Perimenopause and pregnancy: Can you get pregnant during perimenopause?

Menopause can bring big changes, in both the body and mind. For some people, hot flashes and irregular periods will usher in a whole new phase of life. With all that happening, questions about pregnancy are bound to pop up.

Menopause describes a moment in time after menstrual cycles end.¹ It is officially diagnosed after 12 consecutive months without periods. Menopause varies in menstruating people between the ages of 45 and 55, but on average, it happens at age 51 or 52.^2,3

With menopause, the ability to become pregnant using your own eggs ends. Before the official end of menstrual cycles (known as the perimenopause period), periods may become more irregular and fertility levels drop significantly.⁴

People who don’t want to get pregnant may want to know how soon they can stop birth control. People who want to get pregnant may feel like it is a race to beat the clock. Having a good understanding of menopause stages and what they mean in terms of pregnancy can help you avoid any surprises and help with informed decision making.⁵ Read on to get the lowdown on pregnancy and perimenopause.

In this article:

The menopausal transition

The “change” of menopause doesn’t happen overnight. The body goes through a transition before periods stop entirely — and the risk of pregnancy practically disappears.

Typically, the perimenopausal stage — the time just before menopause — lasts about four years. It can last up to eight years and may last longer if the person entered the stage at an earlier age.⁶

Perimenopause can come with symptoms like hot flashes and night sweats. Some people may experience mood changes similar to those associated with menstruation.⁷ Ovulation still happens, but less frequently and unpredictably.⁸

It’s still crucial to use contraception if you don’t want to get pregnant before full menopause.⁹ Menopause itself officially happens after completing one full year with no bleeding or spotting.¹⁰ After that, it’s considered a medical rarity for a person to conceive — meaning it practically never happens without special medical help.¹¹

If you want to conceive during perimenopause, you still can. But according to Xibei Jia, MD, a urogynecologist in Cape Cod,¹² it’s best to explore your options as soon as possible. 

“[People] who are waiting to get pregnant until later in life should discuss fertility options with their obstetrician/gynecologists,” she advises. “Many... will choose to have a consultation with a reproductive endocrinologist or fertility specialist and discuss egg freezing and/or embryo freezing.”

Contraception later in life

With the added risks of pregnancy after age 35, contraception remains an important topic. Many continue their contraception right up until menopause — the full year after having a final period.¹³ Since there’s no official test to confirm when pregnancy is no longer possible, it’s best to err on the side of caution.¹⁴

Fortunately, as Dr. Jia explains, there are many birth control methods available. These include oral contraceptive pills, implants and intrauterine devices.

Not every contraceptive choice may be a fit for every stage of life. Health care providers consider risk of breast cancer, heart attack, stroke and other health issues when evaluating the safety of birth control options.¹⁵ It’s also important to consider personal preferences, such as when and if you want to get pregnant. These can change with the years. So, attend your yearly wellness visit, and contact your health care provider about any new concerns.

Fertility preservation options

Today, there are more fertility options than ever before. If you want to get pregnant, discuss it with your health care provider. Fertility may decline with age. Speak with your health care provider about your concerns early to understand all your options. 

If you’re over 35 and haven’t been able to get pregnant after trying for six months, you should seek fertility evaluation. Don’t delay fertility-planning discussions until you get older.¹⁶

Your health care provider can run tests to evaluate your fertility status and determine if it may be safe for you to get pregnant. They’ll also look for other factors that may affect your or your partner’s fertility and provide recommendations to help you conceive if that’s an option.

While there’s no guaranteed way to preserve fertility, some people choose to freeze their eggs for future use. The process removes unfertilized eggs from the body for future use. It preserves eggs at a younger age so they can be used at a later age, when fertility potentially wanes. It can also be done because some medical conditions, such as cancer, may require therapy that can harm fertility. Harvested eggs are carefully preserved and later fertilized in a laboratory using in vitro fertilization (IVF).¹⁷ Successful fertilization produces embryos that can be implanted back into the person or a surrogate (a person who carries a fetus to full term for the parent).

Knowing your pregnancy risks

It’s possible to get pregnant during the perimenopausal period or even after menopause with medical help. But note that later pregnancies can come with unique risks that require careful monitoring.

“For those over the age of 35, there's an increased risk of adverse outcomes associated with the pregnancy,” explained Dr. Jia. In particular, she notes an increased risk of chromosomal abnormalities in the child. A pregnant person should “discuss prenatal testing with their obstetricians during early pregnancy,” she says.

The risks of miscarriage, preeclampsia, preterm birth and stillbirth also increase after age 35. In addition, babies born to older parents have a greater risk of certain genetic conditions.¹⁸

Maintaining a healthy lifestyle, discussing your risks before getting pregnant and keeping up with your scheduled prenatal visits can increase the chances of a safe pregnancy and birth.

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.