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Achieving Pregnancy During Perimenopause

Achieving Pregnancy During Perimenopause

Trying to Conceive During PerimenopauseSearch the internet using just the word perimenopause and imbedded in many links will be words like disease and condition. Know this, the hormonal transition of perimenopause is perfectly natural and normal which means it is neither a disease, nor a condition.

Perimenopause is the natural cycle of womanhood leading up to menopause during which time sex hormones decline. Despite this time frame being viewed as the normal beginning of the “end in a woman’s reproductive years”, a woman can still become pregnant when perimenopausal because regular ovulation may continue.

The Importance of Pregnancy Preparation in Perimenopause

It is a known fact that more women than ever are waiting to conceive for a variety of reasons. Science has proven fertility health can begin to decline rapidly around the age of 40 and after, making it especially important to prepare for pregnancy prior to conception. Preconception health is known to influence how a woman progresses through perimenopause and enters menopause and will also impact pregnancy health.

Preconception hormonally-driven symptoms, including menstrual cycle changes, are the main reason women seek additional testing or reach out to their healthcare providers for support. While these symptoms are important to know about, it is equally as important to know that presentation and severity of perimenopausal symptoms varies greatly from woman to woman.

“A woman may go in and out of a perimenopausal state for as many as 10-13 years before she arrives at true menopause (the average age of which is 52 in the US). This means that it is perfectly normal, in fact natural, for a woman as young as 40 to begin feeling foreign and seemingly inexplicable changes in her body and emotions. The important thing is to recognize that symptoms, at any age, are the body’s way of telling you that it is not getting the support it needs.” ~ Marcelle Pick, OB/GYN, NP

The following guide will share the symptoms briefly referred to above and how to naturally support the body in preparation for pregnancy when traveling through perimenopause. It is important to look at fertility health from a holistic perspective – with the belief that our fertility is influenced by the interconnection of the physical body, the mind, spirit and the environment in which we live; all of these things work together to lead us to overall health and well-being.

The Symptoms – Determining Perimenopause

Age is a key factor in determining if a woman is perimenopausal. There are also a variety of symptoms reported by women that doctors may use in part to determine if a woman is perimenopausal. These symptoms are only truly useful in determining perimenopause in the absence of other reproductive health issues.

The symptoms are:

  • irregular menstrual cycles (sporadic/changing menstruation and irregular ovulation)
  • breast tenderness
  • low libido
  • sleep disturbances
  • hot flashes/night sweats
  • heightened emotional state in the absence of obvious stressors
    ➞ irritability
    ➞ mood swings
    ➞ depression
    ➞ anxiety
    ➞ a general decline in the joy of life
  • low energy levels
  • loss of vaginal and uterine tone and changing tissue health due to a decrease in estrogen which can lead to vaginal dryness, increase incidents of infection, urinary frequency, changes in sexual arousal and desire, painful intercourse
  • heart palpitations

There are a number of women who experience only a few of these symptoms and others who unfortunately experience many of them. It is normal during perimenopause for periods to become irregular and differ from cycle to cycle. What can be challenging in pinning down perimenopause as a culprit for the above symptoms, is that many other health problems may exhibit similar symptoms. Having a fertility health condition (uterine fibroids, endometriosis, PCOS, etc.) can also contribute to irregular menstrual cycles and disordered ovulation. Ruling out other health problems or fertility issues as the cause for the symptoms is going to be helpful, especially if a woman is wanting to conceive during perimenopause.

So, how can these symptoms be avoided and reproductive health supported during this transition?

As mentioned earlier, natural pregnancy can still occur in perimenopause. Dr. Marcelle Pick, OB/GYN NP, reminds us that “…it is always good to remember that perimenopause is a volatile time and numbers are not necessarily your destiny…” Maintaining hormone levels optimal for conception and pregnancy may require a stronger commitment to a natural pregnancy preparation program and the goal of becoming a mother.

Natural Pregnancy Preparation Program for Perimenopause

A main goal during perimenopause is to focus your natural fertility program on supporting adrenal gland and liver health. It is equally important to eat a nutrient-dense diet, manage stress, support emotional health, and exercise. Keep reading to learn why…

Adrenal Health

The adrenal glands, resting atop the kidneys, release hormones in response to stress. Chronic stress diminishes their health, which in turn impacts fertility health and hormone balance shares Linda Page, ND, PhD, author and educator, in her book Healthy Healing. What many may not know is that the ovaries begin to cease producing estrogen in perimenopause (they completely do so in menopause) at which time the adrenal glands take over estrogen production.

