Can I still get pregnant in the perimenopause?

We take a look at fertility during the perimenopause

One of the defining signs that perimenopause is starting is that your periods begin to change. This is your body’s way of showing you that your ovarian function – therefore your fertility – is changing.

For some women, the potential loss of fertility will cause you little concern. You may have already had children or have chosen to be child-free, and the thought of your periods stopping is actually a positive one.

Alternatively, you may be hoping to become pregnant and are worried that your emerging perimenopause is going to negatively impact your chances.

Let’s take a look at the evidence and see what recommended guidelines say.

I don’t want to become pregnant during the perimenopause – what should I do about contraception?

If a pregnancy is not what you want and you’re in a sexual relationship where this is theoretically possible, no matter how small the chance, it’s important to keep using consistent contraception until the risk is significantly reduced.

The Faculty of Sexual and Reproductive Healthcare (FSRH) produce guidelines on contraception for over 40 year olds and they recommend:

* If you are under 50 years of age, you should use contraception for at least two years after your last period

* If you are over 50, you should use contraception for at least one year after your last period

* At the age of 55 you can stop using contraception even if you still have the occasional period, as the chance of pregnancy is extremely rare.

The FSRH guidelines also offer information on the different types of contraception suitable to use in your 40s and 50s and the risks and benefits to each.

What if I do want to become pregnant?

If you do want to become pregnant, the perimenopause doesn’t automatically mean this will not be possible. When a natural perimenopause is happening, ovulation doesn’t go from happening every month to a sudden stop. Even if your periods are few and far between, you may still ovulate occasionally.

Talk to your healthcare professional and consider seeing a fertility specialist if you need further support to become pregnant during your perimenopause.

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If you want to take HRT for your perimenopause symptoms, there is little evidence on this matter but most experienced clinicians agree that taking HRT is safe and does not usually reduce your chances of conceiving.

It is also safe to take transdermal HRT while breastfeeding. (Remember to follow the recommended instructions on where to apply it, cover the area with clothing and wash hands straight afterwards).

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Be aware that some symptoms of perimenopause can be similar to those occurring in early stages of pregnancy such as missing periods, breast tenderness, and feeling emotional. So don’t always assume your symptoms are related to the perimenopause!