Pregnancy still possible during perimenopause
Dear Doctors: I’m 48 years old and in perimenopause. I’ve missed a few periods and joked with my doctor about being pregnant. She said not to laugh — it can happen. Considering my age, I was really surprised. What happens with your body in perimenopause? Do I need to keep using birth control?
Dear Reader: The term “perimenopause” refers to the physical changes that take place as your reproductive years draw to a close. They begin to occur as the ovaries start the gradual process of ceasing to produce estrogen, one of the reproductive hormones. How long this transition takes can vary greatly. For many women, it lasts from three to four years. But for some, it can be as brief as a few months or as long as a decade.
While perimenopause commonly begins when a woman is in her midto-late 40s, it can happen earlier in life. Genes play a significant role in the age at which this transition begins. When someone has gone a full year without a menstrual cycle, she is considered to be in menopause.
The most common physical symptom of perimenopause, and often among the first, is a change to the monthly rhythms of the menstrual cycle. This includes the length and intensity of each period and the frequency with which they occur. Some women begin to experience hot flashes and night sweats. These can cause discomfort during the day and may interfere with sleep at night. As estrogen ebbs, physical changes to vaginal tissues can make intimacy painful. They can also increase susceptibility to urinary tract infections. Thinning of the tissues in the pelvic floor may lead to urinary incontinence.
Perimenopause can affect not only the body, but the emotions as well.
Some women experience changes to mood and have an increased risk of depression.
When someone enters perimenopause, it’s helpful for them to talk to their doctor or gynecologist about what is going on. Depending on the specific symptoms, their medical care provider can offer options to ease or manage them. These can include hormone-replacement therapy, vaginal estrogen or antidepressants. Gabapentin, a medication approved to treat seizures, has been shown to ease hot flashes. Each of these has risks and benefits, so be sure to ask for a detailed explanation of any medication or treatment that you are offered.
As for pregnancy at your age, it isn’t common, but your doctor is correct that it is possible. The changes in blood levels of estrogen that are occurring also affect progesterone, another reproductive hormone. Estrogen and progesterone work together to regulate the cycles of ovulation. During perimenopause, blood levels of these hormones can both recede and also surge. This leads not only to irregular periods, but also to unpredictable ovulation cycles.
Throughout this time, the ovaries are continuing to release eggs. That means that even though someone is older and experiencing symptoms associated with menopause, they are still fertile. If you want to be absolutely sure that you don’t become pregnant, continue to use birth control until you’ve gone without a
period for one year.
Even brief amounts of exercise have health benefits
Dear Doctors: I heard on the news about research that associates walking every day with living a longer life. Both of my grandfathers are avid walkers. They never miss a day, no matter what, and both of them are well into their 80s. I would like to know more, and also how this research was done.
Dear Reader: We believe you are referring to a study that was recently published in the British Journal of Sports Medicine. The researchers concluded that if you spend at least 11 minutes each day engaged in physical activity at a moderate level of intensity, it can lower the risk of death by close to 25%. A brisk walk falls into that category. So does any kind of movement that raises your heart rate enough for chatting to become difficult.
The link between regular physical activity and a wide range of health benefits is well-established. Of particular note is the fact that, by exercising regularly, you can reduce your risk of developing cardiovascular disease. That’s significant because cardiovascular disease is the leading cause of death in
the United States. The statistics are pretty grim. In 2020, about 697,000 people in the U.S. died from heart disease. That’s 20% of all deaths. Stroke is another result of cardiovascular disease. About 795,000 people have a stroke every year, and nearly one-fourth of them don’t survive.
This research doesn’t break new ground by linking exercise to a healthier life. However, it is notable for several reasons. One is its sheer scope. The findings are drawn from the health data of more than 30 million participants, making it perhaps the largest study to date into this particular topic. The researchers arrived at this large number by pooling and analyzing health data collected in 94 previous large studies.
Another intriguing result is the brevity of the duration of exercise the study pegs as the tipping point at which positive results become evident. The analysis shows that at 75 minutes per week, which translates to just under 11 minutes per day, positive health results became statistically significant.
In addition to a lower risk of death, the researchers saw a 17% reduction in the risk of developing cardiovascular disease and a 7% reduction in the risk of certain cancers. Interestingly, there was a large drop of between 14% and 26% in the risk of developing gastric cancers.
At this time, exercise recommendations for healthy adults in the U.S. weigh in at a minimum of 150 minutes of moderate activity per week, or just over 20 minutes per day. For kids and teens, it’s one hour per day. Unfortunately, and perhaps not all that surprisingly, fewer than half of us meet that standard.
While this new study doesn’t supplant the current recommendations, it does suggest that at least aiming for that goal is beneficial. The findings also add to an emerging body of research that links even brief periods of exercise to measurable health benefits. They also suggest that by walking every day, your grandfathers have the right idea.