Fertility and the menopause

In a natural menopause, fertility does not stop completely overnight. So, whether you’re trying for a baby, or want to know when you can stop using contraception, it’s important to equip yourself with the right knowledge.

Fertility levels decline as we get older

Fertility issues can happen at any time in a woman’s life. But for most of us, our fertility starts to decline around the time we turn 30, decreasing more significantly over the age of 35.

In your 40s, the time when most women will start to go through the perimenopause, fertility drops again, but the chance of pregnancy is not zero – so you still need to use contraception if you don’t want to get pregnant.

In your 50s, fertility continues to decrease further. If your periods stop naturally over the age of 50 for 12 consecutive months (i.e. not because you are taking hormones) you are through the menopause and you can stop using contraception. At the age of 55, you can stop using contraception even if you’re still bleeding. If you are over 50 and are not bleeding because you are using hormone contraception (like the progesterone-only ‘mini pill’ or the Mirena^TM intrauterine system), an FSH (follicle-stimulating hormone) blood test can be helpful in helping you work out when to stop using contraception. Speak to a doctor to arrange this and for advice on how to interpret the results.

The chance of getting pregnant decreases the older you get:

• Age 40-44 – if you don’t use contraception for a year and have regular sex, up to 20% of women will become pregnant
• Age 45-50 – the chances are more like 10%
• Over 50 – the chance of pregnancy is significantly lower
• Over the age of 55 – the chance of pregnancy is low enough for all women to stop using contraception.

Trying for a baby during perimenopause

If you’re trying to get pregnant during the perimenopause, you should take folic acid and speak to your doctor about a referral to a fertility clinic. There are a few tests that your GP may do before they refer you.

You may have heard about a blood test offered by fertility clinics called Anti Mullerian Hormone (AMH), which is available privately. This isn’t a perfect blood test for predicting egg reserve (how many eggs you have left) or fertility.

If you decide to take this test, we recommend getting an infertility specialist to explain it to you and make sure you understand what the results are – and aren’t – telling you.

Advice for conceiving

When you’re trying to become pregnant, there are some basic steps you can take to boost your chances^[1]:

• Have sex – every 2-3 days
• Reduce stress where you can – think meditation, mindfulness, and exercise
• Stop smoking – this can reduce fertility in women
• Reduce alcohol – no more than 1-2 units, once or twice a week
• Think about weight – It can take longer to get pregnant if your BMI is above 30 or below 19.

Fertility and medical or surgical menopause

If you’re about to have a medical or surgical treatment that will cause you to become menopausal, perhaps to treat or prevent cancer or another medical condition, make sure you’ve been given information about the likely effect on your fertility and the menopause.

If you haven’t, speak to your specialist to get more information and, where appropriate, a referral to a fertility or menopause specialist.

Fertility and POI

Around 1% of women go through the menopause under the age of 40, which is known as premature ovarian insufficiency, or POI.

If this is the case for you, and you want to have a baby, you should ask for a referral to a specialist fertility clinic where advice and support can be provided.

Some women with POI do conceive naturally, as there is a small chance that the ovaries will start working again, particularly if no cause of their premature menopause has been found.