Can You Get Pregnant During Perimenopause?

by Sep 9, 2020

Your fertility naturally declines as you age. After age 40, it becomes increasingly unlikely that you will conceive. But “unlikely” does not mean “impossible!” As long as you have not reached menopause, defined as the lack of a menstrual period for 12 consecutive months, you can still become pregnant.

A woman and a man together

Fertility During Perimenopause

Before menopause, you may begin to notice symptoms such as irregular menstrual bleeding, hot flashes, or changes in sexual desire due to fluctuating hormones. The period of time after the onset of these symptoms but before you reach menopause is known as perimenopause.

During perimenopause, your menstrual cycle may become irregular. The closer you get to menopause, the more time you will observe between each menstrual period. Your periods become fewer and far between due to anovulation, or the body’s failure to release an egg during the menstrual cycle.

In perimenopause, you may go several cycles without ovulating, but that does not mean you cannot ovulate at all. Women in perimenopause do, however, have fewer eggs. The quality of their eggs also declines, making it more difficult to get pregnant.

As soon as you ovulate again, your fertile window also returns — and so do your chances of becoming pregnant. This means that you may go several menstrual cycles without ovulating during perimenopause, only to ovulate again months later.

Remember, menopause is defined as going at least 12 months without menstruating (meaning you have also gone 12 months without ovulating). You are less likely to get pregnant during perimenopause, but as long as it has not been 12 months since your last period, you may still be able to become pregnant.

The pregnancy rate for perimenopausal women is estimated to be 10-20 percent in women ages 40-44 and 12 percent in women ages 45-49. Unintentional pregnancy is rare in women over age 50, but you should still exercise caution. About 5 in 100 women having unprotected sexual intercourse at age 50 will become pregnant.

If you do not want to get pregnant while perimenopausal, you should not assume that you have entered menopause if you do not ovulate or have a menstrual period for a few months. You will still need to use a reliable method of birth control to avoid becoming pregnant during perimenopause, even if you have gone several months without a menstrual period.

Risks of Becoming Pregnant During Perimenopause

While you are less fertile during perimenopause, it’s important to know that you can still get pregnant until you reach menopause. You should keep this in mind because there may be increased risks associated with pregnancy after age 40, including:

Miscarriage

Miscarriages are more common than you might think: 12-15 percent of women who become pregnant in their 20s will suffer a miscarriage. The miscarriage rate also increases with age. Approximately 25 percent of pregnant women in their 40s will suffer a miscarriage. Doctors believe this may be due to lower levels of protective hormones like estrogen and progesterone in older women, as well as changes to the uterine lining and lower egg quality.

Premature Birth

Premature birth is defined as giving birth anytime before 37 weeks of gestation. Even after controlling for other risk factors, research has found that women over age 40 are more likely to give birth prematurely. Mothers are also more likely to give birth prematurely if they suffer from complications like hypertension or placenta previa during pregnancy. Many of these conditions are more common in women over age 40 and can compound the risk of premature birth in older mothers. Sadly, premature birth is associated with certain health problems in infants, including cerebral palsy and learning disabilities.

Complications During Pregnancy

The risks of pregnancy during perimenopause affect the mother as well as the fetus. Women over age 40 who become pregnant run a higher risk of developing complications such as gestational diabetes, gestational hypertension, seizures, and death. Conditions like gestational diabetes and gestational hypertension are manageable but can be dangerous. Women in their 40s are also more likely to develop preeclampsia, a sudden increase in blood pressure after 20 weeks of pregnancy that can damage organs and lead to death.

These health conditions have long-term implications for the health of the mother and the infant. Chronic hypertension during pregnancy raises the risk of preterm birth and low birth weight, and gestational diabetes may increase your risk of delivering via C-section and developing type II diabetes later in life.

Women in perimenopause often wrongfully assume they cannot become pregnant; in fact, 75 percent of pregnancies in women in their 40s are unplanned. If you do not want to become pregnant during perimenopause, you should still use a birth control method until you reach menopause — and if you do want to become pregnant, you should speak to your OB/GYN about your personal risk factors.

✔️ Medically Reviewed by Dr Roohi Jeelani, MD, FACOG and Lauren Grimm, MA

roohi jeelaniDr Roohi Jeelani is Director of Research and Education at Vios Fertility Institute in Chicago, Illinois. Dr Jeelani earned her medical degree from Ross University School of Medicine in Portsmouth, Dominica. She then completed a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology and Infertility at Wayne State University, Detroit Medical Center, where she was awarded a Women’s Reproductive Health NIH K12 Research Grant. She is board certified in Obstetrics and Gynecology. Dr Jeelani has authored numerous articles and abstracts in peer-reviewed journals, and presented her research at national and international scientific meetings. A Fellow of the American College of Obstetrics and Gynecology, Dr Jeelani is a member of the American Medical Association, the American Society of Reproductive Medicine, and the American Association of Gynecologic Laparoscopists.

Lauren Grimm is Research Coordinator at Vios Fertility Institute in Chicago, Illinois. Lauren earned her bachelor’s degree from Loyola University Chicago, where she also completed her masters in Medical Sciences. Lauren has worked alongside Dr. Jeelani for the last 3 years, authoring a number of abstracts and articles in peer-reviewed journals, and presented her research at national and international scientific conferences. Lauren will be continuing her education this fall at Rush University Medical College in Chicago, IL as an MD candidate.

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