What is perimenopause?
Perimenopause, also referred to as menopause transition, marks the stage of life when your body begins the transition toward menopause. This transitional phase, which may begin as early as your mid-30s or as late as the mid-50s, signals the end of your reproductive years and can last anywhere from 4 to 8 years.
During this time, your ovaries start to make fewer hormones like estrogen, causing your menstrual cycle to become more irregular. You may also experience shorter menstrual cycles, releasing eggs less regularly, and declining fertility. In the last couple years of perimenopause, the decrease in estrogen may speed up, causing many women to experience symptoms such as hot flashes, mood changes, or sleep disturbances.
Once you reach 12 consecutive months without menstruating, you are considered to be out of perimenopause and into menopause, which is when your ovaries stop releasing eggs.
Symptoms of perimenopause
As you enter perimenopause, you may start to notice some changes in your body. Some signs and symptoms of perimenopause include:
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Hot flashes and night sweats:
Although hot flashes and night sweats occur more commonly during menopause, many women also experience these symptoms during perimenopause. In fact, around 35-50% of women during perimenopause may experience these sudden waves of heat and sweating for up to 10 minutes at a time. Hot flashes can range in severity from a mild feeling of warmth to an intense and sudden flare of heat.
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Mood changes:
While some perimenopausal women go through this transition phase without experiencing any mood disorders, others may be more vulnerable to mood swings, irritability, depression, and anxiety.
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Sleep problems:
It is estimated that 40-60% of perimenopausal women have sleep disturbances. Some studies have shown that the most commonly reported sleep-related complaints are waking up at night and having difficulty staying asleep. However, more research is needed to determine whether this disruption is attributed to night sweats, hormone fluctuations, natural aging, or other factors. Treating the underlying causes of these sleep disturbances can help to improve quality of life.
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Bone loss:
You might also start to lose bone mass during perimenopause. Perimenopausal women are especially vulnerable to bone loss in the years just before and for several years after menopause. A 2008 research study showed that while bone mineral density remained relatively stable before and during the early perimenopausal period, there was dramatic acceleration of bone loss in the late perimenopausal period. Specifically, there was a 1.8-2.3% and 1.0-1.4% annual rate of bone loss in the spine and hip regions, respectively.
The same research study also found that bone loss during the late perimenopausal and postmenopausal stages was 35-55% slower for women in the top tertile of body weight as compared to the lowest tertile. This means that if you have relatively low body weight upon entering the late stages of perimenopause, you may want to have your healthcare provider screen you for osteoporosis.
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Irregular periods:
The length of time between menstrual cycles as well as the amount of period flow can become increasingly unpredictable during perimenopause. If you start to notice a persistent change of 7 or more days in the length of your menstrual cycle, then you could be at the start of perimenopause. For example, if your menstrual cycle is normally 28 days, then a sign that you are at the beginning of perimenopause is your period persistently coming as early as 21 days or as late as 35 days. Furthermore, once you can count 60 days or more between menstrual cycles, then it could be likely that you are nearing late perimenopause and entering menopause.
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Vaginal dryness:
Decreasing levels of estrogen can lead to thinner and drier vaginal tissue, resulting in itching, irritation, or burning sensations. Vaginal tissue can also become less lubricated and have less elasticity during perimenopause which can make intercourse more painful.
Can you get pregnant during perimenopause?
Yes, it is possible to get pregnant during perimenopause. Despite the inevitable decline in fertility, as long as you are still getting your period, it is possible to get pregnant up until you have officially reached menopause.
Though it may be more challenging to conceive naturally due to declining egg quality, lower ovulation frequency, advanced age, and increased hormone fluctuations. Ovulation trackers such as the Eveline Digital Ovulation Test can assist you in navigating your fertility journey by pinpointing your fertile window and identifying when you’re ovulating with high accuracy, improving your chances of getting pregnant during perimenopause.
Risks of getting pregnant during perimenopause
While it is possible to get pregnant during perimenopause, one should still assess possible pregnancy risks associated with advanced maternal age:
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Miscarriage:
Women older than age 35 are at higher risk of miscarriage as compared to younger women. At age 40, a woman’s risk of miscarriage is around 40%. The increase in miscarriage risk can stem from declining egg quality and chromosomal abnormalities in the embryo.
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Premature birth:
Another common complication for women who give birth over the age of 40 is increased risk of premature birth. Also referred to as preterm birth, premature birth is defined as a baby being born before 37 weeks of pregnancy.
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Complications during pregnancy:
Older expectant mothers have a higher risk of developing conditions like gestational diabetes, gestational high blood pressure, and other pregnancy challenges including cesarean delivery complications. Preeclampsia, which is characterized by high blood pressure and high levels of protein in the urine at around 20 weeks of pregnancy, is another medical complication associated with pregnancy at an older age. In fact, mothers aged 40 or older are almost two times as likely to develop preeclampsia as women under 30 years of age.
Takeaway
It’s a well-known fact that fertility declines with age. Once you enter perimenopause and near the end of your reproductive years, it becomes less likely that you will have a naturally smooth and successful pregnancy. However, as long as you are getting your period—however infrequent or irregular—you can still get pregnant during perimenopause.
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This article is for informational purposes only and is not meant to offer medical advice.
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References
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Baker FC, Lampio L, Saaresranta T, Polo-Kantola P. Sleep and Sleep Disorders in the Menopausal Transition. Sleep Med Clin. 2018 Sep;13(3):443-456. doi: 10.1016/j.jsmc.2018.04.011. PMID: 30098758; PMCID: PMC6092036.
Joel S. Finkelstein, Sarah E. Brockwell, Vinay Mehta, Gail A. Greendale, MaryFran R. Sowers, Bruce Ettinger, Joan C. Lo, Janet M. Johnston, Jane A. Cauley, Michelle E. Danielson, Robert M. Neer, Bone Mineral Density Changes during the Menopause Transition in a Multiethnic Cohort of Women, The Journal of Clinical Endocrinology & Metabolism, Volume 93, Issue 3, 1 March 2008, Pages 861–868, https://doi.org/10.1210/jc.2007-1876
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Perimenopause. (2022). https://www.webmd.com/menopause/guide/guide-perimenopause
Miscarriage. (2021). https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298
Dietl A, Cupisti S, Beckmann MW, Schwab M, Zollner U. Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age. Geburtshilfe Frauenheilkd. 2015 Aug;75(8):827-832. doi: 10.1055/s-0035-1546109. PMID: 26366002; PMCID: PMC4554509.
Grandi G, Di Vinci P, Sgandurra A, Feliciello L, Monari F, Facchinetti F. Contraception During Perimenopause: Practical Guidance. Int J Womens Health. 2022 Jul 15;14:913-929. doi: 10.2147/IJWH.S288070. PMID: 35866143; PMCID: PMC9296102.
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