Can you get pregnant during perimenopause?

Hand holding a positive pregnancy test with two lines. Can you get pregnant during perimenopause? This image relates to that question.
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Created with Natasha Lowe Osho, MD, Obstetrician-Gynecologist, USA

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In a nutshell

Yes, you can still become pregnant. Despite hormonal changes that can complicate conception, many women in their 40s still successfully conceive. For those hoping to start or grow their family, tailored health screenings and expert advice are crucial.

For women planning a pregnancy during their perimenopause stage, it’s important to undergo preconception counseling or evaluation, stick to a fixed schedule of counseling and screening, and leverage other health considerations to mitigate potential pregnancy-related risks and make their journeys healthy. For those not planning to get pregnant, it’s crucial to understand the available methods of contraception.

What is perimenopause?

Perimenopause is a transitional stage that leads up to menopause. During this transition, females’ levels of estrogen and progesterone hormones begin to decline. The decline often has an unpredictable and irregular nature, which causes common symptoms like:

  • Irregular periods
  • Hot flashes
  • Sleep difficulties
  • Changes in sexual behavior
  • Mood swings
  • Bladder and vaginal issues

This period typically takes place several years before the last menstrual cycle. The age of its beginning can be very individual. Yet, the average age range for having perimenopause is between 40 and 44 years. The average duration of this change is four years, though the transition can take up to 10 years.

Perimenopause is a natural stage that occurs in most females’ lives. The exception might be women who experience sudden induced menopause due to certain surgeries or treatments.

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Can you get pregnant in perimenopause?

So can you get pregnant during perimenopause? Research finds that the chance of getting pregnant naturally within 12 months is 35% for women in their 40s. This figure and experts’ assessments confirm that yes, you can conceive and give birth in perimenopause.

Perimenopause initiates different physical changes in a female body. To understand your fertility and pregnancy possibilities, it’s good to figure out how different hormones in your body change during this period.

Hormones changes during perimenopause and its impact on fertility

Estrogen, the main female hormone, is responsible for the development and function of your reproductive system. During perimenopause, the amount of this hormone circulating through your body alternates unpredictably.

In addition to estrogen, the levels of other key hormones also vary:

  1. Progesterone is the second key hormone in female bodies. It prepares the uterine lining to create a suitable environment for a fertilized egg and helps maintain early pregnancy. Its amount also declines along with estrogen.
  2. Testosterone is a male hormone that serves the maintenance and repair of reproductive tissues. It plays a major role in estrogen production and contributes to libido. The levels of this hormone decrease by about 50% during a woman’s reproductive life but during the menopausal transition period, its production tends to increase.

👉 Find out more: My husband takes testosterone injections. Can I still get pregnant

Uneven changes in these hormones during perimenopause lead to a loss of overall hormonal balance. As a result, menstrual cycles may also change unpredictably in this period. They may shorten or lengthen and there might be cycles without ovulation, which can directly affect the chances of conceiving. Still, this doesn’t mean that it is not possible to get pregnant during this period at all.

Graph showing fertility decline during perimenopause. Can you get pregnant in perimenopause? Yes, but the chances lower as you age.

Can I ovaluate during perimenopause?

Yes, you can still ovulate during perimenopause. Although your menstrual cycles may become irregular, ovulation can still occur. The frequency and predictability of ovulation may decrease, but it does not entirely stop until menopause is reached. Tracking your ovulation through methods like ovulation predictor kits, basal body temperature charting, or consulting with a healthcare provider can help you better understand your cycle and optimize your chances of conceiving.

The risk of getting pregnant during perimenopause

Due to a combination of factors, experts associate higher maternity ages with certain delivery complications and risks. Studies emphasize increased odds of the following risks in 40-year women and older:

  • Preeclampsia
  • Fetal distress
  • Poor fetal growth
  • Preterm delivery
  • Low birth weight
  • And other adverse outcomes

Despite the potential risks, getting pregnant and becoming a mother in your transition period is possible. If this is something you are striving for, below are some practical tips that can help mitigate the risks.

