Can You Get Pregnant During Perimenopause? What UK Women Need to Know

What Is Perimenopause?

Perimenopause is the transitional phase leading up to menopause when hormonal changes gradually reduce a woman’s fertility. This stage typically begins in the 40s, though it can start earlier for some women, and often lasts several years.

During perimenopause:

1. Oestrogen and progesterone levels fluctuate unpredictably.
2. Menstrual cycles become irregular.
3. Symptoms such as hot flushes, night sweats, and mood swings often appear.

It’s important to know that while fertility declines in this phase, pregnancy remains possible until menopause is confirmed.

Can You Still Ovulate During Perimenopause?

Yes—you can. Even if your periods are irregular, sporadic ovulation may still occur. Some cycles will be anovulatory (no egg released), but others may produce a viable egg.

This unpredictability is why natural conception can still happen during perimenopause, though chances are lower compared to younger ages.

Factors influencing ovulation include:

1. A diminishing ovarian reserve (fewer and lower-quality eggs)
2. Hormonal fluctuations disrupting the cycle
3. Lifestyle elements such as smoking, excess weight, or chronic stress

What Are the Chances of Natural Pregnancy During Perimenopause?

Fertility starts to decline noticeably after age 35 and decreases more sharply after 40. However, conception during perimenopause is still possible:

1. Women in their early 40s have around a 5–10% chance per cycle of conceiving if ovulation occurs.
2. After age 45, the chance falls below 2% per cycle.

Beyond lower egg quantity and quality, there is an increased risk of miscarriage and chromosomal abnormalities with maternal age.

What Are the Risks of Pregnancy During Perimenopause?

Pregnancy in your 40s or during perimenopause can carry higher health risks for both mother and baby, including:

1. Higher miscarriage rates
2. Increased chances of gestational diabetes
3. Elevated risk of high blood pressure and preeclampsia
4. Greater likelihood of chromosomal anomalies, such as Down syndrome
5. Higher risk of preterm birth or low birth weight

This is why any woman considering pregnancy during this time should have a thorough preconception consultation and careful monitoring during pregnancy.

How Can You Tell If You Are Pregnant or Entering Menopause?

Early pregnancy and perimenopause can share similar symptoms, such as:

1. Missed or irregular periods
2. Breast tenderness
3. Fatigue
4. Mood changes

If you suspect pregnancy, taking a test is the most reliable first step. Blood tests measuring hCG can confirm pregnancy even before a home test turns positive.

Menopause is typically diagnosed after 12 consecutive months without a period.

What Fertility Options Exist During Perimenopause?

If you’re hoping to conceive, there are still paths forward—depending on your ovarian function:

Natural Conception

If you’re still ovulating, tracking your cycles and timing intercourse can improve the likelihood of conception.

Ovulation Induction

Medications such as clomiphene citrate may stimulate ovulation in women with irregular cycles.

In Vitro Fertilisation (IVF)

IVF is often recommended for women over 40. This process involves retrieving eggs, fertilising them in the lab, and transferring embryos to the uterus.

Egg Donation

If your ovarian reserve is very low or eggs are poor quality, donor eggs can greatly improve pregnancy success rates.

Fertility Preservation

Women in their late 30s or early 40s who wish to delay pregnancy may consider egg freezing before further decline in egg quality.

Should You Use Contraception During Perimenopause?

Yes. Even if your cycles are erratic, you can still conceive unexpectedly. Until menopause is confirmed, you should use contraception if you don’t wish to become pregnant.

Effective options include:

1. Intrauterine devices (IUDs)
2. Low-dose hormonal contraceptives
3. Barrier methods like condoms

It’s helpful to discuss contraception with your gynaecologist to find a method that balances pregnancy prevention with symptom management.

Can Hormone Replacement Therapy (HRT) Affect Fertility?

HRT is commonly used to ease perimenopausal symptoms such as hot flushes and mood changes. However, HRT does not act as contraception. Women using HRT may still ovulate and need additional birth control if pregnancy is not desired.

Also, it’s important to note that HRT is not designed to improve fertility.

How Can You Prepare for Pregnancy During Perimenopause?

If you are thinking about conceiving, preconception planning is essential:

1. Have a comprehensive health assessment and screening for chronic conditions.
2. Optimise weight, nutrition, and manage lifestyle factors.
3. Take folic acid supplements to lower the risk of neural tube defects.
4. Start prenatal care early to monitor your health and the baby’s development.

Partnering with a reproductive medicine specialist ensures you have personalised guidance tailored to your goals and medical needs.

Final Thoughts: Is Pregnancy During Perimenopause Possible?

Absolutely. While less predictable and associated with more risks, pregnancy during perimenopause can and does happen. Some women conceive naturally, while others need help through assisted reproductive technologies.

Understanding your fertility status, overall health, and reproductive goals is the first step in making an informed choice. With the right support, you can explore your options confidently.

At the clinic of Assoc. Dr. Nurettin Türktekin, we specialise in guiding women through perimenopause, fertility challenges, and safe pregnancy planning. Whether you wish to conceive naturally or explore assisted treatments like IVF or egg donation, our team is here to provide compassionate, expert care every step of the way.

Contact us today to schedule a consultation and discuss the best approach to achieve your family goals.