Quick fact: By age 40, the average woman has approximately 3% of her initial pool of oocytes (eggs) remaining. This significant decline in ovarian reserve is a key factor affecting fertility at this age. (Source: Human Ovarian Reserve from Conception to the Menopause)

That doesn’t mean pregnancy is off the table—but it does mean time, hormones, and health conditions matter more than ever.

Starting With the Real Question:

Can you still get pregnant in your 40s if you’ve had PCOS, endometriosis, or fibroids?

Yes.

But it may take more planning, testing, or support than it did in your 20s or 30s.

This post will walk you through what changes in your body during perimenopause, how these conditions can affect your fertility, and what options are still available—without false hope or fear.

In perimenopause, your hormones don’t just slowly fade—they swing. One month you may ovulate, the next month you may not. Over time, estrogen and progesterone drop off, and ovulation stops completely.

When this happens:

• • Your ovarian reserve (how many eggs you have) declines
  • Egg quality goes down too, increasing the risk of miscarriage
  • Conditions like PCOS or fibroids may react differently to shifting hormones

According to a study, hormone and egg quality changes are the most common reasons pregnancy becomes harder after 40.

Polycystic Ovary Syndrome (PCOS) is a hormone condition that affects how and when your body releases eggs. If you’ve had long or unpredictable cycles in the past, or struggled with ovulation, PCOS may be part of the reason.

Once you reach your 40s, things can shift even more:

• • Ovulation may become even less frequent
  • Insulin resistance often worsens, which can make symptoms stronger
  • Your egg count is already lower, which adds another layer to timing

The good news is, PCOS doesn’t mean fertility is off the table.

Regular movement, balanced meals, and keeping blood sugar steady can improve ovulation. And treatments like metformin or ovulation-stimulating medications have been shown to help many women with PCOS get pregnant—even after 40.

The earlier you look into your cycle patterns and hormone levels, the more options you have.

Endometriosis is a condition where tissue similar to the lining of your uterus grows in places it shouldn’t—like on your ovaries, fallopian tubes, or pelvic wall. This tissue still responds to hormones, which means it can swell and bleed each month, leading to inflammation, pain, and eventually scar tissue.

By the time you reach your 40s:

• • Estrogen levels may start to fall, which can reduce pain for some women
  • But any scarring or damage from years of inflammation may already be affecting fertility
  • When scar tissue blocks your eggs or implantation spots, getting pregnant becomes harder

For women with moderate to severe endometriosis, fertility may be lower—but it’s not hopeless. Surgical removal of endometrial tissue and treatments like IVF have been shown to increase the chances of pregnancy, especially when done before symptoms progress further.

The key is knowing what’s going on inside your body and acting early.

Fibroids are non-cancerous growths that can develop in or around your uterus. They’re surprisingly common—and often grow during your reproductive years because they respond to estrogen.

Depending on their size and location, fibroids can make it harder to get or stay pregnant by:

• • Blocking your fallopian tubes
  • Distorting the shape of your uterus, which affects implantation
  • Increasing the risk of heavy bleeding or complications during pregnancy

While many fibroids shrink naturally after menopause, they can still be an issue during perimenopause. If they’re causing symptoms or getting in the way of your fertility goals, there are ways to manage them.

Treatment options include:

• • Medications that adjust hormone levels
  • Minimally invasive procedures like uterine artery embolization
  • Surgery, such as myomectomy, to remove the fibroids without affecting your uterus

Research shows that treating fibroids can improve fertility—especially when they’re pressing on the uterine lining or blocking the tubes. Knowing what’s going on with your body can help you decide the best path forward.

Fertility isn’t just about whether or not you’re ovulating. There are a few key pieces of the puzzle that tend to shift with age—and understanding them can help you make clearer decisions.

1. Egg Quality

As you get older, your eggs do too. Even if you’re still ovulating, those eggs may not fertilize as easily or develop as well once they do. This can increase the risk of miscarriage or make it harder to get pregnant naturally.

2. Ovarian Reserve

This is the term for how many eggs you have left. It doesn’t predict whether you’ll get pregnant—but it helps you and your doctor understand the window you’re working with. A simple blood test called AMH (anti-Müllerian hormone) can give you a clearer picture.

3. Male Fertility

Fertility is a two-person job. As men age, sperm count, shape, and movement can all decline. That means it’s smart to test both partners early on—especially if you’ve been trying without success.

4. Pregnancy Risks After 40

Pregnancy later in life can absolutely be healthy—but it comes with some added watch-outs. Conditions like gestational diabetes, high blood pressure, and chromosomal differences are more likely. A strong care team and early monitoring can help you stay safe and supported the whole way through.

You don’t need to overhaul your life to start moving in the right direction. These small steps can help you feel more in control—and give you real answers instead of guesswork.

• • Track your cycle — even if it’s irregular, the patterns are still valuable.
  • Ask about hormone and AMH testing — this helps you understand your egg reserve and where your hormones stand.
  • Explore egg freezing or IVF — if you’re not trying to conceive now but might want to later, it’s worth asking about your options.
  • See a fertility specialist early — don’t wait until things feel urgent. The sooner you know your path, the more choices you have.
  • Support your body with movement, good food, and rest — it all adds up, and your hormones respond to how you live.
  • Check your partner’s fertility too — both sides matter, and testing together can give you a fuller picture.

Every step doesn’t have to be perfect. You just need to start somewhere—and stay curious about what your body is telling you.

Trying to conceive in your 40s, especially with conditions like PCOS, endometriosis, or fibroids, can feel overwhelming. But you’re not starting from scratch.

You’re starting with life experience. With questions that matter. With the strength to ask for more than guesswork.

You deserve real answers.

You deserve care that’s built around your timeline—not someone else’s.

At Amazing Meds, we support women at every stage of hormone and fertility health. Whether you’re exploring options, feeling stuck, or simply want to understand what’s happening inside your body—we’re here to walk through it with you.

What we offer:

• • Comprehensive hormone testing (estrogen, thyroid, AMH, cortisol, and more)
  • Fertility and cycle mapping to understand your window
  • Personalized plans that include nutrition, supplements, lifestyle shifts, and BHRT if it’s right for you

👉 Schedule a consultation here if you’re ready to take the next step—with support that sees the full picture.

You don’t have to do this alone.

You just need a path that’s clear—and someone who listens.

Disclaimer: This blog is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider with any questions you may have regarding a medical condition or treatment options. Never disregard professional advice or delay seeking it because of something you have read here.