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.
  • Updated
  • Published

Crafted by human

At Femia, we provide accurate and up-to-date information at every stage of your journey, from trying to conceive, pregnancy and postnatal support. All content is created by a real person based on in-depth research and own professional experience. Femia ensures that you will receive expert advice, strict accuracy and a personalized approach from our authors/medical experts. Learn more about our editorial policy. Discover more about editorial policy.

Fact checked

At Femia Health, we maintain the highest standards of editorial excellence in delivering content focused on helping you conceive, guiding you through pregnancy, and supporting you postpartum. Explore our content review principles to learn how we ensure the accuracy and quality of our health and lifestyle tips for every stage of your journey.

Author picture

Created with Natasha Lowe Osho, MD, FACOG, Board Certified in Obstetrics and Gynecology, NASM Certified Personal Trainer, and Pre/Postnatal Fitness Specialist, USA

In this article
In a nutshell

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. And if you’re not looking to conceive, understanding effective contraception is key. 

Perimenopause usually takes place between 40 and 44 years and acts as a natural transition to menopause in women. Due to unstable hormonal changes that take place during this stage, females in their 40s and 50s may have a lower likelihood of pregnancy. Still, they can conceive and give birth. 

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.

Can you get pregnant 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.

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. However, instead of a balanced decline, we can often see uncontrolled swings. This may lead to a disbalance between estrogen and progesterone levels.
  2. Testosterone is a male hormone. It also regulates some important processes in your reproductive and sexual health. Namely, it 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.

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.

During perimenopause, your levels of reproductive hormones can both recede. But they can unpredictably rise as well. This means that your ovulation cycles, where the ovary releases an egg, might be unpredictable. That’s why women in perimenopause remain fertile.

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.

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

Is it dangerous to get 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

Women in perimenopause often fall into a high-risk group when it comes to pregnancy, but we might want to treat related studies with caution. Lower birth rates in perimenopausal women might be due to fewer purposeful attempts to conceive. Sample sizes in studies on advanced maternal age are often relatively small, which might make their results not as extended or well-researched as they seem.

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.  

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). But don’t worry if your physician orders third-trimester surveillance testing. 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.
How to calculate fertile window?
Try Femia now

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.

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

Precautions and health considerations

When planning a pregnancy during perimenopause, you might want to take a holistic and informed approach.

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.

In addition to comprehensive preconception and pregnancy assessments, future mothers in their perimenopause stage might want to consider certain lifestyle adjustments and prenatal care recommendations to ensure optimal maternal and fetal health. Most of these considerations are very common and standard but here are a few practical recommendations:

  • In order to handle the entire pregnancy and childbirth periods in a healthy way, your body needs to receive a steady flow of nutrients. To receive them 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. If you used to be active and exercise regularly before pregnancy, you might want to consider continuing, though a little less strenuously. If you weren’t active before, you may want to start doing a low to moderate intensity activity without rushing into it in order to reduce the stress on your body. Consider researching different options and consulting with your doctor before engaging in any specific activity.

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, which makes it easy to choose an option that works for you. Namely, CHCs can come as daily pills, transdermal patches, vaginal rings, and injectable combined contraceptives.

CHCs work thanks to an estrogenic component. This hormone inhibits ovulation, stabilizes endometrial proliferation, and makes the cervical mucus inhospitable for spermatozoa.

These contraceptives are highly effective in the ideal (aka regular) intake. They also suit a majority of healthy perimenopausal women. 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)

This next option is an estrogen-free, oral contraceptive. 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.

This kind of contraception might be a suitable option for perimenopausal women who have contraindications to taking CHCs. 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.

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.

These and other contraception methods might work for you in avoiding pregnancy during perimenopause. Consider researching the options and consulting with your healthcare provider to find the most effective and convenient method of 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.

 

Facebook
Twitter
Threads
In this article
Related articles
Woman applying skincare product.
Can you get Botox while pregnant?

Discover the facts about this cosmetic procedure while expecting or nursing a baby, and explore safe alternatives to keep your skin healthy and glowing.