Transcript
Dr. Jill Liss: Hi, I'm Dr. Jill Liss. I'm a board-certified OB- GYN, a Menopause Society Certified Practitioner, and an Associate Clinical Professor of OB-GYN. Today, we're talking about perimenopause and pregnancy.
Ambassador: So how do the hormonal changes during perimenopause affect my menstrual cycle and my ovulation?
Dr. Liss: Perimenopause is a transitional period that's different for everyone, but on average lasts about three to six years. During that time, hormones can become quite erratic. The early signs are typically slight menstrual changes, perhaps cycles coming slightly closer together, and then in later perimenopause cycles may spread apart.
Typically, a menstrual cycle will correlate to ovulation, but in perimenopause, the coordination of all the hormones that sophisticatedly run your menstrual cycle become pretty out of sync. This may mean that each cycle does not have a predictable ovulation or that the timing is irregular. This can make getting pregnant more difficult, but not impossible.
Ambassador: I was wondering how hard is it to get pregnant during perimenopause? I've heard that your fertility drops during that time.
Dr. Liss: It is much more difficult to get pregnant in perimenopause, and this relates to the loss of ovarian function. The number and quality of eggs decrease, and ovulation can become less regular and predictable, making the chance of fertilization less likely.
As long as periods are continuing though, that does signal that ovulation may be occurring. If you are over 40 and desire pregnancy, it's a good idea to talk to a reproductive endocrinologist as you may need assistance in getting pregnant.
Ambassador: How can I tell if I'm pregnant or starting perimenopause? Are those symptoms the same?
Dr. Liss: Pregnancy and perimenopause have some overlapping symptoms that can make this time of life confusing if you're trying to conceive. If you have a missed period, fatigue, breast tenderness, or mood changes, those are symptoms that can play both ways. So you'll want to take a pregnancy test or consult with a healthcare provider to make sure you know what's going on.
Ambassador: What kinds of pregnancy complications or risks should I be aware of if I do get pregnant during perimenopause?
Dr. Liss: As someone gets older, all the risks of pregnancy tend to go up as well. This isn't related to perimenopause in and of itself, but somebody who's in perimenopause tends to be older. But it is important to be informed of your risks based on your personal health history, as well as the age in which you're getting pregnant, and talk to a doctor about what your personal risk profile looks like.
It is still a time that people can have healthy pregnancies, but it's important to be aware of some of both the maternal and fetal risks that are involved in pregnancies that occur over age 40. Things to consider are increasing risk of gestational diabetes, gestational hypertension, delivery complications, and then for the baby, there can be increased risks of chromosomal abnormalities as well as loss of the pregnancy.
Ambassador: What are the benefits of having kids in your 40s doing perimenopause?
Dr. Liss: There are definitely benefits to having kids later in life. Not everyone's going to be ready in their 20s and 30s when fertility is higher. One is that people are often more financially secure and certain in themselves and their life experiences and can find motherhood much more enriching in this life phase. There's also evidence that shows that women who give birth after age 35 have increased longevity.
Most importantly, it's important to make the right decision for you and your family. And if that happens to be after age 40, that's okay. There may be more risks, it may be more difficult, but it is still possible, so talk to your healthcare provider and see what options you have.
In perimenopause, ovulation becomes more unpredictable and less regular. This is going to decrease the chance of pregnancy because ovulation is required for pregnancy to occur. If you're ovulating less, you have fewer opportunities to become pregnant. It is not impossible, and thus if you do not want to become pregnant, it's important to protect against pregnancy.
But if you do want to become pregnant, it is still very much within the realm of possibilities that you can go on to have a healthy pregnancy. It's important to talk to a doctor about your risks and have a good plan in place but do know that many people go on to have healthy pregnancies at later ages over 40.