Fertility During Perimenopause: Can You Still Get Pregnant in Your 40s? [EP 82]
The perimenopause conversation is everywhere right now, especially if you’re in your late 30s or early 40s. Changes in sleep, cycles, body composition, mood, hair, and fertility can quickly get labeled as “perimenopause.” But while perimenopause is very real, it shouldn’t automatically become the explanation for every symptom you experience during these years.
In this episode, we’re taking a closer look at what actually happens to fertility during perimenopause, how to tell when symptoms may be coming from something else, and what you can still do to support fertility in your late 30s and 40s. Your age matters, but it is only one piece of the fertility picture.
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“Fear is not a fertility plan. Information is.”
What You’ll Learn:
What perimenopause actually is and how it can affect ovulation and fertility
Why perimenopause should not automatically explain every symptom in your late 30s and early 40s
How thyroid function, iron status, blood sugar, stress, gut health, inflammation, and nutrient status can overlap with perimenopause symptoms
Why fertility is still possible during perimenopause when ovulation is occurring
What your menstrual cycle and ovulation patterns can tell you about your fertility
Why there is no single blood test that can definitively diagnose perimenopause
Which labs and fertility markers may provide a more complete picture
How metabolic health, nutrition, sleep, and circadian rhythm can support fertility
Why both partners need to be included in the fertility evaluation
What to prioritize if you’re trying to conceive in your late 30s or early 40s
“A changing cycle is information. It gives us somewhere to start looking.”
Blood Work and Fertility Markers Mentioned:
Thyroid panel, including TSH, free T4, free T3, and thyroid antibodies
Ferritin and a full iron panel
Vitamin D
Vitamin B12
Folate
Fasting glucose
Fasting insulin
Hemoglobin A1C
hs-CRP
Homocysteine
Reproductive hormone testing when appropriate
Ovarian reserve markers
Semen analysis and comprehensive male fertility evaluation
Links Mentioned:
Get my FREE Fertility Meal Plan
“You deserve more than a label. You deserve answers and a plan.”
Transcript:
The perimenopause conversation is hot right now. And if you are in your late 30s, early 40s, it can feel like it is everywhere.
Maybe your sleep has changed — must be perimenopause. Your cycle's a little bit different — perimenopause. You gained weight around your middle — must be perimenopause. Maybe your hair is thinning, you're anxious, you're having a harder time getting pregnant. Well, you're probably in perimenopause.
And as someone who works with women trying to get pregnant during these exact years, this is a conversation I think we have to have.
Because yes, perimenopause is very real. And yes, hormonal changes happen as we move toward menopause. And yes, those changes can affect fertility.
But I am also seeing perimenopause become a catch-all explanation for almost every symptom a woman experiences in her late 30s and early 40s. And that concerns me.
Because if your thyroid or your iron status, maybe your blood sugar, stress physiology, your gut health, inflammation, nutrient status, and whether or not you're actually ovulating can create some of the same symptoms, why would we immediately assume that perimenopause is the answer?
Especially if you're trying to get pregnant.
Because once we attach a label to something, there is a tendency to stop looking. And this is where I want to change the conversation.
Today, we're going to talk about what perimenopause actually is, what happens to fertility during this transition, how you can tell whether your symptoms might be coming from something else, and most importantly, whether you can still improve your fertility and get pregnant during this phase of life.
What Is Perimenopause?
Let's start with the basics. What actually is perimenopause?
Perimenopause is a transition leading up to menopause, and it can last several years, even up to a decade.
And during this time, ovarian function becomes less predictable.
One of the earlier changes we often see is less consistent ovulation or even weaker ovulation. And when ovulation becomes less consistent, progesterone decreases because progesterone is primarily produced after ovulation of a good quality egg.
At the same time, estrogen does not necessarily just slowly decline in a nice straight line. It fluctuates like a roller coaster.
Substantially.
You can have periods where estrogen exposure is high and other times when it's low. And eventually you can move closer to menopause.
Menopause itself is a very specific definition. You have reached menopause when you have gone 12 consecutive months without a menstrual period, assuming there isn't another explanation for the missing period.
The average age of natural menopause is 51. So being 38, 48, or 42 does not automatically mean you are perimenopausal.
And it definitely does not mean that you cannot get pregnant.
Perimenopause can absolutely come with symptoms. Cycles can become shorter, longer, or more irregular. Periods can become heavier or lighter. You may experience hot flashes or night sweats. Sleep can change, mood can change.
You may notice more brain fog, changes in body composition, thinning hair, joint discomfort, heart palpitations, or changes in libido.
And these symptoms are very real. They are from the actual transition of your ovaries aging and those hormones shifting.
I don't want this episode to sound like I'm dismissing perimenopause or saying that women should just deal with these symptoms.
Quite the opposite. I don't think women should be expected to suffer through this transition.
But I also don't think every symptom in your late 30s or early 40s should automatically be blamed on your ovaries, especially when you're trying to conceive.
The Problem With the Perimenopause Label
Let's talk more about the problem with the perimenopause label.
Think about some of the symptoms I just mentioned: fatigue, hair loss, brain fog, weight changes, anxiety, poor sleep.
