Women’s Health Concerns

Some women worry that theirs are too big or too small or not as firm and youthful as they once were, but here’s one thing that every woman wants – healthy breasts for a lifetime.
As you enter your 30s, 40s, and 50s, your breasts change along with the rest of your body. In your childbearing years (25-40), you may wonder whether breastfeeding will affect the shape of your breasts. After menopause and if you are starting to gain weight, you might be more concerned about breast cancer risk. Women who are overweight or obese after menopause have a 30 to 60 percent higher breast cancer risk than those who are lean. So please watch your weight!

In your 30s hormones like estrogen help to keep breasts firm. Breasts contain no muscles. Rather, they consist of fibrous tissue, fatty tissue, plus dense glandular tissue that includes milk-producing glands called lobules and ducts to carry milk.

Fortunately, in the 30s, breast problems tend to be benign (non-cancerous). Younger women commonly experience fibrocystic breast disease, a broad term that is characterized by breast pain, cysts, and noncancerous lumpiness. As the years go by, breasts become less glandular and fattier, which makes them less firm. Another factor is the stretching of fibrous bands in the breast called Cooper’s ligaments, hence the term “Cooper’s droopers.”

During the 40s, breast shape continues to change for most women. The breast has now less glandular tissue but more fat, leading to more sagging. At this stage, cysts are the most common type of breast lump, although cysts can develop at other ages as well. These fluid-filled sacs aren’t cancerous, but they can be painful. The numbers show that breast cancer risk rises during this decade; a woman between the ages of 40 and 49 now has a 1 in 68 chance of being diagnosed. Therefore, mammogram screening enters the picture.

In your 50s, after menopause, the breasts not only become fattier but will shrink because women no longer need the milk-producing glands for breastfeeding. That’s a time when women notice their breasts are less firm, certainly less tender if they’ve had problems with tenderness, and they’re less lumpy. Most breast cancers occur in women over age 50, according to the National Cancer Institute from USA. From ages 50 to 59, a woman’s chance of being diagnosed with breast cancer stands at 1 in 37. The good news during this time is that doctors have an easier time detecting breast cancers because breast density is less likely to obscure tumors.

A Naturopathic Doctor will work with the patient to create an individualized Breast Health Plan that will usually emphasize dietary changes, nutritional therapy, acupuncture and botanical remedies

Cervical dysplasia is a pre-cancerous condition in which abnormal cell growth occurs on the surface lining of the cervix or endocervical canal, the opening between the uterus and the vagina. It is also called cervical intraepithelial neoplasia (CIN). Strongly associated with sexually transmitted human papillomavirus (HPV) infection, cervical dysplasia is most common in women under age 30 but can develop at any age.

Cervical dysplasia usually causes no symptoms, and is most often discovered by a routine Pap test. The prognosis is excellent for women with cervical dysplasia who receive appropriate follow-up and treatment. But women who go undiagnosed or who don’t receive appropriate care are at higher risk of developing cervical cancer.

Based on 2010 estimates, about 1 in 152 Canadian women is expected to develop cervical cancer during her lifetime and 1 in 475 will die from it.

Mild cervical dysplasia sometimes resolves without treatment, and may only require careful observation with Pap tests every three or six months. But moderate-to-severe cervical dysplasia, and mild cervical dysplasia that persists for two years, usually requires treatment to remove the abnormal cells and reduce the risk of cervical cancer.

Endometriosis is a problem many women have during their childbearing years. Endometriosis is a very common debilitating disease that occurs in 6 to 10% of the general female population; in women with pain, infertility, or both, the frequency is 35–50%. About 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.

Endometriosis means that a type of tissue that lines your uterus is also growing outside your uterus. This does not always cause symptoms. And it usually isn’t dangerous. But it can cause pain and other problems.

The clumps of tissue that grow outside your uterus are called implants. They usually grow on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the belly. In rare cases they spread to areas beyond the abdomen.

Your uterus is lined with a type of tissue called endometrium. Each month, your body releases hormones that cause the endometrium to thicken and get ready for an egg. If you get pregnant, the fertilized egg attaches to the endometrium and starts to grow. If you do not get pregnant, the endometrium breaks down, and your body sheds it as blood. This is what it’s called your menstrual period.

