Every now and then we see media reports about celebrities in their mid 40s having surprise pregnancies. Or you might hear stories like these from friends or relatives, or see them on TV.

Menopause signals the end of a woman’s reproductive years and happens naturally between age 45 and 55 (the average is 51). After 12 months with no periods, a woman is considered postmenopausal.

While the chance of pregnancy is very low in the years leading up to menopause – the so called menopausal transition or perimenopause – the chance is not zero.

So, what do we know about the chance of conceiving naturally after age 45? And what are the risks?

Is there a spike in fertility before menopause?

The hormonal changes that accompany perimenopause cause changes to the menstrual cycle pattern, and some have suggested there can be a “surge” in fertility at perimenopause. But there’s no evidence this exists.

In the years leading up to menopause, a woman’s periods often become irregular, and she might have some of the common symptoms of menopause such as hot flushes and night sweats.

This might lead women to think they have hit menopause and can’t get pregnant anymore. But while pregnancy in a woman in her mid 40s is significantly less likely compared to a woman in her 20s or 30s, it’s still possible.

The stats for natural pregnancies after age 45

Although women in their mid- to late 40s sometimes have “miracle babies”, the chance of pregnancy is minimal in the five to ten years leading up to menopause.

The monthly chance of pregnancy in a woman aged 30 is about 20%. By age 40 it’s less than 5% and by age 45 the chance is negligible.

We don’t know exactly how many women become pregnant in their mid to late 40s, as many pregnancies at this age miscarry. The risk of miscarriage increases from 10% in women in their 20s to more than 50% in women aged 45 years or older. Also, for personal or medical reasons some pregnancies are terminated.

According to a review of demographic data on age when women had their final birth across several countries, the median age was 38.6 years. But the range of ages reported for last birth in the reviewed studies showed a small proportion of women give birth after age 45.

Having had many children before seems to increase the odds of giving birth after age 45. A study of 209 women in Israel who had conceived spontaneously and given birth after age 45 found 81% had already had six or more deliveries and almost half had had 11 or more previous deliveries.

There’s no reliable data on how common births after age 45 are in Australia. The most recent report on births in Australia show that about 5% of babies are born to women aged 40 years or older.

However, most of those were likely born to women aged between 40 and 45. Also, the data includes women who conceive with assisted reproductive technologies, including with the use of donor eggs. For women in their 40s, using eggs donated by a younger woman significantly increases their chance of having a baby with IVF.

What to be aware of if you experience a late unexpected pregnancy

A surprise pregnancy late in life often comes as a shock and deciding what to do can be difficult.

Depending on their personal circumstances, some women decide to terminate the pregnancy. Contrary to the stereotype that abortions are most common among very young women, women aged 40–44 are more likely to have an abortion than women aged 15–19.

This may in part be explained by the fact older women are up to ten times more likely to have a fetus with chromosomal abnormalities.

There are some extra risks involved in pregnancy when the mother is older. More than half of pregnancies in women aged 45 and older end in miscarriage and some are terminated if prenatal testing shows the fetus has the wrong number of chromosomes.

This is because at that age, most eggs have chromosomal abnormalities. For example, the risk of having a pregnancy affected by Down syndrome is one in 86 at age 40 compared to one in 1,250 at age 20.

Apart from the increased risk of chromosomal abnormalities, advanced maternal age also increases the risk of stillbirth, fetal growth restriction (when the unborn baby doesn’t grow properly), preterm birth, pre-eclampsia, gestational diabetes and caesarean section.

However, it’s important to remember that since the overall risk of all these things is small, even with an increase, the risk is still small and most babies born to older mothers are born healthy.

Multiple births are also more common in older women than in younger women. This is because older women are more likely to release more than one egg if and when they ovulate.

A study of all births in England and Wales found women aged 45 and over were the most likely to have a multiple birth.

The risks of babies being born prematurely and having health complications are higher in twin than singleton pregnancies, and the risks are highest in women of advanced maternal age.

What if you want to become pregnant in your 40s?

If you’re keen to avoid pregnancy during perimenopause, it’s recommended you use contraception.

But if you want to get pregnant in your 40s, there are some things you can do to boost your chance of conceiving and having a healthy baby.

These include preparing for pregnancy by seeing a GP for a preconception health check, taking folic acid and iodine supplements, not smoking, limiting alcohol consumption, maintaining a healthy weight, exercising regularly and having a nutritious diet.

If you get good news, talking to a doctor about what to expect and how to best manage a pregnancy in your 40s can help you be prepared and will allow you to get personalised advice based on your health and circumstances.

Karin Hammarberg, Adjunct Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.