Do you know what else can cause some of these symptoms?
Thyroid dysfunction, iron deficiency, blood sugar dysregulation, undereating, chronic stress, gut issues, nutrient deficiencies, and inflammation.
And several of these things matter. All of these things actually matter for fertility a lot.
So if you're 39 years old, your cycles suddenly become shorter, you're exhausted, your hair is thinning, and you're having difficulty getting pregnant, I don't want you to immediately conclude, “Well, I'm in perimenopause and this is just what happens now.”
I want to know what is going on with your thyroid.
I want to know your ferritin and a full iron panel to see what's happening with iron regulation.
I want to know what's going on with fasting insulin and fasting glucose.
I want to know whether you are ovulating.
I want to know what the second half of your cycle looks like.
So what's going on with your basal body temperatures? What's going on with symptoms during that time frame? What's going on with your period?
And I also want to know whether you're eating enough protein, carbs, fat, and total calories.
I want to know about your sleep and your gut and your inflammation, your nutrient status.
I want to know what changed and why.
Because your age is one piece of the fertility picture, and it's not even close to your entire fertility picture.
Can You Get Pregnant During Perimenopause?
So you're dying to know, I know.
Can you get pregnant during perimenopause?
Yes, absolutely.
When you're ovulating, pregnancy is absolutely still possible. Perimenopause does not equal infertility by any means.
Fertility does change with age, and I don't think it helps women to pretend otherwise.
The number of remaining eggs decreases, ovulation can become less consistent, the percentage of eggs with chromosomal abnormalities can increase, and miscarriage risk can increase.
Time becomes more top of mind because all of these things matter.
But there's a huge difference between acknowledging that age affects fertility and telling a woman that nothing she does matters because she is 39 or 41.
Those are not the same conversation.
I have spent years talking about this because I think women deserve much more nuance.
You cannot create more eggs, but you can look at the environment in which your remaining eggs are developing and work to support egg quality.
You can support metabolic health, address thyroid dysfunction, identify nutrient deficiencies, improve blood sugar, work on decreasing inflammation, support sleep and circadian rhythm, and make sure you're actually ovulating while addressing gut issues.
And of course, we can't forget about your partner's fertility, also.
Because all of these things are going to make a really big difference as to not only the symptoms that you're potentially experiencing, but your ability to get pregnant and have that healthy baby.
Don't Forget Male Fertility
A woman in her late 30s or early 40s does not suddenly make male fertility irrelevant either.
We can't forget about this side.
Half of the DNA of the embryo is coming from the sperm.
So please do not let the entire fertility conversation become, “Well, you're 40, therefore your eggs are the problem.”
We still need to look at both sides.
Is There a Test for Perimenopause?
It can be a little bit challenging because there isn't one perimenopause test.
This is another area where I see a lot of confusion because women will ask me, “What test can I run to see if I'm in perimenopause?”
And there isn't one single blood test that gives us a simple yes or no answer.
Hormones can fluctuate significantly during a perimenopause transition. And that means one estrogen level or one FSH measurement does not necessarily tell the entire story.
But this is why your symptoms, your menstrual history, your cycle patterns, and your age all matter together.
So, if fertility is your goal, we're also asking a slightly different question.
We're not just asking, “Are you entering perimenopause?”
We're asking, “What's happening with your reproductive function right now, and what modifiable factors can we adjust to make sure they're not getting in the way of pregnancy?”
It's a much more useful question.
Because even if you are entering the perimenopausal transition, I still want to know what else is happening.
Look at the Whole Person
And this is exactly why inside Master Your Fertility, we don't start and stop with reproductive hormones.
We take a step back and look at the whole person because hormones are never the driving factor, right?
Your ovaries do not exist in isolation from the rest of your body.
Okay, so we have to run your labs.
If you are listening to this thinking, “Okay, then what should I actually be looking at?”
Start with the basics.
Look at your thyroid. Ideally, a full thyroid panel. So don't just stop at TSH. If there are symptoms or something going on, like a potential perimenopause transition, we want to take a deeper look at a full thyroid panel.
We want to look at overall iron regulation. We want to make sure that your ferritin and the rest of your iron picture are all looking good and supportive.
We want to look at vitamin D, B12, and folate.
We want to make sure we're addressing fasting glucose, fasting insulin, and A1C to understand more about your metabolic picture.
You want to look at inflammation in the context of the bigger picture, also. hs-CRP and homocysteine are a couple of big markers that I suggest running.
And depending on your history, your symptoms, and your fertility goals, you may also need a more detailed reproductive hormone evaluation.
But labs are only one part of this too.
What Your Cycle Can Tell You
We want to definitely take into account your cycle data as well.
What is your cycle telling you?
What's going on with your menstrual cycle pattern every month?
Are they becoming shorter? Getting longer? Are you skipping periods?
Are you still seeing signs of ovulation?
What's happening with cervical mucus? Are you tracking LH? Are you confirming ovulation rather than just assuming it happened because you had an LH surge?
This is where BBT, or basal body temperature, comes in.
Is your luteal phase changing, becoming shorter or more symptomatic?