When you have endometriosis, the implants of tissue outside your uterus act just like the tissue lining your uterus. During your menstrual cycle, they get thicker, then break down and bleed. But the implants are outside your uterus, so the blood cannot flow out of your body. It is trapped inside your body. The implants can get irritated and painful. Sometimes they form scar tissue or fluid-filled sacs (cysts). Scar tissue may make it hard to get pregnant, so infertility it is a real problem.

The experts don’t know what causes endometrial tissue to grow outside your uterus. But they do know that the female hormone estrogen makes the problem worse. Women have high levels of estrogen during their childbearing years. It is during these years-usually from their teens into their 40s-that women have endometriosis. Estrogen levels drop when menstrual periods stop (menopause). Symptoms usually go away then and the condition subsides.

More than half of women experience fibrocystic breast changes at some point in their lives.

For some women, changes in hormones during normal monthly menstrual cycles can create breast changes, like lumps. These are known as fibrocystic breast changes. Women with fibrocystic breasts usually get lumps in both breasts that increase in size and tenderness just before they get their period. They sometimes have nipple discharge as well.

The lumps are milk ducts and tissues around them that have grown and gotten wider to form cysts. The cysts enlarge quickly in response to hormones released near your period. The lumps may be hard or rubbery and may be felt as a single (large or small) breast lump. Fibrocystic changes can also cause breast tissue to thicken.

These changes are often most noticeable during your 40s. They are the most common cause of benign breast lumps in women ages 35 to 50. Postmenopausal women are less likely to have these types of breast changes. That’s because they don’t have monthly changes in hormones anymore.

As many as 43 percent of women and 31 percent of men have experienced sexual dysfunction, and one of the most common problems is low libido, or a low sex drive.

It can be a symptom of many conditions. Whether it’s hormonal changes or depression or fatigue, there is always help and naturopathic medicine has wonderful remedies suitable for this. The answers may be simple, such as using a lubricant to make sex easier, or you may need medications (plants and supplements) to treat an underlying condition. Even what a woman eats can affect her sex drive, so we want to know what you are eating daily too.

With age too, lagging sexual desire is more likely.

Many medications can affect your lack of desire, including antidepressants, tranquilizers and oral contraceptives. If your ovaries have been removed, it can affect desire for sure.

Stress decreases testosterone in both men and women, and that affects desire too. A plan to reduce stress in your life is a good place to start in order to battle low libido.

Ruling out or treating medical problems that may affect desire, such as diabetes, and eliminating medications (or switching to other medications) may help restore desire.

Communication with your partner about what he can do to help you feel aroused can increase female libido too.

Simply changing your routine may help boost your desire. Try having sex in different positions or at different times of the day.

Menopause is a normal condition that all women experience as they age. The term “menopause” can describe any of the changes a woman goes through either just before or after she stops menstruating, marking the end of her reproductive period.

A woman is born with a finite number of reproductive eggs, which are stored in the ovaries. The ovaries also make the hormones estrogen and progesterone, which control menstruation and ovulation. Menopause happens when the ovaries no longer release an egg every month and menstruation stops.

Menopause is considered a normal part of aging when it happens after the age of 40. But some women can go through menopause early, either as a result of surgery, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Menopause that happens before 40, regardless of the cause, is called premature menopause.

The process is gradual and has three stages that blend into each other:

• Perimenopause. This typically begins several years before menopause, when the ovaries gradually make less estrogen. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, the drop in estrogen quickens. At this stage, many women have menopause symptoms.
• Menopause. This is the point when it’s been a year since a woman last had her last menstrual period. At this stage, the ovaries have stopped releasing eggs and making most of their estrogen.
• Postmenopause. These are the years after menopause. During this stage, menopausal symptoms such as hot flashes ease for most women. But health risks related to the loss of estrogen rise as the woman ages.

Most women approaching menopause will have hot flashes, a sudden feeling of warmth that spreads over the upper body, often with blushing and some sweating. The severity of hot flashes varies from mild in most women to severe in others.

