Perimenopause is a transitional period that typically starts in your 40s, though it can even begin earlier. During this time, hormone levels fluctuate, and menstrual cycles can become irregular
Despite these changes, pregnancy is still possible—ovulation can happen, even if it’s unpredictable.
Understanding where you’re at when it comes to perimenopause is an important part of family planning. While your cycles may become less regular, ovulation doesn’t stop right away, which means there’s still a chance of pregnancy during perimenopause if you’re not using contraception.
Finding ways to track your cycle can help manage the uncertainty and give you clarity about your options.
What Is Perimenopause and How Does It Affect Fertility?
Perimenopause is the transitional phase that leads up to menopause, and for many, it starts in their 40s. During this time, your body goes through hormonal changes that can affect menstrual cycles and, importantly, fertility.
If you’re considering pregnancy during this stage (or trying to prevent it), understanding these shifts can help you feel more informed and in control.
Perimenopause vs. Menopause
Although perimenopause and menopause are sometimes used interchangeably, they’re actually distinct phases.
Perimenopause is the time leading up to menopause, and it can last for several years. During this time, estrogen levels fluctuate, causing your periods to become more irregular, along with other symptoms that can vary widely from person to person.
Menopause, on the other hand, is when you haven’t had a menstrual period for 12 consecutive months. May people experience additional symptoms during menopause that are often more bothersome than the absence of their period.Once you reach menopause, natural pregnancy is no longer possible, as ovulation has stopped.
Hormonal Changes
One of the main shifts that happens during perimenopause is a change in your body’s production of estrogen and progesterone.
These hormones fluctuate, which can cause irregular ovulation. While predicting fertile days is more difficult, pregnancy can still happen as long as ovulation is occurring—even if it’s out of sorts.
If you’re trying to conceive, tracking your ovulation can offer valuable insights into your fertile windows. Tools like ovulation kits can help identify those key days, giving you a sense of clarity and control during what can otherwise feel like an uncertain time.
Can You Still Conceive Naturally During Perimenopause?
Although fertility opportunities decline with age, the possibility of conceiving naturally during perimenopause is still very much real.
The chances of conceiving depend on several factors, like how often ovulation occurs and the overall health of your reproductive system.
How Natural Conception Is Still Possible
During perimenopause, your body continues to produce eggs, though the number and quality might decrease over time. As long as ovulation is still happening, pregnancy remains a possibility.
There’s a common misconception that pregnancy is impossible during this stage, or that missing a few periods means you’re no longer fertile.
But that’s simply not true. This is why it’s a good idea to stay in tune with your body and track your ovulation, and if needed, continue to use contraception until menopause is confirmed.
Signs You May Still Be Fertile
If you’re wondering whether you might still be fertile, menstruation (even if it’s a little irregular) is one of the most noticeable signs. But there are other things to watch for as well:
- Ovulation pain or cramping (known as mittelschmerz)
- Changes in cervical mucus (it may become clearer and more stretchy)
- Increased libido
- Tender breasts
If you notice any of these signs and suspect pregnancy could be possible, using a reliable pregnancy test can give you confirmation.
How Likely is Pregnancy During Perimenopause?
Pregnancy during perimenopause is possible, but the likelihood tends to decrease as you get older.
Fertility begins to gradually decline after age 35, and by the time perimenopause begins, the chances of conceiving each month are lower than they were in younger years.
That said, individual factors like overall health and ovulation frequency still influence the likelihood of conception, so experiences can differ.
How Age Affects Fertility
As we age, the number and quality of our eggs naturally decrease, and during perimenopause, this process accelerates. Ovulation becomes less regular, which reduces the chances of conception, but it doesn’t eliminate them.
Understanding these changes can help you make informed decisions about family planning and fertility options.
Chances of Pregnancy in Your 40s and 50s
After 40, the chance of natural conception drops significantly. On average, the monthly chance of pregnancy at age 40 is about 5%, and it decreases further with age.
By 50, the odds of conceiving naturally are below 1% per cycle. These figures are averages; individual experiences vary. Some may conceive later than expected, while others may experience fertility challenges earlier.
Perimenopause Symptoms vs. Pregnancy Symptoms
Perimenopause and early pregnancy can sometimes feel like a confusing mix of similar symptoms.
Irregular periods, fatigue, breast tenderness, and mood swings—these can all show up whether you're transitioning into perimenopause or possibly expecting a baby.
Overlapping Symptoms
Some symptoms are common to both perimenopause and early pregnancy, making it difficult to tell the difference. Here are some of the key signs to watch for:
- Missed or irregular periods: Both perimenopause and pregnancy can cause changes in your cycle.
- Breast changes: Tenderness, swelling, or tingling can happen in both cases.
- Fatigue and low energy: You might feel unusually tired or drained.
- Mood swings: Whether it's irritability, anxiety, or depression, emotional shifts are often present in both stages.
- Bloating and weight gain: This can happen due to hormonal changes in either case.
These overlapping pregnancy and perimenopausal symptoms can make it hard to tell what your body is signalling.
Key Differences
While the symptoms above can happen in both perimenopause and early pregnancy, there are a couple of other signs that could point more specifically to pregnancy.
For instance, nausea and vomiting—especially in the morning—are more commonly associated with early pregnancy. You might also notice food aversions or a heightened sensitivity to certain smells.
If you’ve missed a period and have been sexually active, pregnancy is still a possibility.
When to Take a Pregnancy Test
Taking a pregnancy test is the most direct way to clarify what’s going on. Many tests can detect pregnancy hormones up to six days before a missed period.
