Wait, what’s perimenopause again?
You may be a little hazy on what perimenopause actually is, and that’s understandable.According to the American College of Obstetricians and Gynecologists (ACOG), perimenopause is the time leading up to menopause. It’s the time period during which a woman’s menstrual cycle begins to change and her ovaries begin to get smaller and produce less estrogen. Perimenopause typically begins when a woman is in her 40s, although it is possible to start perimenopause before you turn 40. However, as the changes tend to unfold over time, some women don’t even realize when they’ve entered perimenopause. And the experience (and the time frame) can vary from woman to woman anyway. You might look for signs such as irregularity of your menstrual cycle. According to Dr. Stephanie Faubion, MD, MBA, medical director of the North American Menopause Society (NAMS), your periods might get a little closer together or further apart. “Your ovarian function is not 100%, so there might be a couple of months in a row where they don’t function well at all,” she explains. “And then they might kick back in again. The closer you get to menopause, the more extreme that gets.” Perimenopause lasts, on average about four years, says Dr. Amy Banulis, MD, an OBGYN with the Mid-Atlantic Permanente Medical Group at the Kaiser Permanente Falls Church Medical Center in Virginia. “But for some women, it can last as long as 10 years." When does perimenopause end? It ends when menopause begins. When you haven’t had a menstrual period in one year, you’ve reached menopause, according to ACOG.
Can you get pregnant during perimenopause?
It is possible to get pregnant when you’re going through perimenopause. “It’s less likely, but yes, you can,” says Dr. Faubion. As Dr. Salena Zanotti, MD, explains, “A woman can still get pregnant if not using any contraception as she is still ovulating during this time period.” But your chances are smaller if you’re a 40-something-year-old woman in perimenopause than if you were a woman in her 20s or early 30s.“Fertility decreases as women age,” says Dr. Zanotti, who is an OBGYN at the Cleveland Clinic. “A woman over 40 has an approximately 5 percent chance of getting pregnant each cycle.” You may not be ovulating every cycle, so that lowers your pregnancy chances. Even if you’re ovulating regularly, the egg quality tends to decrease as you age, plus you have hormonal changes to contend with, she adds. Something else to keep in mind: perimenopause is time-limited, too. “Perimenopause ends once you have gone 12 months without a period,” says Dr. Banulis. “At that point, you are in menopause, and there is no risk of becoming pregnant.” And if you don’t want to risk getting pregnant during perimenopause, even with the decreased likelihood, talk to your doctor about the safest and most effective method of birth control for you, she adds.
How can you boost your chances of getting pregnant during perimenopause?
If you’re eager to get pregnant but the 5 percent stat is getting you down, you may be wondering, “What I can do to boost my chances of conceiving?” “The only thing a woman can do to improve her chances of getting pregnant is to be as healthy as she can be,” says Dr. Zanotti. “Obesity and smoking decrease the risk of conception. And if she is not having regular cycles, she should see her provider or a fertility specialist as soon as possible.” Dr. Banulis also advocates for seeking an evaluation as soon as possible if you want to get pregnant. In other words, don’t wait. “While there is no perfect test to determine what your chances of pregnancy are, we can check certain hormone levels to get a better idea of how well your ovaries are functioning,” she says. Dr. Nanette Santoro, MD, a professor in the School of Medicine at the University of Colorado Anschutz Medical Campus, who specializes in reproductive medicine, suggests that a woman who is in perimenopause but wants to get pregnant should get her ovarian reserve assessed. “Once a woman has irregularity to her cycles, which is the definition of perimenopause, she is even more unlikely to get pregnant,” she says. “If the ovarian reserve is very poor … then her chances of conception with medical assistance is quite poor—less than 5%—because the ability to get a good number of eggs to work with will make it more likely that one of those eggs will be normal. In general, women 45 and older have such a poor chance of pregnancy with medical treatment that they are better off using an egg donor.”
Are there any additional risks to being pregnant during perimenopause?
There are risks associated with pregnancy later in life. “Older mothers are much more likely to have blood pressure problems in pregnancy, have premature births and to have gestational diabetes, so they need to be watched closely and treated aggressively if any medical complications occur,” says Dr. Santoro. For example, pre-eclampsia, is one possible pregnancy complication. Pre-eclampsia is a pregnancy-related complication characterized by high blood pressure and signs of damage to an organ system, like your kidneys or liver. If not addressed, it can threaten both you and your baby. As people age, high blood pressure does become more common, and pre-existing high blood pressure can increase your risk of developing pre-eclampsia during pregnancy. But even if you don’t have high blood pressure, your age may still increase your risk of having pre-eclampsia during pregnancy, according to ACOG. So, your doctor may want to watch you closely for signs such as an abnormal amount of protein in the urine, pain in your upper abdomen, a severe headache, changes in vision such as blurred vision. Your doctor might also check you for a lower-than-usual platelet count or signs of abnormal kidney or liver function. The risk doesn’t necessarily mean you’ll experience complications during pregnancy.“However, many women can carry without a lot of trouble,” says Dr. Santoro. But she cautions that she would advise any woman 45 or older to get checked for diabetes and to undergo a basic cardiac workup to make sure they don’t have any underlying signs of cardiovascular disease. Research also suggests that older mothers who get pregnant are more likely to have babies with certain birth defects, such as chromosomal birth defects like trisomies 13, 18, and 21, as well as some cardiac defects and other conditions. That may be something that you might want to discuss with your doctor if you are considering trying to conceive with your own eggs. Next up, here’s your Guide to perimenopause,
Sources
Amy Banulis, MD, OBGYN with Mid-Atlantic Permanente Medical Group at the Kaiser Permanente Falls Church Medical Center in VirginiaStephanie Faubion, MD, medical director of North American Menopause Society (NAMS)Nanette Santoro, MD, professor in the divisions of Reproductive Endocrinology and Infertility & Reproductive Sciences, Department of Obstetrics and Gynecology, at the University of Colorado Anschutz Medical CampusSalena Zanotti, MD, OBGYN at Cleveland ClinicAssociation between Maternal Age and Birth Defects of Unknown Etiology - United States, 1997–2007. United States, 1997-2007. Birth defects research. Part A, Clinical and molecular teratology.Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy. ACOG.Perimenopause Bleeding and Bleeding after Menopause. ACOG.Preeclampsia. Mayo Clinic.