Other common symptoms around the time of menopause include:

• Irregular or skipped periods
• Insomnia
• Mood swings
• Fatigue
• Depression
• Irritability
• Racing heart
• Headaches
• Joint and muscle aches and pains
• Changes in libido (low sex drive)
• Vaginal dryness
• Bladder control problems

Not all women get all of these symptoms. Some will have a minimum, others are not so lucky.

The loss of estrogen linked with menopause has been tied to a number of health problems that become more common as women age.

After menopause, women are more likely to have:

• Osteoporosis
• Heart disease
• A poorly working bladder and bowel
• Greater risk of Alzheimer’s disease
• Poor skin elasticity (increased wrinkling)
• Poor muscle power and tone
• Some weakening in vision, such as from cataracts (clouding of the lens of the eye) and macular degeneration (breakdown of the tiny spot in the center of the retina that is the center of vision)

Most women have tender breasts, bloating, and muscle aches a few days before they start their menstrual periods. These are normal premenstrual symptoms. But when they disrupt your daily life, they are called premenstrual syndrome (PMS). PMS can affect your body, your mood, and how you act in the days leading up to your menstrual period.

Some women first get PMS in their teens or 20s. Others don’t get it until their 30s. The symptoms may get worse in your late 30s and 40s, as you approach perimenopause.

PMS is connected to hormone changes that happen during your menstrual cycle. Doctors don’t fully know why premenstrual symptoms are worse in some women than in others. What they do know is that for many women, PMS runs in the family.

Not getting enough vitamin B6, calcium, or magnesium in the foods you eat can increase your chances of getting PMS. High stress, a lack of exercise, and too much caffeine can make your symptoms worse.

Common physical signs include:

• Bloating
• Swollen and tender breasts.
• Lack of energy.
• Headaches
• Cramps and low back pain.

It is also common to have some emotional problems too:

• Feel sad, angry, irritable, or anxious.
• Be less alert.
• Have trouble focusing on tasks.
• Withdraw from family and friends.

Acupuncture and tinctures (plants) are of great help here.

Osteoporosis is a common condition in humans where bones become weak; it affects both men and women, mainly as they grow older. Bone is living tissue that is in a constant state of regeneration. That is, the body removes old bone (called bone resorption) and replaces it with new bone (bone formation). By their mid-30s, most people begin to slowly lose more bone than can be replaced. As a result, bones become thinner and weaker in structure.

Osteoporosis is silent because there are no symptoms associated with this. It may come to your attention only after you break a bone (post-factum). When you have this condition, a fracture can occur even after a minor injury, such as a fall. The most common fractures occur at the spine, wrist and hip. Spine and hip fractures, in particular, may lead to chronic pain and disability, and even death. The main goal of treating osteoporosis is to prevent such fractures in the first place.

Fortunately, you can take steps to reduce your risk of osteoporosis. By doing so, you can avoid the often-disabling broken bones (fractures) that can result from this condition. If you already have osteoporosis, there is always help from naturopathic medicine; a Treatment Plan will decrease the chance of having a fracture if the patient is compliant with it.

Major risk factors that you cannot change include:

• Older age (starting in the mid-30s but more likely with advancing age, like >60)
• Non-Hispanic white or Asian ethnic background
• Small bone structure
• Family history of osteoporosis or an osteoporosis-related fracture in a parent or sibling
• Prior fracture due to a low-level injury, particularly after age 50

People over age 50 are at greatest risk of developing osteoporosis and having related fractures. Over age 50, one in two women and one in six men will suffer an osteoporosis-related fracture at some point in their lives.

Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women of reproductive age (20-45). Women with PCOS may have enlarged ovaries that contain small collections of fluid, named follicles, located in each ovary.

There’s no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion, which means the doctor considers all of your signs and symptoms and then rules out other possible disorders. An ultrasound exam can show the appearance of your ovaries and the thickness of the lining of your uterus and sheds some light into this condition.

Infrequent or prolonged menstrual periods, excess hair growth (face and body), acne, and obesity can all occur in women with polycystic ovary syndrome. In adolescents, infrequent or absent menstruation may raise suspicion for the condition.

