Until women have reached what is known as the postmenopausal stage, it is still possible to get pregnant.
Many women assume they have entered the menopause when they first have symptoms. However, there are two distinct stages of the process, namely perimenopause and postmenopause.
Perimenopause, which is also referred to as menopause transition, is the time before menopause where the body begins to make changes in preparation for the menopause.
Postmenopause has occurred when a woman has not had a period for 12 months.
How pregnancy occurs during perimenopause
As time goes by, the number of eggs a woman has reduces and the ones that are left continue to age. Older eggs have an increased likelihood of chromosomal abnormalities. This means that, as a woman gets older, her chances of getting pregnant also decrease.
Despite hot flashes and irregular periods, ovulation in perimenopausal women can occur. If a viable egg is released and fertilized, conception can take place.
It is not until ovulation stops permanently that a woman can no longer become pregnant naturally.
Looking out for signs of ovulation, such as breast tenderness, white vaginal discharge, or by using ovulation test strips can help a woman predict when she is ovulating. Then, she can either act to prevent it or to increase the likelihood of pregnancy occurring, depending on what she wants.
There are many reasons why a woman may wish to get pregnant during perimenopause. Some common situations include having had difficulty conceiving before, lifestyle factors such as her career or finances, or not having felt confident or ready to take care of a child earlier.
The time that women reach menopause can vary widely, though this usually takes place somewhere between 40 and 55 years old.
Once menopause occurs, a woman’s hormonal balance changes permanently. At this stage, ovulation will no longer take place, and a woman is unable to conceive naturally.
Increasing the likelihood of getting pregnant during perimenopause and postmenopause
Staying fit and healthy, and eating a varied, nutritious diet, will help improve the chances of a successful pregnancy.
A woman who is hoping to conceive during perimenopause should consult her doctor who can advise on the steps to take.
While her fertility is likely to be reduced, a woman can still boost the chances of getting pregnant. Examples of what she can do include:
Paying attention to ovulation: Knowing the signs and symptoms of ovulation, such as breast tenderness and white vaginal discharge can help women understand when they are ovulating and the best time to try and conceive.
Lifestyle factors, such as diet and exercise: A well-balanced, nutritious diet and plenty of exercise will also keep a prospective mother fit and healthy, which will help to increase the chances of conception.
In vitro fertilization (IVF)
A woman who undergoes IVF treatment either during perimenopause or after menopause may be able to conceive.
Any remaining eggs postmenopause will no longer be viable. However, if a woman chose to freeze her eggs earlier, these can be used, or fresh or frozen donor eggs may be another option.
What other treatments are available?
Even at menopause, there may be further options available in the future to help a woman who might want to conceive a child.
There has been some research on reversing the menopause. It is not yet offered as a treatment for women who want to conceive, but preliminary results have shown some success. There is some evidence that it is possible to ‘rejuvenate’ previously dormant ovaries, stimulating the release of an egg for fertilization.
Research and evidence in this area are currently still limited, although clinical trials have begun.
What are the risks?
Older women face more risks with pregnancy. Getting professional family planning advice may help to minimize some of these risks.
Pregnant women over the age of 35 years old have greater chances of:
miscarriage or stillbirth
an ectopic pregnancy where an egg implants outside the womb
high blood pressure leading to preeclampsia that can cause brain injury, impaired kidney and liver function, blood clots, fluid on the lungs, seizures, or maternal and infant death
placental abruption where the placenta detaches from the womb, leading to fetal growth problems, premature birth or stillbirth
placenta previa where the placenta lies unusually low in the womb and can create problems during delivery
low birth weight of the baby
multiple pregnancies, particularly if a woman has undergone IVF treatment.
Women going through perimenopause are likely to be more than 35 years old. Therefore, the risks outlined above could mean a pregnancy is more difficult.
Delivery can also become complicated and the likelihood of miscarriage, ectopic pregnancy or stillbirth increases.
Chromosomal abnormalities also appear more frequently in children born to older mothers.
The risk of Down syndrome increases from about 1 in 1,500 at age 25 years old, to 1 in 100 at 40 years of age, and to 1 in 50 by the time the mother is 45 years old.
Women going through perimenopause are encouraged to undergo genetic testing before trying to conceive to ensure they understand the risks of chromosomal abnormalities. Many women who are at this menopausal stage and want to become pregnant use donor eggs to maximize their chances of delivering a healthy baby.
IVF also increases risks factors, particularly for postmenopausal women who are more likely to have problems and complications during pregnancy and birth after undergoing IVF treatment.