The menopause marks the end of a woman's fertile years and typically occurs between the ages of 45 and 55. To be precise, menopause is defined as the point when a woman has not had a menstrual period for 12 consecutive months. However, until then, it’s important to remember: as long as you’re still having periods, you can theoretically become pregnant. This also means you should continue using contraception if you’re not planning a pregnancy. The general recommendation is to keep using contraception until menopause is confirmed to avoid unplanned pregnancies.

What happens during menopause?

Menopause begins when the ovaries stop releasing eggs and the production of estrogen and progesterone gradually declines. Without eggs, natural conception is no longer possible. However, the uterus can still support a pregnancy if it’s prepared with hormone therapy. This is a fascinating aspect that highlights the complexity of the female body.

Contraception during Perimenopause

Perimenopause is the transitional phase leading up to menopause and often starts as early as age 40. During this time, hormone levels fluctuate, menstrual cycles become irregular, and fertility declines. But beware: pregnancy is still possible. Many women mistakenly believe they can no longer get pregnant during this phase—a misconception that can lead to unplanned pregnancies. Cycle-based contraceptive methods, such as the temperature method, are no longer reliable during this phase, making other options more suitable.

Which contraceptions are useful?

Women in perimenopause have several choices:

• Hormonal methods: Birth control pills, patches, or hormonal IUDs (e.g., Mirena) can not only prevent pregnancy but also alleviate menopausal symptoms.
• Barrier methods: Condoms or diaphragms offer hormone-free protection and also guard against sexually transmitted infections (STIs).
• Permanent solutions: Sterilization or a partner’s vasectomy are options for women who are certain they no longer want children.
• Hormone-Free IUDs: Copper IUDs provide long-term contraception without hormones.

Hormone replacement therapy (HRT) is not a contraceptive method, but it can be combined with hormonal contraception. For example, a hormonal IUD (Mirena) can be used alongside estrogen-based HRT. Progestin-only contraceptives are generally safe to use with HRT. Alternatively, non-hormonal methods like the copper IUD or barrier methods can be considered.

Pregnancy after Menopause

Although natural conception is no longer possible after menopause, modern reproductive medicine has made pregnancy achievable in certain cases. This is particularly relevant for women who enter menopause early due to medical treatments like chemotherapy.

• IVF with Donor Eggs: Postmenopausal women can become pregnant using donor eggs and hormone therapy.
• Surrogacy: In countries like the U.S., surrogacy can be an option for having a genetically related child. However, this is illegal in Germany.

Risks of late pregnancy

Pregnancy after menopause carries significant risks:

• Increased risk of gestational diabetes, high blood pressure, and preeclampsia.
• Higher likelihood of miscarriage, preterm birth, and low birth weight.
• Health risks for the mother, particularly for the heart and other organs.

Conclusion

While menopause marks the natural end of fertility, advances in modern medicine have made pregnancy possible even after this stage. However, it’s crucial to carefully weigh the medical risks, ethical considerations, and personal circumstances. Consulting with fertility specialists and medical professionals is essential for making the best decision for your individual situation.