Last checked September 2026 against 11 sources · Editorial policy
Can you get pregnant during perimenopause?
Yes, you can get pregnant during perimenopause. Ovulation becomes irregular, not absent, and women still conceive in their late 40s and even into their 50s. Fertility falls gradually from about 32 and faster after 37, so pregnancy is less likely, but not impossible. If you don't want to get pregnant, use contraception until 2 years after your last period if you're under 50, 1 year if you're over 50, or until 55.
Yes. Ovulation becomes irregular but doesn't stop until menopause. How likely pregnancy is by age, signs that overlap with perimenopause, and contraception.
Pregnancy in perimenopause: expectation vs reality
What people often expect
“Irregular periods in your 40s mean you can't get pregnant”
What the evidence shows
Many women assume that because fertility is lower and periods are irregular, contraception can be dropped. UK menopause experts warn this is wrong: women do still get pregnant in their late 40s and into their 50s without fertility treatment. Periods can restart after several months without bleeding, which is why contraception is advised for a year or two after the last period.
Can you get pregnant during perimenopause?
Why you can still get pregnant in perimenopause
In perimenopause, the ovaries still release eggs, just less predictably. Some cycles ovulate and some don't, and a cycle can suddenly ovulate after months of gaps. Researchers describe ovulation and progesterone as becoming insufficient or absent in some cycles, not all. Because you can't tell which cycles will release an egg, and periods can return after several months, unprotected sex still carries a chance of pregnancy.
How fertility changes with age
Fertility decreases gradually but significantly from about 32, and more rapidly after 37, according to the American College of Obstetricians and Gynecologists. At the same time, conditions that impair fertility become more common and the risk of pregnancy loss rises. So pregnancy in perimenopause is less likely than earlier in life, but it's far from impossible, particularly in the early transition when many cycles still ovulate.
Is it dangerous to get pregnant during perimenopause?
Pregnancy in older women is associated with more complications, including miscarriage, high blood pressure, diabetes and chromosomal problems in the baby, so it needs more careful monitoring. Many women over 40 have healthy pregnancies, but good antenatal care matters more at this age. If you're planning a pregnancy, see a doctor beforehand to review your health, medicines and supplements. If a pregnancy is unplanned, a doctor or sexual health clinic can talk through all the options without judgment.
Perimenopause or pregnancy? Telling them apart
The two can look alike. A missed or late period is an early sign of pregnancy and a common sign of perimenopause. Sore breasts, nausea, tiredness and mood changes happen in both. Hot flashes and night sweats point more to perimenopause, but they don't rule out pregnancy. The only way to know is a pregnancy test, so take one if a period is late and there's any chance.
Contraception in perimenopause
UK menopause experts advise continuing contraception until menopause is confirmed: 2 years after your last natural period if you're under 50, and 1 year if you're over 50. If you can't tell, for example because your method stops your periods, you can stop at 55, when pregnancy risk is extremely low. HRT is not contraception. Emergency contraception has no upper age limit.
Learn more →Fertility and pregnancy in perimenopause by the numbers
From 32
6 months
Until 55
Reliable figures for how often women get pregnant in perimenopause are scarce, because many stop contraception early and pregnancies go uncounted. The medical consensus is clear: it happens, so contraception is needed until menopause is confirmed.
Getting pregnant, or avoiding pregnancy, in perimenopause
How to get pregnant during perimenopause
First stepBecause ovulation is unpredictable, timing sex around ovulation is harder. The NHS suggests having sex every 2 or 3 days throughout your cycle if your periods are irregular. See a doctor early: ACOG advises that women over 35 have fertility tests after 6 months of trying, and women over 40 even sooner. Fertility treatment options depend on your age and ovarian reserve.
Prepare for a pregnancy after 40
First stepBecause complications like high blood pressure and diabetes are more common, a pre-pregnancy check helps. A doctor can review blood pressure, blood sugar, medicines and any conditions, and discuss screening for chromosomal problems once you're pregnant. Stopping smoking and limiting alcohol matter at any age.
Contraception to avoid pregnancy in perimenopause
Strong evidenceLong-acting methods are the most reliable: the hormonal IUD, copper IUD and implant are over 99% effective. The combined pill, patch or ring suit healthy non-smokers until 50 and can ease hot flashes. The progestogen-only pill can be used until 55. Condoms also protect against STIs, which are rising in women in their 40s and 50s.
