Menopause & Fertility
- Menopause is defined as the absence of menstrual periods for 12 months; the average age that a woman reaches menopause is 51.
- Menopause does not happen instantly but is instead a gradual process of changes to a woman’s body called perimenopause; a woman can still get pregnant during perimenopause.
- A woman’s fertility peaks between 20 and 24 years old and remains consistent with a 15-20 percent monthly chance of pregnancy until she turns 35; fertility diminishes by 50-95 percent in women ages 40-45.
What is menopause?
Menopause is the absence of menstrual periods for 12 months or more. In the four to five years prior to menopause, there is more variability in estrogen levels. This can result in mood swings, hot flashes and other symptoms during a time called perimenopause.
At about the age of 51, the menstruation cycle ceases. At menopause, a woman cannot get pregnant without the use of assisted reproductive technology and donor eggs.
Menopause & infertility
A woman is born with one to two million eggs, which are stored in the ovaries. The ovaries produce hormones (estrogen and progesterone), which control menstruation and ovulation. Over time, the number of eggs decreases, and the quality of the remaining eggs also decreases, resulting in a decline in fertility.
Menopause is therefore defined as the time when ovaries no longer release eggs and menstruation ceases.
Perimenopause and menopause are a normal part of aging after age 40. However, some women can go through early onset or premature menopause as a result of surgery (hysterectomy), damage to the ovaries, genetics or medical treatments such as chemotherapy and radiation.
Pregnancy during perimenopause
The average length of perimenopause is four years and ends when a woman enters into menopause. It is possible to get pregnant during the premenopausal transition, but age and fluctuating hormones make it difficult to get pregnant naturally. Despite the reduction of fertility, pregnancy is still possible until menopause is confirmed.
Fertility testing for advanced age women
As the number of eggs declines, so does egg equality. This is the main reason for the reduction in fertility associated with aging.
In addition to a review of medical history and physical exam, tests to determine ovarian reserve, uterine and fallopian tube function and hormone levels may be administered.
There is no way to predict when a woman will have menopause or begin having symptoms, as each woman’s experience is different. Common symptoms include irregular vaginal bleeding, hot flashes, night sweats and vaginal dryness.
Women may also experience emotional symptoms such as memory problems, mood changes, fatigue and irritability.
As noted, infertility is also a symptom of menopause, which could be the primary cause of infertility in older age women.
Treatment of menopause
While menopause is a normal biological occurrence, many women may benefit from treatment. Hormonal therapy may be used to control symptoms such as hot flashes and vaginal dryness, and may have other benefits. The decision to use hormone treatment in menopause is complicated, and should be discussed with your physician.
Fertility options for menopausal women
During perimenopause, fertility treatments like IVF may be able to help a woman achieve pregnancy, but due to poor quality eggs as a result of the woman’s age, egg donation may still be recommended to produce healthy embryos.