“Geriatric pregnancy.” “Advanced maternal age.” The terms may not be flattering, but women who have babies later in life hardly carry the stigma they did only a couple of decades ago.
Generally speaking, “advanced maternal age” refers to anyone who becomes pregnant at the age of 35 or older. It’s also during this time that many women begin to experience symptoms of perimenopause, the transitional period leading up to menopause. Although perimenopause tends to start in a woman’s 40s, it can occur as early as their mid-30s.
Unfortunately, perimenopause can be tricky to nail down, because its symptoms and timeline vary by individual. What punctuates this transition is your ovaries will begin producing fewer hormones, which in turn causes your menstrual cycle to become irregular. It can last anywhere from four to eight years — or just a short time. Some additional common symptoms include insomnia, mood changes, hot flashes, heavier or lighter periods, and vaginal dryness.
With all of these hormonal changes coursing through your body, you’d think hitting perimenopause means pregnancy is no longer an option, right?
Not true! Remember, perimenopause doesn’t equal menopause. Even though it may not happen as often, you’re still ovulating. This means you can get pregnant during perimenopause. But there are several important factors to consider before trying to conceive. Rescripted spoke with Anushka Chelliah, M.D., a board-certified maternal-fetal medicine specialist at Pediatrix Medical Group in Houston, Texas, who explained the risks and the possibilities of a perimenopausal pregnancy.
Pregnancy during perimenopause: Is it possible?
Yes, but with some caveats.“ The possibility of pregnancy [during perimenopause] is reduced and is widely dependent on whether there is regular ovulation,” says Dr. Chelliah. “During perimenopause, or in women of advanced maternal age particularly after 40 years old, ovarian reserve decreases and ovulatory cycles may not be as frequent,” she explains. Therefore, the likelihood of pregnancy drops significantly. “In those who are truly in the perimenopausal phase, ovulation may still occur in about 20-23% of women.”
Dr. Chelliah goes on to say that typically, the chances of getting pregnant do decrease “as maternal age advances.” Although 41 is the median age women “lose their natural fertility,” she acknowledges that “this can range up to 51 in some populations.”
How to increase your chances of pregnancy if you’re in perimenopause
From a natural standpoint, Dr. Chellia recommends ovulation testing and timed intercourse if you’re TTC and you’re perimenopausal. But if you’re unsuccessful after six months, then she suggests visiting your health provider for a fertility evaluation (for both partners). It’s also important to take fertility risk factors like “prior pelvic surgery involving ovaries, endometriosis, pelvic infections, chemotherapy, chronic medical conditions or known male factor infertility” into consideration immediately. If you think you need to be evaluated for these conditions, the sooner the better.
Pregnancy risks throughout perimenopause
Any risks during a perimenopausal pregnancy “are largely dependent on maternal age and preexisting medical history,” rather than perimenopause itself, says Dr. Chelliah. “Pregnancy after 35 years of age is associated with an increased risk of fetal chromosomal anomalies, in particular aneuploidy or an abnormal number of chromosomes. This is associated with a higher risk of diseases such as Trisomy 21 [Down syndrome], Trisomy 18 [Edwards syndrome], and Trisomy 13 [Patau syndrome].”
In terms of potential risks to the mother, Dr. Chelliah says these are primarily related to any “underlying medical complications that exist at the time of conception,” this includes obesity, hypertension, diabetes, and cardiac disease.
She also points out that there can be an increased risk of miscarriage, growth disorders, stillbirth, Cesarean section, preeclampsia, and pregnancy-related hypertension and diabetes, “particularly after the age of 40.”
Medical recommendations in pregnancy for perimenopausal women
If you are pregnant while in perimenopause, your healthcare team will want to monitor you more often due to the risks involved with your age. “We recommend close surveillance with your doctor or provider, careful evaluation of past medical history, and optimization of medical conditions such as diabetes or hypertension,” says Dr. Chelliah. She also advises early genetic screening and a first-trimester ultrasound “due to the increased risks of chromosomal anomalies.” Additional recommended testing includes a detailed anatomy ultrasound of the fetus in the second trimester. Depending on the patient’s medical history and age, consideration for fetal growth and ultrasound surveillance with antenatal testing will also take place in the third trimester.
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So, is it worth TTC during perimenopause?
“Many women are becoming pregnant later in life now more than ever before,” observes Dr. Chelliah. Thanks to the numerous breakthroughs in reproductive medicine, perimenopausal women have far more options “available to optimize [their] health and [their] chances at a healthy pregnancy” than ever before. Above all, if you want to try for a baby and you’re in perimenopause, the best course of action is an open conversation with your healthcare provider. “Talk to your doctor about this and use the resources available, both before, during, and after pregnancy, for the best chances of good maternal and neonatal outcomes,” advises Dr. Chelliah.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.