By Dr. Victoria Verdú (Licensed Gynaecologist No. 282847366).
The age at which women have children is increasingly delayed. In Spain, the average age for women to have their first child was 33.4 years in 2024, a figure that increases every year. Factors explaining this include job market stability or the lack of a stable partner, but this represents a growing risk to fertility.
The challenge women face during this time is a key stage of the female reproductive cycle: perimenopause. But what does this phase entail? Is it still possible to conceive naturally or through fertility treatments?
Premenopause should not be confused with perimenopause. The former is the initial period of transition towards menopause, a time with no significant changes in a woman’s body although the first symptoms may appear. Perimenopause, on the other hand, refers to the phase closer to menopause, with more evident hormonal changes that affect the menstrual cycle and therefore fertility.
This phase can start several years before menopause itself (between 40 and 45 years old), which is diagnosed after 12 consecutive months without menstruation.
Every body is different, with factors such as lifestyle and genetics influencing symptoms. Common symptoms include:
Other women may experience sleep disturbances and vaginal dryness. These symptoms are mainly due to increased FSH hormone levels or drops in estrogen. Additionally, during perimenopause, estrogen—the primary female hormone—fluctuates.
Although the body undergoes various changes, pregnancy is still possible. Fertility naturally decreases with age, but ovulation may still occur irregularly during perimenopause. Therefore, as long as menstruation continues, there remains a possibility of pregnancy.
However, the likelihood of natural conception is considerably lower than at younger ages, due to diminished egg quality and quantity over time. Assisted reproduction can help achieve pregnancy in these cases. Techniques such as in vitro fertilization (IVF), ovarian stimulation, or the use of donated eggs increase success rates, especially when ovarian reserve is low or egg quality is compromised.
Thus, perimenopause does not mean the immediate end of fertility but marks a turning point in reproductive capacity.

One of the most critical determinants of female reproductive capacity is egg quality. With age, eggs age too, increasing the chances of genetic abnormalities and failures in fertilization or embryo implantation.
During perimenopause, not only does the number of available eggs decrease, but ovulation becomes irregular, complicating pregnancy planning, even in women without previous fertility issues.
Advances in reproductive medicine provide solutions for women desiring motherhood at this stage. Common treatments include:
At IVF-Life, expert teams individually assess each case to find the most suitable treatment based on ovarian reserve, hormonal status, and patient medical history.
Age is also a very significant factor here that must be carefully considered. After the age of 40, pregnancy (whether natural or through assisted reproduction) carries certain risks for both the mother and the future baby. For this reason, it is important to carry out more thorough pregnancy monitoring.
At advanced ages, there is a higher probability of spontaneous miscarriages, increased risk of hypertension and diabetes, premature or complicated deliveries, and even a higher incidence of chromosomal abnormalities in the fetus.
For this reason, it is essential that any pregnancy during this stage is accompanied by rigorous and personalized medical supervision, both during the conception process and prenatal follow-up.