Perimenopause & Beyond
In Perimenopause but want a baby? Diet & lifestyle as well as supplements that may help your fertility journey.
Being in perimenopause does not mean that you cannot get pregnant. If you think you are in perimenopause but want a baby, there’s a few things you can do to improve your chances. This article looks at pregnancy rates for women over 40, hormone changes in perimenopause, diet, lifestyle and supplements that may help your fertility journey.
Women are having babies later in life.
Women are having babies later in life. In England & Wales, women on average have given birth to their first child aged 31. The trend of more babies been born to mums ages 31 to 34, 35 t0 39 and 40 and over has seen a steady increase according to the Office for National Statistics. Statistically, if a woman aged 40-44 is having regular unprotected sex, her chance of conceiving in a year is 10-30%. After 45 the chance of pregnancy drops by around 10% and drops even further after 50 years. (1)
In terms of assisted reproductive technology (ART), in the UK, women aged 40-42 years have a pregnancy rate per embryo transfer increase from 10% in 2012 to 16% in 2022. Women aged 43-44 years had a pregnancy rate per embryo transfer increase when using their own eggs from 5% in 2012 to 9% in 2022. (2)
Women who are able to fund ART are more likely to have the opportunity to conceive in later life as NHS funding for IVF cycles varies considerably across the UK depending on national funding criteria and local funding across Integrated Care Boards (ICBs).
Menopause marks the end of ovulation but there is a chance we can conceive in the run up, if we want to.
What causes infertility?
One of the leading correlations to infertility is body fat, specifically centrally deposited body fat. As we age insulin resistance becomes more prevalent, but some have a genetic predisposition to this biological marker than others. The lack of insulin sensitivity is linked to central body fat stores (particularly abdominal fat) and some studies show that this determines fertility rate more so than visceral fat around organs or overall body fat stores. (3, 4) This means waist circumference is a better indicator of fertility than BMI. Visceral fat produces inflammatory proteins that can disrupt hormonal balance as well as insulin resistance affecting ovulation and reproductive function.
What can we do to increase fertility?
Lifestyle
Getting enough sleep has been shown to impact insulin resistance. Having less than 6 hours sleep has been shown to reduce insulin sensitivity. Frequent awakenings or fragmented sleep reduce the brain’s ability to regulate glucose. (5,6) Leptin (satiety hormone) decreases, and ghrelin (hunger hormone) increases with sleep deprivation, further adding to the weight gain trajectory.
Exercise, specifically resistance training can help build muscle in women and support metabolic rate. This means we will use more energy every time we move. Obesity often reduces metabolic rate per unit of lean mass, worsening insulin resistance and inflammation.
Even moderate alcohol intake (5–10 drinks per week) has been linked to: Irregular menstrual cycles, delayed or absent ovulation, reduced luteal phase progesterone, lower likelihood of conception. In a Danish study of younger females (20-35 years), even 5 or fewer alcoholic drinks per week was shown to reduce pregnancy rates (7)
Women who smoke are up to 60% more likely to experience infertility, take longer to conceive (average delay of 6–12 months) and reach menopause 1–4 years earlier (8,9) Furthermore, smoking lowers oestrogen and mimics premature ovarian aging (10)
Diet
A reduction of starch and removal of sugar will help improve insulin sensitivity. Balancing blood sugar by reducing sugar & adding protein and fibre has an overall positive effect over time on central fat stores. Low-Glycaemic and Insulin-Sensitive Diets feature unprocessed carbs, high fibre, lean proteins, and healthy fats. These prevent post-meal glucose spikes and lower insulin resistance, which worsens with age. Specifically, they are most beneficial for women with PCOS, prediabetes, or metabolic syndrome, with the latter two most prevalent as we age.
Women in perimenopause have a higher risk of subclinical micronutrient deficiencies too (e.g., CoQ10, folate, B12, vitamin D,) all of which can play a role in fertility. A diet that supports metabolic stability, antioxidant defence, and hormone balance can help mitigate these age-related declines. (11)
Supplements
Clinical evidence supports a number of nutrients and enzymes in relation to improved fertility. My favourites and go-to supplements in relation to improved fertility are:
- Inositol
- Co Q 10
- Omega 3 fatty acids – both EPA & DHA
- Vit D
- N- acetyl cysteine
Final thoughts
Although statistically our chances of pregnancy are lower during perimenopause than our younger years, it is possible to conceive at this time. If you are considering another child or your first, an overall health and wellness focus, encompassing diet and lifestyle practices and a little help from science backed supplements may make all the difference.
References
1 Births in England and Wales - Office for National Statistics
2 Key facts and statistics | HFEA
5 Impact of sleep debt on metabolic and endocrine function - The Lancet
6 Effects of sleep fragmentation on glucose metabolism in normal subjects - PubMed
9 Effects of cigarette smoking on reproduction - PubMed
10 Smoking and infertility: a committee opinion - ScienceDirect
11 Can Nutrition Help in the Treatment of Infertility? - PMC
