Monday, November 15, 2010

42 Year Old UK Woman With Irregular Periods, Hot Flashes: Is She Perimenopausal? Can She Still Get Pregnant?


I am 42 years old and have had irregular periods for about the last 10 months, also hot flushes, etc. I have had blood tests at my doctors which showed I have started early menopause. How do I know if I am still producing any eggs and if so could I become pregnant? Is there anything I could do to help in getting pregnant or is this not going to be possible? Thank you, S. from the U.K.


Hi S. from the U.K.,

The term "early menopause" is actually a misnomer. There is no way to tell if a woman is entering menopause until it actually happens. That is to say, a woman can be in the perimenopausal period, diagnosed by changes such as irregular cycles, mood changes, hot flashes, insomnia, etc., for years (5-10 yrs) before she actually goes into the menopause. During the peri-menopausal period, the ovary is starting to dysfunction as it leads into menopause, where it shuts down. During this "perimenopausal period" the ovary still ovulates, but often in an irregular fashion. Therefore, pregnancy can still occur. However, the chances are low, and some of the times that you ovulate, and egg is not given off i.e. the follicle is empty.

Some doctors will define "perimenopause" if the cycle day #2 FSH level is greater than 10 (between 10-20), but this actually is a measure of ovarian reserve and does not tell you if menopause is coming soon or not.

The biggest problem, however, is if the ovary is dysfunctioning, the hormones are out of balance and so, the steps following ovulation sometimes are out of synchrony so that pregnancy does not occur, and due to age, the ovulated eggs are often of very poor quality such that fertilization does not occur, or an abnormal embryo is formed that does not go to implantation or that the abnormal embryo leads to miscarriage. For these and other reasons, the chances of a successful pregnancy decline.

If you are contemplating pregnancy at this point, and have not entered menopause, then you have to worry that time is not on your side. That is to say, your time is short to achieve the pregnancy. Therefore, you need to proceed aggressively and with haste. For that reason, I recommend to my patients to do IVF. It has the highest chances of getting you pregnant in the shortest period of time. Trying by natural means, simple intercourse, ovulation induction with intercourse or IUI, will take much time, and you may lose your window of opportunity to use your own eggs.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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