What To Know About Perimenopause and Fertility

Gabrielle Union is bringing attention to perimenopause, or the transition to menopause. Here's what you need to know about its impact on fertility.

Medically reviewed by Alyssa Dweck, MS, MD, FACOG

Like many other women, actress Gabrielle Union was unfamiliar with the term perimenopause until, at 37, blood work indicated she was going through it. Soon, she began experiencing symptoms, including extreme hot flashes, hair loss, weight gain, and mental health challenges. It wasn’t something she ever expected at that age.

“I thought menopause was something mothers and grandmothers go through,” she says. “That's how we've been trained to think about it; it’s taboo and shrouded in mystery and people don't talk about it. And if you ask your mothers and grandmothers, they didn’t have a lot that they could do about it, so they were suffering in silence.”

The Hollywood star, now 51, wants to put an end to that secrecy. She’s using her large platform to bring attention to perimenopause. That’s more important than ever as people are delaying having kids for a number of valid reasons, including career chasing, advancing education, or simply personal preferences. That means more people could be trying to have a child while going through perimenopause, whether they know it or not (and many don't).

The good news is pregnancy is totally still possible during perimenopause. Union herself welcomed daughter Kaavia via surrogate with husband Dwyane Wade in 2016. But there’s a lot more to dig into when it comes to perimenopause and pregnancy.

What Is Perimenopause?

Perimenopause is a natural process that occurs when the ovaries slowly stop working and the body begins the transition to menopause–aka you’ve gone 12 months or more without a period.

“Perimenopause is when estrogen is declining and also progesterone is declining,” says Heather Hirsch, MD, board-certified internist and clinical program director for the menopause and midlife clinic at the Brigham and Women's Hospital in Boston.

The decline of estrogen, though, isn't always a straight line. During perimenopause, ovulation can occur less frequently and irregularly, resulting in highly variable estrogen levels—sometimes with levels higher than in the past.

Perimenopause usually begins in the mid to late-40s, but it can start earlier or later. Genetics, medical conditions, and lifestyle can all impact one’s perimenopause timeline.

How long does it last? That depends, too. Perimenopause can be experienced for a short period of time or as long as 10 years or more before menopause occurs. Union, for example, says she’s still going through it.

There are two stages: early and late perimenopause. During early perimenopause, you may being noticing changes in your periods, including them being heavier or shorter, while in late perimenopause, periods begin to space out, coming less often.

Signs of Perimenopause To Know

It’s not unusual for perimenopause symptoms to go undiagnosed.

“There was a gender disparity for a long time where we didn't really consider perimenopausal symptoms as something we need to be concerned about,” says Kavita Desai, PharmD, founder of the women’s health platform Revivele, and author of Lady Parts: Putting Women's Health Back Into Women's Hands. “We've always relegated it to telling women that this is normal and it's something they just had to endure and get past. We know better now.”

Dr. Desai says it’s essential to seek treatment if you have bothersome symptoms, especially because many of these symptoms are the same risk factors that experts are concerned about for chronic diseases, including Alzheimer’s disease and cardiovascular disease. And, importantly, it’s no longer necessary to suffer through symptoms when you don’t have to.

Symptoms can vary and also differ in their severity, but common ones include:

• Hot flashes

• Vaginal dryness

• Decreased libido

• Sleep disturbances

• Mood changes, including irritability, depression, and/or anxiety

• Changes in the menstrual cycle and heavy bleeding

Lesser-known symptoms include:

• Tinnitus (ringing in the ear)

• Vertigo

• Nausea

• Gastrointestinal issues, such as bloating and constipation

• Restless legs

Can You Get Pregnant During Perimenopause?

The short answer is yes, you can get pregnant during perimenopause. You aren’t infertile just because you are going through this transition, but perimenopause can impact ovulation, which is critical for pregnancy.

“During perimenopause, women's cycles become irregular and ovulation is less predictable,” explains Banafsheh Kashani, MD, OB-GYN, reproductive endocrinologist and infertility specialist. “Therefore, if a woman is not regularly ovulating and releasing an egg, it makes it more difficult to get pregnant.”

How To Boost Your Fertility During Perimenopause

Dr. Kashani notes that, typically, when a person is going through perimenopause, they are older and it’s no secret egg quality declines with age. Seeking a consultation with a fertility specialist—also known as a reproductive endocrinologist—is a good idea.

“This is because their number of oocytes (eggs) is probably lower and their reproductive lifespan is likely shorter,” explains Dr. Kashani. “They may require some assistance to help them achieve a pregnancy or preserve their fertility.”

A fertility specialist can monitor ovulation through ultrasounds, check hormone levels, and use injections to help trigger ovulation if necessary.

“Women can also undergo treatments to help them ovulate more than one egg to improve their odds of achieving a pregnancy,” says Dr. Kashani. “Some women may consider fertility treatments, such as IVF, to help give them higher chances of achieving a pregnancy. IVF also allows women to freeze their eggs or embryos for the future.”

There are things you can do at home, too. Research has found it’s possible to improve egg quality through eating a healthy, nutrient-dense diet, taking supplements, and making lifestyle changes, including exercise and limiting alcohol.

How To Check for Perimenopause

If you are experiencing symptoms, experts say to speak with an OB-GYN or an endocrinologist who can check hormone levels through blood work.

Over-the-counter tests are also now available, including the Clearblue Menopause Stage Indicator, to assess if there is an elevated follicle stimulating hormone (FSH), or the hormone the brain releases to help grow a follicle–that’s where an egg sits and matures before ovulation.

“When women enter perimenopause, their egg quantity is diminished so the brain has to make higher and higher levels of the hormone FSH,” says Dr. Kashani. “When this hormone level rises, this is abnormal, and it may be associated with perimenopause.”

