Can You Get Pregnant in Perimenopause? Yes, Here’s What You Need to Know

Perimenopause catches many women by surprise. It can start earlier than you expect and last for years. As your hormones and symptoms change, you might wonder about your fertility. Can you still get pregnant during menopause? The short answer is yes. But it’s more complicated than a simple yes or no. Read on to learn more about fertility during perimenopause, and what to know about your chances of getting pregnant during this time.

What age does perimenopause start?

Perimenopause usually starts in the mid- to late 40s. But there’s a wide range of what’s normal. Some women will start perimenopause in their early 30s, while others won’t experience it until their 50s. 

For most women, perimenopause will last about 4 to 8 years. It starts when your periods become less regular, and ends a year after your last period (the official beginning of menopause). But there are many other symptoms that can show up along with changes in your period frequency. You might have all of them or none of them. 

Can you get pregnant during perimenopause?

Yes, you can get pregnant during perimenopause. But your chances go down. 

As long as you’re getting your period occasionally, you still have a chance of getting pregnant. 

Your chance of getting pregnant during perimenopause depends on:

• Your age: Fertility for most women peaks in the early 30s and starts to decline after that. 

• Stage of perimenopause: You have a higher chance of getting pregnant if you’re in an earlier stage of perimenopause than a later stage.

• Your hormone levels: During perimenopause, your anti-Müllerian hormone (AMC) and estrogen levels go down, and your follicle stimulating hormone (FSH) goes up. You have a better chance of getting pregnant if those changes in hormones haven’t started yet. 

• Other medical conditions: Some conditions, such as endometriosis or uterine fibroids, can make it harder to get pregnant. Chemotherapy, radiation, or surgery on your ovaries can also lower the number of remaining eggs and affect fertility. 

• Natural vs. assisted fertility treatments: During perimenopause, your chances of getting pregnant are increased by using fertility treatments like assisted reproductive technology (ART).

Odds of getting pregnant by age

It’s hard to report clear statistics on a person’s chance of getting pregnant during perimenopause because it varies so much from person to person. But experts do know that age plays one of the biggest roles in fertility. Your chances of getting pregnant are summarized in the chart below.

It’s also important to keep in mind that the risk of miscarriage also increases with age.

Perimenopause vs. pregnancy symptoms?

It can be hard to tell if you’re pregnant in perimenopause since there are many symptoms that can happen in both conditions. 

Both pregnancy and perimenopause can lead to:

• Missing your period

• Feeling tired

• Mood changes

• Sleep problems

Pregnancy is more likely to lead to: 

• Nausea

• Breast fullness 

• Vaginal discharge

Perimenopause is more likely to lead to:

• Vaginal dryness

• Hot flashes or night sweats

The best way to know if you’re pregnant or not is to take a pregnancy test. You can buy an over-the-counter (OTC) urine pregnancy test, or contact a healthcare professional to get a blood test. Both tests measure the amount of the pregnancy hormone called human chorionic gonadotropin (HCG). A blood test is the most accurate test, but the at-home urine test can detect most pregnancies by a day after the missed period. 

Is it dangerous to get pregnant in perimenopause?

Pregnancy in older women tends to be more high-risk. Since egg quality goes down as you get older, the embryo has a higher chance of having a problem with the chromosomes. This can result in a miscarriage. Also, older women are more at risk for health problems. You can still have a healthy pregnancy if you get pregnant during perimenopause. But you should be monitored more closely. 

Getting pregnant during perimenopause increases the risk for:

• Miscarriage

• Ectopic pregnancy

• Preterm labor

• Gestational diabetes

• High blood pressure during pregnancy (gestational hypertension)

• Needing a C-section to deliver the baby

• Stillbirth (scheduling an earlier delivery for older moms can reduce this risk)

How can you increase fertility during perimenopause?

Even though your fertility goes down during perimenopause, there are things you can do to help your chances. You may be able to increase your fertility during perimenopause by:

• Eating a nutritious diet: Foods high in whole grains, fruit, and unsaturated fat may help overall fertility. 

• Taking supplements: Coenzyme Q may help improve egg quality. Omega-3-fatty acids can increase your chances of getting pregnant. Other vitamins that may help improve fertility include folic acid, selenium, and vitamin D. 

• Acupuncture: Some studies suggest that acupuncture can increase your chances of getting pregnant. 

• Exercise: Regular exercise can boost your chances of getting pregnant. But keep in mind that vigorous exercise might actually lower your odds. Talk with a healthcare professional about the level of exercise that’s best for you if you’re trying to get pregnant. 

• Assisted reproductive technology (ART): Fertility treatments like IVF can boost your chances of getting pregnant. 

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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