Doctors say late pregnancies reflect fertility treatment and changing lifestyles, not a shift in when women reach menopause.
When she walked into Dr Charles Masiko’s clinic at 45, she was pregnant for the first time. There had been no fertility treatment, no hormones, no procedure. She had simply conceived naturally, at an age when many women are approaching the end of their reproductive years.
Two years later, she is back in his consulting room. At 47, she is pregnant again, and Dr Masiko says this pregnancy, too, was conceived naturally. When the pregnancy was confirmed, he says, she struggled to believe she was expecting another baby. He describes her as a woman who keeps fit and eats well.
Dr Masiko, a gynaecologist at Kawempe National Referral Hospital and La Bridge Hospital in Lusanja, says he is seeing more women starting families later than their mothers did.
A woman of 35 who is only just beginning to have children no longer surprises him. But a pregnancy at 47 raises a question that goes beyond the age at which women are having babies: if motherhood is possible later in life, does that mean menopause is also happening later?
The distinction matters because the ability to carry a pregnancy and the age at which a woman reaches menopause are not the same thing.
What fertility treatment can and cannot do
Safinah Namukwaya’s pregnancies brought that distinction into sharp focus. In 2020, at 64, she gave birth to a baby girl after in vitro fertilisation (IVF) using donor eggs. In November 2023, at 70, she delivered twins, a boy and a girl, through another IVF pregnancy.
Her pregnancies were made possible by fertility treatment, not by her ovaries continuing to release eggs into her seventies. Once a woman has reached menopause, donor eggs can make pregnancy possible if she is medically suitable for treatment and her uterus can carry the pregnancy.
According to Dr Edward Tamale Ssali, director of the Women’s Hospital International and Fertility Centre in Bukoto, Kampala, Namukwaya was the 25th woman above 50 to conceive through IVF at his centre.
The hospital operates an egg-sharing programme through which eggs donated by eligible IVF patients can be used to help other women conceive.
The treatment, however, raises questions beyond the medical possibilities. Uganda has long operated without a specific law governing assisted reproductive technology. The Human Assisted Reproductive Technology Bill, 2023, which was tabled in Parliament in March 2024 to regulate the sector, had yet to become law at the time of reporting.
Namukwaya’s story demonstrates what fertility treatment can achieve, but it should not be confused with a change in the natural ageing of the ovaries.
‘Women are not reaching menopause later,’ says Dr Vincent Karuhanga, a general practitioner at Friends Polyclinic in Kampala. He says the pregnancies that attract attention are better understood as examples of what fertility treatment can make possible, rather than evidence that the age of menopause is changing.
The woman pregnant at 47 presents a different case. Her pregnancies occurred without medical assistance, making them unusual at her age. Dr Masiko says natural conception becomes increasingly uncommon as women grow older, although it is not impossible before menopause. She is not the only one in her family, she says: her sister conceived naturally at 50.
Why women are starting families later
A woman’s natural fertility declines with age as the number and quality of her remaining eggs decrease. As the ovaries age, the likelihood of conception falls, while the likelihood of chromosomal abnormalities in eggs increases. These changes affect both the chances of becoming pregnant and the risk of miscarriage.
By menopause, the ovaries have stopped releasing eggs, making natural conception no longer possible. Fertility treatment may sometimes overcome the barrier to pregnancy by using donor eggs or previously frozen embryos, but it does not reverse the natural ageing of a woman’s ovaries.
The reasons women begin families later vary. Dr Masiko points to women pursuing higher education and careers before having children. Dr Karuhanga says some want financial security before taking on the cost of raising a family. Others take longer to find a partner or experience difficulties conceiving. These circumstances can mean that a woman begins trying for a child when her natural fertility has already declined. Some then seek medical assistance, while others may conceive naturally, as the 47-year-old patient did.
What late pregnancy means
Being able to conceive is not the same as being medically fit to carry a pregnancy. Pregnancy at an older age is associated with increased risks for both mother and baby, including high blood pressure disorders during pregnancy, gestational diabetes, miscarriage and preterm birth. The likelihood of some complications rises with age, and existing medical conditions may increase the risks further.
The age of the egg also matters. As women grow older, their remaining eggs are more likely to have chromosomal abnormalities, increasing the risk of miscarriage and certain conditions affecting the baby. Using donor eggs changes the age-related risks associated with the egg, but it does not remove the risks associated with the age and health of the woman carrying the pregnancy.
Namukwaya’s first delivery illustrated why pregnancies at very advanced ages require close medical attention.
Dr Herbert Kalema, a gynaecologist at Masaka Regional Referral Hospital, told the Daily Monitor that Namukwaya arrived with abdominal pain, high blood pressure, difficulty breathing and swollen legs. Her doctors opted for a caesarean delivery at eight months.
For the woman pregnant at 47, Dr Masiko says he is managing the pregnancy through monthly antenatal appointments. Her case illustrates why a pregnancy at this age needs medical supervision rather than assumptions based on how healthy or physically fit a woman appears.
For women considering pregnancy later in life, a discussion with a qualified health professional is important. Their age, existing medical conditions and individual circumstances all matter when assessing whether pregnancy is advisable and what monitoring may be required.
The point is not that every pregnancy in the forties will have complications. Rather, the risks change with age, and women need accurate information to make decisions about their reproductive health.
When does menopause actually happen?
Menopause is confirmed after 12 consecutive months without menstruation, provided there is no other medical explanation.
According to the World Health Organisation, most women experience natural menopause between 45 and 55 years.
During perimenopause, periods may become irregular, but pregnancy remains possible if ovulation continues.
However, conceiving in one’s forties does not mean menopause will occur later, and there is insufficient evidence that Ugandan women are reaching menopause later than previous generations.
When should you seek fertility advice?
Women aged 40 and above who wish to conceive should seek medical advice early rather than spend months trying without understanding their fertility prospects.
A fertility assessment may examine ovarian function, menstrual history and other factors affecting conception. Depending on the findings, a doctor may discuss natural conception, assisted reproductive techniques or other options.
Women who become pregnant in their forties also need early antenatal care because pregnancy at an advanced maternal age carries higher risks, including miscarriage, gestational diabetes, high blood pressure and chromosomal abnormalities.