Perimenopause and Fertility - Ellen Dolgen

Perimenopause and Fertility

As we approach spring and Easter, most people begin to focus on eggs. Specifically, the kind you can paint, decorate, and put in a cute basket. Instead, my thoughts drift off to how perimenopause can affect your egg production and fertility!

Perimenopause is the 2-10 years before you reach menopause. During this time, a woman’s body is transitioning to menopause which marks the end of her reproductive years. You reach menopause when you have been without a period for one solid year. The average age of menopause is 51.

It is essential to understand that fertility declines as women enter perimenopause and their ovaries gradually stop working. This decline takes place much sooner than most women expect.

Perimenopause comes hand in hand with waning fertility. Our menstrual cycles usually remain regular until our late 30s to early ’40s. That is when our perimenopause journey begins. During perimenopause, the period becomes quite the drama queen. She may come and go irregularly, and/or you may experience a shorter cycle or a missed period. I must caution you not to get overly excited the first time your period goes missing and immediately toss your tampons in the garbage and let the pads with wings fly out the window. The period can leave for months and then suddenly return while wearing your favorite white cotton dress! Be sure to know that once you do bleed, you must start the menopausal clock over. Remember, you reach menopause when you have been without a period for 12 consecutive months.

According to the American Society of Reproductive Medicine, “A woman’s best reproductive years are in her 20s. Fertility gradually declines in the 30s, particularly after age 35. Each month that she tries, a healthy, fertile 30-year-old woman has a 20% chance of getting pregnant. That means that for every 100 fertile 30-year-old women trying to get pregnant in 1 cycle, 20 will be successful, and the other 80 will have to try again. By age 40, a woman’s chance is less than 5% per cycle, so fewer than 5 out of every 100 women are expected to be successful each month.”

 To take charge of your fertility and family planning, I reached out to David B. Smotrich, M.D., a Diplomate of the American Board of Obstetrics and Gynecology specializing in Reproductive Endocrinology and Fertility for some tips.

Dr. Smotrich explained that while it’s easiest for women to become pregnant before age 35, all egg-laying ovaries are not created equal. He says that in our early 30s, our eggs can decline in quality, and we might begin ovulating less frequently, even if we have regular periods. That’s where some newfangled fertility tests come in.

If you plan to have a baby in the great “someday,” Smotrich recommends treating yourself to a baseline exam or two for your 30th birthday. Follow-up with yearly tests until age 35, semi-annual tests until 39, and quarterly tests after that to monitor your fertility.

He did mention that during perimenopause, it is possible to conceive a healthy baby while transitioning to menopause. Good to know!

Dr. Smotrich shared these tests that can help determine where you are in your fertility & menopausal journey:

  • Follicle-Stimulating Hormone (FSH) Test–  Follicle-stimulating hormone (FSH) levels are sometimes measured to confirm menopause. This test also determines a woman’s likelihood of conceiving a child. The test is generally repeated over several months to account for fluctuations in hormone levels that may be occurring. After several tests, if a woman’s FSH blood level is consistently elevated to 30 mIU/mL or higher and she has not had a menstrual period for a year, it is generally accepted that she has reached menopause. Some doctors prefer to test the anti-Mullerian hormone (AMH) levels instead. The AMH levels decrease in perimenopause. Fertility doctors have used this test for years because birth control pills do not affect the levels.
  • 25-Hydroxy Vitamin D Test  – A blood test that determines if your body is deficient in calcitriol, your body’s main form of stored vitamin D. Calcitriol levels generally decline with age, and deficiencies can predispose your baby to health complications, according to Smotrich.
  • Estradiol Test – This is the main type of estrogen produced in the body, secreted by the ovaries. Low levels can cause memory lapses, anxiety, depression, uncontrollable bursts of anger, sleeplessness, night sweats, and more.
  • Anti-Mullerian Hormone (AMH) Test – A blood test that estimates the number of eggs in the ovaries.

If you are more in the grandma stage of life than the mom stage, please share this information with the young women in your life who are in their mid-30s.

My motto:  Suffering in silence is OUT!  Reaching out is IN.

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* does not recommend, endorse, or make any representation about any tests, studies, practices, procedures, treatments, services, opinions, healthcare providers, physicians, or medical institutions that may be mentioned or referenced.





2 thoughts on “Perimenopause and Fertility”

  1. Ronnie Piracci

    Ellen, As usual. Your blog was informative and gave me insight into the cycle of egg production .
    Have a Happy and Healthy Happy Holiday

    1. Thank you, Ronnie. I am so happy that you found the information helpful. So many women are unaware that perimenopause usually begins in your 40s and can affect fertility. Dr. Smotrich was so sweet to explain how women can take control of their fertility by asking for these blood tests. Please share this with the sisterhood so we can empower women to ask for what they need so that they can be in control of their family planning.

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