Can You Get Pregnant During Perimenopause?

Perimenopause is a transitional period where your hormones start to fluctuate dramatically as you approach menopause. During perimenopause, which typically occurs in your 40s (most often starting around ages 40-44¹), estrogen and progesterone  levels begin to shift significantly, which often causes menstrual cycles to become irregular; it can also cause the onset of several mood-related and physical symptoms – such as increased irritability, fatigue, or even hot flashes.²

When weeks or months go by without a period, you may start to wonder if you're experiencing a typical perimenopause symptom, or if you could be pregnant. Many women may even find themselves asking, “can you still get pregnant during perimenopause”? Keep reading to find out the answer to this commonly asked question as well as to learn more about perimenopause and its impact on fertility.

Pregnancy During Perimenopause

You might go months without a period and think you've entered menopause, only for your menstrual cycle to restart and for pregnancy to again become possible. Remember, it takes a full 12 consecutive months without a period to transition fully out of perimenopause into menopause.³ A woman’s last period usually occurs between the ages of 40 and 55, with the average being 51.⁴ And while menopausal women don't ovulate, meaning they can’t conceive naturally, they still may be able get pregnant via in vitro fertilization, coupled with fertility hormone support, if the desire is there.⁵

Pregnancy during perimenopause isn't necessarily common, but since you still ovulate during this time, it is possible. Estrogen and progesterone levels fluctuate often during perimenopause, which can lead to less predictable menstrual cycles and ovulation occurrence. However, during perimenopause, if you’re still releasing eggs that are able to be fertilized during ovulation, you can become pregnant during this time.⁶

Factors Impacting Fertility During Perimenopause

In the event you’re interested in trying to get pregnant during perimenopause, there are several common factors that can impact your fertility. These may include:

• Age: The quality and quantity of your eggs declines as you get older, so it may be easier to become pregnant during the earlier days of perimenopause than it is in your late 40s or early 50s.⁷
• Diet: Healthy diets rich in folic acid, vitamin B12, and omega-3 fatty acids may help to promote fertility, while diets rich in trans fats, red and processed meats, potatoes, sweets, and sugary drinks often have the opposite effect.⁸
• Sleeping habits: Regularly getting a good night's sleep – ideally around 7-8 hours – can help to regulate your menstrual cycle and may play a role in supporting fertility.⁹
• Smoking: One study noted that, on average, women who smoked, started menopause a year earlier than those who didn’t.¹⁰ And as mentioned previously, menopause eliminates the chances of conceiving naturally.
• Alcohol consumption: Studies have shown that mild to moderate alcohol use has the potential to disrupt menstrual cycles, which can make it more difficult to become pregnant.¹¹
• Specific medical conditions: Some conditions, including tubal disease, uterine fibroids, polycystic ovary syndrome, and endometriosis, may decrease fertility.¹²
• Certain medical treatments and procedures: Chemotherapy, radiation, tubal surgery, and ovarian surgery can all negatively impact fertility, as well.¹³

Is It Dangerous to Get Pregnant During Perimenopause?

Pregnancy risks can become more common with advancing age, including during perimenopause. Women within this age group are more likely to struggle with chronic conditions such as obesity, diabetes and high blood pressure, which could make having a healthy pregnancy more difficult. The risk of complications, such as unexplained stillbirth, gestational diabetes, and ectopic pregnancies also increases for women in perimenopause.¹⁴

Miscarriages can be more common for perimenopausal women as well, as eggs are of often of poorer quality – miscarriage can also be due to hormonal shifts and uterine changes that are experienced during this time. Having poor quality eggs may also increase the chances of a baby being born with chromosomal abnormalities, such as Down Syndrome, or other birth defects.¹⁵ The need for a cesarean section may similarly become more likely.¹⁶

The risks associated with perimenopausal pregnancy can be overwhelming, so it's important to consult with your team of healthcare providers in the event you want to or become pregnant during this transitional time. They can help to monitor you and your baby closely, which can aid in reducing some of the risks, and keep you closely informed on your progress (and your baby’s) throughout the pregnancy.

Preventing Pregnancy During Perimenopause

So, while your fertility potential is lower during perimenopause, it’s still possible to get pregnant. In the event you’re trying to avoid pregnancy, using contraception during perimenopause is the best way to prevent it.

It’s also important to keep in mind that as you enter perimenopause, periods can stop for months before potentially resuming. For this reason, it's generally a good idea to continue using contraceptive measures for the 12 consecutive months you don’t have a period,¹⁷ until you feel confident you've entered menopause and have confirmed this with your healthcare provider.

If you're concerned that you may be pregnant or have any other questions about perimenopause, it’s always a good idea to touch base with your healthcare provider. They can offer personalized advice and run specific tests so you can know for sure what’s going on with your health and take the best next steps forward.

Resources:

1. https://www.mountsinai.org/health-library/report/menopause#:~:text=Perimenopause%20can%20begin%20in%20some,be%20sudden%20surges%20in%20estrogen
2. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
3. https://www.mayoclinic.org/diseases-conditions/perimenopause/symptoms-causes/syc-20354666
4. https://www.healthline.com/health/menopause/menopause-pregnancy
5. https://www.healthline.com/health/menopause/menopause-pregnancy
6. https://www.uclahealth.org/news/pregnancy-still-possible-during-perimenopause
7. https://www.ncbi.nlm.nih.gov/books/NBK576440/
8. https://www.health.harvard.edu/blog/fertility-and-diet-is-there-a-connection-2018053113949
9. https://rbej.biomedcentral.com/articles/10.1186/s12958-022-00889-3
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128850/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676690/
12. https://www.ncbi.nlm.nih.gov/books/NBK576440/
13. https://www.ncbi.nlm.nih.gov/books/NBK576440/
14. https://pubmed.ncbi.nlm.nih.gov/19933469
15. https://www.verywellhealth.com/change-of-life-baby-is-pregnancy-possible-during-perimenopause-3576789
16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345458/
17. https://www.menopause.org/for-women/sexual-health-menopause-online/reminders-and-resources/contraception-you-need-it-longer-than-you-may-think