I’ll jump straight to the point: yes, some women can get pregnant during perimenopause, but others will have a hard time becoming or staying pregnant because of.
Perimenopause encompasses the years leading up to menopause or the cessation of your period for at least 12 months. During perimenopause, hormonal shifts cause irregular menstrual cycles, making it more difficult to predict when ovulation will occur.
The average age of perimenopause is around age 45, although cycle changes can start earlier for some. As more women choose to start families later in life, it’s helpful to understand how your fertility is impacted if you’re trying to conceive. It’s also essential for women who don’t want to become pregnant to recognize that now is not the time to forego contraception.
Here’s what to know about pregnancy later in life, why it may be harder to get pregnant as you get older, and how to support fertility if becoming pregnant is part of your future plans.
When Does Fertility Start to Decline?
A woman is born with all the eggs she’ll have throughout her life—around 1-2 million—but the quality and number of eggs decline with age. Many factors contribute to fertility, but with perimenopause, the decline in egg quality paired with irregular menstrual cycles can make conception more difficult.
Fertility begins to decline around age 32 (but of course, this doesn’t mean you can’t become pregnant in your 30s). By around age 37, around 25,000 eggs still exist, but this number drops to about 1000 by age 51.
In other words, the cycle changes during perimenopause coincide with a natural decline in viable eggs available for fertilization. Setting expectations is helpful, so just know that conceiving during perimenopause could take longer than expected.
Fertility Rates by Age
Studies suggest the following fertility rates by age:
- Age 30 and younger: 85% chance of conception within one year.
- Age 30: 75% chance of conception within the first year.
- Age 35: 66% of conception within the first year.
- Age 40: 44% of conception within the first year.
I know many women who have had strong, healthy babies around age 40 (including me!), so please recognize these numbers are estimates and may not represent what is true for you. In fact, population studies show that birth rates for women aged 35 to 44 increased between 2010 and 2019. This change is partially explained by women waiting longer due to careers or life choices and increased use of reproductive technology like IVF.
But I think it’s important to understand that age impacts the chances of conception, so taking additional steps to support fertility for a healthy pregnancy (or using contraception if you don’t want a baby) is key.
Hormone Levels During Perimenopause
Hormones are major drivers of fertility, and understanding more about them can help you make informed choices.
There are generally four phases of perimenopause:
- Very Early perimenopause: When periods are still regular, but symptoms are just starting to appear.
- Early perimenopause: Characterized by transitioning into irregular menstrual cycles.
- Late perimenopause transition: When the cycles are exceeding 60 days.
- Late perimenopause: Characterized by even more sporadic menstrual cycles, missed periods, and increased symptoms (as described below) and is the final 12 month stretch before you enter menopause.
Each of these phases is influenced by shifting hormones, especially estrogen and progesterone. Instead of following an expected pattern throughout the month, they become more sporadic, so ovulation during perimenopause can be unpredictable.
The reduced number of eggs also coincides with an increase in follicle-stimulating hormone (FSH) and a decrease in anti-mullerian hormone (AMH). AMH is used to assess ovarian reserve or how many eggs are available for fertilization, so lower circulating levels can indicate reduced fertility.
FSH stimulates follicles in the ovary to release an egg for fertilization, but it also triggers estrogen production. As the number of follicles decreases and estrogen levels drop as a woman approaches menopause, more FSH is released as the body tries to compensate for losses.
Can You Get Pregnant During Perimenopause?
In early perimenopause, ovulation is still regular. Even as perimenopause progresses, you may still be fertile as the ovaries will ovulate, although much more irregular, as you near menopause.
As mentioned above, even though fertility rates begin to decline as we move through our thirties, pregnancy may still be possible (and happens more often than some people may think). For some, the shifting hormones mean an irregular menstrual cycle, so it’s not as easy to predict ovulation, but with tracking and timing intercourse, you may still be able to conceive.
What Are the Chances of Getting Pregnant During Perimenopause?
Chances of getting pregnant during perimenopause depend on your age, your personal health history, family history, environmental exposures, and how many eggs you have left. While many more women are able to become pregnant during perimenopause compared to the past, we must also recognize that this can be due to reproductive technologies such as egg preservation and IVF.
As long as you are ovulating with viable eggs, you may be able to get pregnant.
Understanding Potential Pregnancy Risks
Medical professionals use the unfortunate phrase “advanced maternal age” or “geriatric pregnancy” to describe pregnancies after age 35 because it’s considered a high risk pregnancy, but what does that really mean?
It’s true that statistically, health risks increase for mother and baby as you get older. For example, as eggs can’t regenerate or repair themselves (and remember you’ve had these eggs in your body since birth), the risk of certain chromosomal abnormalities like Down Syndrome increases.