If you’re planning to get pregnant:

  • Receive preconception evaluations by your OBGYN, midwife, family practice doctor, family nurse practitioner, or women’s health nurse practitioner. Consider seeing other specialists if necessary, including maternal-fetal medicine (MFM) specialist or fertility specialist.
  • Before conception, focus on addressing pre-existing medical conditions.
  • If you’re over 35 and trying to get pregnant for six months or more, consider talking to your doctor and discussing the options of assisted reproductive technologies (ART). ACOG (American College of Obstetrics and Gynecology) recommends that any woman 40 or above immediately see a fertility specialist if desiring pregnancy.

👉 Find out more: Can an ovulation test detect pregnancy: Here’s what you may want to know

If you’re already pregnant:

  • Develop and stick to a fixed schedule of counseling and aneuploidy screening during the first trimester. The term aneuploidy refers to the presence of extra chromosomes or the absence of one or more chromosomes in a fetus. This condition might potentially lead to miscarriage or medical conditions in a baby, including Down syndrome. The possibility of fetal aneuploidy may rise with maternal age. But the accuracy of noninvasive prenatal testing (NIPT) increases with age, which is why it becomes possible to detect 82% to 87% of pathologies if you adhere to a schedule of first-trimester screenings.
  • Complete a fetal echocardiogram and anatomy scan by 22 weeks into pregnancy.
  • Consider third-trimester fetal surveillance if necessary. It’s a series of assessments ordered to monitor pregnancies that are associated with certain medical conditions or might have potential complications. The tests involved in fetal surveillance typically include ultrasound, non-stress test (NST), contraction stress test (CST), and biophysical profiles (BPP). These assessments are just extra measures of vigilance and are designed to make the pregnancy and birth as safe and healthy as possible, both for the mother and baby.

If you want to have a smooth and positive pregnancy journey, you might want to prepare for conception well, follow all routine parental care steps, and carefully consider all the recommendations of your specialists.

Health screening tips during perimenopause: consult OB-GYN, schedule screenings, adopt healthy habits.

What if you are using HRT?

In the United States, HRT is usually started after a woman reaches menopause. During perimenopause, hormonal contraception can be used to prevent pregnancy and regulate irregular menstrual cycles.

But if you are already using hormone replacement therapy to treat the symptoms of perimenopause, continuous combined HRT is not linked with any harm or risks for pregnancy, but it also doesn’t act as contraception and thus, doesn’t prevent pregnancy.

In the United States, HRT is usually started after a woman reaches menopause. During perimenopause, hormonal contraception can be used to prevent pregnancy and regulate irregular menstrual cycles.

If you are planning a pregnancy or think that you are already pregnant and you are currently taking HRT, you might want to see your doctor and discuss the possibility of discontinuation of your HRT intake. Although there are no risks, HRT is generally not necessary during pregnancy when your estrogen and progesterone are naturally rising.

Precautions and health considerations

Start by having a comprehensive health evaluation before conception. This is important to detect any chronic conditions, imbalances, and other issues that you might have. To get the preconception health assessment right, make an appointment with your doctor early on. 

A specialist most likely will request a full medical history from you and your partner. Then, they will typically run a number of blood tests, a Pap smear, and other recommended screenings based on your medical history, lifestyle, and other factors.

Specialists might also recommend you see a genetic counselor, medical geneticist, or other genetics professional and run some additional screenings in certain situations. Some common reasons for such suggestions include when there is a personal or family history of a genetic condition, hereditary cancer, birth defect, or chromosomal disorder. A personal history of stillbirth or two or more miscarriages may also serve as reasons for recommended genetic counseling.

Hand holding a positive pregnancy test with two lines. Can you get pregnant during perimenopause? This image relates to that question.

After conception, the recommended health screenings include:

  • Chromosome screening. This assessment is there to detect any chromosomal abnormalities.
  • Diabetes and blood pressure screenings. Studies indicate higher risks of these conditions in pregnant women in perimenopause so it’s important to keep them under control.
  • Ultrasound scans for abnormalities. This is a typical screening type doctors use to assess the fetus’s development. It helps detect any abnormalities and develop an efficient postnatal care plan if necessary.
  • Preeclampsia screening. Preeclampsia is a condition that could become a risk factor for future kidney, cerebrovascular, and cardiovascular disease developing in perimenopausal women. Pregnancy might become a trigger for this condition but respective screening can help reveal and address it effectively.
  • Premature birth risk screening. This is a specific screening meant for advanced maternal age. It identifies how a mother’s age and current health condition can impact pregnancy and what risks it may convey.