If your test is positive or you’re unsure about the results, consulting a sexual and reproductive healthcare provider is the next best step. They can confirm the pregnancy or help you understand and manage perimenopausal symptoms.
Health Considerations for Pregnancy During Perimenopause
Getting pregnant during perimenopause can involve some additional health considerations, but that doesn’t mean it’s unsafe or unwise—it just means there’s more to keep in mind.
Some of the common risks for older mothers include:
- Gestational diabetes
- High blood pressure or preeclampsia
- Placenta-related pregnancy complications
- Higher likelihood of a C-section
- Miscarriage or stillbirth
While these risks are important to be aware of, many people in their 40s and 50s have healthy pregnancies. The key is regular, attentive prenatal care and open conversations with a healthcare professional; Roon is a trusted source you can turn to for any guidance you may need when it comes to your reproductive health.
Every pregnancy is different, and educating yourself with reliable medical advice will help you make sure you’re making the best possible decisions for both you and your baby in your unique situation.
How to Boost Your Chances of Conceiving During Perimenopause
Trying to conceive during perimenopause can be challenging for some, but it’s more possible than many realize. When you understand how your body is changing, you can make smarter, more informed decisions to support yourself.
Learn to Track Your Cycle
Perimenopause typically brings irregular cycles, but ovulation still occurs in a less predictable pattern. Paying attention to your body can help you improve your timing and boost your chances of conceiving.
Ovulation predictor kits (OPKs) detect the surge in luteinizing hormone (LH) that happens 24 to 36 hours before ovulation. By testing your urine for this hormone, these kits can help identify your most fertile days—when you’re most likely to conceive.
While testing isn’t always 100% accurate, it can be a useful tool, especially during perimenopause when cycles are less regular.
There are also other, more natural methods you can use, such as:
- Tracking your basal body temperature daily
- Observing and noting changes in your cervical mucus (it often becomes clearer and stretchier around ovulation)
- Using a fertility tracking app to log your cycle and patterns over time
These methods can help you better understand your cycle and make informed choices during perimenopause.
Reach Out When You Need Extra Support
If you’re over the age of 35 and have been trying for six months or more without success, it's reasonable to start asking for help and looking into fertility treatments.
Dr. Shruthi Mahalingaiah suggests that a fertility test may be a good option for perimenopausal women looking to conceive if they’d like to better understand their chances.
A compassionate healthcare provider or fertility specialist can also offer insight into what’s going on beneath the surface. Whether that involves testing or a conversation about your cycle and symptoms, a provider will be able to offer clarity and discuss some appropriate options with you.
Preventing Pregnancy During Perimenopause
If you’re in perimenopause and don’t want to get pregnant, it’s important to know that contraception still matters. Fertility declines during this time, but it doesn’t disappear overnight. Until you’ve gone 12 full months without a period, pregnancy is still possible.
That’s why having a birth control plan that fits your needs—physically and mentally—is a practical part of managing this stage of life.
Contraception Options in Perimenopause
There’s no one-size-fits-all when it comes to birth control, especially in perimenopause, when hormone levels are shifting and health needs may be changing. Some of the more common and effective options include:
- Hormonal methods, like low-dose birth control pills, patches, or rings (such as NuvaRing)
- Intrauterine devices (IUDs) like Mirena or Paragard, which can offer years of protection
- Barrier methods, like condoms or diaphragms, which don’t involve hormones at all
- Permanent options, such as tubal ligation, for those who are sure they’re done having children
A conversation with a trusted healthcare provider can help you weigh the pros and cons of each method based on your health profile and priorities. The goal is to make an informed choice that supports your well-being, not just now, but in the long term.
Clarity and Confidence in a Time of Change
Perimenopause can bring a lot of uncertainty around fertility—whether you're trying to get pregnant, avoid it, or simply understand what's happening in your body. Hormone shifts may make things feel unpredictable, but you're not without options or support.
Pregnancy is still possible during perimenopause, but it may come with more questions: How likely is it? What are the risks? What steps should I be taking now? Having access to reliable, straightforward information can help you make informed decisions with more confidence.
At Roon, we work with leading reproductive endocrinologists like Dr. Amanda Adeleye and Dr. Randi Goldman to answer your questions clearly and honestly.
Whether you're trying to conceive or want to prevent pregnancy, taking steps like tracking your cycle, using effective contraceptive methods, and speaking with a knowledgeable provider can help you feel more in control.
Looking for answers or support? Roon connects you with trusted resources and expert guidance to help you make decisions that work for you. Visit Roon to learn more.
Frequently Asked Questions (FAQ):
What are the early signs of pregnancy during perimenopause?
They’re often similar to typical pregnancy symptoms: a missed period, breast tenderness, nausea, fatigue, or frequent urination. It can be tricky to tell them apart from perimenopause symptoms, so it’s okay to ask your healthcare provider if something feels off.
How do I know what stage of perimenopause I'm in?
Start by tracking your cycle. Irregular periods, hot flashes, mood changes, and night sweats are common signs. A healthcare provider can also run order tests to give you a clearer picture of what your body’s going through.
Do you still ovulate in perimenopause?
Yes—ovulation can still happen, even if it’s unpredictable. That means pregnancy is still a possibility until you've gone 12 months without a period.
What are the odds of getting pregnant at 49?
The odds are lower—the pregnancy rate is less than 5% in most cases—because the number of viable eggs decreases with age. But it’s not impossible. If pregnancy is still something you're considering (or hoping to avoid), it’s worth having an open conversation with a trusted provider.