This doesn’t necessarily mean you can’t have a healthy pregnancy, but it does mean your OB-GYN or midwife will likely recommend more office visits and lab work, which may actually be beneficial for you and your baby. A large study found that the babies of pregnant women over 35 who underwent more frequent prenatal care had better outcomes.
Below I’ll share some of the pregnancy risks associated with increased age. These risk are related to egg quality that declines with age and hormone shifts associated with perimenopause. This isn’t meant to scare you, but I think it’s important for anyone to be informed about risks.
Content warning here: I will discuss miscarriage and other triggering subjects below.
As someone who had a healthy 40 year-old pregnancy and then went on to have multiple miscarriages at 41.5-42 years-old, I know just how heartbreaking this can be.
What is the Rate of Miscarriage After 40?
It is estimated that approximately 35% of pregnancies end in miscarriage for women between the ages of 40-44. After 45 that number jumps to 53%.
It’s important to note that while all of these statistics can sound scary, it doesn’t mean it is true for you. Your individual health, lifestyle, and other factors can greatly impact your fertility.
Risk of miscarriage by age
The data in this table was taken from several studies.
|Percent Risk of Miscarriage
Prematurity means a baby is delivered before 37 weeks. Women older than 40 are at a higher risk, while age 30 to 34 are associated with low risk. Scientists aren’t sure why, but the reasons may include placental health and low progesterone levels.
The risk of certain complications for mom also rises with age. Gestational diabetes (high blood sugar during pregnancy) is common due to reduced insulin sensitivity, as is high blood pressure and preeclampsia. Rates of c-sections are also higher for older mothers.
Finally, it’s important to note that despite the increased risks, most pregnancies after 40 go smoothly and end in healthy babies. As with any pregnancy, the important thing is to work closely with your provider and take good care of yourself.
How to Increase Your Fertility During Perimenopause
The following steps can help support you in your fertility journey. While lifestyle changes can’t guarantee you will become pregnant, focusing on the following can nourish and support your body throughout the perimenopause transition, and possibly improve the chances of conception.
Hormone shifts are the foundation of perimenopause, so finding a balance that feels good in your body will also help with fertility. Progesterone is made following ovulation, but as the ovaries progress into perimenopause, their production of this hormone may not be sufficient. Declining progesterone levels in perimenopause make it harder to become pregnant and maintain the pregnancy.
Fluctuating progesterone levels don’t just affect your fertility, they impact how you feel on a daily basis. Irregular periods, insomnia, and mood changes are some of the symptoms associated with low levels. Lower progesterone levels also throw off the delicate balance with estrogen.
Supporting progesterone production and balancing estrogen levels are a key part of any hormone optimization plan. Here are some key nutrients and herbs that can help:
Vitamin C is important for progesterone production and can help with adrenal health. It is an important antioxidant in the body. You can learn more about vitamin C here.
This is a necessary nutrient to help with progesterone production. Aim for 25-30 mg daily.
Chaste Tree Berry
Also known as Vitex, this herb can help promote healthy levels of progesterone in the body. Learn more about chaste tree berry here.
This nutrient helps support estrogen metabolism. When paired with sulforaphane and myrosinase, it can help your body produce healthier estrogen metabolites and balance estrogen with progesterone.
This specific form of calcium helps with processing estrogen in the digestive tract so you can keep your levels in balance.
We specifically formulated Balance – Women’s Hormone Support to contain the optimal amounts of nutrients and herbs to support healthy levels of estrogen and progesterone in the body. Itis a comprehensive formula with botanicals, vitamins, and antioxidants created to support healthy hormone levels.
Keep reading for additional ways to optimize your hormones.
Support Your Adrenal Health
The adrenals are the glands responsible for releasing hormones like cortisol and adrenaline, which help you manage stress. If the hypothalamic pituitary adrenal axis is overworking—maybe you aren’t sleeping well, work is extra challenging, or your stress levels are high—these hormones can take a toll on fertility and hormone balance.
Nourishing those adrenals is always a focus for my patients, especially in perimenopause. This can look different for everyone, but the big picture means prioritizing those self-care pieces that may be lacking in your life.
Actions like going to bed earlier to get more sleep, feeding yourself nutrient-dense meals (not starting your day with four cups of coffee and skipping breakfast), or standing outside in the sun for fifteen minutes to breathe are all possibilities. Don’t add even more stress by telling yourself you must completely overhaul your lifestyle. Start with one small change that brings joy or calm to your life.
I invite you to read this article to learn more about specific steps to take care of your adrenal glands.
