Can I Still Get Pregnant During Perimenopause?

Fertility declines as people get older, which means that conceiving might be difficult for people who are trying to start a family later in life. 

However, until you reach menopause, which is characterized as 12 months without a menstrual cycle, it is still possible to conceive—and an increasing number of people are. According to the National Center for Health Statistics, there were 1,073 women aged 50 and over who gave birth in 2019, which is up from 959 births in 2018. Meanwhile, the birthrate of women aged between 40 and 44 has steadily risen since 1985.

"It is absolutely possible to conceive until you go through those 12 months without a period," says Mary Jane Minkin, MD, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University School of Medicine. "I personally have delivered [babies from] three women who were 47 at the time of their deliveries."

While conception during perimenopause—a term used to describe when a person's body starts the transition into menopause—is possible, there are additional factors to take into account before considering it as an option.

What Is Perimenopause?

Perimenopause is sometimes referred to as the menopause transition and describes the stage your body enters before it produces its final menstrual cycles. For some people, perimenopause can last for just a few months, but for others, it can be as long as 14 years.

The age a person enters perimenopause depends on how old you will be when you reach menopause. In the United States, the average age of menopause is 51. However, some people reach menopause as early as 35 or as late as 60. 

“[A person] can have all the symptoms of menopause but just hasn’t gone a full year without a period,” explains Dr. Minkin, who is also a North American Menopause Society certified menopause clinician. "Classically, women have erratic periods and then hot flashes, night sweats, sleep disturbances, anxiety, [and] body aches.” 

However, not everyone experiences symptoms, which means that it can be difficult for some to recognize when they are perimenopausal. 

“[Perimenopause] is characterized as the time before the woman goes into menopause. Because menopause is defined as not having a menstrual cycle for a full year, [perimenopause] is a diagnosis that’s made after it’s already happened,” says Monica Christmas, MD, an associate professor of Obstetrics and Gynecology and director of the Menopause Program at the University of Chicago Medicine.

Is It Still Possible To Get Pregnant During Perimenopause?

Although fertility is significantly diminished by the time people reach the perimenopausal transition, it is still possible to become pregnant. However, the follicular dysfunction associated with perimenopause means that it is harder to conceive during this time. 

“Typically, what starts to happen in those years prior to [when] the ovaries just stop working is that they’re kind of malfunctioning, so to speak,” explains Dr. Christmas. “During that perimenopausal transition, your ovaries are still functioning, but they are not as efficient as they were when [you] were younger and [your] ovaries were more vibrant.”

Your body’s production of estrogen and progesterone is an essential step in reproduction, says Dr. Christmas. During perimenopause, levels of these hormones rise and fall sporadically, causing irregular periods, reduced ovulation, and some of the symptoms associated with menopause—such as fluctuating moods and night sweats. As such, the ups and downs of these reproductive hormone levels make it harder to become pregnant. 

However, until your ovaries cease to function entirely, and provided that you are still ovulating occasionally, pregnancy during perimenopause is still a possibility. If you aren’t hoping to conceive during this time, Dr. Minkin advises using a low dose combined hormonal contraceptive. 

The age at which you reach perimenopause also has a huge bearing on fertility, as the quality of eggs continue to deteriorate over time. “It would be very unlikely for a perimenopausal woman of age 55 to conceive, but much more likely for a 45-year-old perimenopausal woman,” explains Dr. Minkin.

What Are the Options For Conception During Perimenopause?

If you think you could be entering perimenopause and are still hoping to conceive, Dr. Christmas recommends seeking the advice of a fertility specialist to explore cryopreservation, also known as elective egg freezing. This is a means of preserving the quality of your eggs before they deteriorate further with age. 

“For anybody who comes to me in their late 30s or early 40s who aren't actively trying to conceive but want to preserve that option, I'll tend to send them to a fertility specialist to discuss cryopreservation of their eggs,” Dr. Christmas says. 

While you can freeze your eggs in your early 40s, the odds of those frozen eggs helping you conceive aren't as good as if you had frozen them when you were younger. The older a person is, the less likely they will be able to conceive with cryopreserved eggs, and people should know this before investing their money and exposing their bodies to the procedure.

In addition to cryopreservation, Dr. Christmas urges those looking to conceive during perimenopause to have their FSH (follicle stimulating hormone) levels evaluated to assess their ovarian reserves. This can be done via a blood test.

“The first thing a fertility specialist is going to do for someone who is having issues at an advanced age is to check to see what the ovarian follicular function is,” Dr. Christmas says.

It's important to remember that the age of menopause is different for everyone. While the average age is 51, menopause can happen anywhere from 45 to 55. "People will be on a continuum, so if you’re somebody who isn’t actually going to hit that menopause transition until you’re 55 or 56, you may actually be fine at even 44 or 45, and may be able to conceive without much difficulty at all".

But what about a person who is on an earlier spectrum of menopause? That person might start to exhibit ovarian follicular dysfunction in their late thirties. "They would probably have a more difficult time conceiving—at least spontaneously or naturally," Dr. Christmas says.

What Are the Risks of a Perimenopausal Pregnancy?

There is a certain level of risk associated with an advanced age pregnancy, which is widely considered to be over the age of 35. The likelihood of a pregnancy resulting in a miscarriage or a baby born with chromosomal abnormalities—such as Down Syndrome—increases with age, as the quality and quantity of our eggs diminish with time.

Additionally, the risk of preterm delivery (which is classified as any time before 37 weeks) increases with the parent's age. The complicated health implications associated with this include cerebral palsy, as well as learning and behavioral disabilities. What’s more, the toll of an advanced-age pregnancy puts older parents at risk of high blood pressure, strokes, seizures, and gestational diabetes.

However, that doesn’t mean that every advanced age pregnancy will be negatively impacted. If you are concerned that your age could affect either your pregnancy or your own health, talk it through with a healthcare provider. 

A Word from Verywell

While there is nothing you can do to delay or stop menopause, it is still possible to get pregnant during perimenopause, which is the period of time leading up to menopause. Everyone enters perimenopause at a different age, so talk with a healthcare provider if you have any questions about what conceiving later in life might look like for you.