Can a woman still get pregnant after menopause?

Pregnancy After Menopause: Possibility and Risks

While pregnancy after natural menopause is not possible without assisted reproductive technology, women should continue using contraception until menopause is definitively confirmed, as spontaneous pregnancies can occur during perimenopause. 1, 2

Natural Fertility and Menopause Timeline

• The median age of menopause is approximately 51 years in North America, but can vary from ages 40 to 60 years 1
• Fertility declines gradually with age, becoming more pronounced between ages 35-40, and declining dramatically after age 40 3
• The median age of definitive loss of natural fertility is 41 years, but can range up to age 51 years 1
• Spontaneous pregnancies have been reported in women up to age 59, meaning sterility cannot be assumed until at least age 60 2

When Contraception Can Be Discontinued

• Women should continue contraceptive use until menopause is confirmed or until age 50-55 years 1
• Menopause can be confirmed by:
  • Cessation of menses for 2 years prior to age 50 2
  • Cessation of menses for 1 year after age 50 2
  • Two elevated follicle-stimulating hormone (FSH) values ≥20-30 IU/L while off hormonal methods for at least 2 weeks 2

Important Considerations

• No reliable laboratory tests are available to confirm definitive loss of fertility in women 1
• Assessment of follicle-stimulating hormone levels to determine fertility status might not be accurate 1
• Although uncommon, spontaneous pregnancies do occur among women aged >44 years 1

Risks of Pregnancy in Advanced Reproductive Age

• Pregnancies in women of advanced reproductive age have higher risks for maternal complications, including: 1
  • Hemorrhage
  • Venous thromboembolism
  • Death
• Fetal complications are also increased, including: 1
  • Spontaneous abortion
  • Stillbirth
  • Congenital anomalies
• The risk of chromosomal abnormalities is significantly higher 4, 5

Pregnancy After Natural Menopause

• Natural conception after complete menopause is not physiologically possible 3
• Pregnancy after natural menopause is only possible through assisted reproductive technologies using donor eggs 6
• Women who undergo egg donation procedures can achieve pregnancy even after natural menopause has occurred 6
• Thorough medical screening is essential before attempting pregnancy after menopause to minimize obstetric risks 6

Clinical Implications

• Healthcare providers should discuss contraception with all premenopausal women during routine health care encounters 2
• All contraceptive methods are considered U.S. Medical Eligibility Criteria category 1 or 2 (no restriction or advantages generally outweigh risks) based on age alone 1
• Estrogen-containing contraceptives should be used with caution in women over 45 due to potentially increased cardiovascular risks 1
• The levonorgestrel intrauterine system (LNG-IUS) has particular benefits during perimenopause and can help with heavy menstrual bleeding 2