Fertility and Menopause what to expect?

The number of couples trying to conceive in their late 30s and 40s is increasing. It is common to delay starting a family for any number of reasons. These might include second relationships, the demands of career and education, a desire for financial stability, or waiting for a stable relationship.

It is important to understand, though, that a woman’s fertility declines with age, particularly in her late 30s and 40s. This is a normal part of the aging process, and a delicate balance act occurs between fertility and menopause for some women and couples.

As women become older, the chance of becoming pregnant is lower, the chance of having a miscarriage is higher and there is an increased risk of chromosomal abnormalities in the baby.

In the general population, the chance of becoming pregnant after the age of 40 is estimated to be 5% per cycle, compared with about 20% per cycle in the under 40 age groups.

It’s not clear why fertility declines with age in women who have regular menstrual cycles. Fertility treatments such as in vitro fertilization (IVF) can’t reverse the effects of age on fertility. By the time most women enter their forties, their hormones begin to decline slowly as they enter the final stage of reproduction: menopause.

Although we can’t beat the aging process, fertility doesn’t have to end at forty. It’s possible to fall pregnant in your forties and knowledge is key to understanding our biology and the fertility process.

Let’s start!

Menopause

A woman reaches menopause when it’s been 12 months since her last menstrual period. This is just a way of defining a life stage.

It’s important to establish this to understand the difference between fertility decline, age, perimenopause, and menopausal signs and symptoms.

Women’s fertile stage goes from their first menstruation during puberty until the last one. There are major hormonal changes during puberty and during menopause.

You can learn more about the menstrual cycle in Menstrual Cycle-Stages, Phases and What To Expect.

Menopausal symptoms

Once a woman’s fertile stage comes to an end, her fertility hormone levels (progesterone and estrogen levels) decrease. This decline in hormone levels can cause a variety of symptoms.

Although not every woman experiences all of them, women might experience a range of symptoms in the years leading to menopause, and after, until they finally cease.

Here is a list of the most common symptoms:

Irregular periods
Vaginal dryness
Hot flashes
Chills and shivers
Night sweats
Sleep problems
Mood swings
Lower metabolism that leads to weight gain
Fragile hair and brittle nails
Loss of breast volume.

You can read more information about menopausal signs and symptoms in [insert link to next article Menopause, symptoms, signs and treatment]

Perimenopause

The period between women’s first experience of menopausal symptoms and the time menopause occurs is called perimenopause.

Perimenopause usually lasts between 4 and 5 years. The frequency and intensity of perimenopausal symptoms will fluctuate during this period. Some women experience symptoms occasionally for a while, before they ramp up. Others might have months of hot flashes, then a break for months.

Until a woman has reached menopause she’s considered premenopausal.

Early menopause

Menopause occurs at a different time in each woman. The average age at which western women reach menopause is 51 years.

If perimenopause starts before a woman turns 40, it is called premature menopause; this is mostly determined by your genes.

What age does a woman stop being fertile?

As we know, no one size fits all and the end of fertility will differ in every woman. Your genes will influence this a lot. To give you an idea of when it might happen to you, ask your mother and grandmother about their experience.

You are not them, however, and many other different factors might apply. Your mother’s genes are different from yours. Bear in mind your father contributed to half of your genetical material and this manifests differently in each one of us.

Menopause is usually when a woman’s fertile stage has come to an end. However, if you continue reading, you’ll see this isn’t always the case.

Can you get pregnant during perimenopause?

Absolutely, yes. For most women, though, the chances of conceiving during perimenopause are 25% of the chances a woman under 40 has to conceive naturally.

If you don’t want to become pregnant make sure you’re using an appropriate birth control method.

This also means if you’re starting to experience perimenopausal signs and symptoms such as hot flashes, and you’d like to become a mother, there’s still time for you to get pregnant the natural way.

Ovulation over 40 – signs

As you grow older you get closer to menopause but this doesn’t mean your body stops being fertile at one specific point in your life. Life is a process and so is each of its stages.

Although there are menstrual cycles when an egg isn’t released, the vast majority of healthy women will have cycles where an egg is released during ovulation.

The signs you’re ovulating are very similar throughout your fertile life. To help you work out when you’re ovulating, let’s look at these signs:

Drop in basal body temperature. Women’s basal body temperature drops sharply (by about 0.5ºC) just before ovulation occurs. This is caused by the estrogens level reaching its highest peak. You won’t be able to notice this drop unless you take and chart your basal temperature daily. Learn more in Charting Your Cycle – 6 Ways It Helps You Conceive Faster
Changes in your cervical mucus. Your mucus changes, depending on the stage of the menstrual cycle you’ve reached. Around the time of ovulation, it becomes transparent, slippery, and stretchy, like raw egg white. As you become older, you might notice the time frame when your cervical mucus is like this is shorter. This means that you’re fertile for a shorter time each menstrual cycle but there’s still a viable, receptive egg waiting to be fertilized
Changes in your cervix. Checking your own cervix at different stages of your cycle is a very good way to help you understand what’s going on in your body and what happens in the different stages of your cycle. During the days around ovulation your cervix softens and comes forward. It feels wet because of the fluidity of the mucus and it’s open, to facilitate the passage of the sperm
Increased libido. It’s quite common for most women to feel an increase in libido during their fertile days. Women’s body systems work in harmony and it’s only natural that when you’re fertile your hormones also work towards making you want to have sex.

