Perimenopause is the transition before menopause, and it can begin right when many queer people are finally in a position to have a family. Understanding what perimenopause entails, the stigmas practitioners may hold, and the options available is important for building a realistic timeline.
What perimenopause actually does to your fertility
Perimenopause is a gradual shift that can last anywhere from two years to a decade, during which ovarian reserve declines and hormone levels rapidly change. Ovulation still happens, and pregnancy is still possible. Some people move through perimenopause, and even menopause, with no symptoms, while others notice irregular cycles, fibroids or cysts, sleep changes, or shifts in mood. The two markers that matter most for pregnancy planning are:
- AMH (anti-Müllerian hormone): reflects how many eggs you have, and
- FSH (follicle-stimulating hormone): stimulates egg production
Why queer people are misunderstood
Most healthcare pathways do not include a fertility screen. A heterosexual person or couple trying to conceive will often receive a referral to a reproductive endocrinologist after six months of attempts. On the other hand, queer people begin trying for kids after they’ve navigated legal, financial, medical, and relational infrastructure.
Your options
Egg freezing: This can be a viable option if you aren’t ready to be pregnant yet, depending on your AMH levels and the number of retrievable follicles.
IUI (in utero fertilization) with donor sperm: A first option for many people. Success rates depend on ovarian function, but tend to hover around 10-20%.
IVF (in vitro fertilization) with your eggs: Some people start here, but most people move to IVF after 3-4 failed IUIs. Success rates are around 30% per cycle.
IVF with donor eggs: For people whose own eggs are no longer a viable path, donor eggs can restore success rates to over 50% per cycle, regardless of age.
Embryo donation or adoption: I took the path of embryo adoption for my own journey. Fertility clinics can store embryos for years. And it’s a good way to keep future children genetically connected and to minimize the search for sperm donors. When used, donor embryos increase the success rate to nearly 50%.
Questions worth bringing to your next appointment
- What are my current AMH and FSH levels, and what do they mean for my options?
- Based on my markers and timeline, which paths are realistically available to me right now?
- Does your practice have experience with LGBTQIA+ family structures, and how do your intake and care processes reflect that?
- What does your clinic’s success data look like for LGBTQIA+ patients?
A provider who can’t answer these questions clearly or makes you feel like you’re asking too much isn’t the right provider for your journey.
The bottom line
Perimenopause doesn’t end the conversation about birthing. The most important thing is getting information that’s honest, specific, and unbiased.
MD Sitzes is the founder of The Family Circle
