In your 30s
Contraception issues
It may be time to reevaluate your method of contraception. “As we become older, we usually gain a bit of weight and our risk for blood clots increases,” says Dr. Jerilynn C. Prior, founder and scientific director of
The Centre for Menstrual Cycle and Ovulation Research in Vancouver. “The usual dose of a combined hormonal contraceptive—the pill, patch or vaginal ring—doubles our clot risk in our 20s and may triple it in our 30s. Weight gain, especially to a body mass index of 30 or higher, also increases the risk of blood clots related to the use of combined hormonal contraceptives.”
There are other contraceptive options, including using a barrier method (diaphragm or condom), combined with a vaginal spermicide, or a copper or progestin-releasing intrauterine device, which is easily removed with no delay in fertility returning (as there is when stopping the pill) if you decide to have a child.
Drop in fertility
Your menstrual cycle, between 21 and 35 days, and your normal ovulation are likely the most regular they have ever been. “While this decade is the start of perimenopause [the transition into menopause, usually associated with changes in your cycle and ovarian hormone levels] for a small percentage of women, the majority will carry on as premenopausal women with an increasing desire for—and, sometimes, difficulty with—getting pregnant,” says Dr. Prior, adding that women may have regular cycles and yet not release an egg and make progesterone. Even a cycle with ovulation but too few days of progesterone is one in which a woman won’t be able to become pregnant. “A couple shouldn’t begin to think they’re having difficulty getting pregnant until they’ve tried without contraceptives for one year,” says Dr. Prior.
Keeping a record of your period (and, yes, there are apps for that) is still the gold standard when you’re unsure about what’s going on with your cycle. The Centre for Menstrual Cycle and Ovulation Research offers free tools for monitoring your cycle and ovulation (cemcor.ca). Show the record to your doctor, who may be able to spot inconsistencies and offer solutions. If you’re having trouble getting pregnant, see a reproductive endocrinologist to check for hormone-related fertility problems.