Loading…
Yes, pregnancy is still possible in perimenopause. Learn how fertility changes in your 40s, when to stop contraception, which methods suit you and HRT facts.
Yes. You can still get pregnant during perimenopause, even if your periods are irregular or you have skipped several. Fertility falls sharply through your 40s, and by 45 natural pregnancy is unlikely, but ovulation can still happen unpredictably. If you don’t want to become pregnant, you need contraception until guidance says you can stop.
During perimenopause, the ovaries release eggs less often and less predictably. Some cycles include ovulation and some don’t. Mayo Clinic’s specialists put it simply: ovulation is still likely to happen, just less often and without an easy-to-follow pattern.
That unpredictability is the problem. A period can return after months without one, and ovulation happens about two weeks before a period. You cannot know in advance which cycles are fertile.
The UN Population Fund notes that pregnancy is still possible during perimenopause, although the likelihood gradually decreases.
For an overview of what is happening in your body, see our complete guide to perimenopause.
Fertility declines with age, and the decline speeds up in the mid-30s.
| Age group | Chance of pregnancy per cycle (when trying) |
|---|---|
| 20s to early 30s | About 1 in 4 |
| 40 and over | About 1 in 10 |
| 45 and over | Natural pregnancy is unlikely |
Figures from the American College of Obstetricians and Gynecologists (ACOG).
"Unlikely" is not the same as impossible. If you are having sex and do not want to become pregnant, the safest approach is to use contraception until you meet the criteria for stopping.
Many people have healthy pregnancies in their 40s. Risks do rise with age, though, and they are worth knowing when deciding about contraception.
If you want to become pregnant in your 40s, speaking to a clinician before trying is worthwhile. ACOG recommends that women aged 40 and over have a fertility evaluation before trying to conceive.
UK guidance from the Faculty of Sexual and Reproductive Healthcare (FSRH) and the NHS says that, if you are not using hormonal contraception, you can stop:
| Age at your last period | When contraception can stop |
|---|---|
| Under 50 | 2 years after your last period |
| 50 or over | 1 year after your last period |
| Any | At age 55, whether or not you are still bleeding |
The FSRH explains that at 55 the risk of pregnancy is extremely low, so contraception can stop even if some bleeding continues.
If you use hormonal contraception, you may not know when your natural periods stopped (see how long perimenopause lasts for how the end is judged). Some methods cause regular bleeds, while others stop periods. Options include:
Guidance in other countries may use different wording, so check with your clinician what applies where you live.
The right method depends on your health, your symptoms and your preferences. Several methods can help with perimenopause symptoms as well.
| Method | Can usually be used until | Useful to know |
|---|---|---|
| Combined pill, patch or ring | 50, if suitable for you | Can ease hot flashes and irregular bleeding; the NHS does not recommend the combined pill from 50 |
| Progestogen-only pill | 55 | Can be used alongside HRT |
| Implant | 55 | Can be used alongside HRT |
| Injection | Generally 50 | Usually switched to another method at 50 |
| Hormonal IUD | 55 if fitted at 45 or over | Reduces heavy bleeding; can also form part of HRT |
| Copper IUD | Menopause, if fitted at 40 or over | Hormone-free, but can make periods heavier |
| Condoms and diaphragm | Any age | Condoms also protect against sexually transmitted infections |
Based on FSRH guidance. Method availability and licensing vary by country.
A few points often get missed:
The best method depends on what you want it to do besides preventing pregnancy. Useful questions to discuss with your clinician:
No. Hormone therapy uses similar hormones to contraception, but not at doses that prevent pregnancy. The FSRH states that HRT is not given at the right levels to stop ovulation.
If you are using HRT during perimenopause and could still become pregnant, you also need contraception. Suitable options include the progestogen-only pill, the implant, the hormonal IUD, the copper IUD or barrier methods.
Missed periods, tiredness, breast tenderness and nausea can be signs of either. If there is any chance you could be pregnant, take a pregnancy test, even if you think you are "too old." See our guide to perimenopause or something else.
Emergency contraception is still an option if you have had unprotected sex and do not want to become pregnant. Ask a pharmacist or clinician as soon as possible.
Our guide to preparing for an appointment can help you get the most from the conversation.
Yes. Periods can return after long gaps, and ovulation happens before a period. You still need contraception until you meet the criteria for stopping.
Once you are postmenopausal, natural pregnancy is not expected. The UN Population Fund notes that pregnancy is then improbable without treatment such as IVF using donor eggs. Because menopause can only be confirmed in hindsight, follow the contraception rules above.
Yes, if you are still in perimenopause. HRT does not work as contraception, so you need a separate method if pregnancy is possible.
Under UK guidance, yes. You can stop once you have gone a full year without a period, if your last period was at 50 or over, or at 55.
For many people it can be used until 50, but it is not suitable for everyone. Your clinician will check risk factors such as smoking, blood pressure, migraine and clotting risk.
Editorial status: evidence-based educational article; not individually medically reviewed. Last evidence check: September 10, 2026.
9 printable pages including a symptom checklist, a 30-day symptom tracker, an appointment checklist and questions to ask — delivered to your inbox.