Can you get pregnant during perimenopause?

Menopause comes with a wide range of myths and misconceptions — arguably too many. And a lot of that centers around whether or not you can get pregnant during the transition. Whether you’re trying to conceive or not, understanding how menopause affects your fertility can help you plan for the future. Because here’s the truth: Perimenopause’s fluctuating hormones may make it tougher to get pregnant, but not impossible. 

This article sheds some light on menopause and its impact on fertility, and answers questions like whether you can get pregnant during perimenopause or after menopause, if it can happen naturally, and the signs of pregnancy during menopause.

Your ability to get pregnant naturally declines with age and is affected by where you are in your menopause transition: perimenopause vs menopause vs postmenopause. Perimenopause is the time before menopause, which often occurs in your 40s. It’s characterized by fluctuating hormones that can cause symptoms like hot flashes. While your ovulation becomes less predictable, it still occurs. And if you’re ovulating, it may be possible to get pregnant.

You experience actual menopause after you go 12 consecutive months without a period. Menopause marks the end of your reproductive years, and you are no longer able to get pregnant. It’s important to continue using contraception until menopause is confirmed.

How clinicians assess menopause stage

Menopause or perimenopause diagnoses are largely clinical. Menopause hormone testing is not routinely needed, but it may be recommended in select cases to rule out any other causes for symptoms you’re experiencing.

If your periods become irregular, light, or infrequent, your doctor may ask you to take a pregnancy test as part of the perimenopause or menopause diagnosis.

During your diagnosis visit, your clinician will need to know your cycle and symptom history, review your medication, and assess any other potential causes for symptoms.

Yes, you may still be able to get pregnant during perimenopause. Sporadic ovulation can still happen during this time, even as your cycle becomes irregular. 

The likelihood of you getting pregnant while experiencing perimenopause depends on ovulation, frequency of sex, efficacy of contraception (if used), and male partner fertility. The chances of becoming pregnant naturally are quite low, due to a reduction in the quantity and quality of oocytes (developing eggs). If you do get pregnant, you may have a higher risk of complications, so make sure to discuss those risks with a clinician.

And if you are trying to conceive during perimenopause, have an early conversation with your clinician for support and to discuss your options.

Trying to conceive during perimenopause

If you’re still ovulating, getting pregnant in your 40s may be a possibility. Seek early advice from a fertility specialist who may be able to support or provide recommendations. Where cycles allow, try to time intercourse with ovulation. Assisted reproductive technologies like IUI or IVF could also be discussed with your clinician.

Schedule an appointment with your clinician to review your health history, including any vaccinations you've received and medications you are currently taking. They should help you form an individualized plan and your clinician may even refer you to a fertility specialist.

If you want to avoid pregnancy

Contraception is recommended if you’re sexually active and not planning on getting pregnant, as sporadic ovulation keeps pregnancy as a possibility.

Your clinician can help you choose methods of birth control in perimenopause that may also help to reduce other symptoms. For example, hormonal contraceptives may help to minimize vasomotor symptoms and menstrual migraines as well as protect against bone loss.

Natural pregnancy can’t occur after menopause because you’re no longer ovulating. However, assisted reproductive options, like using donor eggs or embryos, may enable pregnancy after menopause under specialist care.

Natural conception vs assisted options

While it’s not possible to get pregnant naturally after you reach menopause, you may still be able to get pregnant through fertility treatments like in vitro fertilization (IVF). In this process, the sperm and egg are combined in a laboratory, and the embryo is transferred to the uterus. 

Women who are postmenopausal and trying to get pregnant may also use a donor egg from someone else. But thorough medical, reproductive and psychosocial screening prior to conception is essential for the best chance of a successful pregnancy in this older age group.

If infertility treatments are an option for you, remember that they can take time and require patience. There are also cost considerations, as they can be expensive and may not be covered by insurance. It’s best to speak to your healthcare provider for advice and support on whether you can get pregnant after menopause.

While a missed period may be a tell-tale sign of a potential pregnancy, cycle irregularity is also a side effect of perimenopause. Bloating and cramping, changes in sex drive, fatigue, and sleep issues are common symptoms across both as well. So how can you tell if you’re pregnant or in perimenopause?

There are some symptoms that tend to happen in one more than the other. For instance, common early pregnancy symptoms include nausea and vomiting, especially in the morning. But the only way to know for sure is to take a pregnancy test. So, if you haven’t yet reached menopause and you’re experiencing symptoms of pregnancy, like a missed period, use a home test and contact your clinician with any questions. 

Other conditions that can mimic symptoms

While perimenopause or pregnancy may be the more obvious culprits for cycle changes, there may be other reasons for it. These may include medications, health changes, or thyroid issues. For instance, women with either underactive or overactive thyroids report a greater prevalence of menstrual disturbances than those with normal functioning thyroids. If you’re concerned about any symptoms, it’s always best to check in with a clinician to rule out other causes.

To avoid unexpected pregnancies, contraception is recommended until menopause is confirmed. While variable ovarian cycles in perimenopause may lead to lower fertility, research suggests that it corresponds to higher rates of unexpected pregnancies in these women.

Condoms and short-acting hormonal contraceptives, like the pill or vaginal ring, are the most common contraceptive methods until the age of 40 to 45 years. After this point, long-acting reversible and permanent contraceptives, like an IUD or implant, are the most prevalent. Both hormonal and non-hormonal contraceptive methods may be appropriate for you, depending on your health history and personal goals.

Other conditions related to perimenopause may benefit from hormonal contraceptives, including vasomotor symptoms. For example, birth control pills that contain both estrogen and progesterone may help minimize hormone-related headaches or migraines and provide protection against bone loss.

Choosing a method with your clinician

Your clinician will be able to advise on which contraception option might be most suitable for your personal circumstances. It’s important to discuss the benefits and risks of perimenopause contraception options and how it may impact your symptoms and other health needs. You should also plan periodic check-ins so you and your clinician can see how your choice is working for you.

Remember that birth control during perimenopause may change your bleeding patterns and may mask menopause symptoms — artificially regulating your periods or causing you to not have any at all. This is normal.

Pregnancy in advanced maternal age is associated with increased risk of complications, including:

• Miscarriage

• Ectopic pregnancies

• Gestational diabetes

• Hypertension

• Unexplained stillbirth

Planning a safe pregnancy in menopause

To set yourself up for the best chance of a safe pregnancy in perimenopause, seek early prenatal care. If planning to get pregnant, consult a fertility specialist and go for a pre-pregnancy health check to learn how you can optimize your health before conception. And once you’re pregnant, discuss your pregnancy with an obstetric clinician and how you can optimize your health.

At every stage of your menopause journey, shared decision-making and support from a clinician are invaluable. If you notice any of the following, it’s important to get checked by a healthcare professional:

• Heavy or unusual bleeding

• Bleeding after 12 months without a period 

• New symptoms

• Severe symptoms 

If you think you may be pregnant, have earlier-than-expected symptoms, or complex medical histories, it’s essential to seek personalized medical advice.

There’s a lot of confusion surrounding menopause and fertility. Your fertility declines with age, but you may still be able to get pregnant during perimenopause due to sporadic ovulation. This means that pregnancy may be a possibility until menopause is confirmed (that’s when you’ve gone 12 months without a period). 

If you don’t want to get pregnant but haven’t reached menopause yet, use a method of contraception during sex. And if you’re trying to conceive during perimenopause, partner with a clinician early to discuss your options and safety.