Can You Get Pregnant During Perimenopause? We Asked a Doctor

Can You Get Pregnant During Perimenopause? We Asked a Doctor

If your period’s been unpredictable lately, you may be starting perimenopause. During this transitional period leading up to menopause, fluctuating hormone levels can cause symptoms like hot flashes, mood swings, and irregular menstrual cycles. And while perimenopause typically starts in your 40s, it can start as early as the mid-30s for some women and may last for up to 10 years—which means there’s a chance it might overlap with your pregnancy planning.1

So if you’re experiencing symptoms of perimenopause, is it still possible to get pregnant? Whether you’re currently trying to conceive or you’re wondering if you still need to use contraception, the short answer is that you can still get pregnant during perimenopause. However, some of the changes that happen during perimenopause can make successful conception and pregnancy a bit more challenging. Here’s what you need to know. 

How Perimenopause Affects Fertility

When you hit perimenopause, ovarian function starts to decline, which can lead to fluctuating estrogen levels, sporadic ovulation, and irregular menstrual cycles.2 And if you do get pregnant, you’ll also have to contend with the usual risks of getting pregnant at an “advanced maternal age”—a.k.a. over the age of 35.3 

“As we increase in age, ovulation decreases in frequency as well as quality of eggs,” says Dr. Amber Samuel, MD, a board-certified OB/GYN and Maternal Fetal Medicine doctor. “This makes conception less likely over time and also increases the risk of early pregnancy loss, maternal medical problems, and abnormal chromosomal issues."

But that doesn’t mean pregnancy is off the table. In fact, research suggests a 40-year-old woman has a 44% chance of conceiving naturally after a year of trying.4 Getting pregnant may take a bit longer if you’re in perimenopause, but until your periods stop completely, you can still have a healthy pregnancy.

How to Support Fertility During Perimenopause

If you’ve already started perimenopause but you’re still hoping to grow your family, there are a few steps you can take to boost your fertility. 

1. Adopt a healthy lifestyle.

“As with all patients trying to conceive, maintaining a healthy lifestyle and normal BMI will increase ovulation,” Dr. Samuel says. Obesity can affect ovarian function and egg quality and quantity, which can make it even harder to get pregnant during perimenopause—so talk to your doctor about lifestyle modifications that can help improve fertility. 

Smoking has also been linked to infertility and miscarriage risk, and it may even accelerate menopause.“Nicotine decreases fertility in any part of a reproductive journey, particularly perimenopause,” Dr. Samuel says. If you need help kicking the habit, your doctor can recommend the most effective methods for quitting.    

2. Pop your prenatal vitamins. 

“All women attempting to conceive should consume the recommended amount of nutritional components such as protein, folate, omega-3 fatty acids, and vitamin D—even prior to a positive pregnancy test, as the risks of deficiencies are often present before a person knows they have conceived,” Dr. Samuel says. 

Folate in particular is important during the earliest weeks of pregnancy to help protect against neural tube defects—which is why many doctors recommend starting prenatal vitamins up to a year before you start trying to conceive. This is especially important during perimenopause, since irregular cycles make it harder to know exactly when your period is due—so it could take a bit longer before you realize you’re pregnant.

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3. Try an at-home ovulation test kit. 

If you’re TTC, irregular menstrual cycles during perimenopause can make it tough to predict your fertile window. When your periods aren’t exactly running like clockwork, ovulation test kits can help you pinpoint when you’re most likely to conceive. These tests detect a spike in luteinizing hormone (LH), which signals the ovary to release an egg. You can typically expect to ovulate within 24 to 36 hours of a positive test result.6 While a blood test performed by your physician is the most accurate way to check LH levels, Dr. Samuel says, most women can get reliable results from at-home urine tests. 

4. Talk to a specialist. 

Your chances of getting pregnant decline dramatically as you get closer to menopause.7 So if you’re already in perimenopause and hoping to get pregnant, time is of the essence. Schedule an appointment with your OB/GYN or a fertility specialist to discuss your options—especially if you’re over 35 and haven’t conceived after six months of trying

5. Mind your perspective.

If you're struggling to get pregnant, it’s easy to feel frustrated. But stress and its related hormones (cortisol and  epinephrine) can have a negative impact on fertility. No matter where you are in your fertility journey, it's important to remember that you are not alone. "When you can tap into community help, it releases a lot of tension and pressure," says  Perelel Panelist Dr. Sarah Oreck, MD MS, a Columbia-trained reproductive psychiatrist and therapist.

What if you’re not trying to get pregnant?

If expanding your family isn’t on your radar right now, be sure you’re using contraception even if you’re already in perimenopause. And keep in mind that irregular cycles during perimenopause can make calendar-based methods of contraception less effective. “Given that cycles are not regular, even a very seasoned person can have episodes of ovulation not in sync with the prior menses and get inadvertently pregnant,” Dr. Samuel says. Talk to your doctor to determine the safest and most effective form of contraception during this phase of life. 

Up next: some the most common misconceptions our experts hear around TTC, and tips for conception from one of Hollywood's most beloved fertility specialists. Plus, find support by joining our community, Village by Perelel on Geneva, or read more about adapting to the new identity of “mother.”


  1. Mayo Clinic: Perimenopause
  2. Johns Hopkins Medicine: Perimenopause
  3. Johns Hopkins Medicine: Advanced Maternal Age
  4. Ilse Delbaere et al; Knowledge about the impact of age on fertility: a brief review; Jan 2020
  5. Cleveland Clinic: How Stopping Smoking Boosts Your Fertility Naturally
  6. MedlinePlus: Ovulation home test
  7. The American College of Obstetricians and Gynecologists; Having a Baby After Age 35: How Aging Affects Fertility and Pregnancy