I was worried about getting pregnant, but my doctor reassured me. Fortunately, the chances are very small at this stage.
Your cycle is changing, you’re noticing various physical changes, and you feel different. But is it still possible to conceive during this phase of life? And if so, how likely is it? During perimenopause, your fertility declines significantly, but that doesn’t mean pregnancy is entirely out of the question. As long as you are still ovulating, it remains technically possible to conceive.
This raises important questions—especially if you’re trying to avoid pregnancy or are still hoping to have a child. In this article, you’ll learn how your fertility changes during perimenopause, the role of your hormones, and when contraception may still be necessary.
Perimenopause is the phase when menopause begins. It is the transitional period before your last menstrual period. Your periods may become shorter, longer, or more irregular. Your hormone levels fluctuate significantly, and your fertility decreases further, but it hasn’t disappeared entirely. As your cycle becomes more irregular, ovulations occur less frequently. This indicates that menopause is approaching—although this phase can last for years.
Average chance of pregnancy by age group:
Your fertility is regulated by a delicate interplay of hormones. During perimenopause, this balance is disrupted, affecting your cycle and your chances of becoming pregnant. These hormones play a role:
Estrogen
Stimulates the build-up of the uterine lining and prepares your body for a potential pregnancy. During perimenopause, this hormone fluctuates, which can lead to irregular ovulation and reduced fertility.
Follicle-stimulating hormone (FSH)
FSH supports the growth of follicles in the ovaries. During perimenopause, FSH levels rise because the ovaries become less responsive to this hormone. This is a sign that your egg reserve is diminishing. The higher the FSH level, the lower the chance of ovulation and, consequently, pregnancy.
Want to know if you’re already in menopause?
Sometimes you experience symptoms but are still unsure. Want to find out if you’re in menopause? Take a test, such as the Silex self-test.
Luteinising hormone (LH)
LH is the hormone that typically triggers ovulation: the moment when an egg is released and can be fertilised. During perimenopause, LH levels can still rise, but this sometimes happens without an actual ovulation occurring. As a result, your cycle becomes more irregular, and there are fewer moments when you are truly fertile.
Progesterone
Produced after ovulation, progesterone helps create a uterine lining where a fertilised egg can implant. Since ovulations occur less frequently, your progesterone levels decrease, reducing the likelihood of implantation.
Anti-Müllerian hormone (AMH)
AMH provides an indication of your egg reserve. During perimenopause, AMH levels drop rapidly. Low AMH indicates reduced fertility but does not completely rule out pregnancy. Home tests are available to measure your AMH level, but it’s important to know that this test does not predict whether you can conceive at that moment. In healthcare, AMH is not yet routinely used to determine fertility during perimenopause. However, research is ongoing to see if this value can help estimate how long it will take until menopause.
Want to get pregnant?
Proper guidance is essential. Seek advice on your options and ensure your health is as optimal as possible.
As long as you are menstruating, you can technically become pregnant—even if the chances are small. Especially if you no longer wish to have children, it’s important to keep this in mind.
Contraception advice by age:
Many women continue using contraception longer than necessary out of fear of becoming pregnant. As long as you are still ovulating, the chance—however small—remains. At the same time, if you are using contraception solely to relieve menopausal symptoms, consider whether hormone therapy might be a better fit. This is more targeted and can provide better results. Discuss with a healthcare provider what suits your situation best.
Want to know more? Read our blog: How does the pill affect menopause?
Considering contraception?
Ask your (family) doctor or midwife which method is best for you at this stage. There are options with and without hormones—depending on your situation, preferences, and any symptoms
Pregnancy at a later age usually goes well, but the risks do increase. Your body is different now than it was at 25, so proper monitoring during pregnancy is important. In many cases, this means extra check-ups at the hospital—just to ensure everything is going well for you and your baby.
You have a higher risk of:
I had no idea I was still fertile. The pregnancy brought stress, but fortunately also joy. With proper guidance, everything went well.
Whether or not you still want children, it’s completely normal to have questions about your fertility during perimenopause. These questions deserve serious attention. You have the right to understand what’s happening in your body and to make informed decisions in a way that suits 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.
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