How to Extend Fertility Into Perimenopause

Table of Contents
View All
Table of Contents

Menopause is the point in a person's reproductive cycle when they stop menstruating and therefore are no longer able to conceive a child. Perimenopause is the stage leading up to menopause, during which time the hormones estrogen and progesterone start declining.

Though menopause traditionally marks the end of fertility, there has been some success with experimental treatments to temporarily reverse this process, allowing the body to restart menstruation. If proven to be safe and effective in the future, such treatments could be promising for people who are exploring reproductive options during perimenopause.

This article provides an overview of perimenopause and menopause, as well as experimental treatments that could potentially restore fertility during these periods.

pregnant mature woman looking out window

Justin Paget / Getty Images

What Are Perimenopause and Menopause?

Menopause is the permanent end of a person's menstrual cycle. This milestone is medically defined as not having a period for a year (12 months in a row).

The menopause process doesn't happen overnight. Instead, it occurs over time in stages. Gradually, the ovaries stop making estrogen and progesterone (the hormones needed to conceive a baby) and releasing eggs (ovulating) monthly.

While menopause usually occurs naturally between the ages of 40 and 58, the exact age varies based on the individual's genetics, medical conditions, and lifestyle factors.

Both perimenopause and menopause are a part of the same transition that marks the ending of a person's reproductive cycle. Technically, they represent two different stages, which are:

  • Perimenopause is the stage leading up to menopause. It's the segment of time when the ovaries gradually decrease the levels of hormones they produce and the number of eggs released. This winding down of ovarian function commonly starts in a person's 40s, and the process can take a few months or several years. During this transition, noticeable physical signs include irregular periods, hot flashes, mood swings, vaginal dryness, fatigue, and difficulty sleeping.
  • Menopause is the point in time when a person's menstrual period has permanently stopped. This means no bleeding or spotting for 12 months in a row. At this point, the ovaries have stopped producing hormones and releasing eggs. The average age for menopause in the United States is 52 years, though some people experience premature menopause or medical menopause (when the ovaries are surgically removed or damaged by medical treatments).

Menopause Staging and Terminology

Menopause timing can be a confusing concept, in part due to a misuse of terminology. For example, you may hear someone say that they're "going through menopause," when it's actually more likely that they're experiencing perimenopause. Perimenopause is the period of time leading up to menopause when common symptoms like irregular periods and hot flashes occur.

Can Menopause Be Reversed?

Strictly speaking, menopause is a process that cannot be reversed naturally. It's considered to be the end of a person's reproductive cycle, meaning that they no longer have the ability to get pregnant.

That said, over the past several years, researchers have been looking into treatments that could potentially reverse menopause in its earlier stages, at least temporarily. This could potentially provide menstruating people with alternative options for pursuing a pregnancy during that point of their life.

Much more research is needed before science can confirm the widespread effectiveness of treatments that promote menopause reversal.

Pregnancy During Perimenopause

Getting pregnant during perimenopause (the months or years leading up to your last menstrual period) may be challenging, but it is possible.

Once perimenopause begins, ovulation (the release of eggs from the ovaries) may not happen every single month. In addition, levels of estrogen, progesterone, and other hormones in the body tend to be irregular and egg quality decreases during this time. These combined factors contribute to a significant decrease in fertility among people in the perimenopausal stage, compared to younger age groups.

Many unplanned pregnancies are reported to happen in menstruating people over the age of 40, so experts recommend assuming that you're still capable of getting pregnant until menopause is complete (after menstrual periods have permanently stopped for 12 months in a row).

Treatments

Researchers are studying possibilities for temporarily restoring ovulation in perimenopausal people or in those who are closely approaching or have reached menopause. In theory, these treatments could make it possible for an otherwise healthy person in perimenopause or menopause to become pregnant via natural conception or with additional fertility support.

As many experts point out, there's not enough evidence to broadly recommend specific treatments for reversing menopause or to predict who would benefit from them. But the research does show promise for future treatments in this area, should they prove to be safe and effective.

Ovarian Rejuvenation

A major experimental treatment being studied is the use of platelet-rich plasma (PRP) injections to restimulate the reproductive system. It involves injecting the ovaries with PRP, which is a concentrated solution of platelets derived from a person’s own blood.

Based on PRP's reported ability to help heal injuries or damage in the body (like knee osteoarthritis), some scientists theorize that PRP injections may be able to stimulate the ovaries and reverse menopause, at least for a period of time.  

