For many of us, menopause can feel scary to think about. We're told it's lurking around the corner, that our bodies and hormones will change — but what does that actually mean?
There are a lot of myths and misinformation to sift through regarding menopause [1]. Whether you're currently going through it, or want to learn what to expect, it can be challenging to figure out where to go for answers.
Knowing more about how menopause works, as well as how and when it affects your fertility can help you plan for the future.
In this article, we'll tackle one of the most frequently asked questions when it comes to menopause: Can you still get pregnant? We'll also explore how you can manage the symptoms, and where to go for advice.
What is menopause?
Menopause happens when ovarian function declines and reproductive hormones cease working as they used to [2]. It's a natural part of ageing, but can also be brought on by surgery, chemotherapy, or radiation.
Menopause is a complex process that happens differently for everyone — no two people will experience symptoms in the same way.
In Australia, most women have reached menopause by the age of 51, but start going through changes about 4-8 years prior [3].
Usually, a woman's last period will happen between the ages of 40-58 years old. Early and premature menopause can also occur— if you're 40 years old or younger, it's classed as premature, and before 45 years is considered early [4].
When there hasn't been a menstrual period for 12 months or more (and other causes have been ruled out by a doctor), menopause can be officially diagnosed.
Menopause is really individual. Things like social changes, stress levels, environmental factors, overall health, or preexisting conditions can all have an impact on experiences of menopause.
So, what should you expect? And what if menopause feels more like it's time to take a pregnancy test?
The symptoms of pregnancy versus menopause
It's true that when you're approaching menopause, many of the symptoms could be confused with signs of pregnancy [5]. During the menopausal transition, symptoms can include:
- Change in menstrual periods
- Difficulty sleeping
- Mood changes
- Joint pains and body aches
- Tiredness
- Hot flashes (or night sweats)
- Vaginal dryness
- Sore or tender breasts
- Changes to sex drive
- Bladder changes — feeling like you need to urinate more often, can't hold on, or your bladder feels irritable/full.
According to the Royal Australian College of General Practitioners (RACGP), the first signs of pregnancy usually include [6]:
- Change in menstrual cycle/loss of period
- Breast tenderness
- Nausea and vomiting
- Tiredness
- Mood swings
- Urinating more frequently
Looking at these lists visually (who doesn't love a Venn diagram?), there's a fair amount of overlap between pregnancy and menopausal symptoms.
But what does that mean for sexually active people as they approach menopause? How do you tell which one it is?
Can I get pregnant during menopause?
The short answer is yes, it's definitely possible to fall pregnant naturally during menopause.
Even though fertility is lower than it would've been earlier in life, women can still get pregnant if they're sexually active (in a heterosexual relationship) and not using any form of birth control or contraception.
Even if your period is slowing down, has become irregular, or has recently finished, it's recommended that if you're trying to avoid pregnancy you should discuss your contraceptive options with your doctor.
Remember, for menopause to be diagnosed your period needs to have been absent for at least 12 months. Some doctors say for women under 50 years old, your menstrual cycle needs to have stopped for 24 months.
Some types of contraception aren't suitable for people over the age of 50 (or those at risk of cardiovascular disease or thrombosis), so it's important to get the right advice.
It's also important to note that hormone therapy used to manage menopausal symptoms is not a form of contraception.
If you're in doubt about the symptoms you're experiencing or not sure if you could be pregnant, it's always best to chat with your GP.
How likely is it to get pregnant during menopause?
Getting pregnant during menopause isn't super likely, but it's not impossible.
After the age of 35, fertility starts to decline, and according to a recent study, less than 1 in 100 women conceive naturally over the age of 50 [7].
Women with a family history of late menopause, or those with family members who didn't have many symptoms when they went through it, might want to be a little more cautious if they're avoiding pregnancy.
If you think you've started menopause already (or it's on its way) and you want to get pregnant, you can find out more about your options by taking a fertility test.
What is perimenopause?
Now that we've established the facts about menopause, it's time to look at the other part of the puzzle: Perimenopause.
Sometimes the terms menopause and perimenopause are used interchangeably, but they refer to two different processes in the body.
Perimenopause is the period of time just before and after menopause — basically the transitional phase [8].
The average age it occurs is usually between the ages of 40-55 years old, and most studies suggest that this transition takes an average of 3.8 years to be complete [9].
Perimenopause is when the symptoms we mentioned above start to pop up. It's also when some women might start looking into treatment options, or have questions about their fertility.
Can you get pregnant during perimenopause?
Just like with menopause, it's absolutely possible to get pregnant during perimenopause. Even though the risk of pregnancy isn't as high as it would be for premenopausal women, it can still happen!
In fact, some studies suggest that women going through perimenopause experience unplanned pregnancies at similar rates to younger women.
Even people who have irregular periods, or who have unpredictable ovulation cycles can still fall pregnant.
For heterosexual women, this depends on sexual activity, where your ovulation is at, contraception, and the fertility of the male partner.
Natural pregnancies have been reported in women up to the age of 59 years old but can be associated with more health risks — for both the pregnant woman and the baby.
What are the risks involved with pregnancy later in life?
Becoming pregnant after the age of 35 can lead to an increased risk of complications and/or developing other health conditions.
Research shows that women over 35 are more at risk of things like gestational diabetes, heart problems, high blood pressure and hypertension. There are also higher chances of miscarriage and ectopic pregnancies.
For the baby, pregnancy during these stages can mean a higher risk of chromosomal abnormalities or genetic disorders, low birth weight and premature birth.
All of this is dependent on the individual and their health history — it's not necessarily impossible to have a healthy pregnancy later in life.
If you're planning a pregnancy, getting advice from your GP or fertility specialist can help you discuss your options. That way you can make an informed choice about what's best for you and your body.
Can you get pregnant after menopause?
A lot of the stuff we read in the media portrays menopause as the absolute end of our reproductive years, but this isn't always the case.
According to this study, postmenopausal women can still carry a pregnancy to term. The chances of natural conception are much lower though, and there are risks involved — as we explored above.
For anyone wanting to become pregnant after menopause, there are options available. This could mean looking into fertility treatments such as in vitro fertilisation (IVF) which might involve using frozen donor eggs.
A thorough health screen and hormonal support might also be required. If this is something you're considering, make sure you have a trusted health professional you can discuss the risks and processes with.
Managing menopause
Managing perimenopause and menopause sounds daunting, but it doesn't have to be. Some aspects might even be easily managed with small lifestyle changes.
If you're dealing with hot flashes, avoiding warm environments, hot food or drinks and trying to minimise stress might help. There's also evidence to suggest that practising mindfulness can also help [10].
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