Boost your fertility to get pregnant during perimenopause

Perimenopause can make conceiving more challenging due to fluctuating hormone levels and irregular menstrual cycles. However, it is still possible to boost your fertility and increase your chances of getting pregnant during this phase by focusing on maintaining a healthy lifestyle.

  • To receive a steady flow of nutrients in sufficient amounts, build your daily diet by blending nutrient-rich products from all food groups:
    • Whole grains
    • Protein foods
    • Whole fruits
    • Veggies
    • Low-fat or fat-free dairy
    • Oils and foods rich in oil

Use the freshest edition of dietary guidelines to build your healthy diet.

  • Studies show that excessive caffeine intake can potentially slow down the process of conception. If you’re used to drinking lots of coffee and tea a day, consider gradually replacing them with decaffeinated options. Or you might assess your current caffeine consumption and gradually reduce it to moderate indicators recommended for pregnancy – 200 mg per day or less.
  • Generally, moderate sports and physical activity are considered to contribute to a healthy conception and pregnancy by reducing the risks of chronic illnesses, helping retain a healthy weight, and mitigating stress, anxiety, and other mental challenges.

What if I’m perimenopausal and I don’t want to get pregnant? Contraception in perimenopause

If you don’t want to get pregnant during this stage in your life, this is absolutely natural regardless of your reasons. But the possibility of conception is still there, so it’s good to be aware of the best contraception practices during perimenopause to avoid unwanted pregnancy.

An infographic discusses pregnancy prevention during perimenopause. Contraception options: Pill 91% effective, IUD 99% effective, Condom 85% effective.

Combined hormonal contraceptives (CHCs)

This type of contraceptive comes in many different forms: daily pills, transdermal patches, vaginal rings, and injectable combined contraceptives.

As a bonus to contraception, CHCs can offer extra benefits, such as:

  • Stabilized menstrual cycle
  • Reduced vasomotor symptoms (such as perimenopausal migraine)
  • Reduced cancer risks
  • Bone loss protection

The contraindications to taking CHCs include:

  • Obesity
  • Long-standing diabetes
  • Tobacco use
  • Migraines with aura

Important note: In the United States, HRT is usually started after a woman reaches menopause. But if you are on HRT, taking it together with combined hormonal contraceptives might lead to hormonal disbalance. Early studies reported an increased likelihood of cardiovascular events and other health outcomes on this occasion. Today, formulations tend to contain lower doses of hormones but it’s still important to consult with a doctor before combining HRT and hormonal contraception.

Progestin-only pills (POPs)

The primary active compound in POPs is synthetic progestin. Regular intake of these pills thins your uterine lining, thickens cervical mucus, and stops ovulation. Some women may stop having periods in the course of using pills or experience less bleeding, which is a benefit for females suffering from heavy or painful periods. The contraindications to using POPs get down to a personal history of active or recent breast cancer.

Note: if you are planning to use any combined contraceptives, including POPs, it’s important to consult with a healthcare provider.

How to calculate fertile window?

Femia offers the most accurate tool for determining ovulation and fertile days

Try Femia now

Condoms

Condoms might be among the most popular types of contraception of all. They are easy to use and suit the vast majority of people. The only two contraindications to their use are a latex allergy or current use of antifungal medicine on or around your or your partner’s genitals.

Condoms are proven to be an effective method of contraception in 98% of cases if used correctly and in 82% if used incorrectly.

Intrauterine device (IUD)

IUD is another popular method of contraception today used by 151 million married/in-union women and eight million unmarried women. It’s a small, T-shaped device put into the female womb. This method boasts 99% effectiveness and lasts for 5-10 years. It also starts working instantly after the implantation, which means it can work as emergency contraception.

The bottom line

So can you get pregnant during perimenopause? The short answer is yes.

The likelihood of pregnancy remains even when you step into your perimenopause stage. The overall birth rate for perimenopausal women might be lower compared to females who are at the peak of their reproductive years due to fewer conscious conception attempts. Still, a 35% chance of getting pregnant naturally is fairly good so with the right approach and comprehensive screening, it’s possible to conceive a child and give birth.

For women who aren’t planning pregnancy during perimenopause, it’s also important to understand the available contraception methods and the potential risks related to unwanted pregnancies.

Now, depending on your goals, be sure to consult with your healthcare provider to develop a healthcare plan aimed at pregnancy or contraception based on your unique needs.

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