Groups of researchers have been testing the use of PRP injections in early menopausal, perimenopausal, and menopausal patients interested in exploring their reproductive options. In two of these studies, many of the participants experienced restored menstruation, and some who had low ovarian reserve (possibly perimenopausal) were able to undergo in vitro fertilization (IVF) egg retrieval and, in certain cases, achieve a pregnancy.

Long-term results from these studies aren't yet available, and more concrete evidence is needed on the effectiveness of ovarian rejuvenation.

How PRP Works

PRP injections are currently used in other fields of medicine, such as orthopedics, wound healing, and dermatology. It's still not entirely clear exactly how PRP works, but it's thought that the blood platelets' natural growth factors help prompt the healing process through tissue regeneration, blood flow improvement, and inflammation reduction.

Natural Treatment

Another treatment that's been investigated is the use of melatonin.

Known as the sleep hormone, melatonin is a naturally occurring chemical that tells your body when to go to sleep and wake up. It's also available over the counter as a sleep aid supplement.

Because melatonin is influenced by hormones such as estrogen and progesterone, it's affected by hormonal shifts like menopause.

Melatonin is also important to the development of a fetus, and lower levels of this hormone have been linked to infertility.

Research has shown that taking melatonin supplementation may improve thyroid function and improve the levels of certain hormones associated with menopause. Additional studies are needed, but based on these results, some experts believe that melatonin could be a natural treatment option for delaying menopause.

Risks

As with any medical treatment, there are potential risks that each person must weigh against the benefits, which should be done in consultation with a healthcare provider.

For ovarian rejuvenation, there is the possibility of side effects following PRP injections, such as:

  • Pain
  • Inflammation
  • Tissue damage
  • Infection

In addition, pregnancies during perimenopause have more associated risks due to the potential for lower-quality eggs, variable hormones, and uterine changes that may not support a successful pregnancy. So even if a treatment proves to be more broadly effective, there hasn't been any research on the health and viability of the restored eggs and potential pregnancies that could follow.

While experts consider melatonin generally safe for most people to use in the short term, there hasn't been much research on the safety of its long-term use.

Additionally, melatonin has the potential to interact with other medications, and some people experience side effects such as dizziness, drowsiness, headache, and nausea.

Costs

Ovarian rejuvenation may be available at some fertility clinics around the country, but it's still considered to be an experimental treatment by many insurance companies and healthcare providers. That means it isn’t covered by most insurance providers, so costs are likely to be high.

Keep in mind that the combination of IVF with ovarian rejuvenation (which was recommended for some patients in the studies) could add roughly $12,000 to the bill.

By contrast, melatonin is available over the counter, so this price tag is much less in comparison. Still, it's a good idea to discuss any new supplements with a healthcare provider first to avoid any potential complications or medication interactions.

Summary

Experimental treatments are currently being investigated for their potential to extend fertility into perimenopause, which precedes menopause (the point in time that traditionally marks the end of a menstruating person's fertility). If proven to be safe and effective, these options could offer people who have reached or are approaching perimenopause an opportunity to become pregnant.

These treatments include ovarian rejuvenation and melatonin supplementation. Both still require further study and experimentation.

A Word From Verywell

Menopause is a normal part of a menstruating person's reproductive cycle, but it's common to feel overwhelmed by the many physical and emotional changes happening during this time. If you're approaching menopause but are still hoping to conceive, there are treatments to potentially help boost fertility during perimenopause. While experimental treatments like ovarian rejuvenation may not be widely accessible or recommended just yet, speak with a healthcare provider or other trusted health source about your options.

Frequently Asked Questions

  • Can you ovulate during menopause?

    You may still ovulate during perimenopause (the transition to menopause), though ovulation will likely be irregular from month to month. Once you reach menopause (medically defined as not having had a menstrual period for 12 months in a row), ovulation will no longer take place.

  • Can you delay menopause naturally?

    In short, no. The age that a person reaches menopause is determined by a combination of things, including genetics, diet, exercise, and other lifestyle factors. Some studies have found that menopause tends to start later in people who consume more fish and legumes, but simply changing your diet isn't a proven way to automatically delay menopause.