The adrenal glands work to support not only a healthy stress response during perimenopause, but also hormonal balance which is important for a healthy menstrual cycle and pregnancy. Supporting their function during this time may also help you avoid a symptom-ridden transition to menopause when the time comes.

You will not regret taking the time to support your adrenal health! It is also critical to manage stress and support your emotional health! The bottom line is this… each and every person is affected by stress emotionally and in their everyday lives in a different way. One person’s heavy or chronic stress may be mild to another. It is important to find ways to diligently work to lower stress levels every day that suit your needs.

Liver Health

At the age of 40 or older, the liver (the master detoxifier), has been exposed to many years worth of both nutritive substances and toxins. It has continually worked for many years (and hopefully many more) breaking down and expelling excess hormones and toxins circulating within body. It also converts food, fluid, and the air you breathe (including that which the body absorbs through the air we breathe) into the life-sustaining vitamins, minerals, enzymes, and nutrients that fuel and protect the body.

When overworked, or tired it can cause a myriad of symptoms that many associate with hormonal imbalance. These symptoms can certainly exacerbate fertility health issues and efforts to achieve hormonal balance in perimenopause.

It is vital to support liver health in perimenopause. A foundational way to encourage hormone balance and nourish the liver is Fertility Cleansing. Performing a Fertility Cleanse that utilizes specific herbal blends to cleanse the liver and uterus of excess hormones and tissues is a good way to prepare for pregnancy. Fertility cleansing focuses on rejuvenating liver health and preparing the uterus for pregnancy and implantation of an embryo. It is also important to consciously reduce exposure to xenohormones which are those toxins the liver continuously works to break down and expel.


Optimize Fertility - The Fertility DietA nutrient-dense, whole food Fertility Diet that is rich in fresh leafy vegetables and fruit, whole grains, nuts and seeds, fiber, and moderate amounts of lean organic animal products is important for overall health and vitality, fertility health as well as egg and sperm health. A Fertility Diet provides nutrients specific to perimenopausal hormone balance and health that include…

  • Bioflavonoids – to reduce hot flashes, regulate moods and balance estrogen levels.
  • Calcium – to maintain bone strength and support bone growth (in perimenopause and pregnancy).
  • Boron – to help harden bones (bone loss is one major concern for women in menopause).
  • Essential Fatty Acids, EFAs, – the good fats – cholesterol from high-quality fats helps the body produce hormones, supports smooth muscle, brain and nervous system health, and impacts every body system’s health.
  • Hydration – Drink a minimum of eight 8oz. glasses of water every day, add a squeeze of fresh lemon juice for added liver support. Dehydration leads to a decrease in circulation within the body, as well as many other issues. Take water with you wherever you go… NOT in a plastic bottle though!

Additional tips…
Think about periodically eating flax seeds (Linum usitatissimum). Within a flax seed is a thin black layer/sheath called a lignan that is instrumental in supporting hormone metabolism according to Harvard educated pioneer in integrative medicine Dr. Andrew Weil, M.D.. Flax is also high in fiber which helps the body rid itself of endogenous estrogens/xenoestrogens. Freshly grind whole flax seeds at home or purchase a quality oil with the lignans included.

Take your wholefood multivitamin and quality omega-3 supplement daily as well!

Limit, or Avoid; conventional meat, especially red meats which tend to be high in hormones – choose free-range, organic chicken and coldwater fish like Wild Alaskan Salmon, and avoid alcohol, tobacco, caffeine and highly processed foods. Avoid fried foods as well (eat them raw, steam or bake them).

Hormonal Balance

Herbs and nutritional supplements are able to offer tremendous benefit when eating a clean, whole food diet and living a healthy lifestyle. Consider the following herbs to support hormonal balance during perimenopause:

Herbs to offer additional support are:
Maca (Lepidium meyenii)Maca is considered a foundational fertility superfood that provides 31 different minerals and 60 different micronutrients for sperm and egg health support, energy and libido. Maca has been traditionally used to support hormone balance by nourishing the endocrine and immune systems, while also promoting a healthy stress response in the body.

Dong Quai (Angelica sinensis) – Dong Quai is a female fertility tonic that “tonifies and strengthens the uterus by regulating hormonal control, improving uterine tone, and improving the timing of the menstrual cycle,” according to Natural Fertility Company founder Hethir Rodriguez, and does so without estrogenic activity. Dong Quai is a reproductive system tonic that encourages circulation to the uterus, ovaries and fallopian tubes.

