Can You Get Pregnant During Perimenopause? Yes – Here’s Why

August 08, 2025

A woman viewing the results of a pregnancy test

As fertility declines with age and a woman’s period becomes irregular, many assume they’re no longer at risk of getting pregnant. But that assumption can lead to unplanned pregnancies. Fertility in perimenopause is one of the most misunderstood times in a woman’s reproductive life.

Let’s clear up the confusion about common perimenopause and pregnancy myths.

Myth #1: If your periods are irregular, you can’t get pregnant.

Fact: You can still ovulate during perimenopause, sometimes more than once in a cycle. Menopause is defined as 12 full months without a period. In perimenopause, ovulation still occurs but it’s unpredictable, says University Hospitals OB/GYN physician Corinne Bazella, MD. Some women may even ovulate multiple times in a short span due to hormonal fluctuations.”

That is why the odds of a twin pregnancy increase with time. By age 35, a woman’s chance of a spontaneous twin pregnancy doubles, and by 40 that risk is threefold. This unpredictability makes it hard to tell when it’s truly “safe” to stop using birth control. The risk of pregnancy declines with age, but it doesn’t hit zero until menopause.

Myth #2: There’s a hormone test that can tell you how close you are to menopause.

Fact: No blood test can currently predict with accuracy when menopause will officially happen.

Despite marketing claims, there’s no lab test that can tell you whether you’re months or years away from menopause. There are measures that are commonly checked for fertility testing; however, they don’t give a reliable timescale on the length of fertility or when ovulation will stop.

Myth #3: The chance of pregnancy in your 40s is too low to worry about.

Fact: Pregnancy rates drop, but the consequences of an unplanned pregnancy in your 40s can be serious.

By your early 40s, the chance of getting pregnant in any given month is about 10 percent. By your late 40s, it’s closer to 2 or 3 percent, and less than 1 percent by age 50. But that’s not zero and the stakes are often higher.

With pregnancy in a woman’s 40s, there is an increased risk of miscarriage due to genetic abnormalities, as well as the risks of pregnancy complications like gestational diabetes, high blood pressure and postpartum hemorrhage. There is also an increased potential risk of the baby having a chromosomal abnormality like Down’s syndrome.

Myth #4: You don’t need birth control after 40.

Fact: If you want to avoid pregnancy, you still need reliable contraception until menopause is confirmed by your doctor.

Depending on your health history and symptoms, several birth control options are available:

Progestin-releasing IUDs: Effective for both birth control and managing heavy, frequent bleeding common in early perimenopause.
Progestin-only pills or estrogen patches: Effective and safer for women with high blood pressure or who smoke.
Permanent options: Tubal ligation (having your “tubes tied”) is still a choice for those who are certain they’re done with childbearing. Male partners can choose a vasectomy to prevent unwanted pregnancy as well.

Natural family planning becomes much more difficult during perimenopause due to unpredictable cycles, and for that reason is not recommended.

Myth #5: Hormones are hormones – birth control and HRT for menopause are the same.

Fact: All hormones are not created equal. Contraceptive and menopausal hormones serve different purposes and carry different risks.

Many patients assume all hormones are the same – that estrogen is estrogen. But contraceptive hormones use a type called ethinyl estradiol, which isn’t ideal for women with high blood pressure or who smoke. Menopausal hormone therapy uses estradiol, which is often safer and can be used via patches or gels, even for women with certain risk factors.

Pregnancy in Perimenopause: Rare But Very Real

Only once you’ve gone 12 consecutive months without a period can you safely say you’re in menopause and no longer need birth control. Until then, contraception remains essential if pregnancy isn’t part of your plan.

There’s no one-size-fits-all answer to contraception. It’s important to have open conversations with your provider about your preferences and the side effect you have experienced in the past in addition to the lifestyle factors that are important for you. We want women to feel empowered to be pregnant when they desire and to prevent when they do not desire being proactive to achieve their reproductive goals.

It is important to have the education to know that this stage of life isn’t a pass from pregnancy. It’s a time to be extra intentional, whether you're planning to grow your family or making sure you're done.