Perimenopause and Fertility

Menopause is the natural end to the reproductive phase of a woman’s life. Usually between the age of 45 to 58 years, the ovaries no longer respond to stimulation from the brain to produce ova (eggs), and Menstruation stops completely.

This is preceded by years of irregular cycles and is confirmed after a complete year in which there is no menstruation.  This time, from the start of irregular cycles until menopause is confirmed, is called “perimenopause”.

Three main changes may indicate that a woman is in Perimenopause:

  1. variations in cycle length
  2. modification in the menstrual flow
  3. anovulatory episodes

Changes in Cycle Length

During the first phase of perimenopause, menstrual cycles tend to shorten while they remain relatively regular. For example, a woman whose cycles used to vary from 28 to 30 days will vary from 25 to 28 days in her late 30s or early 40s. This phase often goes by unnoticed.

During the second phase of perimenopause, menstrual cycles gradually become more and more irregular. At first there can be one isolated cycle that is one or two weeks longer than normal, followed by many ovulatory cycles of the usual length. Later, longer ovulatory cycles will be more and more frequent, interspersed with occasional short cycles. Closer to menopause, cycles may last for up to several months. However, occasional short cycles can still occur.

Menstrual Flow

For most women between adolescence and perimenopause the menstrual flow is heaviest for a few days, and then tapers off gradually. When women reach ages 35 to 45, it often becomes irregular. Menstruation may be longer or shorter, and more or less abundant than before. Sometimes flow may vary during the same menstrual period from spotting to very abundant, or it may contain blood clots (especially following long cycles).

Anovulatory Bleeding

When an ovary fails to respond to hormonal signals, a follicle does not develop, and Ovulation does not occur. This is a common occurrence during the second phase of perimenopause. A woman will then experience anovulatory bleeding, which is the shedding of the superficial layers of the lining of the uterus (this is not true menstruation). Blood flow can range from brief or spotty to excessively heavy or long-lasting.

The Symptothermal Method During Perimenopause.

Even with irregular cycles, the Symptothermal Method is still applicable and effective during perimenopause.

The Symptothermal Method, adapted for perimenopause, teaches couples to:

  • identify the infertile times before ovulation
  • identify anovulatory bleeding (bleeding episodes that are not a true menstruation)
  • recognize the approach of ovulation and the fertile time,
  • confirm when ovulation has passed and the definitely infertile phase has begun.

Thus, irregularities in cycle length do not reduce effectiveness due to the possible irregular cycle length.

With help from a Serena teacher-couple couples can continue to effectively achieve their family planning goals by using the Symptothermal Method throughout perimenopause.