The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

Most women will experience some form of vaginal infection or inflammation during their lifetime. It could come from an infection caused by bacteria, yeast, or viruses. Chemicals in soaps, sprays, or even clothing that come in contact with this area could be irritating the delicate skin and tissues and thus causing this inflammation that is so bothersome.

Doctors refer to the various conditions that cause an infection or inflammation of the vagina as “vaginitis.” The most common kinds are:

• Bacterial vaginosis (not well understood if it is a STD)
• Yeast infections (Candida albicans)
• Chlamydia (Chlamydia trachomatis)
• Gonorrhea (Neisseria gonorrhoeae)
• Reactions or allergies (non-infectious vaginitis)
• Trichomoniasis (Trichomonas vaginalis)
• Viral vaginitis (Herpes simplex)

The diagnosis can be difficult because the patient could have more than one at the same time.

A woman’s vagina makes discharge that’s usually clear or slightly cloudy and no odor. It’s how the vagina cleans itself.

It doesn’t really have a smell or make you itch. How much of it and exactly what it looks and feels like can vary during your menstrual cycle. At one point, you may have only a small amount of a very thin or watery discharge, and at another time of the month, it’s thicker and there’s more of it. That’s all normal.

When discharge has a very noticeable odor, or burns or itches, that’s likely a problem. You might feel an irritation any time of the day, but it’s most often bothersome at night. Having sex can make some symptoms worse.

A healthy vagina has many bacteria and yeast that live symbiotically in the reproductive system. However, some things can disturb the healthy balance. These include, but not limited to:

• Douches
• Hormone level changes
• High number of sexual partners
• Antibiotics
• Vaginal creams/suppositories
• Pregnancy and breastfeeding
• Poor hygiene

The ovaries are two small, bean-shaped organs that are part of the female reproductive system. A woman has two ovaries – one each side of the uterus.

The ovaries have two main functions. They are:

• to release an egg approximately every 28 days as part of the menstrual cycle
• to release the female sex hormones, estrogen and progesterone, which play an important role in female reproduction

An ovarian cyst is a fluid-filled sac that develops on a woman’s ovary. They are very common and do not usually cause any symptoms.

Ovarian cysts may affect both ovaries at the same time, or they may only affect one.

The two main types of ovarian are:

• functional ovarian cysts – cysts that develop as part of the menstrual cycle and are usually harmless and short-lived; these are the most common type of ovarian cyst
• pathological ovarian cysts – cysts that occur due to abnormal cell growth; these are much less common

Ovarian cysts can sometimes also be caused by an underlying condition, such as endometriosis.

The vast majority of ovarian cysts are non-cancerous (benign), although a small number are cancerous (malignant). Cancerous cysts are more common in women who have been through the menopause.

An ovarian cyst will usually cause symptoms if it splits (ruptures), is very large, or it blocks the blood supply to the ovaries. In these cases, you may have some of the following symptoms:

• pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain
• pain during sex
• difficulty emptying your bowels
• a frequent need to urinate
• heavy periods, irregular periods or lighter periods than normal
• bloating and a swollen tummy
• feeling very full after only eating a little
• difficulty getting pregnant (although fertility is unaffected in most women with ovarian cysts)

To diagnose this, the patient is usually referred for an ultrasound scan, carried out by using a probe placed inside your vagina. If a cyst is identified during the ultrasound scan, you may need to have this monitored with a repeat ultrasound scan in a few weeks, or your MD may refer you to a gynecologist

Pelvic inflammatory disease, commonly called PID, is an infection of the female reproductive organs. PID is one of the most serious complications of a sexually transmitted disease in women: It can lead to irreversible damage to the uterus, ovaries, fallopian tubes, or other parts of the female reproductive system, and is the primary preventable cause of infertility in women.

There are approximately 100,000 cases of symptomatic PID annually in Canada, although PID is not nationally reportable, so exact numbers are unknown.

It is estimated that 10–15% of women of reproductive age have had one episode of PID in their life.

What causes PID?