What's going on with your flow? Is your bleeding changing? Are your periods suddenly much heavier? Or are you experiencing more spotting before your period?
These are all questions to ask yourself and start collecting data around.
I want women to become really curious about these patterns instead of immediately becoming afraid of them.
A changing cycle is information. It gives us somewhere to start looking.
And if pregnancy is the goal, confirming whether and when you're ovulating becomes extremely important.
Especially because you may not have the perfectly predictable 28-day cycle that you had 10 years ago, right?
Your fertile window can absolutely move.
So you need to work with the cycle that you have, not the cycle that an app predicts based on your previous six months.
What If You Really Are in Perimenopause?
This is an important question to ask because I don't want the takeaway from this episode to be that perimenopause is always a misdiagnosis because it's definitely not.
You may actually be in perimenopause.
We just want to think critically about this because there's a lot of noise around it and all of the symptoms always being perimenopause.
We want to make sure we're separating those things.
But if you are in perimenopause, that still doesn't mean that we throw our hands up.
It means that we get more strategic.
If pregnancy is something that you want, then this is not the phase where I want you waiting a year to see what happens.
We want to get good information early on, understand whether you're ovulating, get that comprehensive fertility evaluation of the whole person, and look at ovarian reserve markers with the understanding that they are just pieces of the information, not crystal balls predicting whether you'll get pregnant or not.
We want to make sure we're including the male side and evaluating sperm properly because this can absolutely decrease time to a healthy baby.
Again, looking at thyroid, metabolic health markers, correcting any nutrient deficiencies, supporting your body as a whole, and talking with your fertility support team about your options sooner rather than later if you do need additional support.
So you can hold two ideas at the same time.
Time matters and your health matters.
And we don't have to choose between them. We can work simultaneously to support all of it.
What to Do If You're Trying to Conceive in Your 40s
So what can you actually do?
If you're in your early 40s and you're trying to conceive, I would focus on things that give you the most useful information and the biggest return.
First, figure out whether you are consistently ovulating.
Don't rely on an app. Track your cycle. Confirm ovulation.
Second, get comprehensive blood work.
And if you've been told that everything is normal, but you still feel terrible and you're struggling to conceive, ask what was actually tested and what ranges they were actually falling into.
Very different markers or very different ranges can be considered “normal” versus optimal and fertility supportive.
Third, prioritize metabolic health.
Build meals around adequate protein, fiber-rich carbohydrates, and healthy fats.
Strength train. Walk after meals. Don't spend the entire day grazing.
And make sure you're eating enough.
This is not the time for aggressive dieting because you're worried about changes in body composition.
Fourth, protect your sleep and your circadian rhythm.
Get outside in the morning. Keep your sleep and wake times consistent and give yourself enough time in bed.
Make sure you're reducing the bright light at night.
Fifth, address nutrient deficiencies instead of blindly taking more supplements.
More is not always better.
We want to test appropriately, identify what you actually need, and then support it to meet your body where it's at.
And last but not least, don't forget about sperm.
If you've been trying to conceive and your entire workup has focused on you because of your age, that is incomplete.
A basic semen analysis is a starting point, not necessarily the entire male fertility evaluation.
Your Symptoms Are Information
And finally, don't ignore symptoms, but also don't fear them.
Use them.
Your symptoms are information.
I think this conversation matters because women in their late 30s and early 40s are already receiving so much messaging around their fertility.
Your clock is ticking. Your eggs are getting old. Your AMH is low. You're probably in perimenopause. You need to hurry.
And yes, I want you to take time seriously, but fear is not a fertility plan.
Information is.
If you're experiencing symptoms that could be related to perimenopause, investigate them.
Maybe you are beginning that transition, or maybe it's your thyroid. Maybe it's your iron.
Okay, maybe it is ovulation that's inconsistent due to something else entirely.
Maybe your blood sugar is all over the place, and supporting this is going to be the key.
Maybe there are several things happening at the same time, which is honestly most often the case because everything is very connected and absolutely influences fertility and symptoms in the body.
Bodies are rarely as simple as one label.
And that is exactly why I believe so strongly in taking a whole human, whole body approach to fertility.
Perimenopause is real, it can affect fertility, and you can still get pregnant during perimenopause as long as ovulation is occurring.
But please don't let this label become the end of the investigation, especially if having a baby is your goal.
Look at your labs. Look at your cycle. Look at your metabolic health, your thyroid, your gut, your nutrient status, inflammation, sperm. Look at the whole picture.
If we just blame every symptom and every fertility challenge after 38 on perimenopause, we risk missing the imbalances sitting right in front of us.
And those may be the very things that we can change and do something about.
Because your symptoms are information.
Your age is information.
Your labs are information.
Your cycle provides us so much information.
None of these things should be viewed in isolation.
Put all the pieces together. Find out what's actually happening in your body and then build your fertility plan from there.
Because whether you are approaching perimenopause, already experiencing some of these hormonal shifts, or simply wondering if this is what's happening to you, you deserve more than a label.
You deserve answers and you deserve a plan that supports your health and your fertility through your forties.
Thanks for tuning in. Hope to see you next week.