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Menopause is that “next phase” of a woman’s life. Well known for hot flashes and emotional breakdowns, menopause is when a woman is no longer fertile. Her ovaries no longer release eggs nor do they produce the hormones that she’s been accustomed to for so many years. She can no longer get pregnant. Menopause is defined as starting once a woman has gone one full calendar year without a menstrual period. And while menopause itself could have an entire blog post (or 6) dedicated to it, today I want to talk about that time period before menopause - perimenopause.
Perimenopause starts at 40. 40?!?! Yes, 40. For some women, it starts a few years after 40, but 40 is the general cutoff. Menopause doesn’t just happen. Women don’t go from regularly ovulating to not ovulating overnight. It’s a process. Just like 12-year-old girls don’t go from their first period to regular cycles overnight. It takes time. The body needs time to ramp up and, in the case of menopause, shut down. This is why it becomes more difficult to get pregnant starting around the age of 40. And by the age of 45, it gets even more difficult to get pregnant. This is why the entire IVF industry targets women in their 40’s as a “special category” of infertility. Women in their 40s have started the process of entering into menopause.
So what does this look like? It usually starts with a subtle shift in the cycle. One cycle here and there may be a day or two shorter or longer. The occasional cycle may have ovulation overlap with menstrual bleeding, so pregnancy can occur during menstruation. There can also be cycles where ovulation doesn’t happen at all but the period starts right on time. This is called anovulation. These are all normal parts of perimenopause. There can also be irregular bleeding and spotting throughout the cycle due to insufficient or changing hormones. On a side note, irregular bleeding and mid-cycle spotting can also indicate more serious issues like cancer so if you’re experiencing this, then it’s best to see a doctor. And as a woman approaches her 50’s, these irregularities can increase until they are, well, regular. A woman may go months without ovulating or having a period until, eventually, it just stops altogether. It is this normal, but unpredictable, time in life that resulted in so many unintended pregnancies couples had with the Rhythm Method of NFP. It is also the reason that couples find NFP in their 40’s difficult and frustrating.
So what is a woman to do? Women who used to rely on Basal Body Temperature monitoring may find themselves woefully unprepared for the reality that they won’t see a shift in temperature for months on end. Women monitoring their urine hormones may find that their monitor never catches changes (or constantly reads as fertile). Cervical mucus can change and be confusing. These realities can be particularly difficult for couples who have relied on “post-peak” only instructions for avoiding pregnancy. Why? Because post-peak could, in fact, only occur once every few months (or once a year) for 10 days. Couples also begin to question what they’re seeing. Is this really fertile?
Couples trying to get pregnant can find themselves in despair. Periods of fertility (and the hopes of a beautiful baby) could be as few as once a year. And when those periods do occur, poor quality mucus or other issues could make conception difficult.
The Creighton Model specifically addresses these issues – although it can be more challenging to chart. Even if you’ve been charting successfully for years, it’s important to see your Practitioner once you hit 40. These are the times to review early ovulation, double-peak, and long cycle instructions. You can also find out what to expect and how to achieve or avoid pregnancy. You may need to see a NaPro Doctor to increase your chances of a successful pregnancy or to reduce the unpleasant symptoms of perimenopause.
Because many women are getting married later in life, they can find themselves beginning their families after 40. And a lot of couples, for various reasons, may be avoiding pregnancy in their 40’s. Because Creighton is a prospective model of NFP, it can predict ovulation instead of simply confirming that it has occurred. It doesn’t use algorithms, which can become less accurate in your 40’s, to predict ovulation. It uses real-time, daily observations to predict ovulation. This allows couples to plan accordingly.
But what about those couples who are avoiding and using post-peak only? What to do when post-peak rarely (or never) comes? This is a difficult situation. Oftentimes, couples using post-peak only instructions in Creighton do so because they don’t trust the system to be accurate pre-peak. They self-impose post-peak only instructions. For couples in this case, anxiety, and not the system, could be the problem. Or they could have a confusing or difficult pre-peak chart. Regardless, it’s important to work with a really good practitioner. Family planning blood draws could be an option. There are additional ways to work through it. It may mean that you meet more regularly. Or you may need updated instructions. But it is possible to successfully work through perimenopause for couples who are avoiding.
Creighton really is a method for all women in their reproductive years, even if those years are challenging. Contact one of our Practitioners to learn more about charting in perimenopause.