How Menopause Affects Fertility
Clearing up common misconceptions about fertility in midlife and menopause
By Janene Mascarella
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If you're like many women, you may assume that menopause is the end of fertility and that, without a period, you couldn't possibly become pregnant. While both are mostly true, it's important to know that the termmenopausemight be somewhat misleading.
According to the North American Menopause Society (NAMS), menopause is the point in time when a woman reaches 12 consecutive months without having a menstrual period. NAMS says phrases such as "in menopause" and "going through menopause" are actually misnomers, often used to describe the period leading up to menopause (medically known asperimenopause) or the overall menopausal transition.
Perimenopause can last as long as six or more years in some women. It begins with the onset of menstrual cycle changes and other menopause-related symptoms, usually in a woman's mid-40s, and extends into menopause (the last menstrual period), which typically occurs about age 51.
So, yes, while menopause does mark the permanent end to your fertility, until you've truly reached it, there's still a chance you can conceive.
Your Fertility During Perimenopause: Can You Get Pregnant?
It's also harder to get pregnant during the perimenopausal transition, explains Dr. Kagan. Women are born with 1 to 2 million eggs, and as menopause nears, only about 100 eggs remain. The declining number and quality of these eggs, as well as age-related uterine changes, contribute to reduced fertility, perhaps even before signs of perimenopause are noticeable. According to one recent study, women aged 35 are six times more likely to have problems conceiving than women aged 25.
It's also harder to get pregnant during the perimenopausal transition, explains Dr. Kagan. Women are born with 1 to 2 million eggs, and as menopause nears, only about 100 eggs remain. The declining number and quality of these eggs, as well as age-related uterine changes, contribute to reduced fertility, perhaps even before signs of perimenopause are noticeable.
But even if you've missed your period for a few months and have lots of menopausal symptoms, you should be aware that you are not completely protected from an unplanned pregnancy until you've officially reached menopause.
Understanding the Risks of an Unplanned Pregnancy in Perimenopause
A pregnancy during your perimenopausal years can potentially pose many health risks. "The management of a pregnancy can be very challenging for a woman in that advanced stage [of her reproductive life]," says Raul Artal, MD, chair of the Department of Obstetrics, Gynecology, and Women's Health at Saint Louis University. "There could be a variety of complications. Women at that age who contemplate pregnancy should be very well informed and medically cleared to make sure there are no preexisting medical conditions that could further complicate a pregnancy."
In addition, it's important to know that women between the ages of 40 and 45 have about a 50 percent risk of miscarriage. If you do get pregnant later in life, experts say, the chances are much higher that it won't be a healthy pregnancy.
A Mini Lecture on Birth Control at Midlife
Just like when you were a teen, the message stressed to sexually active women approaching menopause is the importance of always using protection to prevent pregnancy as well as sexually transmitted diseases (STDs). Now is not the time to throw caution to the wind and think, What are the chances?
Dr. Kagan makes it crystal clear: "It says it over and over in the books and literature: Despite the reduction of fertility, women should be aware that pregnancy is possible until menopause is confirmed, either by 12 consecutive months of no periods or by consistently elevated levels of a follicle-stimulating hormone, which we call FSH," she says.
While barrier forms of protection, such as condoms, diaphragms, and spermicide, as well as intrauterine devices (IUD), are popular among women in this age group, Dr. Kagan offers the following advice to sexually active women in this stage of life: If you're healthy, don't smoke, and don't have hypertension, diabetes, or a history of blood clots, one of the newer low-dose birth control pills on the market might be a good choice for you. These low-dose hormones are also helpful in treating such perimenopausal symptoms as hot flashes, irregular cycles, and PMS, and they are sometimes continued through the menopausal transition, primarily from ages 52 to 54.
One Last Clarification About Fertility and Menopause
Every once in a while a woman in her late 50s makes headline news for having a baby. You may find yourself wondering if it's at all possible to get pregnant postmenopause. Dr. Kagan says the answer is yes, you can, but it won't happen naturally. After menopause, the only way a woman can get pregnant is through a donor egg and in vitro fertilization. Period.
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