Take Care of Gut Health
Your gut is a hormone balance epicenter, where you absorb nutrients from food and process hormones like estrogen. An imbalanced gut microbiome (the collection of healthy microbes in your GI tract) can lead to hormone imbalance or worsen perimenopause symptoms.
We understand that gut health is pivotal in fertility—from fertilization to implantation and the health of the pregnancy. In certain situations, correcting microbial imbalances may lead to better fertility outcomes.
This is because, at least impart, the gut can contribute to inflammation that can impact implantation and can be part of autoimmune conditions that prevent a healthy pregnancy. This doesn’t mean it is your fault if you’ve experienced recurrent miscarriage or pregnancy loss. Instead, this is an invitation to examine this area of your life and take action.
Including fiber (at least 25g a day) is essential for gut health. Think of foods like legumes, leafy greens, and nuts. These foods fuel your gut bacteria and help stabilize your blood sugar levels (also closely tied to hormones). Interestingly, a study on women and fiber during perimenopause found those who ate more experienced fewer depressive symptoms.
Eliminating the use (as much as possible) or NSAIDs, alcohol, and other harmful practices to your gut microbes can go a long way in improving your gut health and hormones.
Fermented foods and probiotic supplements can also support your gut health. Kimchi, tempeh, miso, and cultured yogurt are all great options. Choose a probiotic supplement that contains specific strains for women’s health to support hormone balance.
Taking a quality probiotic can also be a part of your gut health regimen. Women’s Probiotic by Dr. Brighten was specifically designed with both Lactobacillus strains, prebiotics and phytonutrients to help support women's health at all stages.
Keeping stress low, getting adequate sleep, and exercising regularly can also help promote a healthy gut.
I encourage you to work with a provider who will address gut health specifics to ensure you’re getting the holistic care you need on your fertility journey.
Exercise and Movement
Exercise that gets your heart thumping and feels nourishing is incredibly helpful for hormone balance and overall well-being. Research points to exercise as an essential part of a healthy lifestyle to reduce the risk of infertility.
Movement also helps with digestion, supports circulation and blood sugar (also crucial for hormone balance), and can help manage stress levels. Plus, it encourages the production of endorphins, your body’s natural feel-good hormones that can help with mood.
Remember that over-exerting your body can do the opposite (we want to nourish our adrenals, not tax them), so rest days and gentle movement are key.
Focus on Nutrition
Nutrient-dense foods are again essential for hormone balance, as well as fertility. This means a whole food-based diet rich in vitamins, minerals, antioxidants, and healthy fats is one of the best natural ways to increase fertility. Include plenty of fruits and vegetables, proteins like fish or poultry, whole grains (think quinoa or brown rice), nuts, seeds, and legumes. Studies show that these foods are associated with a reduced risk of infertility.
A prenatal vitamin is also essential if you want to become pregnant. Food comes first, but since your need for certain vitamins and minerals increases during pregnancy, a prenatal ensures you get enough.
Feel overwhelmed or like you have a lot of diet changes to make? Try this: instead of worrying about what you need to cut out, think of your body as something that deserves all these beautiful nutrients to run optimally and thrive.
If you need a little help or feel overwhelmed, my free Hormone Balancing Starter Kit includes a 7-day meal plan and recipe guide to get you started on the path to hormone balance.
This doesn’t mean that you don’t occasionally have a treat—it’s not all or nothing—but these foods will make you feel good and set your body up with optimal nutrition before, during, and after pregnancy.
Improve Egg Quality
Another reason to optimize nutrition? Egg health. Eggs (and sperm) are especially vulnerable to oxidative damage, so antioxidants like selenium or Coq10 from food and fertility supplements can help reduce the impact of free radicals and support egg health.
Foods high in antioxidants include dark leafy greens, like kale and spinach, and colorful fruits and vegetables, like berries, tomatoes, and sweet potatoes. Foods like garlic, turmeric, walnuts, and flax seeds also contain antioxidants. Your prenatal vitamin can also offer nutrients that act as antioxidants to improve egg quality.
Healthy fats from foods like avocado, nuts, and cold-pressed olive oil can also help support egg health. Omega-3 fatty acids, found in foods like wild-caught salmon and sardines, are essential for egg health. Studies show that supplementing with omega-3 can support egg health and improve fertility.
I talk all about supplements to consider when trying to conceive in your forties here and in the video above!
Perimenopause signals the beginning of huge changes in a woman’s life, but pregnancy may still be an option if timed correctly. With a combination of self-care, exercise, prenatal supplements, and nutrition focusing on fiber, antioxidants, and healthy fat, you can support fertility, egg health, and your overall wellness throughout the process.
If you are considering having a baby and believe you are in perimenopause, I encourage you to meet with a licensed health care practitioner to have your health evaluated and understand what your options are.
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