Normally, the cervix prevents bacteria that enter the vagina from spreading to the internal reproductive organs. If the cervix is exposed to a sexually transmitted disease, such as gonorrhea and/or chlamydia, the cervix itself becomes infected and less able to prevent the spread of organisms to the internal organs. PID occurs when the disease-causing organisms travel from the cervix to the upper genital tract. Untreated gonorrhea and chlamydia cause about 90% of all cases of PID. Other causes include abortion, childbirth, and pelvic procedures.

The symptoms of PID can vary, but may include some of the following:

• Dull pain or tenderness in the stomach or lower abdominal area, or pain in the right upper abdomen
• Abnormal vaginal discharge that is yellow or green in color or that has an unusual odor
• Painful urination
• Chills or high fever
• Nausea and vomiting
• Pain during sex

If the doctor suspects PID, he/she may order other tests, including:

• Blood tests to analyze blood for evidence of infection.
• Ultrasound (sonogram) to view the reproductive organs.

Other tests less commonly performed include:

• Endometrial biopsy, a procedure in which a small sample of tissue from the lining of the uterus (endometrium) is removed for evaluation and testing.
• Laparoscopy, a procedure during which a thin, lighted instrument (laparoscope) is inserted through a small cut in the lower abdomen to allow the doctor to examine the internal reproductive organs.

Some studies suggest that douching may contribute to PID. Douching may push bacteria into the upper genital tract and may mask the discharge that could alert a woman to seek medical attention.

The medical term used to describe “absence of periods” is amenorrhea. Women normally do not menstruate before puberty, during pregnancy, and after menopause. If a woman does not get her period when she normally should, it may be the symptom of a treatable medical condition.

There are two types of amenorrhea:

• primary amenorrhea; Primary amenorrhea is when a young woman has not had her first period by the age of 16. Possible causes of primary amenorrhea include:

• Failure of the ovaries (female sex organs that hold the ovarian eggs)
• Problems in the central nervous system (brain and spinal cord) or the pituitary gland (a gland in the brain that makes hormones involved in menstruation)
• Poorly formed reproductive organs
• In many cases, the cause of primary amenorrhea is not known.
• secondary amenorrhea; Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period for three or more months. Common causes of secondary amenorrhea include:
• Pregnancy
• Breast feeding
• Stopping the use of birth control
• Menopause
• Some birth control methods

A woman who has had her uterus or ovaries removed will also stop menstruating.

Other causes of secondary amenorrhea include:

• Stress
• Poor nutrition
• Depression
• Certain drugs
• Extreme weight loss
• Over-exercising
• Ongoing illness
• Sudden weight gain or being very overweight (obesity)
• Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
• Thyroid gland disorders
• Tumors on the ovaries or brain (but this is rare)

If you bleed a lot during your menstrual cycle, you’re not alone. Many women do. When you have heavy menstrual periods (also called menorrhagia), you may:

• Pass large blood clots and soak through your usual pads or tampons.
• Bleed for more than 7 days. (A normal period usually lasts 4 to 6 days.)
• Have severe menstrual cramps.

Heavy periods can be messy and unpleasant, and they may disrupt your life. But in most cases, they aren’t a sign of a serious problem.

A number of things can cause heavy periods. These include:

• A change in hormones. Normally one of your ovaries releases an egg during your menstrual cycle. This is called ovulation. If you don’t ovulate, your hormone levels can get out of balance. This can affect the lining in your uterus and may cause heavy bleeding.
• An irritation in the uterus. Certain things can cause this, such as using a copper IUD.
• A growth in the uterus, such as a polyp or fibroid.
• This condition occurs when the cells that normally line the uterus grow into the wall of the uterus.
• Bleeding disorders that prevent blood from clotting properly.
• Certain medicines, such as anticoagulants.

When you lose a lot of blood during your period, your iron levels can drop. This can cause anemia. Anemia can make you feel tired and weak and have spells of dizziness.

On average, a woman gets her period every 24 to 38 days. A period usually lasts about two to eight days. You may have irregular periods if:

• The time between each period starts to change.
• You are losing more or less blood during a period than usual.
• The number of days that your period lasts varies significantly.

Irregular periods can be caused by many different things. Changes in your body’s level of the hormones estrogen and progesterone can disrupt the normal pattern of your period. That’s why young girls going through puberty and women approaching menopause commonly have irregular periods.

