Can you still get pregnant during perimenopause? Everything you need to know

If you’re navigating perimenopause, you might have wondered if pregnancy is still possible. With irregular periods, shifting hormones, and a mix of symptoms that feel unfamiliar, it can be tough to know exactly what your body is up to. The short answer is yes - you can get pregnant during perimenopause - but the chances and circumstances are very different from your earlier years. Here we dive deeper into what this means and how to approach it.

Understanding perimenopause and fertility

Perimenopause is the transitional phase leading up to menopause, marked by fluctuating hormone levels and irregular menstrual cycles. It often begins in your 40s, though for some women, it can start as early as their mid-30s. During this time, oestrogen and progesterone - the key hormones that regulate your menstrual cycle - don’t follow their usual patterns. Ovulation becomes less predictable, but it doesn’t stop altogether. And where there’s ovulation, there’s still the possibility of pregnancy.

That said, fertility naturally declines with age. The quantity and quality of eggs diminish, and the eggs that are released are more likely to have chromosomal abnormalities, which can make conception more challenging and increase the risk of miscarriage. While it might be harder to get pregnant, it’s not impossible.

Can you still ovulate during perimenopause?

Yes, ovulation can and does still happen during perimenopause - though not as regularly as before. Some women may go months without ovulating, while others ovulate sporadically. If you’re still having periods, even irregular ones, there’s a chance that your ovaries are releasing eggs.

It’s worth noting that ovulation during perimenopause can feel different too. Symptoms like changes in cervical mucus, mild pelvic pain (sometimes called mittelschmerz), or a surge in libido might still show up, signalling that ovulation is occurring. However, even without these signs, it’s possible to ovulate, making it difficult to predict exactly when you might be fertile.

How likely is pregnancy during perimenopause?

While the chances of conceiving naturally decrease significantly with age, pregnancy during perimenopause is still possible. Women in their early 40s have about a 5–10% chance of getting pregnant per cycle. By the mid-to-late 40s, those chances drop to less than 1% per cycle. These numbers reflect the challenges posed by both irregular ovulation and the decline in egg quality.

So while the odds aren’t high, they’re not zero. Many women assume that irregular periods mean they’re no longer fertile, but that’s not the case until menopause is fully confirmed - 12 months without a period.

The emotional side of perimenopause and pregnancy

For some women, the idea of getting pregnant during perimenopause feels stressful - especially if it’s unplanned. For others, it might feel like a last chance to expand their family. Wherever you fall on this spectrum, it’s important to understand that your feelings are valid. This phase of life is already full of transitions, and adding pregnancy to the mix - whether it’s desired or not - can feel overwhelming.

If you’re sexually active and not planning to have children, contraception is still essential. And if you are hoping to conceive, understanding the realities of fertility during this time can help you make informed decisions about your next steps.

If you’re trying to avoid pregnancy

Perimenopause can be a tricky time to navigate when it comes to contraception. Because ovulation is unpredictable, it’s crucial to use birth control until menopause is officially confirmed. Options include hormonal methods like the pill, patch, or IUD, which can also help with other symptoms like heavy periods or mood swings. Non-hormonal options, such as condoms or diaphragms, are also effective for those looking to avoid additional hormones.

Even if your periods are irregular or seem to be tapering off, remember: as long as there’s even a small chance of ovulation, pregnancy is still possible.

If you’re hoping to conceive

On the flip side, if you’re trying to get pregnant during perimenopause, it’s worth noting that time is of the essence. Declining egg quality and irregular ovulation make natural conception more challenging, but it’s not impossible. Some women conceive naturally during perimenopause, especially in their early 40s.

For those who struggle to conceive, fertility treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF) can increase your chances. Egg donation is another option, as donor eggs from younger women are more likely to result in a successful pregnancy.

In addition to medical interventions, lifestyle changes like maintaining a healthy weight, eating a nutrient-rich diet, managing stress, and avoiding smoking or excessive alcohol consumption can support your fertility.

Risks of pregnancy during perimenopause

Pregnancy during perimenopause comes with unique risks. As women age, the chances of complications for both mother and baby increase. Some of the most common risks include:

• Miscarriage: Higher rates due to chromosomal abnormalities in eggs.
• Gestational diabetes or high blood pressure: These conditions are more common in pregnancies at an older age.
• Cesarean delivery: Older maternal age increases the likelihood of needing a C-section.
• Baby’s health risks: The chances of chromosomal abnormalities, such as Down syndrome, increase significantly with age.

If you’re considering pregnancy during perimenopause, it’s important to work closely with your doctor to monitor and manage these potential risks.

When menopause symptoms mimic pregnancy

One confusing aspect of perimenopause is how closely its symptoms can resemble early pregnancy. Missed or irregular periods, breast tenderness, fatigue, and mood swings are hallmarks of both pregnancy and hormonal shifts during perimenopause. If you suspect pregnancy, taking a test can provide clarity.

The bottom line

Yes, you can get pregnant during perimenopause, but the likelihood depends on factors like your age, ovulation patterns, and overall health. If pregnancy isn’t part of your plan, it’s crucial to continue using contraception until you’ve gone a full year without a period. On the other hand, if you’re hoping to conceive, there are still options - both natural and assisted - to help you achieve your goal.

Perimenopause is a time of change and unpredictability, but understanding what’s happening in your body can help you make confident choices about your future. Whether you’re navigating contraception, fertility, or just trying to make sense of your symptoms, knowledge and support are key. Explore our blog or symptom library for more insights to guide you through this transition.