Can You Get Pregnant During Perimenopause?

Dear Doctor,

I’m 47, my periods are super irregular, and I’m sweating through my sheets at night—hello, perimenopause! My partner and I stopped using protection a while ago, assuming our baby days were behind us. But now I’m wondering… is it still possible to get pregnant? Am I officially out of the woods, or should I be worried about a surprise plus sign?

— Hot (Flashing) & Confused

Dear Hot (Flashing) & Confused,

While hot flashes and an irregular period are the telltale signs of menopause, as long as you are getting a period, you can get pregnant. Let me explain a bit further.

What is Perimenopause

Menopause isn’t a one-and-done event—it’s a gradual transition that can take anywhere from four to 14 years. Perimenopause is the first phase of that journey. It refers to the time leading up to menopause, when your ovaries begin to slow down. You might start having fewer periods and experience hot flashes, mood swings, and other emotional or physical symptoms. While the menopause transition typically lasts a few years, it can stretch up to a decade for some women—and yes, during this time, pregnancy is still possible.

Perimenopause vs Menopause

Even when you haven’t had a period in a few months, that doesn’t mean you should put away the contraception just yet. To put it simply:

• Perimenopause: The transitional period leading up to menopause, where hormones like estrogen start to fluctuate. These fluctuations are what cause irregular periods, mood swings, and other perimenopause symptoms. 
• Menopause: Menopause is when you have not had a period for 12 months without any other underlying condition. 

The key difference between the two is that during menopause, you may still have a period, though it may be irregular, lighter, or heavier than your normal flow. But the presence of a period means you’re ovulating, which means you can get pregnant. 

Furthermore, the average age of perimenopause is around ~47 years old, though some women start in their late 30s or early 40s. And it’s not uncommon to have a pregnancy in your 30s or 40s. 

Adding to the confusion, early signs of pregnancy and perimenopause symptoms can overlap: missed period, mood swings, and fatigue are just a few examples. 

Just to be sure, unless you hear from your healthcare provider that you are officially post-menopausal, you should continue to use a contraception method. Are you experiencing perimenopause symptoms? Request an appointment with your Genesis provider today so we can support you on your journey.

Hoping you have fewer hot flashes and more fun,

Dr. Christopher Sullivan

Christopher Sullivan, MD, FACOG, is a board-certified gynecologist practicing at Genesis OB/GYN in Tucson, AZ.