Black Cohosh (Cimicifuga racemosa) – Black Cohosh is very commonly discussed in conversations about managing hot flashes in perimenopause and menopause. Black Cohosh has also traditionally been used for absent periods, painful menstruation, uterine and ovarian pain and irritation, PMS-induced migraine headaches, congested pelvic conditions and uterine prolapse.

    Precaution: Not to be used by women who experience heavy menstrual blood loss. Also not recommended for use beyond six months.

Consider also adding additional supplements…

B Complex – A complex of B vitamins supports a healthy stress response and overall vitality which can impact emotional health/mood, increase energy, support healthy thyroid function and may be instrumental in reducing hair loss (or facial hair growth).

Royal Jelly – Royal Jelly is a quality nutrient-dense fertility superfood. It contains a myriad of nutrients including pantothenic acid (a member of the B vitamin family, B5) that boosts adrenal health, may be instrumental in curbing perimenopausal weight gain (although not alone), supporting healthy libido and a healthy vaginal environment to reduce vaginal dryness.

Evening Primrose OilEvening Primrose Oil (EPO) is known to reduce PMS, support healthy cervical mucus production again to reduce vaginal dryness and alleviate painful intercourse, reduce inflammation and support hormonal balance. EPO also provides a quality source of gamma-linolenic acid (GLA) that can help with many symptoms of perimenopause.

Natural Progesterone Cream – Bioidentical hormone creams are often used to alleviate “menopausal” symptoms and may be suggested in perimenopause as well. Consider talking with your healthcare provider about using progesterone cream and seeking guidance on the best dose for your specific need.

Biphasic Menstrual Cycle Support in perimenopause could possibly be the most influential way to impact a healthy menstrual cycle. The FertiliCare Phase 1 & 2 biphasic monthly program contains herbs that have been shown to have an impact on each phase of the menstrual cycle – the follicular phase and luteal phase, as well as regular ovulation. These herbs may also help with perimenopausal symptoms. Four key herbs for supporting perimenopausal hormone balance – liver and menstrual cycle health, ovarian function and libido in these formulas are:

  • Vitex (Vitex agnus-castus) – promotes hormonal balance, normal ovulation, adequate progesterone and prolactin levels, and is helpful in maintaining fertile FSH levels.
  • Tribulus (Tribulus terrestris) – has an affinity for the ovaries and has been found to promote ovulation when used prior to ovulation, as well as increase serum FSH and estradiol in women.
  • Dandelion root and leaf (Taraxacum officinale) – The root, a gentle liver cleanser and tonic that stimulates bile flow and supports the body in metabolizing estrogen: The leaf, nutrient packed and nourishing to the liver.
  • Damiana (Turnera diffusa) – encourages circulation and blood flow to the uterus and vagina to heighten libido – an herbal aphrodisiac.

Egg Health in Perimenopause

At the age of 40 and throughout perimenopause, the ovaries begin to lose their ability to produce mature follicles, estrogen and progesterone. Natural Fertility Senior Herbalist, Dalene Barton-Schuster, reminds us that egg health and ovarian reserve begin to decline around the age of 37-40 (on average) and throughout perimenopause. It is because of this that we feel it is imperative you work to preserve and increase your egg health during this time.


Exercise or movement increases blood flow throughout the body and supports proper oxygenation of the reproductive organs. It also helps to maintain bone mass. Find something to do that you enjoy! Walking, leisurely running, dancing, swimming, or Fertility Yoga are a few fertility friendly exercises.

Learn Fertility Massage

Massage is one of the best natural therapies for increasing blood flow to the reproductive system. Done in the privacy of your own home, Self Fertility Massage can become both a reproductive health and stress-reduction ally for you.

Having a Healthy Pregnancy During Perimenopause

shutterstock_150297362Making healthy prenatal care choices once pregnancy is achieved in perimenopause will help you have the healthiest pregnancy possible and impact the health of your child. Find a doctor or midwife to work with! Specific foods, exercises, stress-reduction tips, affirmations, herbs and nutritional supplements are known to support the body’s needs throughout pregnancy. Click to browse our complete library of articles on pregnancy health…

Closing Thoughts

Perimenopause is considered the preparatory time for the “hormonal hallmark of menopause”, Herbalist Susan Weed acknowledges that menopause = metamorphosis, “the change”. It is not a time to worry about the changes going on within you, but to honor them and focus on supporting your body in managing them without symptoms.

