There is a tendency to regard menopause as though it were a single event occurring at one point in time. This has created confusion about “perimenopause”, the period of time that is the transition between the reproductive years and menopause”2. The term “perimenopause” describes the transition from having regular monthly periods into no longer menstruating. Periods may taper off slowly, reappear after a few months, and then continue to taper off. As menstruation decreases, so does the ability to become pregnant.
To put it simply, the more regular and consistent your periods are, the likelier you are to become pregnant.
Ability to conceive naturally diminishes gradually. The ability to conceive without medical intervention ends one year after the last menstrual period. Women may become pregnant using donated eggs and in-vitro fertilization after menstruation and ovulation have ended, but without medical intervention, pregnancy after menopause is not possible 1.
With age, the risks associated with pregnancy increase. In a study on 29 women over 50 compared with younger age groups the pregnancy rate with IVF was equal (about 30%) to that in younger women. However, 60% of the older women compared with 30% of younger groups miscarried.2
Even if you are still menstruating, risk of miscarriage is elevated after the age of forty. One study showed that the miscarriage rate of women over forty was about 36%. The rate of maternal mortality is also four times greater in women over forty than in women aged 30-39. 2
Despite decreased fertility, data from the 1995 National Survey of Family Growth reveal 51% of pregnancies among women 40 and older are unintended.3 This is likely due to the broad assumption that after 40 your odds of conceiving are low leading to discontinuation or inconsistent use of birth control.
The best way to know whether it’s safe to discontinue hormonal birth control is to have your doctor measure your measure follicle stimulating hormone (FSH) serum at the end of the placebo week. You should not be taking birth control pills when you have an FSH test because they contain hormones that will affect the test results.
FSH is produced by your pituitary gland and stimulates your ovaries to produce estrogen. As your estrogen levels decline, your pituitary gland produces more FSH, which enters your blood in an attempt to stimulate more estrogen. When blood levels of FSH are shown to consistently be rising, it is likely that you have reached menopause, and therefore cannot naturally become pregnant. Higher FSH levels indicate lower fertility. More than one FSH test may be needed to confirm menopause.
According to a 2011 study published in the Journal of Obstetrics and Gynecology Canada, egg donation is the most reliable option for becoming pregnant during perimenopause. With egg donation, the cumulative birth rates after four treatment cycles is approximately 80%. This outcome is favorable compared with the high miscarriage rate after age 40 with IVF.
Read more about treatments for infertility here.
1Sauer, M.V. et al. “Pregnancy after age 50: application of oocyte donation to women after natural menopause,” The Lancet 341, no. 8841 (1993): 321-323.
2 Prior, Jerilynn C. “Perimenopause: The Complex Endocrinology of the Menopausal Transition” Endocrine Reviews 19, no. 4 (1998): 397–428
3 Sherman, Christy et al. ““Are They Still Having Sex?” STIs and Unintended Pregnancy Among Mid-Life Women, ” Journal of Women & Aging 17, no. 3 (2005) :41-55.
4 Tarlatzis, BC et al. “Perimenopausal conception,”Annals of the New York Academy of Science. 11, no. 997 (2003):93-104. 5 Cheung, AP et al. “Advanced reproductive age and fertility,” Journal of Obstetrics and Gynecology Canada 33, no. 11 (2011) 1165-1175.
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