Is Pregnancy Possible During Perimenopause?

Facts About Fertility, Pregnancy Risks, and More

Couple with dog in sunny home office
Caiaimage/Paul Viant/Getty Images

While fertility gradually diminishes as you age, women at midlife are still able to conceive—whether they want to or not.

In fact, according to the National Center for Health Statistics, there were 743 births to women 50 years and over in 2014. In addition, the birth rate for women aged 45 to 49 was 0.8 births per 1,000 women. While these are small numbers, it indicates that pregnancy can happen in midlife (when many erroneously assume naturally conceived pregnancy is no longer possible.) 

Many other questions surround the biological transition from child-bearing years to post-menopause, including:

What is Perimenopause?

Perimenopause refers to the months or years leading up to menopause, which is the permanent cessation of menstrual periods that occurs at an average age of 51. Perimenopause (also called menopausal transition) can last just a few months or for up to eight years, beginning as early as a woman’s late thirties. Periods tend to become irregular during perimenopause, and women often experience hot flashes, mood swings, vaginal dryness, fatigue or difficulty sleeping.

Am I Pregnant or Perimenopausal?

Doctors may perform blood tests to determine if a woman who has skipped one or more periods is either pregnant or approaching menopause. These tests measure the levels of certain hormones, some of which signal pregnancy (a positive hCG test) and others that can provide clues about a woman's ovarian function or decline.

FSH, or follicle-stimulating hormone, is produced in the brain and increases as the number of eggs produced by a woman's ovaries decreases. With that, a consistently elevated FSH level along with the ending of menstrual cycles for twelve months supports a diagnosis of menopause.

That being said, FSH levels fluctuate during perimenopause—so it is difficult to interpret a single number.

This is why an FSH blood or urine level cannot accurately diagnosis perimenopause or menopause. It is simply another piece of the pie. A women's symptoms and menstrual history are also needed to put the whole picture together. 

How Do You Know if You're Still Fertile?

You must assume you're still capable of conceiving until menopause is complete, which has not occurred until menstrual periods have ceased for twelve full months. “Menopause is not an on-off switch,” says Dr. Stuenkel. “But many women don’t really understand exactly what’s happening.”

Ovarian function waxes and wanes in perimenopause, meaning that a woman may release an egg some months but not others. Additionally, body levels of estrogenprogesterone, and other hormones tend to be erratic during this time and egg quality decreases, all contributing to more than a 50 percent decrease in fertility among women 40 and over compared to younger women. But natural conception is still possible—if remote—for women until their mid-fifties.

Do You Still Need Contraception?

Yes. Unless you want to conceive during perimenopause, contraception is essential until you haven’t had a period for a full year. But the query is a common one. A study of perimenopausal contraception among Turkish women in BMC Nursing found that while 87 percent of participants were sexually active, the vast majority of them had no idea when they should abandon contraception use. “If you really want to be sure,” Dr. Stuenkel says, “it would be best to continue [using contraception].”

What are the Pregnancy Risks During Perimenopause?

The possible hazards are many to both mother and baby. Miscarriage increases among older mothers because of lower-quality eggs, variable hormones, and uterine changes. Poor egg quality also ups the chances for birth defects such as Down syndrome, which is caused by an error in cell division which produces an extra chromosome.

Other risks to the baby include premature birth (anytime before 37 weeks of gestation), which is linked to a host of complications ranging from cerebral palsy to learning and developmental disabilities.

The rigors of pregnancy are also harder on older mothers, who suffer more than their younger counterparts from complications such as high blood pressure, strokes, seizures, gestational diabetes and heart problems.

What if I’m in Perimenopause and Still Want to Have a Baby?

Act quickly. Beyond that, consult your doctor if you haven’t conceived after six months of unprotected intercourse (one year is the recommendation for women 35 years of age and younger). The good news is that there are a number of options available to help couples struggling with conceiving a child.

Sources:

American Society for Reproductive Medicine. (2012). Age and Fertility

Centers for Disease Control and Prevention. (December 2015). National Vital Statistics Report. Births: Final Data for 2014

National Institute of Health. (2010). An Introduction to Menopause

Sahin, NH, Kharbouch, SB. Perimenopausal contraception in Turkish women: A cross-sectional study. BMC Nurs. 2007;6:1.

Stuenkel, Cynthia. (August 2008). Telephone interview.

The National Infertility Association. (2016). Family Building Options

Continue Reading