Reproductive Health for Women 30+

Understanding Fertility in Your 30s and 40s

Fertility declines with age, but the timeline varies significantly between individuals.✓✓✓ Well-Established

Age 35 marks an inflection point where decline accelerates, but many women conceive naturally in their late 30s and even 40s.

Fertility by Age ✓✓✓

Age Range	Chance of Conceiving Within 1 Year	Key Considerations
30-34	~86%	Fertility still strong; optimal window
35-37	~78%	Decline begins accelerating after 35
38-40	~65%	Seek evaluation after 6 months of trying
41+	~44%	Immediate evaluation recommended

What's happening: You're born with all the eggs you'll ever have. As you age, both the number and quality of eggs decline. After 35, this decline speeds up, and miscarriage risk increases.

Important: These are averages. Some women conceive easily at 40; others struggle at 30. Testing can provide personalized information about YOUR fertility.

When to Seek Fertility Testing

Don't Wait Too Long

The "try for a year before getting help" rule doesn't apply to everyone:

Seek evaluation if:

☐ Age 35-37: Not pregnant after 6 months of trying
☐ Age 38+: Evaluation after 3 months, or immediately when starting
☐ Irregular or absent periods: May indicate ovulation problems
☐ Known fertility issues: PCOS, endometriosis, previous pelvic surgery
☐ Partner concerns: Known low sperm count or fertility issues
☐ Recurrent miscarriage: 2+ pregnancy losses (don't wait for 3)

Basic Fertility Testing

Initial evaluation is straightforward and can be done by your OB/GYN or a fertility specialist:

For you:

Blood tests (day 2-4 of cycle): FSH, estradiol, AMH (egg supply indicators), TSH (thyroid)
Ovulation confirmation: Progesterone blood test (day 21 or 7 days after suspected ovulation), or ovulation predictor kits at home
Ultrasound: Check uterus, ovaries, and count resting follicles

For your partner:

Semen analysis: Simple, non-invasive test that checks sperm count, movement, and shape. Male factor contributes to ~40% of fertility issues.

Speak Up: If your doctor suggests "just keep trying" when you meet the age-based criteria above, say: "I understand my age puts me in a category where earlier evaluation is recommended by ASRM. I'd like to start testing now rather than lose more months."

Pregnancy After 35

What Changes

Pregnancy after 35 (termed "advanced maternal age") does carry some increased risks, but most women have healthy pregnancies and babies. ✓✓✓

Increased risks include:

Chromosomal abnormalities: Down syndrome risk increases (1 in 350 at age 35; 1 in 100 at age 40). Genetic screening is offered early in pregnancy.
Miscarriage: Risk rises from ~15-20% in your 30s to 25-35% by age 40
Gestational diabetes: About 2x higher risk
Preeclampsia (high blood pressure): 1.5-2x higher risk
Cesarean delivery: Rates are higher, partly due to medical intervention, not just age

Context matters: While relative risks increase, absolute risks remain low for most complications. At age 40, 99% of pregnancies do NOT result in Down syndrome. Focus on optimizing your health and getting appropriate monitoring.

Preconception Health ✓✓✓

Start optimizing 3-6 months before trying to conceive:

Preconception Checklist:

☐ Folic acid: 400-800 mcg daily (reduces neural tube defects by 70%)
☐ Prenatal vitamin: Start now, not when pregnant
☐ Achieve healthy weight: BMI 18.5-24.9 ideal; even modest weight loss helps if overweight
☐ Review medications: Some are unsafe during pregnancy; discuss alternatives
☐ Update vaccines: Flu, Tdap, check rubella/varicella immunity
☐ Manage chronic conditions: Optimize diabetes, high blood pressure, thyroid disorders
☐ Stop smoking, limit alcohol: Eliminate both when trying to conceive
☐ Genetic carrier screening: Consider testing for inherited conditions

Contraception Options for Women 30+

Your contraceptive needs may shift in your 30s and 40s based on whether your family is complete, changing health conditions, and personal preferences.

Most Effective Options ✓✓✓

Method	Effectiveness	Key Points
IUD - Hormonal (Mirena, Kyleena, Skyla)	99.8%	Lasts 3-8 years; lighter/no periods; reversible immediately
IUD - Copper (Paragard)	99.2%	Hormone-free; lasts 10+ years; heavier periods possible
Implant (Nexplanon)	99.95%	Lasts 3 years; arm insertion; may cause irregular bleeding
Sterilization (tubal ligation or partner vasectomy)	99.5%+	Permanent; consider if family complete

Birth Control Pills After 35

Combined pills (estrogen + progestin) become riskier after 35 in certain situations:

⚠ Do NOT use combination pills if you:

Smoke (any amount) and are over 35—significantly increases stroke/blood clot risk
Have migraines with aura (at any age)
Have history of blood clots or stroke
Have uncontrolled high blood pressure

Safe alternatives if you have these risk factors:

Progestin-only pill (mini-pill)
Hormonal IUD (Mirena, Kyleena)
Implant (Nexplanon)
Copper IUD (hormone-free)

Contraception During Perimenopause

Many women mistakenly believe they can't get pregnant once periods become irregular. You CAN—continue contraception until menopause is confirmed (12 months without a period).

