
- Vaginal dryness
- Changes in sexual desire
There’s no diagnostic test for perimenopause, but doctors can tell through measuring hormone levels that a woman has entered this stage. One of the main indicators is FSH, or follicle-stimulating hormone, which helps manage the menstrual cycle and directs the ovaries to produce eggs.
Perimenopause can last up to a decade, until a woman hasn’t had a period for 12 months, at which point she is in menopause.
Can I get pregnant during perimenopause?
For women who want to get pregnant during this stage of life, it’s less likely and may take longer, but it is possible.
“It really depends on where you are in the perimenopause process,” Dr. Urrutia says. “As you get closer to menopause, you don’t ovulate as frequently. When you do ovulate, it may be a lower-quality egg, or the hormones associated with ovulation aren’t optimal enough to support a pregnancy. So, for all those reasons, it’s much less common to become pregnant—but it can happen.”
In other words, even with irregular menstrual cycles and yo-yoing hormone levels, your ovaries are continuing to release eggs for fertilization. As long as you are still having a period, you could potentially conceive.
“I’ve had many patients who may have found their partner in their early 40s and are trying to conceive for the first time, and it works. Others struggle,” Dr. Urrutia says. “It’s just all about the individual being informed about their bodies and making the best decision for them and their families.”
She notes that it is easier for women to become pregnant in their earlier perimenopausal years than in their late 40s and early 50s.
That said, if you are ready to conceive before perimenopause, your chances of success are much higher. “If you don’t have to wait, you may not want to,” Dr. Urrutia says.
Can I increase my chances of getting pregnant during perimenopause?
There are plenty of things women in midlife can do to support a healthy pregnancy—but some of them may require a doctor’s help. If you are over age 35 and haven’t conceived after six months of unprotected intercourse, it’s time to schedule a consultation and fertility evaluation with your doctor.
“Having the discussion with your provider about fertility treatments sooner rather than later is the best decision,” Dr. Urrutia says.
Common fertility treatment options include medications that help stimulate ovulation, intrauterine insemination, in vitro fertilization and surgery.
You and your doctor should also discuss other lifestyle factors that can increase your chances of success.
“All the things that will help promote a healthy pregnancy still apply, especially during perimenopause. This means a woman should stick to eating a healthy diet, exercising, getting good sleep, minimizing stress and not using substances,” Dr. Urrutia says.
Is it risky to conceive during perimenopause?
It’s important to be aware of complications that can arise during any pregnancy, but particularly during perimenopause. Older women tend to have more chronic conditions such as diabetes and high blood pressure, which can raise their risk of pregnancy complications. Be sure to discuss any risk factors you have with your doctor.
Also, carrying a pregnancy to full term may be difficult.
“The risk of miscarriage increases a lot in the late 30s and 40s, mostly due to poorer egg quality and genetic abnormalities with the embryo,” Dr. Urrutia says.
Further, there is a higher chance of preeclampsia, gestational diabetes and other pregnancy complications among older expectant mothers, as well as risks to their babies that include low birth weight, premature birth, chromosomal abnormalities and complications during cesarean deliveries.
What if I’m perimenopausal and I don’t want to get pregnant?
Maybe you are thrilled at the prospect of kissing pregnancy goodbye. That’s fine, too. Just remember that although pregnancy becomes less likely as you get older, an unplanned pregnancy is still possible until you’ve officially reached menopause. You will need to use birth control throughout perimenopause if you do not want to become pregnant.
Dr. Urrutia recommends talking to your doctor about the best contraceptive option for you. Common methods include oral hormonal contraceptives, estrogen-based birth control such as NuvaRing or the patch, and intrauterine devices.
Want to discuss your fertility or birth control options? Find a provider near you.