“If you are not supporting your hormones through optimal nutrition, detox, good lifestyle habits and emotional release, your systems will begin to break down. This leads to symptoms. Nature intended us to go through hormonal transitions, but it is not natural or necessary to suffer with unbearable, or even uncomfortable health concerns.” ~ Marcelle Pick, OB/GYN NP

Perimenopause is a volatile time during which the choices you make to impact your health may be more important than ever before – especially if you still wish to conceive naturally. Begin to pay attention to the “whole” you – your body, mind, spirit and the environment in which you live. Conception, pregnancy and having a healthy child when over the age of 40 is possible! You are hopefully now well equipped to meet the demands of your body and if need be, we are here to help you along the way.

Too learn more about related subjects covered in this article, please visit the following links:

Learn about Fertility Superfoods too!


Dr. Kimberly Langdon Cull M.D., OB/GYN
Dr. Kimberly Langdon Cull M.D., OB/GYN

Dr. Kimberly Langdon Cull is a University-trained Obstetrician/Gynecologist with 19-years of clinical experience. She delivered over 2000 babies and specializes in gynecologic diseases such as menstrual disorders, infertility diagnosis and treatment especially pertaining to tubal blockage and polycystic ovarian syndrome (PCOS). Dr. Langdon is the inventor of 6 patent pending medical devices, and attended Ohio State University from 1987-1995 receiving her Medical Doctorate Degree (M.D.) with Honors in Obstetrics and Gynecology.

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  1. Avatar

    Every time I take maca, even just one pill (gelatinized), I wake up the next day with a painful breast lump. One of them had to be biopsied (negative). Is this common??

    • Dear Missy,

      Any shift in estrogen or progesterone levels can cause glands in the breast or breast tissue to swell. Estrogen encourages swelling in fat cells in the breasts. Progesterone increases the size of the milk glands. While Maca is not known to cause changes in breast tissue, the shift in hormones that it is working to support could be the cause.

      Perhaps cutting back on the amount of Maca being taken could help. Depending on how long you’ve taken it, if you feel strongly that you need its benefits, it may be best to give it more time. Or this simply may not be the herb for you.

  2. Avatar

    Will the TCM herbs Xiao Yao San help?

  3. Avatar

    can maca be taken with milk or various juices?

  4. Avatar

    Can i take Maca and Vitex at the same time? Im taking Fertil Aid which has Vitex and Maca. Im Peri menopausal trying to conceive. Pls Help. Thanks.

    • Hello Aj!

      You might not need to add extra Vitex and Maca to the FertilAid depending on how much you take. Vitex and Maca can be taken together though. This is fine!

  5. Avatar

    How will I get started with my fertility program during perimenopause?

    • Dear Idowu,

      Fertility Cleansing and dietary changes to begin eating a Fertility Diet are foundational steps to take. After this the additional herbs and supplements could be considered depending on your needs. The very best way to receive a fertility program designed specifically for your fertility health needs is to have a Fertility Consultation.

      Through a Fertility Consultation, you will submit a comprehensive intake form, including information about your fertility history, your 3 detailed questions and overall goal for your fertility. Then, within five business days our Master Herbalist will review, layout and explain each step of your consultation. Once completed, your Fertility Consultation will be emailed to you as a PDF and you will receive a live link to an audio recording to save and review as often as you need. You also receive the opportunity to continue your relationship with your herbalist through follow-up email correspondence for a few weeks after receiving your consultation, with any questions you may have regarding your consultation.

      I hope you will consider this experience!

  6. Avatar

    Can Vitex and Tribulus be taken at the same time to address progesterone (and prolactin) and FSH levels? (Fertliity health conditions are not an issue as menstrual cycle is regular and consistent.) Literature on your site suggests Tribulus is most effective when taken after menstruation and before ovulation, while Vitex can be taken any time (does that include during menstruation?) and seems to be most effective over time.

    • Dear Denise,

      Fertilica Vitex and Tribulus can be taken together. It is true, Fertilica Vitex general suggested use is all cycle long without taking a break, even during menstruation and that of Fertilica Tribulus is from the day after menstruation ends until ovulation, not after.

      Fertilica Vitex is known to support healthy progesterone and prolactin levels over time. Fertilica Tribulus is known to support women with menstrual cycle irregularities by improving the timing of the menstrual cycle including ovulation.

      Consider also learning other natural options for promoting healthy FSH levels via the article FSH Levels and Your Fertility.

      Take care!