Pregnancy still possible during perimenopause

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Dear Doctors: I’m 48 years old and in perimenopause. I’ve missed a few periods and joked with my doctor about being pregnant. She said not to laugh -- it can happen. Considering my age, I was really surprised. What happens with your body in perimenopause? Do I need to keep using birth control?

Dear Reader: The term “perimenopause” refers to the physical changes that take place as your reproductive years draw to a close. They begin to occur as the ovaries start the gradual process of ceasing to produce estrogen, one of the reproductive hormones. How long this transition takes can vary greatly. For many women, it lasts from three to four years. But for some, it can be as brief as a few months or as long as a decade.

While perimenopause commonly begins when a woman is in her mid-to-late 40s, it can happen earlier in life. Genes play a significant role in the age at which this transition begins. When someone has gone a full year without a menstrual cycle, she is considered to be in menopause.

The most common physical symptom of perimenopause, and often among the first, is a change to the monthly rhythms of the menstrual cycle. This includes the length and intensity of each period and the frequency with which they occur. Some women begin to experience hot flashes and night sweats. These can cause discomfort during the day and may interfere with sleep at night. As estrogen ebbs, physical changes to vaginal tissues can make intimacy painful. They can also increase susceptibility to urinary tract infections. Thinning of the tissues in the pelvic floor may lead to urinary incontinence.

Perimenopause can affect not only the body, but the emotions as well. Some women experience changes to mood and have an increased risk of depression.

When someone enters perimenopause, it’s helpful for them to talk to their doctor or gynecologist about what is going on. Depending on the specific symptoms, their medical care provider can offer options to ease or manage them. These can include hormone-replacement therapy, vaginal estrogen or antidepressants. Gabapentin, a medication approved to treat seizures, has been shown to ease hot flashes. Each of these has risks and benefits, so be sure to ask for a detailed explanation of any medication or treatment that you are offered.

As for pregnancy at your age, it isn’t common, but your doctor is correct that it is possible. The changes in blood levels of estrogen that are occurring also affect progesterone, another reproductive hormone. Estrogen and progesterone work together to regulate the cycles of ovulation. During perimenopause, blood levels of these hormones can both recede and also surge. This leads not only to irregular periods, but also to unpredictable ovulation cycles.

Throughout this time, the ovaries are continuing to release eggs. That means that even though someone is older and experiencing symptoms associated with menopause, they are still fertile. If you want to be absolutely sure that you don’t become pregnant, continue to use birth control until you've gone without a period for one year.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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