Perimenopause And Pregnancy

Introduction 

As a woman goes through stages of life, they encounter some physical and emotional changes. Perimenopause is when a woman’s body begins to transition towards menopause, marking the end of her reproductive years, this is a natural stage that happens in a woman's life.¹ Coincidentally, women in this perimenopause stage may still consider pregnancy. For women’s health and family planning it is important to understand the interplay between perimenopause and pregnancy. This article offers an insight into the challenges, considerations and possibilities that arise during this time.

What is perimenopause?

• Menopause is defined by the absence of a menstrual period for one year and typically begins when a woman is in her mid/late 40s, but it can start earlier or later for some individuals²
• Perimenopause is the years leading up to menopause and this time period can vary from person to person. During this phase, a woman will undergo significant hormonal shifts, especially a decline in estrogen level, which can lead to various symptoms
• Common signs of perimenopause include a change in the menstrual cycle (length of periods or how much you bleed each period)³ It's always best to contact your gynaecologist if you ever experience abnormal bleeding as it can also be a sign of other issues

Symptoms of perimenopause

• Irregular periods 
• PMS-like symptoms
• Hot flashes 
• Night sweats
• Difficulties sleeping
• Weight gain
• Vaginal dryness 
• Changes in sexual desires (libido levels)

Pregnancy or perimenopause

Pregnancy symptoms and perimenopause symptoms tend to overlap so some women may wonder whether they are pregnant or experiencing perimenopause. At times the symptoms of perimenopause may not be present at all. When pregnant you may experience food sensitivity, sensitive or swollen breasts, increased urination and nausea. These symptoms are not commonly experienced by women going into/through perimenopause, if you are in doubt it's always best to take your concerns to a doctor or gynaecologist as they would be able to advise you further. 

Diagnosing perimenopause

Unfortunately, there is no diagnostic test for perimenopause, doctors can however tell by measuring the hormone levels of a woman entering this stage. One of the main indicators is FSH (follicle-stimulating hormone) which helps manage a woman's menstrual cycle and directs the ovaries to produce eggs.

Challenges and considerations for perimenopause

Women navigating perimenopause and pregnancy desires simultaneously will need to consider some of the challenges and considerations into play.

• Fertility concerns: As a woman ages her fertility levels will naturally decrease and the number and quality of eggs she has declines. Whilst it is still possible for individuals to get pregnant during this stage of perimenopause, the likelihood diminished, necessitating proactive fertility assessments and discussion options with healthcare providers
• Hormone fluctuations: The fluctuations in hormone levels can impact the chances of getting pregnant when experiencing perimenopause. Irregular menstrual cycles make it difficult to pinpoint ovulation which is needed to assess fertile windows. Individuals experiencing this require vigilant monitoring through methods like ovulation predictor kits or tracking basal body temperature⁴
• Health risks: Getting pregnant later in life carries health risks for both mother and baby. Women in perimenopause may have higher chances of pregnancy complications like gestational diabetes, hypertension and chromosomal abnormalities in the child. Health issues that are pre-existing need to be managed and carefully monitored⁴
• Emotional considerations: Perimenopause is encompassed with various emotions such as a fluctuation in mood swings, which can influence the decision-making process regarding pregnancy. As a woman you need to make sure you assess emotional readiness and support systems before you embark on a pregnancy journey during perimenopause
• Financial preparation: Parenthood comes with lots of financial responsibilities. Women approaching perimenopause need to evaluate their financial readiness for raising a child, considering factors such as childcare costs, education expenses, and potential impacts on retirement plans

Options to explore for individuals with perimenopause trying to get pregnant 

Despite the challenges, many women are able to successfully conceive and carry pregnancy to full term during perimenopause. There are several options that women can use to aid them in their pregnancy journey. 

Consultation with doctors

• Always seek guidance from healthcare professionals specializing in reproductive health so this can be your gynecologist or a fertility specialist
• Fertility assessments and medical evaluations will be done to help women make informed decisions whilst also discussing potential risks and strategies⁵

Fertility treatment

• Depending on the circumstance of the individual in-vitro fertilization (IVF) or intrauterine insemination (ICSI) can be alternative options for women experiencing perimenopause, trying to get pregnant⁶
• These interventions bypass some of the challenges that are posed by perimenopause and increase the likelihood of successful conception 

Lifestyle modification

• Adopting a healthy lifestyle is important as this can help optimize fertility and well-being during perimenopause
• Maintaining a balanced diet, regularly exercising, managing stress and avoiding things like excessive alcohol and tobacco use

Alternative paths to parenthood

• Women experiencing extreme health concerns or fertility issues are able to look into other ways to parenthood. This could be through surrogacy or adoption⁷

Emotional support

• Navigating perimenopause and pregnancy can bring about a range of emotions. It's important to seek advice and support from loved ones, support groups, or mental health professionals who can provide invaluable support emotionally and mentally throughout this journey

Myths and facts about perimenopause and pregnancy

Myth 1: Perimenopause only happens when you're too old to have a baby

Fact 1: Perimenopause can occur anywhere from a few months to over 10 years. Typically, it lasts four to eight years. Most women experience it in their mid to late 40s while still ovulating, meaning pregnancy is possible during this time.⁸

Myth 2: Your chances of getting pregnant during perimenopause are so low that you don’t need birth control

Fact 2: Pregnancy is less likely as you age, but it's still possible unless you've gone 12 months without a period which could mean you've entered menopause. Irregular periods make it hard to predict ovulation, so using birth control is recommended until menopause.⁸

Myth 3: If you're in your 40s and haven’t reached menopause, fertility treatments are a good backup plan if you can't conceive naturally

Fact 3: Fertility begins to decline in your 30s, and by the mid-40s, most women struggle to get pregnant naturally or with treatments like IVF due to declining egg quality and quantity. According to the American Society for Reproductive Medicine (ASRM), a woman's chances of getting pregnant is less than 5% per cycle, naturally or with the help of fertility treatments by age 40.⁹

Myth 4: If you have perimenopause symptoms but want a baby, it's hopeless

Fact 4: Even in your 40s, you can still conceive naturally if your ovaries produce viable eggs. Depending on your age, medical history, and other factors you may still be able to conceive. Studies show that 4.5% of women are unable to conceive naturally at 25 years old — and that figure jumps to 50% at 41 and 90% at 45.¹⁰ But those statistics also mean that even if you’re more than 40 years old, you can still get pregnant naturally. As long as your ovaries produce a viable egg (which is still possible while experiencing perimenopause), you can get pregnant. But as you get older, getting pregnant naturally does become more difficult. 

Myth 5: Every woman will go through perimenopause

Fact 5: Induced menopause (this could be due to surgical removal of ovaries) or certain cancer treatments can prevent perimenopause in some cases.¹¹

Summary

Perimenopause and pregnancy both represent significant transitions in a woman's life, with each of them accompanied by their challenges and considerations. Navigating the connection between perimenopause and pregnancy requires careful assessment, proactive planning and informed decision-making. Consulting healthcare providers, adopting healthy lifestyle practices, and exploring the options that are available for women experiencing perimenopause. The journey to becoming a mother during perimenopause may be complex and hard, but with the right support and determination, it can be a very fulfilling and rewarding experience.