Getting pregnant during perimenopause: Is it still possible?

I was worried about getting pregnant, but my doctor reassured me. Fortunately, the chances are very small at this stage. – Esther (age 48)

When your cycle begins to change, you might ask yourself: can I still conceive? And if so, how likely is it? During perimenopause, your fertility declines significantly, but pregnancy is not entirely out of the question. As long as ovulation occurs, conception remains technically possible.  

This raises important questions—whether you’re hoping to avoid pregnancy or trying for a child. In this article, we’ll explore how fertility changes during perimenopause, the role of hormones, and when contraception is still necessary.

What exactly is perimenopause?

Perimenopause is the transitional phase leading up to menopause. It’s the period before your final menstrual cycle, during which your periods may become shorter, longer, or irregular. Hormone levels fluctuate considerably, and fertility decreases but does not vanish completely. As your cycle becomes more unpredictable, ovulations occur less frequently. This signals that menopause is approaching, though this phase can last for several years.  

On average, the likelihood of pregnancy decreases as follows: 

• Under 35 years: approximately 10–15% per cycle
• Between 35–40 years: <5% per cycle
• Around 50 years: <1% per cycle  

Which hormones play a role?

Your fertility is governed by a complex interplay of hormones. During perimenopause, this balance is disrupted, affecting your cycle and your chances of conceiving:  

Estrogen 

Estrogen helps build the uterine lining and prepares your body for a potential pregnancy. During perimenopause, fluctuating estrogen levels can lead to irregular ovulation and reduced fertility.  

Follicle-Stimulating Hormone (FSH) 

FSH stimulates the development of follicles in the ovaries. During perimenopause, FSH levels rise as the ovaries become less responsive to this hormone. This indicates a declining ovarian reserve. Higher FSH levels mean lower chances of ovulation and, therefore, pregnancy.  

Wondering if you’re still fertile? 

It’s a common question during this stage. You can measure your FSH levels through your doctor or with a home test like the Silex Menopause Self-Test.  

A doctor can perform a blood test to determine your exact FSH level, offering more insight into your hormonal phase.  

Note: Even this test cannot definitively determine your fertility. Elevated FSH levels indicate that your ovaries are less responsive, prompting your pituitary gland to work harder to stimulate them. Ovulations occur less frequently, reducing the chances of pregnancy but not eliminating them entirely.  

Luteinising Hormone (LH) 

LH triggers ovulation—the release of an egg that can be fertilised. During perimenopause, LH levels may still rise, but this can sometimes occur without actual ovulation. This contributes to irregular cycles and fewer fertile moments.  

Progesterone 

Progesterone is produced after ovulation and supports the uterine lining for implantation. With fewer ovulations, progesterone levels drop, reducing the likelihood of implantation.  

Anti-Müllerian Hormone (AMH) 

AMH indicates your ovarian reserve. During perimenopause, AMH levels decline rapidly. Low AMH levels suggest reduced fertility but do not rule out pregnancy entirely. Home tests can measure AMH levels, but they cannot predict your immediate ability to conceive. In healthcare, AMH is not yet routinely used to assess fertility during perimenopause, though research is ongoing to determine its potential in estimating time to menopause.  

Want to get pregnant? 

If you’re trying to conceive, professional guidance is crucial. Seek advice on fertility options and ensure your health is optimised for pregnancy.

Is contraception still necessary?

As long as you are menstruating, pregnancy remains technically possible—even if the chances are slim. If you no longer wish to conceive, this is important to bear in mind.  

Contraception advice by age: 

• <50 years: continue contraception for 2 years after your last period 
• ≥50 years: continue contraception for 1 year after your last period  

Many women use contraception longer than necessary due to concerns about pregnancy. However, as long as ovulation occurs, the risk—however small—remains. At the same time, menopausal symptoms alone are not a reason to use hormonal contraception. It’s essential to consider your overall situation and consult a healthcare provider to determine the best option for you.  

Want to learn more? Read our blog: How do contraceptive pills affect menopause?  

Considering Contraception? 

Speak to your doctor or midwife to explore the most suitable method for you at this stage. Options include hormonal and non-hormonal methods, depending on your preferences, symptoms, and circumstances.  

Pregnancy at a later age

Pregnancy later in life is often successful, but the risks do increase. Your body is not the same as it was at 25, so thorough monitoring during pregnancy is essential. This often involves additional hospital check-ups to ensure the wellbeing of both you and your baby.  

Potential risks include: 

• Gestational diabetes
• High blood pressure and pre-eclampsia
• Chromosomal abnormalities, such as Down’s syndrome
• Miscarriage or premature birth
• Caesarean section or complicated delivery
• Blood clots or thrombosis

I had no idea I was still fertile. The pregnancy brought stress but also joy. With proper guidance, everything turned out fine. – Marlies (age 46)

You deserve clarity and control

Whether you wish to have children or not, it’s entirely normal to have questions about your fertility during perimenopause. These questions deserve to be taken seriously. You don’t have to simply accept the changes—you have the right to understand your body and make informed decisions that suit you. 

The transition was the start of a new chapter for me—but it was also confusing. Thanks to honest information, I was able to regain control. – Amina (age 49)

You’re welcome at SeeMe-nopause

At SeeMe-nopause, we aim to break the silence. Fertility and menopause should be open topics, free from stigma. We provide reliable information, medical support, and a space to explore what works best for you. Whatever your circumstances, you don’t have to face this journey alone. 

Tips and advice