Can you get pregnant during perimenopause?

Yes, you can get pregnant during perimenopause. Fertility declines through your 40s, but perimenopause is a time of irregular ovulation, not absent ovulation, and an egg can still be released in a cycle you did not expect. If you do not want to become pregnant, US guidance is to keep using contraception until you have gone 12 months without a period, or until roughly age 50 to 55 if your method hides your cycle.

Why pregnancy is still possible

The Menopause Society explains that perimenopausal period changes come from the ovaries’ erratic production of hormones and less frequent release of an egg, and states plainly that even when cycles are irregular, women in perimenopause can still get pregnant.

The best direct evidence comes from a study that followed 108 women aged 25 to 58, who collected daily urine samples for six months in each of five consecutive years so researchers could detect ovulation cycle by cycle. Cycles without ovulation became steadily more common across perimenopause, and in late perimenopause more than 60% of cycles were anovulatory. But one quarter of cycles longer than 60 days still included ovulation, and in late perimenopause ovulation happened later in the cycle, on average around day 27. The authors concluded that the risk of conception in late perimenopause is “far from negligible.”

The practical problem is timing. Ovulation comes before the period that follows it, so after a long gap you have no way of knowing whether an egg is about to be released. For the hormone changes behind this, see what happens to your hormones in perimenopause.

How likely is it?

Lower than in your 30s, but hard to pin down for any one woman. The CDC’s 2024 contraception guidance gives the key figures: the median age at which natural fertility is definitively lost is 41, but it can range up to 51, and the median age of menopause in North America is about 51, varying from 40 to 60. A 2018 review of contraception for midlife women described the risk of pregnancy after 40 as decreased, but not trivial.

US birth data show that pregnancies in the 40s are not rare:

Mother’s age	US births in 2024	Birth rate
40 to 44	141,515	12.7 per 1,000 women
45 to 49	9,688	1.1 per 1,000 women (rate includes births at 50 and older)
50 to 54	1,188	1.2 per 10,000 women

The birth rate for women aged 40 to 44 in 2024 was the highest since 1965. These figures count births however they were conceived, and they do not include pregnancies that ended before birth, so they are a rough guide rather than a measure of natural fertility.

Why a test cannot clear you

It would be convenient if a hormone test could say when fertility has ended. None can. The CDC states that no reliable laboratory tests are available to confirm definitive loss of fertility, and that using FSH levels to decide when a woman is no longer fertile might not be accurate.

The FDA makes the same point about urine FSH home tests: as you get older, FSH can rise and fall, and while hormone levels are changing, your ovaries continue to release eggs and you can still become pregnant. It advises not to stop contraception based on these results, because they are not foolproof. Our guide to why hormone tests are often normal explains why FSH is so unreliable during the transition.

Pregnancy later in life carries more risk

This is not a reason for alarm, but it is a reason to plan. The CDC notes that pregnancies among women of advanced reproductive age are at higher risk for maternal complications, including hemorrhage, venous thromboembolism and death. If you are hoping to conceive in your 40s, a preconception visit is worthwhile. If you are not, effective contraception matters as much now as it did earlier.

Choosing contraception in perimenopause

Most methods remain options after 40. The 2018 review summarized the evidence:

• IUDs are among the most effective methods and are safe for midlife women with few exceptions.
• Progestin-only methods are a safe option for most, because they are not associated with increased cardiovascular risk.
• Combined estrogen-containing methods can be used safely by women without cardiovascular risk factors.

Some methods do double duty. The review lists improved abnormal bleeding, fewer hot flashes and lower cancer risk among the extra benefits for this age group. The Menopause Society notes that continuous combined hormonal contraceptives are often used in perimenopause because they treat hot flashes while providing birth control. For a method-by-method comparison, see birth control in perimenopause.

When you can stop

Your situation	When contraception can stop
Not using hormones, periods still coming	After 12 months with no period, which confirms menopause
Using a method that hides your periods	Discuss with your clinician; ACOG and The Menopause Society recommend contraception until menopause or age 50 to 55
A positive home menopause test	Not on that basis; FSH results cannot confirm infertility

The 2018 review notes that women without medical contraindications can continue contraception until the age of menopause, then consider switching to hormone therapy if symptoms need treatment. Hormone therapy itself is not contraception.

When it might be pregnancy

A late period in your 40s is ambiguous. Missed or delayed periods, tiredness, breast tenderness, nausea and mood changes can come from either perimenopause or early pregnancy. If you have had sex since your last period and it is late, a home pregnancy test is the quickest way to know. If it is negative but your period still does not come, repeat the test or check in with your clinician.

When to see a clinician

• You want to review whether your current method is still the best fit, especially if you smoke or have high blood pressure or other cardiovascular risk factors
• You have a positive pregnancy test, planned or not, so that care can start early
• You have very heavy bleeding, bleeding between periods or after sex; see heavy bleeding and clots for what counts as too much
• You are unsure whether you have reached the point where contraception can stop

To find a clinician who can help with contraception and perimenopause care, search for an ob-gyn near you, or check your symptoms first with the symptom check.