Was this page helpful?
26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Gold E. The timing of the age at which natural menopause occursObstet Gynecol Clin North Am. 2011;38(3):425-440. doi:10.1016/j.ogc.2011.05.002

  2. U.S. Department of Health and Human Services Office on Women’s Health. Menopause basics.

  3. Santoro N. Perimenopause: from research to practiceJ Womens Health. 2016;25(4):332-9. doi:10.1089/jwh.2015.5556

  4. North American Menopause Society. Overview of menopause.

  5. Shifren J, Gass M. The North American Menopause Society recommendations for clinical care of midlife womenMenopause. 2014;21(10):1038-1062. doi:10.1097/gme.0000000000000319

  6. American Society for Reproductive Medicine. Age and fertility.

  7. Long ME, Faubion SS, MacLaughlin KL, Pruthi S, Casey PM. Contraception and hormonal management in the perimenopauseJ Womens Health. 2015;24(1):3-10. doi:10.1089/jwh.2013.4544

  8. Scott Sills E, Wood SH. Appraisal of experimental methods to manage menopause and infertility: Intraovarian platelet rich plasma vs. condensed platelet-derived cytokines. Medicina. 2022;58(1):3. doi:10.3390/medicina58010003

  9. Ficek K, Kamiński T, Wach E, Cholewiński J, Cięszczyk P. Application of platelet-rich plasma in sports medicineJ Hum Kinet. 2011;30:85-97. doi:10.2478/v10078-011-0076-z

  10. Hsu CC, Hsu I, Hsu L, Chiu YJ, Sonam D. Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins. Menopause. 2021;28(6):660-666. doi:10.1097/GME.0000000000001746

  11. Sfakianoudis K, Simopoulou M, Grigoriadis S, et al. Reactivating ovarian function through autologous platelet-rich plasma intraovarian infusion: Pilot data on premature ovarian insufficiency, perimenopausal, menopausal, and poor responder women. J Clin Med. 2020;9(6):1809. doi:10.3390/jcm9061809

  12.  Scott Sills E, Wood SH. Progress in human ovarian rejuvenation: Current platelet-rich plasma and condensed cytokine research activity by scope and international origin. Clin Exp Reprod Med. 2021;48(4):311-315. doi:10.5653/cerm.2021.04651

  13. Alser OH, Goutos I. The evidence behind the use of platelet-rich plasma (PRP) in scar management: a literature review. Scars Burn Heal. 2018;4. doi:10.1177/2059513118808773

  14. Ficek K, Kamiński T, Wach E, Cholewiński J, Cięszczyk P. Application of platelet-rich plasma in sports medicineJ Hum Kinet. 2011;30:85-97. doi:10.2478/v10078-011-0076-z

  15. Andersen LP, Gögenur I, Rosenberg J, Reiter RJ. The safety of melatonin in humansClin Drug Investig. 2016;36(3):169-75. doi:10.1007/s40261-015-0368-5

  16. Jehan S, Jean-Louis G, Zizi F, et al. Sleep, melatonin, and the menopausal transition: what are the links?Sleep Science. 2017;10(1). doi:10.5935/1984-0063.20170003

  17. Sciarra F, Franceschini E, Campolo F, et al. Disruption of circadian rhythms: a crucial factor in the etiology of infertilityInt J Mol Sci. 2020;21(11):3943. doi:10.3390/ijms21113943

  18. Bellianni G, Di Marzo F, Blais F, Di Marzo A. Effects of melatonin in perimenopausal and menopausal women: our personal experience. Ann NY Acad Sci. 2005;1057:393-402. doi:10.1196/annals.1356.030

  19. Bellipanni G, Bianchi P, Pierpaoli W, Bulian D, Ilyia E. Effects of melatonin in perimenopausal and menopausal women: a randomied and placebo controlled study. Exp Gerontol. 2001;36(2):297-310. doi:10.1016/s0531-5565(00)00217-5

  20. Johns Hopkins Medicine. Platelet-rich plasma (PRP) injections.

  21. Atkinson L, Martin F, Sturmey RG. Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon?. Hum Reprod. 2021;36(7):1737:1737-1750. doi:10.1093/humrep/deab106

  22. Besag FMC, Vasey MJ, Lao KSJ, Wong ICK. Adverse events associated with melatonin for the treatment of primary or secondary sleep disorders: A systematic reviewCNS Drugs. 2019;33(12):1167-1186. doi:10.1007/s40263-019-00680-w

  23. Kaiser Family Foundation. Coverage and use of fertility services in the U.S.

  24. American Society for Reproductive Medicine. Is in vitro fertilization expensive.

  25. Sapre S, Thakur R. Lifestyle and dietary factors determine age at natural menopause. J Midlife Health. 2014;5(1):3-5. doi:10.4103/0976-7800.127779

  26. Dunneram Y, Greenwood DC, Burley VJ, Cade JE. Dietary intake and age at natural menopause: results from the UK Women's Cohort Study. J Epidemiol Comm Health. 2018;72(8):733-740. doi:10.1136/jech-2017-209887