Good option for perimenopause: Hormonal IUD (Mirena) serves double duty—contraception AND helps with heavy periods or irregular bleeding. If you need estrogen for hot flashes, the IUD protects your uterine lining.

Common Reproductive Health Concerns

Irregular Periods

What's normal: Cycles of 21-35 days, varying by up to 7 days month-to-month.

See your doctor if:

Cycles shorter than 21 days or longer than 35 days
Bleeding between periods
Periods lasting more than 7 days
Soaking through protection every 1-2 hours
Absent periods (not due to pregnancy or menopause)

Possible causes: PCOS, thyroid disorders, stress, significant weight changes, perimenopause (if in your 40s), uterine fibroids, endometrial polyps.

Heavy Bleeding

Heavy periods become more common in your late 30s and 40s, often due to fibroids, polyps, or perimenopause.

Treatment options:

Hormonal IUD (Mirena): Reduces bleeding by 90% in most women; first-line treatment
Birth control pills: Regulate and lighten periods
Tranexamic acid: Non-hormonal medication taken during period; reduces bleeding ~40%
Ibuprofen: Reduces bleeding 25-30% and helps cramping

Don't Suffer: Heavy bleeding is NOT something to "just deal with." If changing protection every 1-2 hours or passing large clots, say: "This is severely impacting my quality of life. I'd like to discuss treatment options including hormonal IUD or other interventions."

Pelvic Pain

Chronic pelvic pain has many possible causes and deserves thorough evaluation:

Endometriosis: Tissue similar to uterine lining grows outside uterus; causes pain, heavy periods, painful sex
Adenomyosis: Endometrial tissue grows into uterine muscle; causes heavy bleeding and cramping
Fibroids: Benign muscle tumors; can cause pain if large
Ovarian cysts: Usually resolve on their own; complex cysts need monitoring
Pelvic floor dysfunction: Muscle tension/spasm in pelvic floor

If initial ultrasound is "normal": Persistent pain still needs investigation. Ask about MRI, referral to gynecologist specializing in endometriosis, or pelvic floor physical therapy evaluation.

Considering Egg Freezing? ✓✓

Egg freezing (oocyte cryopreservation) preserves your fertility options if you're not ready for pregnancy but want to keep the door open.

Key Facts

Optimal age: Before 35 yields highest quantity and quality; still viable option through early 40s
Process: 2 weeks of hormone injections to stimulate egg production, monitoring visits, egg retrieval under sedation
Numbers matter: 15-20 mature eggs gives ~70% chance of one live birth later; many women do 2-3 cycles to reach this
Success rates: ~80-90% of frozen eggs survive thawing. Pregnancy rate per thawed egg: 4-12% depending on age when frozen
Cost: $10,000-15,000 per cycle plus $500-1,000/year storage. Some insurance covers if medical need (e.g., cancer treatment)
No guarantees: Frozen eggs may not fertilize or result in pregnancy when used

This is YOUR decision. If a provider dismisses your interest ("You have plenty of time"), find a reproductive endocrinologist who will support your choice. Age-related fertility decline is real and happens faster than most people realize.

Advocate for Yourself

Questions to Ask Your Doctor

☐ "Based on my age and health, when should I start fertility testing if I'm planning pregnancy?"
☐ "What contraception options are safest and most effective for my situation?"
☐ "My periods are [irregular/heavy/painful]. What tests can identify the cause?"
☐ "I have [symptom]. What are the possible causes and next steps for evaluation?"
☐ "Should I consider egg freezing? Can you refer me to a fertility specialist to discuss?"

Red Flags—When to Seek a Second Opinion

You're told to "just keep trying" for 12 months when you're 38+ (guidelines say 3-6 months)
Your concerns about heavy bleeding or pain are dismissed as "normal" without evaluation
You're denied desired contraception (especially IUD or implant) without medical reason
Your irregular cycles are ignored without checking hormones, thyroid, or ovulation
You want to discuss egg freezing but provider dismisses it without referral

Remember: Your reproductive health affects your overall wellbeing and future options. You deserve timely evaluation, evidence-based treatment, and support for your reproductive goals—whatever they may be.

Key Takeaways

Fertility declines significantly after 35, with accelerated decline in late 30s and 40s.
Don't wait too long for evaluation: 6 months if 35-37, sooner if 38+.
Most women over 35 have healthy pregnancies, though some risks increase. Focus on preconception optimization and appropriate monitoring.
IUDs and implants are highly effective (99%+), reversible, and safe for most women 30+.
Combined birth control pills become riskier after 35 if you smoke, have migraines with aura, or certain other conditions. Progestin-only options are safer.
Continue contraception until menopause is confirmed (12 months without period) if you want to avoid pregnancy.
Heavy bleeding, irregular cycles, and pelvic pain warrant investigation, not dismissal.
Egg freezing is most effective before 35 but remains an option if you want to preserve fertility.