If a test indicates an elevated FSH, “it should still be followed up with a reliable blood panel that is then interpreted by a medical professional,” adds Dr. Kashani.

Dr. Hirsch says an at-home test is a smart first step, but additional testing is important in order to know what to do next. “I would encourage her to get into a specialist office, so that he or she could run even more detailed tests and really give her more of a predictive outcome,” she says.

Keep in mind, no matter your age or presence of symptoms, an anti-mullerian hormone (AMH) test can check one’s ovarian reserve to detect how many eggs are left and at what rate the ovaries are aging. A blood test is all that’s needed to determine the levels of AMH, which is produced by the ovarian follicles. But AMH testing reflects a specific window in time; it doesn’t predict future fertility.

How To Cope With Perimenopause

There's a lot to unpack when it comes to perimenopause, physically and emotionally, and the transition to menopause can feel like a hard and isolating experience.

“I felt like I was a raw nerve; everything irritated me; everything was wrong,” says Union. “You want to be able to feel all the things that you're feeling without people wondering what’s going on. You just pull back and pull back and pull back and then you feel like, ‘I'm alone. No one could understand it,’ and then the spiral happens fast.”

Fortunately, there are ways to treat perimenopause and make symptoms feel more manageable–whether you are trying to conceive or not.

Make lifestyle changes

Lifestyle changes can help some people going through perimenopause manage the symptoms. Again, these can also help boost fertility. Two of these include:

• Exercise. Being active has been found to reduce perimenopause symptoms. One study shows women going through the menopausal transition who regularly exercised for 12 weeks saw positive changes in their mental health and vitality. Another study found those who regularly exercised had a decreased negative mood compared to those who didn’t.

• Food choices. Eating a healthy diet rich in fruits and vegetables, whole grains, and proteins may also help reduce symptoms. Union says an anti-inflammatory diet of limiting gluten, dairy, caffeine, and alcohol has helped keep her symptoms—aside from the hair loss—at bay. “Every time I try to cheat,” she says, “they come back. And the hot flashes come back first.”

Try medication

Hormone replacement therapy (HRT) can be helpful in relieving symptoms of perimenopause. These days, that typically includes a low-dose topical estrogen or oral progesterone—the latter is only if you have a uterus.

HRT’s controversial history dating back to the 1960s has made many people steer clear of this treatment. One reason was that older findings showed an increased risk for certain cancers. “That’s not the case for newer formulations at all,” says Dr. Desai. Research published in 2018 found vaginal estrogen did not increase the risk of cancer or cardiovascular disease.

Find a community

For Union, being able to talk about perimenopause and connect with others who have had similar experiences has been comforting. “The more women talk about it, the more you exchange information,” explains Union, who says she often scrolls through TikTok to find community. Possible misinformation aside, social media is a great way to discover what has worked for others and even find a group that can help you feel less alone.

Scrolling the “perimenopause” hashtag on TikTok or joining Facebook groups, including the Perimenopause Hub and Let’s Talk Menopause & Perimenopause, can be helpful. Just always make sure to confirm any medical information with a health care provider. The North American Menopause Society is also available to help you find a menopause provider.

Talking to a therapist who has experience in the menopause transition can be helpful as well. If you’re dealing with infertility, speaking with a therapist trained in fertility issues may also offer much-needed comfort.

Be vocal about your needs

Communicate with those in your life and let them know what you need, especially on days you aren't feeling your best. That’s true whether you are trying to conceive or already have a family.

Union says she often has conversations with her family to let them know when she needs a moment to herself. She says she tells 5-year-old daughter, “Sometimes, it doesn't matter how old we are, we just need a minute to kind of gather ourselves and to feel our big feelings. And then we can come back.”

Learn your family history

Genetic factors contribute to the age a person may go through menopause. For example, research shows Black women tend to go through menopause around nine months earlier than White women and can have more intense symptoms.

Union advises speaking with other women in your family who have been through perimenopause or menopause, particularly your mother and grandmother, to get an idea of what they experienced and when they went through it. This can help you better navigate your own experience or get an idea of what you might expect if you are trying to get pregnant.

Advocate for yourself

Unfortunately, not every medical professional is trained adequately in perimenopause and menopause, so a trip to the doctor’s office may feel, well, unhelpful.

Dr. Desai says advocating for yourself is critical. “Unfortunately, right now, women need to educate themselves and find the right practitioner,” she says, adding, “Find a practitioner that actually specializes in women's health, because I'm still hearing a lot of women are being turned away. They're being told that unless they're trying to conceive, nobody cares about their hormones.”

Union’s advice: go into a doctor’s office prepared, especially if you are Black or a woman of color, as medical gaslighting is often real, especially when it comes to women’s health issues. You can do that by having everything you are experiencing written down on paper or in an app so you can reference it if needed. “You have to be your own best advocate,” advises Union.

Focus on self-care

Dr. Hirsch knows how difficult it can be dealing with perimenopause symptoms while going through your day-to-day. “I'm taking care of aging parents; I'm taking care of three children, a house, a dog, multiple businesses, and symptoms,” she says.

The key is also focusing on yourself when you can. For her, that looks like taking what she calls “exercise snacks” where she does small 60-second exercises throughout the day. But anyone can engage in “self-care snacks” that work for them. “It’s bite-sized things that you can do throughout the day,” she says. “Indulge in the things that you feel are really good for you that you like.”

And remember, there’s a reason they say to put your oxygen mask on first.

“If you're not addressing all of these things and helping yourself feel better, it's almost impossible to be a great mom, a great career woman, an amazing daughter helping your parents or whoever needs you in your life,” says Dr. Desai. “This is all the more reason why women have to start prioritizing their health and they need to take control of it.”

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