These are the most common ovulation symptoms.

You can find out more in these articles:

How can I increase my fertility in late 40s?

As we’ve discussed, there is little we can do about a woman’s age, and her eggs reserves decrease more and more as she grows older.

However, there are several things you can do if you want to get pregnant with those remaining eggs:

Change your diet. Reduce the amount of processed food, sugar and refinated carbohydrates. Increase the amount of vegetables and fruit, especially in their raw form (salads, nuts, seeds). Read more in Low Carb Diet Increases Your Chance Of Pregnancy, Studies Find
Get active. Exercise is key to become healthy. It boost your heart’s health, your blood vessels, and your organs. Being active helps your whole body, including your reproductive system, to perform much better
Get sexy. Oxytocin is the most important hormone during sex and reproduction. It’s the one that tells our bodies to conceive, the one we secrete when we’re enjoying life, when we’re happy, and when we’re in love. It’s the hormone that gives us that great feeling when we have sex, when we orgasm, when we give birth or breastfeed our babies. Having oxytocin regularly flowing through your veins will increase your chances of conceiving.
Bring your stress down to its lowest possible level. Oxytocin needs a good atmosphere to flow. If your stress hormone levels are high your oxytocin levels will be low. Have you ever tried to have fun or to have sex when your mind is focused on something that’s stressing you out? It doesn’t happen, does it? Stress is your worst enemy if you’re trying to get pregnant.

You can read more in How To Increase Your Changes Of Getting Pregnant-10 Tips.

Can fertility return after menopause?

According to the North American Menopause Society, to become ‘menopausal’ women must have ceased having a menstrual bleed for 12 consecutive months in the absence of pregnancy.

This simply means the natural end of a woman’s reproductive life is menopause. It doesn’t mean your fertility is absolutely gone and it doesn’t mean you will never have another menstrual period again. It means a whole year without periods.

It’s quite likely that you will never get more menstrual cycles when you’ve reached a certain age and hit menopause.

However, keep reading. In fact, there have been cases of post menopausal women who have achieved successful, unplanned pregnancies.

What is a menopause baby?

A baby conceived after a woman has reached menopause is called a menopause baby. Most of these pregnancies are totally unexpected. Usually, when a woman has spent a whole year without menstrual periods it’s usually a sign her fertile life is over.

Falling pregnant naturally at that stage might go undetected for a long time, as women wouldn’t usually think the symptoms they were experiencing were due to a pregnancy but more likely associated with menopause.

When a woman has gone through hormone therapy or in vitro fertilization treatments, however, a menopause pregnancy would be identified much earlier, as the fertility team would be checking whether or not the treatment had been successful.

Either way, it might be difficult for many women to identify their pregnancy in the early stages if they hadn’t had menstrual cycles for a long time.

Signs of pregnancy after menopause

For postmenopausal women, a ‘late period’ is out of the picture for diagnosing pregnancy.

Here are other signs that can help women who suspect they might be pregnant after menopause.

Intuition. Some women just know they are pregnant – especially if they’re well connected to their bodies and they’ve been pregnant before. They might be able to ‘feel’ they’re pregnant in the very early weeks of the pregnancy. Remember that hormone levels are quite different during pregnancy from what they are after menopause. Women might notice what their bodies are experiencing has taken a turn and it’s different from what they experienced during their menopause
Tiredness. During the early stages of pregnancy, our bodies want us to focus on the embryo implantation. This is a delicate process that requires a lot of energy. Being tired and sleepy is a common sign of pregnancy
Uterine discomfort. Women might experience some discomfort, even pain in the pelvic area, as the blood flow to the nurturing and growing uterus has increased. For the past months or even years the uterus had been getting less active and all of a sudden it’s asked to perform its most important task. Some women might be more able to perceive these changes in their reproductive system
Morning sickness. Perimenopausal women don’t usually experience morning sickness as a menopausal sign. Morning sickness is usually caused by the raise of human Chorionic Gonadotropin (hCG) or estrogen at the beginning of pregnancy. Morning sickness can be one of the clearer signs for a postmenopausal woman to suspect she might be pregnant.

You can read more about pregnancy signs and symptoms in Pregnancy Symptoms | 17 Early Signs You Might Be Pregnant.

If you have the slightest suspicion that you might be pregnant after menopause, we recommend you find out as soon as possible. Pregnancy in older women means higher health risks to the woman and the baby than those risks to women who are younger.

Getting the reproductive medicine team on board as soon as possible, to provide medical advice and supervision, is of paramount importance to achieve a successful term pregnancy without major complications for either the mother or the baby.