Pregnancy During Menopause Transition: What to Know

The average age for menopause in the United States is 51 to 52, with perimenopause—the transitional period leading up to menopause—often beginning in a woman's 40s. This phase can still allow for natural conception, though the probability significantly decreases with age.

Actress Hilary Swank announced her third pregnancy at 52, joining a growing number of women who conceive during perimenopause. In 2017, the National Center for Health Statistics reported 840 births to women aged 50 and older, a rate of 0.8 per 1,000 women in that age group. While natural pregnancy is possible if ovulation occurs, even sporadically, the risk of early pregnancy loss increases due to a decline in egg quality.

Dr. Natasha Spencer, an obstetrician gynecologist at Orlando Health Physician Associates, explained that while pregnancy during perimenopause is possible, it carries risks. "If a woman is experiencing ovulation/cycling, although irregularly and/or sporadic, it is always possible to achieve pregnancy naturally — however, with a lower probability," Spencer stated. She also noted that older women face a higher rate of early pregnancy loss, both trisomic and euploid, primarily attributed to decreased egg quality. Changes in uterine and hormonal function further contribute to pregnancy loss, with many occurring between six and 14 weeks of gestation.

Assisted reproductive technologies, such as in vitro fertilization (IVF), can offer more opportunities for pregnancy for older women. However, factors like female age, the specific diagnosis of infertility, and previous reproductive or obstetric history can affect success rates. Pregnancy in older women is associated with increased risks for both mother and child, including early pregnancy loss, ectopic pregnancies, placenta previa, prolonged labor, and severe maternal morbidity. Fetal and neonatal risks can include chromosomal abnormalities, congenital malformations, low birth weight, preterm births, and perinatal mortality.

Once menopause is complete, defined as 12 consecutive months without a menstrual cycle and accompanied by symptoms like hot flashes, pregnancy is no longer possible as the ovaries no longer contain eggs. However, women in perimenopause or even early menopause can still carry a child through assisted reproductive technologies using egg donors or previously created embryos.

Despite the risks, Spencer noted that many older women experience positive pregnancy outcomes and are well-equipped to handle the physical and emotional demands of pregnancy and parenting. Additionally, increasing maternal age has been linked to improved health and development outcomes for young children.