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. According to Jean Marino, CNP, a nurse practitioner specializing in women’s midlife health at University Hospitals, perimenopause is one of the most misunderstood times in a woman’s reproductive life.

Here, she helps 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,” explains Marino. “But in perimenopause, ovulation still occurs, it’s just unpredictable. 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. “Hormone levels are commonly checked in fertility testing,” says Marino, “but they don’t give you a reliable read on how much longer you’re fertile or when ovulation will stop for good.”

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,” says Marino. “We also need to consider the potential risks to the baby, including the development of conditions related to chromosomal abnormalities.”

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.

“This is one of the biggest reasons we see unplanned pregnancies in women over 40,” Marino says. “Some patients have even been told by other providers that they were too old to conceive, only to later learn otherwise.”

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. And Marino points out that 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, Marino adds.

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 estrogen is estrogen,” says Marino. “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,” Marino says. “That’s why it’s important to have open, informed conversations with your provider.” Whether you’re hoping to have a baby later in life or want to make sure it doesn’t happen, Marino emphasizes the importance of education and proactive care.

“We want women to feel empowered, not afraid,” she says. “But they also need 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.”