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Perimenopause starts years before your last period, with hormone fluctuations triggering up to 50 symptoms like hot flushes, mood swings, sleep issues, and brain fog.
- Menopause itself is a one-day milestone (12 months without a period) — but the effects can linger, often lasting 4–10+ years.
- Postmenopause brings lower hormone levels and new health risks like osteoporosis, cardiovascular concerns, and vaginal changes.
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The simple answer: yes, you can still get pregnant during perimenopause. But fertility is far from simple. The hormonal shifts happening in your body make ovulation less frequent, reduce your total egg count, and make pregnancy less likely than in your premenopausal years.
As perimenopause arrives, typically in the late 30s and early 40s, you will begin to feel the early symptoms like mood swings, irregular periods, even hot flushes and night sweats. It's essential to understand what these hormonal changes mean for your fertility. Whether you're hoping for a baby or just need to know how on top of your birth control to be, you deserve the facts.
01
Fertility During Perimenopause
During perimenopause, the ovaries produce fewer eggs, but ovulation can still occur. Estrogen levels fluctuate, and even though fertility decreases, getting pregnant is not entirely out of the question. According to the North American Menopause Society, many women underestimate their chances of getting pregnant during this phase1. While fertility declines, pregnancy is possible as long as you're still ovulating.
02
Chances of Getting Pregnant Naturally
The chances of getting pregnant naturally during perimenopause depend on several factors, including hormone levels, regularity of your menstrual cycle, and the availability of a viable egg. Follicle-stimulating hormone (FSH) plays a critical role in this process. While the body produces estrogen and FSH, they regulate the menstrual cycle, keeping the possibility of getting pregnant open2.
Most women experience a decline in natural fertility, but conception can still occur naturally, especially in the early perimenopause stage when menstrual periods are still somewhat regular. However, the chances of getting pregnant decrease as perimenopause lasts for a few months or even years, with ovulation becoming less frequent over time3.
03
Pregnancy vs. Perimenopause Symptoms
One challenge for women in perimenopause is that pregnancy symptoms and perimenopause symptoms can overlap. Missed periods, breast tenderness, and weight gain are common signs of both pregnancy and perimenopause. A blood test is often necessary to determine whether you're pregnant or experiencing typical symptoms of perimenopause4.
04
Unplanned Pregnancy Risks
Because the menstrual cycle becomes irregular, many women assume they cannot get pregnant naturally during perimenopause. However, unplanned pregnancies can still happen if you're not using birth control5. For women who want to avoid pregnancy, continuing birth control during perimenopause is important. Healthcare professionals recommend continuing birth control until you've officially reached menopause (12 consecutive months without a menstrual period)1.
05
Ensuring a Healthy Pregnancy During Perimenopause
A healthy pregnancy during perimenopause is completely achievable. Healthcare professionals recommend managing lifestyle factors like a healthy diet and regular check-ups to monitor conditions such as high blood pressure and other health concerns6.
06
Fertility Treatments and Reproductive Medicine
If natural conception is not possible, many turn to fertility treatments like in vitro fertilisation or assisted reproductive technology. Fertility treatments can increase the likelihood of a successful pregnancy for those trying to conceive during perimenopause. Reproductive medicine offers a range of options, including donor eggs, for women struggling to conceive naturally7.
07
Conclusion: Navigating Fertility in Perimenopause
While getting pregnant during perimenopause is more challenging, it is still possible, especially in the early stages. Understanding your body's hormonal changes and working with a healthcare professional can help you navigate this complex phase. Whether you’re looking to avoid an unplanned pregnancy or trying to have a healthy pregnancy, managing your reproductive health during perimenopause is essential.
At Biolae, we’re here to support women through every stage of hormonal change with science-backed care, no judgment, and no guesswork. We believe education plays a powerful role in helping you understand what’s happening in your body and how to care for it.
Our content is guided by a commitment to clarity, trust, and evidence. Everything we share is reviewed for accuracy and informed by the latest clinical research and expert insight — so you can feel confident in every step you take with us.
References:
- NAMS. Menopause FAQs. Read here
- NAMS. (2021). Perimenopause and Pregnancy. Read here
- North American Menopause Society. (2021). Perimenopause: The Reproductive Transition. Read here
- NCBI. (2020). Pregnancy Symptoms vs Perimenopause. Read here
- National Women's Health Network. (2018). Unplanned Pregnancies During Perimenopause. Read here
- Women's Midlife Health Journal. (2021). Navigating Fertility During Perimenopause. Read here
- American College of Obstetricians and Gynecologists (ACOG). (2020). Fertility Preservation in Perimenopause. Read here
