As menopause approaches, it can be more difficult to get pregnant naturally. In some cases, this might influence a person’s decisions on birth control and when to plan for a family.
Many people now wait until later in life to have children. Changes that occur around menopause may affect the options available to them.
The age when menopause occurs can vary widely. In the United States, it usually happens between the ages of 45 and 58 years, with 52 years being the average age. However, people can enter menopause at an age outside of this range.
Menopause may begin at a younger age in people who have specific health conditions or have had certain types of medical treatment or surgery.
Some people assume that it is not possible to conceive once symptoms of perimenopause, such as hot flashes and irregular periods, appear.
However, a doctor will not rule out the possibility of pregnancy until a person’s periods have been absent for 12 months.
Understanding how menopause affects fertility can help people make plans, whether they wish to have children or want to avoid becoming pregnant.
Menopause happens when a female has not had a menstrual period for 12 months. The years before menopause are called perimenopause.
For most people, estrogen levels begin to fall gradually when they are in their 40s. A person will continue to ovulate and menstruate, but periods may become irregular or less frequent.
For some people, periods may stop for several months but then reappear. The reason for this is that ovulation can continue, even though periods do not occur.
As the transition progresses, a fall both in sex hormones and in the number and quality of eggs will reduce the chances of the person becoming pregnant. According to the American Society for Reproductive Medicine, fertility usually ends 5–10 years before menopause.
However, this is not always the case. For some people, pregnancy is still possible until menopause happens.
At birth, a female has about 1 million follicles in the ovaries that can become eggs. By puberty, they have close to 300,000. During their reproductive years, they will release approximately 300 of these. The other follicles become lost through degeneration.
At the age of 25 years, statistics show that 4.5% of females are unable to conceive naturally. At 38 years, the figure is 20%, rising to 50% at 41 years, nearly 90% at 45 years, and almost 100% at 50 years. Researchers based these figures on data from more than 58,000 women.
This increase in infertility occurs because the quality of eggs and the chance of a healthy pregnancy decline with age.
Nevertheless, it may still be possible to conceive, as long as ovulation continues. If the ovaries produce a viable egg and it becomes fertilized, conception can take place.
There are several reasons why a person might wish to become pregnant during perimenopause. These may include:
- They have been trying for a long time to conceive.
- Their relationship, career, financial situation, or other factors were not suitable before.
- They did not previously feel confident or ready to take care of a child.
Once menopause occurs, ovulation will no longer take place, and it will not be possible to conceive naturally.
People who have surgery to remove the uterus or both ovaries will experience menopause directly. They will not go through perimenopause. Find out more here about surgical menopause and how it affects a person.
Anyone who is hoping to conceive during perimenopause should discuss their options with a doctor.
While fertility is likely to be reduced, there are ways of increasing the chances of getting pregnant.
Paying attention to ovulation
Breast tenderness and white vaginal discharge are among the natural signs that can help a person identify the best time to try to conceive. Alternatively, they can use ovulation test strips.
Lifestyle factors, such as diet and exercise
A well-balanced, nutritious diet and regular exercise can boost overall health, which may increase the chances of conception.
In vitro fertilization (IVF)
It is possible to conceive with the help of assisted reproductive technology, such as IVF, both during perimenopause and after menopause.
Any eggs that remain after menopause will not be viable. This may also be true of eggs that the body releases in the years before menopause.
However, people who have previously chosen to freeze their eggs may be able to use these for IVF. Fresh or frozen donor eggs may be another option.
It is worth noting, however, that the chance of a healthy pregnancy using assisted reproductive technology also decreases with age.
After the age of 35 years, there is a higher risk during pregnancy of :
- pregnancy loss
- complications during childbirth and the need for a cesarean delivery
- having a child with a congenital abnormality
- maternal health problems
These risks can increase with age.
The likelihood of having twins or triplets also increases with age, especially if a person has IVF.
Studies show that, after the age of 50 years, those who conceive with IVF appear to have a higher risk of preterm delivery, low fetal size and birth weight, and fetal mortality.
A doctor can advise on individual risks.
Learn more here about the risks of becoming pregnant after the age of 35 years.
As a female gets older, the chance of having a baby with a chromosomal abnormality increases.
According to the advocacy group March of Dimes, the likelihood of having a baby with Down syndrome is as follows:
- Age 25 years: 1 in 1,340.
- Age 30 years: 1 in 940.
- Age 35 years: 1 in 353.
- Age 40 years: 1 in 85.
- Age 45 years: 1 in 35.
Genetic testing can help people learn more about their options.
Even after menopause, it is possible to become pregnant using assisted reproductive technology, such as IVF.
In the future, other options may help a person conceive.
Some scientists have researched ways to reverse menopause by “rejuvenating” previously dormant ovaries. Doing this would stimulate the release of an egg for fertilization.
However, more research and clinical trials are necessary to confirm the safety and effectiveness of this type of treatment.
Although it is uncommon, a person may become pregnant naturally during perimenopause and with IVF treatment after menopause.
Anyone who is going through perimenopause and does not wish to become pregnant should continue to use birth control until they have not menstruated for 12 months.
Those who wish to become pregnant can ask their doctor for advice on suitable options.
Click here for more information about sex after menopause.