Other common causes of irregular periods include:

• Having an intrauterine device (IUD)
• Changing birth control pills or using certain medications
• Excessive exercise
• Travel
• Eating disorders (anorexia or bulimia)
• Polycystic ovary disease (PCOS)
• Pregnancy or breastfeeding
• Stress
• Overactive thyroid (hyperthyroidism)
• Thickening of or polyps on the uterine lining
• Uterine fibroids

Usually, no treatment is needed for irregular periods caused by puberty and menopause unless they are excessive or bothersome. It is also normal for your period to stop when you are pregnant

Uterine fibroids (leiomyomata) are non-cancerous growths that develop in or just outside a woman’s uterus (womb). Uterine fibroids develop from normal uterus muscle cells that start growing abnormally. As the cells grow, they form a benign tumor.

No one knows what causes uterine fibroids, but their growth seems to depend on estrogen, the female hormone. Uterine fibroids don’t develop until after puberty, and usually after age 30. Uterine fibroids tend to shrink or disappear after menopause, when estrogen levels fall.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

African-American women tend to get uterine fibroids two to three times as often as white women, and also tend to have more symptoms from uterine fibroids. The reason is unknown.

Other factors that may influence development of uterine fibroids:

• Pregnancy: Women who have had children are less likely to get fibroids.
• Early menstruation: Women whose first period was before age 10 are more likely to have uterine fibroids.
• Women taking birth control pills are less likely to develop significant uterine fibroids.
• Family history: Women whose mothers and sisters have uterine fibroids are more likely to have them.

Most often, uterine fibroids cause no symptoms at all, so most women don’t realize they have them. When women do experience symptoms from uterine fibroids, they can include:

• Prolonged menstrual periods (7 days or longer)
• Heavy bleeding during periods
• Bloating or fullness in the belly or pelvis
• Pain in the lower abdomen or pelvis
• Constipation
• Pain with intercourse

To diagnose the uterine fibroids, imaging test are often done: ultrasound, pelvic MRI or biopsy.

Infertility is defined as not getting pregnant after a year of regular, unprotected sex. The man, the woman, or both, may have a fertility problem. In women over 35 years old, infertility means not getting pregnant after six months of regular, unprotected sex.

Infertility doesn’t always mean a person is sterile (unable ever to have a child). Up to 15% of all couples are infertile, but only 1% to 2% are sterile. Half of couples who seek help can eventually have a child, either on their own or with medical help.

In Canada, the prevalence of past-12-month infertility rose from 5% in 1984 to a range of 12% to 16% in 2009/2010.

Both men and women can have a fertility problem. In about 20% of infertile couples, both partners have fertility problems, and in about 15% of couples, no cause is found after all tests have been done. This is called “unexplained infertility.”

In MEN, the most common reasons for infertility are problems with sperm, including:

• Low sperm count. Too few or no sperm in the semen.
• Low sperm motility. Sperm don’t move as well as they should.
• Abnormally formed sperm.
• Blocked sperm ducts.

Another common problem is a temporary drop in sperm production. This happens when the testicles have been injured, such as when they have been too hot for too long or the man has been exposed to chemicals or drugs that affect sperm production.

Drinking alcohol and smoking can lower sperm count. And the fertility decreases naturally in men aged 40 and older, even if they don’t want to admit it!

In WOMEN, the main reason for infertility is not ovulating, which means not releasing eggs from the ovary. Polycystic ovary syndrome (PCOS) is usually the main cause of not ovulating.

Problems with the fallopian tubes, which carry eggs from the ovary to the uterus, are a common cause of female infertility. Sometimes the tubes are blocked by scar tissue from an infection or from a condition called endometriosis.

Smoking can decrease fertility in women too (as much as it decreases in men) and can increase risk of ectopic pregnancy.

If an egg does make its way through the fallopian tubes, many things can stop it from implanting in the uterus. And cervical mucus can damage sperm or slow their progress.

Age can be a problem, too. In women, fertility drops with age, and even more so after the age of 35. Getting pregnant after age 45 is rare. Being overweight or underweight can also play a role.