Reading: Are You Pregnant or in Menopause?

Shortly after going off the Pill — in my late 40s — and missing a couple of periods, I called a slightly younger friend to announce that I had reached a milestone. “I think I’m in menopause,” I told her.

“Are you sure you aren’t pregnant?” she asked. The thought hadn’t even occurred to me, but her innocent question sent me into a tailspin, prompting a spike in pregnancy test sales at my local Walgreens. Because some of the early signs of menopause mimic those of pregnancy — hello missed periods and breast tenderness — I couldn’t be sure. So instead of picking up my new pack of pills every month, I stopped by for my fix of Clearblue Easy.

Even during my last few months on the Pill, the length and intensity of my period had dwindled to a mere day or two of spotting. Surely I was nearing the end of my childbearing years. As a health writer, I knew I could still get pregnant during that in-between life stage known as perimenopause. Yet I hadn’t replaced my oral contraceptives with any other birth control. Discontinuing the Pill made my monthly migraines disappear, so I had sworn off hormone-based contraceptives, and it seemed ill-timed to have an IUD inserted just as my fertility was waning. I was approaching 50 — what were my chances of getting pregnant anyway?

In fact, while pregnancy in women 50 and over is still relatively rare, the number of births in this age group has tripled since the year 2000. In 2016, an average of 15 babies were born each week to US mothers 50 and older, according to the National Center for Health Statistics. And births in women aged 45-49 rose 3 percent from 2016 to 2017, despite the fact that overall birth rates in this country are declining.

50: The New 40?

When Janet Jackson gave birth to her first child at 50 last year, CNN asked, “Is 50 the new 40?”

Indeed, there has been a veritable parade of high-profile, midlife moms-to-be announcing their pregnancies in the media recently. In April, 50-year-old Tammy Duckworth made history by bringing her newborn to a vote on the Senate floor.  And former actress and model Brigitte Nielsen gave birth to her fifth child in June at age 54.

The truth is that most of the older moms sparking headlines conceived with the help of assisted reproductive technology, some with the help of donor eggs. “The chance of spontaneous pregnancy from age 45 up until the time of menopause is extremely low,” notes Pasquale Patrizio, MD, director of the Yale Fertility Center and Fertility Preservation Program. Still, he adds, “It’s not zero.”

I wasn’t pregnant, but when I reached out to women in a Facebook group called “Having Babies Over Forty,” several members confided that they’d found themselves unexpectedly pregnant in their late 40s. Experts recommend that women who don’t want to get pregnant continue on birth control until menopause, keeping in mind that certain forms of contraception are preferable in midlife.

Birth Control Picks for Perimenopausal Women

Leisa Thompson, a 46-year-old Australian mom of two college-age boys, ditched her hormonal contraceptive on the advice of doctors when she was diagnosed with breast cancer a decade ago. She met her current partner last year, but never bothered to find a new method of contraception, figuring menopause was around the corner. “I went to the doctor after missing a period, thinking I was going into menopause,” she says, “And surprise — I was pregnant with a little girl!” She gave birth to her first daughter (and her partner’s first child) in October.

Indeed, missed periods at this stage of life can send mixed messages. As women approach the end of their childbearing years, their bodies begin to produce less of the hormones estrogen and progesterone, causing periods to become less regular. “But as long as women continue to ovulate, there is some chance of pregnancy,” says Andrew Kaunitz, MD, associate chairman of ob/gyn at University of Florida College of Medicine.

Healthy non-smoking women, he says, can safely stay on the Pill until menopause (or until age 55, since being on oral contraceptives may mask the onset of menopause). In fact, the Pill offers many benefits for women in this age group. “Women who continue the Pill will not experience irregular bleeding or hot flashes, and they will arrive at menopause with substantially more bone density, lowering their future risk of osteoporosis,” continues Dr. Kaunitz. Women who use the Pill long-term also reduce their risk for ovarian and endometrial cancers.

Certain conditions, however, many of which are associated with aging, preclude the use of birth control pills containing estrogen. Women with high blood pressure, diabetes, obesity, blood clotting disorders, heart or liver disease — as well as those who smoke — are better off using non-estrogenic contraceptives. For these women, progestin-only pills, injections, and implants, or the progestin-releasing IUD, offer the added benefit of reducing heavy menstrual bleeding and cramps while eliminating the estrogen.

Women like Thompson who have had breast cancer (and are thus not candidates for hormonal contraception) can turn to the copper IUD or barrier methods such as condoms.

Getting Pregnant at 45-plus

Though most of us midlife moms aren’t ready to trade in the empty nest for another round of motherhood, older women who want to get pregnant should take heart: Thanks to advances in reproductive technology, women ready to tackle motherhood later in life can have successful pregnancies.

As women increasingly wait longer to start families, fertility centers are seeing an influx of older patients, says Norbert Gleicher, MD, medical director and chief scientist of the Center for Human Reproduction in New York City. Gleicher estimates that in 2017, as many as 40 percent of his patients were over 45.

Still, women 45 and older who want to have children face difficult odds — a birth rate just shy of one in a thousand. The problem? Ovarian aging. Not only does the quantity of eggs in the ovaries decline dramatically over the course of a woman’s lifetime — from between 800,000 and a million at birth to maybe 1000 eggs at age 50 — but the quality of those eggs declines as well. “It’s a double whammy,” Dr. Gleicher says. “They produce fewer embryos, and these embryos are less likely to implant and cause a pregnancy.”

Even with in vitro fertilization, the likelihood of pregnancy for women 45 and over is less than 1 percent. As Dr. Patrizio puts it, “We cannot rejuvenate eggs.” In fact, many infertility centers strongly encourage women over 42 to use donor eggs — unless, of course, they froze their own eggs when they were younger. Both increase the odds significantly.

How Old is Too Old?

Whether planned or unplanned, pregnancy and childbirth in older women carries increased health risks. Older women are more prone to suffer from gestational diabetes, hypertension, and preeclampsia, more likely to miscarry (a 45-year-old has a 50 percent chance), and more likely to require cesarean delivery. Indeed, Thompson, who developed gestational diabetes during her pregnancy, concedes that being pregnant at 46 “is a lot harder than being pregnant in my 20s.”

Women are living longer and staying healthier and more fit as they age, and reproductive specialists continue to make strides in treating this population. So in spite of challenging odds, the limits of reproductive age are continually being tested. And Thompson is a testament to the fact that even midlife women can be caught unawares by pregnancy. “I was hoping to be a grandma soon — not to have my own,” she admits. “But every day my partner and I are overwhelmed by how lucky we are.”