Perimenopause and Your Fertility: What To Know

If your periods are becoming irregular and you’re dealing with hot flashes, mood changes or other signs of perimenopause, you might assume pregnancy is no longer in the cards.

After all, you’ve probably heard that your fertility declines after your mid-30s. And if you’re approaching menopause, surely pregnancy isn’t an option, right?

Not quite.

Ob/Gyn and menopause specialist Catherine Caponero, DO, shares what you need to know about perimenopause and pregnancy.

Can you get pregnant during perimenopause?

Yes, you can still get pregnant during perimenopause.

That’s because, while female fertility declines with age, it doesn’t disappear overnight. In fact, estimates from the U.S. Centers for Disease Control and Prevention (CDC) show that more babies were born to women aged 40 to 44 than to teen mothers in recent years.

And no, we’re not just talking about assisted reproduction treatments, like IVF or intrauterine insemination.

“You’re not more fertile during perimenopause, but fertility doesn’t go down to zero until you reach menopause,” Dr. Caponero states. “Spontaneous pregnancies can — and do — happen until you reach your final menstrual period.”

If you don’t have any conditions that affect your ability to conceive, it’s possible to get pregnant until you reach menopause. That’s the point at which you’ve gone one full year without a menstrual cycle.

On average, menopause happens around age 52. But it can vary a lot.

Why pregnancy is still possible in perimenopause

Perimenopause is the transition leading up to menopause. It typically happens in your 40s.

Your fertility can decline during this time because you have fewer healthy eggs as you age. But you still ovulate during perimenopause. In other words, your ovaries can still release eggs. And if you have sex, those eggs can get fertilized.

But you may not ovulate as regularly as you used to. So, if you rely on tracking your cycle to know when you’re most fertile, those calculations can be off.

“Ovulation becomes more erratic and unpredictable,” Dr. Caponero explains. “This causes your cycle length to change, which can make tracking fertility much less reliable.”

Perimenopause can last for years for some women. For others, it may only be a matter of months.

Birth control and perimenopause

Depending on your goals, knowing that you can get pregnant even as your body prepares for menopause may come as welcome news.

And if you’re not keen to conceive? Take it as a reminder that reliable birth control is still important during perimenopause.

Dr. Caponero says women’s health providers often recommend continuing contraception until age 55.

That advice is extra important if you’ve been taking hormonal birth control — like pills and IUDs — which can mask the changes that happen during perimenopause.

“Just because you reach a certain age doesn’t mean you’ve gone through menopause,” Dr. Caponero clarifies. “If you’re on birth control that affects your cycles, it can be harder to know when menopause has truly happened.”

For example, birth control pills may keep your cycles more regular than they would otherwise be. And if you have an IUD, you may not bleed, or you may bleed only lightly.

In some cases, too, continuing birth control throughout perimenopause can do double duty — guarding against pregnancy and managing perimenopause symptoms.

“One effective approach is to use both an IUD and an estrogen hormone replacement patch,” Dr. Caponero suggests. “The IUD uses progesterone to protect the uterus and prevent pregnancy, while estrogen from the patch can help relieve perimenopause symptoms and support bone health.”

Talk with a women’s health provider about your best options for birth control during perimenopause.

What to know if you’re trying to conceive during perimenopause

If you’re hoping to become pregnant, you may be worried about declining fertility as you enter perimenopause.

Dr. Caponero explains when to seek help:

• If you’re under age 35: Try to conceive for up to one year before pursuing fertility testing or treatment.
• Between ages 35 and 40: Check in with a women’s health specialist or fertility provider after six months of trying.
• Age 40 and older: See a fertility specialist right away to discuss testing and options.

“Fertility continues to decline with age, and the risk of chromosomal abnormalities increases,” Dr. Caponero explains. “We want to get people connected appropriately so that they can have safe and healthy pregnancies.”

A healthcare provider can also help clarify whether you’re still ovulating, what your hormone levels look like and whether fertility treatments might improve your chances.

Pregnancy risks during perimenopause

You can have a healthy pregnancy at any age. But pregnancy in women aged 35 and older (what healthcare providers call “advanced maternal age”) can come with some higher risks.

“The risks aren’t entirely because of the hormonal changes of perimenopause, but more so because the health of your eggs declines with age,” Dr. Caponero explains.

In your late 30s and beyond, you may be at higher risk for:

• Chromosomal abnormalities
• Preeclampsia
• Gestational diabetes
• C-section delivery
• Preterm birth or low birth weight

If you’re pregnant and over age 35, your provider will likely recommend closer monitoring and additional testing to monitor fetal development.

Final thoughts

If you’re in your perimenopause era, it’s important to know that you still have choices when it comes to your fertility.

That could mean rethinking your birth control. Or taking advantage of your remaining fertility.

Understanding what’s still possible can help you make decisions that feel right for your body at this stage of life. A women’s health provider can help you talk through your goals and options.

“Perimenopause can be unpredictable, and it can catch you off guard,” Dr. Caponero says. “Having an open conversation with your provider can help you avoid surprises and make choices that match your goals.”