Fertility During Perimenopause

More and more women are choosing to have babies later in life. Here are some ways to maximise the chances of trying to conceive during perimenopause.

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More women having babies later in life

The average age for perimenopause, the transition to menopause, is 47.5. While it is most common to experience it in your 40s, around 1 in 100 women experience the menopause before they turn 40.

The average age at which women have children has been increasing since the middle of the 1970s, with the number of women having children after the age of 45 rising by almost half over the past decade. Perhaps it’s not surprising then, that for the last few years the fertility rate of women aged 40 and over has exceeded that of women aged under 20. 

It’s clear from the data that more and more women are choosing to have babies later in life. In this article we take a look at fertility during perimenopause and look at some of the ways you can maximise your chances of trying to conceive during this phase of life.  

What perimenopause means for fertility 

If your body has started transitioning to the menopause, you’re in the transitional state known as the perimenopause. During this time your ovaries produce less hormones, causing your periods to change. You might find you have more or less time between cycles, and they may be heavier or lighter than normal. 

As well as irregular periods, you may also experience symptoms like hot flushes, sleep problems and mood change. But while this shift is your body moving toward the end of your reproductive years, it is not yet the end. You are not considered menopausal until you have had no period for a full year. 

Can you get pregnant in the perimenopause?

Yes! If you are ovulating, there is still a chance you could conceive. 

But there are some points to consider. During the perimenopause your ovaries will wax and wane; some months you might release an egg and other months you won’t. This means knowing when you’re ovulating is key to conceiving. The level of your hormones, like oestrogen and progesterone, also becomes erratic, which means your egg quality decreases. But you only need one good egg to get pregnant.

Natural conception is still possible for some women in their 40s and even occasionally into their 50s (though the latter is very rare, with most using assistive reproductive technologies and donor eggs). 

While pregnancy during the perimenopause is possible, it does come with some increased risks such as a higher chance of experiencing miscarriage, ectopic pregnancies, gestational diabetes and hypertension, along with a high rate of Caesarean sections.

Can you test for perimenopause?

Before you start trying to conceive, it would be helpful to know where you're at in the perimenopause stage. While a fertility and hormone blood test can be useful for measuring certain fertility indicators, it can’t definitively diagnose perimenopause. That’s because during this transitional period, hormone levels change throughout. 

This is inline with NICE guidelines, which state: “Women over 45 years presenting with menopausal symptoms are diagnosed with perimenopause or menopause based on their symptoms alone, without confirmatory laboratory tests.” 

So, if you are over 45 and experiencing menopause symptoms associated with the perimenopause, it’s safe to assume you’re perimenopausal (though we always advise speaking with your GP if you have any concerns).

How to increase fertility in women in the perimenopause 

If you’re perimenopausal, or more generally looking how to increase fertility after 35, here are some of the next steps you can take.  

1. Get a clear picture on your fertility

Before you start, it’s a good idea to get a detailed understanding of where your body is at. At home health tests offer a convenient way to get these results and our hormone and fertility blood test will give you insights into your ovarian reserve, thyroid hormones and much more. You’ll get results for 24 blood markers, which you can use to get a broad overview of your overall fertility.

All the markers play a role, but in the perimenopause, you’ll want to pay close attention to: 

  • Anti-Mullerian hormone (AMH): An AMH blood test looks at AMH, a hormone made by the granulosa cells in your ovarian follicles; its production is considered reflective of your ovarian reserve (your remaining pool of eggs). It is currently the most accurate predictor of your ovarian reserve and there has been lots of research which found strong correlations between AMH levels and the number of eggs seen on ultrasounds of the ovaries. 
  • Follicle-stimulating hormone (FSH): FSH is responsible for the growth of ovarian follicles, stimulating egg development and producing oestrogen. FSH levels vary depending on age, but high levels can indicate a loss of ovarian function and a reduction in the production of good quality eggs. 

Remember that these tests will not conclusively tell you whether or not you can get pregnant and carry a baby to term, but they can show you if age-related changes of the ovaries have begun, which can help you plan your next steps more effectively. 

2. Evaluate your lifestyle 

When it comes down to the nitty gritty of how to get pregnant during perimenopause, there are some lifestyle changes you can make to better support your fertility.  

  • Healthy diet: New research out of Harvard Medical School has found that women trying to conceive naturally (i.e. without assistive reproductive technologies like IVF) should make sure they take the right levels of folic acid and vitamin B12, get enough omega-3 fatty acids and otherwise eat a healthy diet, like the Mediterranean diet.
  • Exercise enough: Staying active has a positive impact on your hormones. It improves blood flow to the muscles and increases hormone receptor sensitivity and amino acid transporters, which helps with the delivery of nutrients and hormone signals. 
  • Avoid stress : Trying to conceive can be a highly stressful time for anyone, let alone if you’re dealing with perimenopausal symptoms too. You’ll want to manage your stress as best as you can through practices like good sleep hygiene and mindfulness, or whatever helps you to decompress. 

3. Consult your healthcare provider

If you are over 35 and haven’t conceived after six months of unprotected sex, get in touch with your healthcare provider. They’ll help guide you to the next step and together you can discuss your options for the future, whether that’s further tests, medication or IVF. 

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