Related guide →Emergency contraception
If this is the causeIf you've had unprotected sex or a contraceptive failure, emergency contraception works at any age. Emergency pills are available from pharmacies without a prescription, and the emergency IUD is the most effective option and can stay in as ongoing contraception. Emergency pills work best the sooner you take them, so don’t wait if you think your contraception has failed.
When to see a doctor about pregnancy in perimenopause
A late period and any chance of pregnancy
Take a pregnancy test first. If it's positive, see a doctor early, since pregnancy after 40 needs closer monitoring.
More →Urgent: Pregnant with pain on one side, bleeding or feeling faint
Get urgent medical help. Pain and bleeding in early pregnancy can be a miscarriage or an ectopic pregnancy.
Trying to conceive for 6 months over 35, or at all over 40
Ask for a fertility evaluation. Waiting longer reduces the options.
Pregnancy during perimenopause: questions women ask
Can you get pregnant during perimenopause?
Yes. Ovulation becomes irregular rather than stopping, and women still conceive in their late 40s and into their 50s. Fertility is lower than in your 20s and 30s, but not zero, so use contraception if you don't want to get pregnant.
Can you get pregnant at menopause?
Once you've reached menopause, 12 months without a period after 50 or 2 years before 50, natural pregnancy is no longer expected. Before that point, pregnancy is possible. If you can't tell when your last natural period was, contraception is advised until 55.
Is it dangerous to get pregnant during perimenopause?
It carries more risk than pregnancy at a younger age: miscarriage, high blood pressure, diabetes and chromosomal problems are all more common. Many women still have healthy pregnancies, with closer monitoring. See a doctor early if you're pregnant or planning to be.
How do I know if I'm pregnant or in perimenopause?
Take a pregnancy test. Missed periods, sore breasts, nausea, tiredness and mood changes happen in both. Hot flashes point more to perimenopause but don't rule out pregnancy. Our check can help you think through the signs.
Related →How can I get pregnant during perimenopause naturally?
Have sex every 2 or 3 days throughout your cycle, since ovulation is hard to predict, and see a doctor early rather than waiting a year. ACOG advises fertility tests after 6 months of trying over 35, and sooner over 40. Healthy weight, no smoking and limited alcohol help too.
Can a premenopausal woman get pregnant?
Yes. Premenopausal means you haven't started the transition and your cycles are regular, so you ovulate most months. Fertility does decline with age from about 32, but pregnancy is still quite possible. If you are premenopausal and do not want to get pregnant, you need contraception like anyone else.
When can I stop using contraception in perimenopause?
After 2 years without a period if you're under 50, after 1 year if you're over 50, or at 55 whatever your periods are doing. If your contraception stops your periods, keep using it until 55 or ask about a blood test to guide timing.
Does HRT prevent pregnancy?
No. HRT is not contraception. If you're still having periods and start HRT, use contraception as well. The 52 mg hormonal IUD can do both jobs, providing contraception and the progestogen part of HRT. Continue contraception alongside HRT until 55 if HRT bleeds make it hard to tell when your natural periods stopped.
Can you get pregnant with irregular periods in perimenopause?
Yes. Irregular periods mean ovulation is less predictable, not that it has stopped. You may ovulate earlier or later than usual, or after a long gap, which makes pregnancy harder to plan and harder to avoid. If you do not want to conceive, keep using contraception; if you do, see a doctor early.
I got pregnant during perimenopause. What now?
See a doctor or midwife as soon as you can. Pregnancy at this age needs closer monitoring because miscarriage, high blood pressure, diabetes and chromosomal problems are more common, and early care makes a difference. If the pregnancy was unplanned, a doctor or sexual health clinic can talk through all your options.
Sources
- Women's Health Concern (British Menopause Society). Contraception for women over the age of 40. Fact sheet, 2025.
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014;101(3):633-4.
- Prior JC. Progesterone for Symptomatic Perimenopause Treatment - Progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn. 2011;3(2):109-20.
- NHS. Irregular periods.
- NHS. Breast pain.
- NHS. Feeling sick (nausea).
- NHS. How well contraception works at preventing pregnancy.
- NHS. Ovulation pain.
- NHS. Side effects and risks of an IUS or hormonal coil.
- NHS. What are menopause and perimenopause?
- Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10. J Clin Endocrinol Metab. 2012;97(4):1159-1168.
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