1. What happens to fertility as women age?

As women age, the number of remaining eggs decreases. At age 37, a woman has approximately 25,000 eggs left. At 51, that number is about 1,000, and more of the remaining eggs become abnormal, thus decreasing the chance for pregnancy and increasing the likelihood of chromosomal abnormalities such as Down syndrome. A woman’s chances of conceiving after trying for 3 months at age 25 are 18 percent; at age 30 are 16 percent; at age 35 are 12 percent; and, at age 40 are 7 percent.

While pregnancy becomes less likely as women grow older, age 40 is NOT the time to stop using birth control unless a pregnancy would be welcome.

Many of my patients who are considering timing of their pregnancy request blood work because they want to “check my fertility.” These tests, anti-Mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol are, in some ways, an indirect measure of your ovarian reserve. Levels in the “normal” range suggest that you have sufficient reserve and are, therefore, potentially fertile. Note: a “normal” value does not guarantee that you can get pregnant, just that your levels are in the “normal range” for people who can conceive. It is also only a snapshot in time. If it is “normal” this year, it may not be “normal” in another year. If it is abnormal, you might have to reconsider your timing or speak with a specialist about potentially “freezing your eggs,” otherwise known as fertility preservation, or using a donor egg.

 2. What is perimenopause?

Perimenopause, also known as the climacteric, is literally the time around menopause that marks the end of the reproductive phase of life. It typically begins in the mid to late 40’s and can precede the last menstrual period by a few months to a couple of years.  The average age in the U.S. for the last menstrual period is 51, but the range can be from 48 – 52.  During this time, few eggs remain, and many of them are abnormal. Therefore, successful ovulations are less frequent and result in less predictability in your cycle. Your period may be a few weeks late followed by another period a couple of weeks later…You may start to have night sweats or flashes, insomnia, and mood swings for a few days or weeks and then feel fine. A week or two later, you get a period.

 3. At what age should I start getting mammograms?

If you do not have a family history of first-degree relatives with premenopausal breast cancer, you should consider getting your first mammogram at age 40. There is some controversy about this recommendation though. Prior to age 50, most women are still cycling, and their breasts are under hormonal stimulation. Thus, there are many benign changes that can be noted on the mammogram. These changes can result in the need for extra tests being done to confirm the changes are benign. This can cause significant anxiety and, of course, extra cost. However, breast cancers that occur in the 40’s although far less frequent than those that occur in the 50’s and beyond, are more likely to be genetic and far more deadly. 

Remember though, no one dies of anxiety or extra testing. It’s up to you though to decide if and when you want to be tested in your 40’s. From age 50 on, the incidence of breast cancer increases, and the false positives are lower, so there is no question that screening should be done on a yearly basis from that point forward. We don’t really have much information on the effectiveness of testing beyond age 65 or 70. A lot depends on expected years of remaining “productive life.”

 4. What age is too early to go through menopause?

While the average age for the last period is 48 to 52, a number of women become menopausal before that age. However, if you are 40 to 42 and stop menstruating, there may be a reason for that. Sometimes it is due to a family history of “premature ovarian insufficiency” or premature menopause. But there may be hormonal or chromosomal abnormalities that cause this at an earlier age. Please consult with your GYN if this happens to you. Women who have had hysterectomies, even if their ovaries were preserved, and women with previous chemotherapy tend to enter menopause earlier.

 5. What are the most important medical factors to take into consideration re: menopause? (e.g., pre-existing conditions, diabetes, weight gain, etc.)

Prior to menopause, women are protected from a number of devastating disorders by the estrogen they produce. Men, not so much. However, after menopause, medical conditions such as heart disease, high cholesterol, hypertension and diabetes rise sharply and quickly reach that of men. This is the time to pay strict attention to your diet and exercise regimen if you want to avoid/reduce your risks. Some weight gain is inevitable, especially that around your middle due to loss of estrogen, but scrupulous attention to the above should keep you on tract. And, NO, taking hormone replacement therapy (HRT) will NOT make you thin. Sorry about that!

There are very few women, or men for that matter, over the age of 30 who haven’t noticed that they can no longer eat what they want and not gain weight. By 40, many realize that even when they watch what they eat, they gain weight. By 50, the game is over. Simply looking at food seems to put on pounds. Even if you don’t gain a pound, the distribution of your weight will change as you approach and go through menopause.

 6. What are the takeaways that ALL women should keep in mind as they start to go through menopause?

Going through menopause is a natural part of aging, but that doesn’t mean it’s easy! Remember that this is a natural phenomenon. You are born with just so many eggs.  When they are gone, you are menopausal. Nature really didn’t intend for women to live as long as we do, but we have decided that we will! We don’t get a vote here. Don’t bemoan it or whine about it. It is what it is. Accept it. Embrace it and move forward proactively to live the best life you can live. You have a lot of meaningful years ahead of you!  There are options, both natural and medical. Speak with your health care provider. Ask questions. Be informed and make the best of your future! 

ABOUT

 Dr. Heather L. Johnson is an award winning, actively practicing gynecologist AND author of two books, who, after delivering more than 3,500 babies over 40 years, recently retired as an obstetrician. Her new book, What They Don’t Tell You about Menopause: A Gynecologist’s Unofficial Guide to Premenopausal, Perimenopausal and Postmenopausal Life, was released in late November of 2020. Dr. Johnson discusses the various stages of menopause and what to expect throughout this natural aspect of life for women. From perimenopause to postmenopause, and everything in between, this book offers practical, fact-based information that will be your guide through this daunting period of womanhood.

In her books about pregnancy and menopause, she shares what she has learned throughout her career, fact-filled and up-to-date medical insights, humorous anecdotes, and “Dr. J’s Pearls” of bite-sized advice & information. Both of her books are available in both Paperback and eBook on Amazon.com, BarnesandNoble.com, Walmart.com and Goodreads.com.

She is the senior partner at Reiter, Hill & Johnson, an Advantia practice, with offices in Washington, DC, Chevy Chase, MD and Falls Church, VA. Dr. Johnson attended Yale University School of Medicine and trained at The Walter Reed Army Medical Center in Washington, DC.  She has two children and is a proud grandmother of two granddaughters.

To learn more about Dr. Johnson, her books and Dr. J’s Pearls of bite-sized advice, please visit her website https://AskDrHeatherJohnson.com, and follow her on Instagram (@askdrheatherjohnson), Facebook (@askdrheatherjohnson) and Twitter (@askdrjohnson)!