While there is increased difficulty and complication risks, pregnancy during menopause is still possible. Here’s what menopausal women should look out for, and the options to consider.
Unlike men, who carry on producing sperm throughout their lifespan, the number of eggs a woman can produce during her reproductive years is fixed . This means that female fertility naturally declines over time.
From the onset of puberty, an egg is released each menstrual cycle, giving rise to the possibility of fertilisation and pregnancy. This continues until the last egg is produced, after which pregnancy is no longer possible (unless a donor egg is involved) .
The period leading up to this event is most commonly known as menopause, and it is commonly accompanied by bodily changes that may be mistaken for pregnancy symptoms — even as they make getting pregnant more challenging.
On the other hand, period irregularities and fluctuating hormone levels can lead to unexpected pregnancy in women undergoing menopause. This means that yes, pregnancy can still occur during a woman’s menopausal years, but we may be getting ahead of ourselves a little.
A timeline for understanding menopause
Let’s start by clarifying what menopause is, and how it progresses.
The word ‘menopause’ is often used to describe a period of a woman’s life following their first symptoms (we’ll touch on this later), but there’s more to it than that. And contrary to popular belif, menopause also doesn’t happen overnight .
Technically speaking, menopause is split into 3 stages — perimenopause, menopause, and postmenopause. Being clear about what happens during each of these stages will give you a better idea of what to expect.
Perimenopause (mid-30s to mid-50s)
Perimenopause is the period during which your body begins the transition to menopause. It can begin as early as mid-30s, or as late as mid-50s, but the majority of women experience perimenopause in their 40s .
For most, perimenopause lasts between 4 to 8 years, but some women may experience it for a shorter time . During perimenopause, the ovaries start producing less oestrogen, throwing off the balance with progesterone — together, these 2 hormones regulate ovulation and menstruation .
As a result, the menstrual cycle becomes irregular, making it difficult to track ovulation cycles properly. There may also be cycles where an egg is not released .
The hormonal changes also start a cascade of other symptoms and bodily changes, some of which can overlap with pregnancy symptoms. We’ll discuss some of these symptoms later in the article.
Menopause (12 months without menstrual cycles)
This is when ovulation no longer takes place, menstruation stops, and natural pregnancy no longer becomes possible. If you have gone through at least 12 months without a menstrual cycle, menopause has officially been reached .
After menopause (which technically only lasts a day) comes postmenopause, which persists for the rest of your life .
While some women may be relieved that their childbearing years are over, others may mourn the loss of their ability to bear children. There may also be other mental health challenges including moodiness, anxiety and depression, which may be brought on by decreased hormone levels .
Perimenopause and pregnancy
Specifically, pregnancy can occur during perimenopause, even if the onset of symptoms can make success more elusive.
Note that ovulation is still taking place during perimenopause. There are, afterall, around 1,000 eggs still yet to be released by this point . This means that the menstrual cycle still continues, and the possibility of conceiving remains.
However, common perimenopause symptoms can make natural conception more challenging.
The change in the oestrogen-progesterone balance in perimenopause brings about menstrual irregularities. Cycles may lengthen or shorten, vary from light to heavy, and periods may even be missing for months, before starting back up again.
This increased unpredictability in ovulation can make getting pregnant significantly more difficult.
Mood changes 
Another result of the hormonal changes is mood disturbances, such as irritability and depression. This can cause a women to be disinterested in sex, leading to reduced sexual expression and activity.
Bodily symptoms 
Various bodily symptoms that commonly accompany perimenopause can also affect libido in several ways. For instance, increased vaginal dryness can make sex uncomfortable or unappealing.
Weight gain may also occur, and discomfort with this physical change can decrease desire for sex. Additionally, hot flashes and night sweats are also common, which can leave you feeling too tired for sex.
Decreased egg quality and fertility
After the age of 35, there is a decline in the quality and quantity of eggs, and they become more difficult to fertilise . There is also an increased chance of conditions like endometriosis and uterine fibroids that can make it harder for pregnancy to take place .
Tips to increase your pregnancy chances during perimenopause
Check your hormone levels
As perimenopause marks a decline in fertility, it is helpful to obtain a clear view of your reproductive health when trying to conceive. A blood test can provide a detailed snapshot of several hormones that are important for reproductive health, such as:
- Anti-Mullerian Hormone (AMH), which is considered to be the one of the most reliable indicators of your ovarian reserve. Researchers have found there is a strong correlation between AMH levels and the number of eggs in the ovaries .
- Follicle-stimulating Hormone (FSH), which is released by the body to stimulate the growth and release of eggs. FSH levels vary by age, but high levels can mean that ovarian response is diminished, which in turn may mean there are fewer healthy eggs to work with .
- Thyroid-stimulating Hormone (TSH) and Free Thyroxine (FT4). This pair of hormones share an inverse relationship that can indicate underlying problems with the thyroid. Thyroid issues have been shown to increase the risk of several pregnancy complications, including preeclampsia, premature birth, miscarriage and low birth weight .
The twoplus Fertility Hormone Test Kit offers a quick and convenient way to find out your hormone levels — right in the privacy of your own home, office, or anywhere you choose. Simply order the hormone test online, and make an appointment for a phlebotomist to visit you for a quick blood draw. You’ll receive a personalised report of your results in two weeks or less. (Note: The twoplus Fertility Hormone Test Kit is currently available in Singapore and the United States only.)
Get fertility care and support
Given the increased challenge of trying to conceive during menopause, starting on a fertility care plan would be beneficial.
Working with a fertility specialist means you can expect to receive fertility care and support, not only for treatments but also personalised advice and recommendations for lifestyle changes. It might also be helpful to explore some alternative options for having children in lieu of natural conception.
In-Vitro Fertilisation (IVF) and menopause
IVF treatments are a viable path towards successful pregnancy, even for menopausal women.
Pregnancy during menopause, while more difficult due to age, is still possible with assisted reproduction technology like IVF by using eggs you had frozen earlier, or using the fresh or frozen donor eggs.
In a previous study, a cohort of postmenopausal women aged 50 to 63, underwent IVF treatment using donated eggs. Out of a total of 121 attempts, there were 45 births . However, do note that there is an increased risk of pregnancy complications in IVF use during menopause .
Pregnancy during menopause is possible, but beware increased risk of complications
A woman can still naturally conceive during perimenopause. After menopause, women can also become pregnant using her own eggs harvested and frozen earlier, or with the help of donor eggs.
However, it is important to understand that pregnancy during older ages will have increased risk of complications. Some of these include :
- Multiple pregnancies (especially with IVF), which can result in early birth, low birth weight, and difficult delivery
- Higher chance of gestational diabetes and gestational hypertension
- Placenta previa, which may require bed rest, medications, or caesarean delivery
- Miscarriage or stillbirth
- Caesarean birth
- Premature or low birth weight.
Regardless, with close monitoring and quality healthcare, such risks can be safely managed, helping even menopausal women to fulfil long-held dreams of having a baby .
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