How to Extend Fertility Into Perimenopause

Menopause is the point in a person’s reproductive cycle when they stop menstruating and therefore can no longer conceive a child. Perimenopause is the stage that leads to menopause, during which the hormones estrogen and progesterone begin to decrease.

Although menopause traditionally indicates the end of fertility, there has been some success with experimental treatments to temporarily reverse this process so that the body can begin menstruating again. If it is proven to be safe and effective in the future, such treatments may be promising for people exploring reproductive options during perimenopause.

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

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What is 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 menopausal process does not take place overnight. Instead, it occurs in phases over time. Gradually, the ovaries stop making estrogen and progesterone (the hormones needed to conceive a baby) and release eggs monthly (ovulating).

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 part of the same transition that marks the end of a person’s reproductive cycle. Technically, they represent two different stages, which are:

  • Perimenopause is the stage that leads to menopause. This is the segment of time when the ovaries gradually lower the levels of hormones they produce and the number of eggs released. This degradation of ovarian function usually begins in a person’s 40s, and the process can take several months or several years. During this transition, noticeable physical signs include irregular periods, hot flashes, moodiness, vaginal dryness, fatigue, and sleep problems.
  • Menopause is the time when a person’s menstrual period has stopped permanently. This means no bleeding or stains 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, although some people experience premature menopause or medical menopause (when the ovaries are surgically removed or damaged by medical treatment).

Menopause staging and terminology

Menopause timing can be a confusing concept, in part due to an abuse of terminology. For example, you may hear someone say that they are “going through menopause,” when in fact they are more likely to experience perimenopause. Perimenopause is the period leading up to menopause when common symptoms such as irregular periods and hot flashes occur.

Can menopause be reversed?

Strictly speaking, menopause is a process that cannot be reversed naturally. It is considered to be the end of a person’s reproductive cycle, which means that they no longer have the ability to conceive.

That said, over the past few years, researchers have looked at treatments that could potentially reverse menopause in its earlier stages, at least temporarily. It could possibly offer people who are menstruating alternative options to follow a pregnancy during that stage of their life.

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

Pregnancy during Perimenopause

Getting pregnant during perimenopause (the months or years before your last menstrual period) can be challenging, but it is possible.

Once perimenopause begins, ovulation (the release of eggs from the ovaries) cannot occur every 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 occur in people over 40 who are menstruating, so experts recommend that you still be able to conceive until menopause is complete (after menstrual periods have stopped permanently for 12 months in a row).


Researchers are studying possibilities to temporarily restore ovulation in perimenopausal people or in those who are approaching or have reached menopause. In theory, these treatments may allow an otherwise healthy person in perimenopause or menopause to become pregnant through natural conception or with additional fertility support.

As many experts point out, there is not enough evidence to broadly recommend specific treatments for menopause reversal or to predict who will benefit from it. But the research shows promise for future treatments in this area, should it prove safe and effective.

Ovarian rejuvenation

An important experimental treatment being studied is the use of platelet-rich plasma (PRP) injections to stimulate 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 (such as knee osteoarthritis), some scientists theorize that PRP injections can stimulate the ovaries and reverse menopause, at least for a period of time.

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

Long-term results of these studies are not yet available, and more concrete evidence is needed on the efficacy of ovarian rejuvenation.

How PRP works

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

Natural treatment

Another treatment that has been investigated is the use of melatonin.

Known as the sleep hormone, melatonin is a natural chemical that tells your body when to go to sleep and wake up. It is also available over the counter as a sleeping aid.

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

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

Research has shown that taking melatonin supplementation can 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 may be a natural treatment option to delay menopause.


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

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

  • Ache
  • Inflammation
  • Tissue damage
  • Infection

In addition, pregnancies during perimenopause carry 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 though a treatment appears to be more effective, there was no research on the health and viability of the recovered eggs and possible pregnancies that could follow.

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

In addition, melatonin has the potential to react with other medications, and some people experience side effects such as dizziness, drowsiness, headaches and nausea.


Ovarian rejuvenation may be available at some fertility clinics across the country, but it is still considered an experimental treatment by many insurance companies and healthcare providers. This means that it is not covered by most insurance providers, so costs are likely to be high.

Keep in mind that combining IVF with ovarian rejuvenation (recommended for some patients in the studies) can add about $ 12,000 to the bill.

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


Experimental treatments are currently being investigated for their potential to extend fertility to perimenopause, which precedes menopause (the time that traditionally indicates the end of a menstruating person’s fertility). If it is proven to be safe and effective, these options can offer people who have reached or are approaching perimenopause an opportunity to conceive.

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

A word from Verywell

Menopause is a normal part of a menstruating person’s reproductive cycle, but it is common to feel overwhelmed by the many physical and emotional changes that take place during this time. If you are approaching menopause but are still hoping to conceive, there are treatments to possibly help boost fertility during perimenopause. While experimental treatments such as ovarian rejuvenation may not yet be widely available or recommended, talk to a healthcare provider or other reputable health source about your options.

Frequently Asked Questions

  • Can you ovulate during menopause?

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

  • Can you naturally delay menopause?

    In short, no. The age at which 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 eat more fish and legumes, but simply changing your diet is not a proven way to delay menopause automatically.

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