Can You Still Get Pregnant During Perimenopause?

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.

Why can you still get pregnant in perimenopause?

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.

How likely is pregnancy in your 40s?

Fertility declines with age, and the decline speeds up in the mid-30s.

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.

What are the risks of pregnancy after 40?

Many people have healthy pregnancies in their 40s. Risks do rise with age, though, and they are worth knowing when deciding about contraception.

• Miscarriage. In one large study, women aged 40 or over had about four times the odds of miscarriage of women aged 30 to 34.
• Pregnancy complications. A US analysis of nearly 34 million deliveries, cited by ACOG, found pregnancy-related complications were 1.8 times as likely at 40 to 44, and 3.3 times as likely at 45 to 54, compared with ages 25 to 29.
• Stillbirth and other outcomes. A systematic review found higher risks of stillbirth, pre-eclampsia, preterm birth and cesarean delivery at 40 and over.
• Chromosomal conditions, such as Down syndrome, become more likely as egg quality changes with age.

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.

When can you stop using contraception?

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:

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:

• Continuing a suitable method until 55. The progestogen-only pill, the implant, the hormonal IUD and the copper IUD can generally be used until then.
• Checking FSH if you are over 50 and use a progestogen-only pill or implant. The FSRH suggests two FSH blood tests taken one to two months apart. If both are raised, you can continue contraception for one more year before stopping.

Guidance in other countries may use different wording, so check with your clinician what applies where you live.

Which contraception works best in perimenopause?

The right method depends on your health, your symptoms and your preferences. Several methods can help with perimenopause symptoms as well.

Based on FSRH guidance. Method availability and licensing vary by country.

A few points often get missed:

• Combined contraception can double as symptom relief. For people under 50 who can safely use it, the combined pill, patch or ring can ease perimenopause symptoms and may be used instead of HRT, according to the FSRH.
• The hormonal IUD can help heavy bleeding. It reduces heavy and irregular bleeding at any age. See heavy bleeding.
• Combined contraception and HRT are not taken together. If you need both contraception and HRT, a progestogen-only method or IUD is usually used alongside HRT.

How do you choose a method in your 40s?

The best method depends on what you want it to do besides preventing pregnancy. Useful questions to discuss with your clinician:

• Do you also want help with symptoms? Combined methods can ease hot flashes and irregular bleeding if suitable for you. The hormonal IUD can reduce heavy bleeding and later form part of HRT.
• Do you want to avoid hormones? The copper IUD and barrier methods are hormone-free, although the copper IUD can make periods heavier.
• Do you have health factors that rule some methods out? Smoking, high blood pressure, migraine with aura and a history of blood clots affect whether estrogen-containing methods are safe.
• How long do you need it for? Some methods fitted in your 40s can stay in place until contraception is no longer needed.
• Do you need protection from sexually transmitted infections? Only condoms protect against these. This matters with a new partner, at any age.

Does HRT prevent pregnancy?

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.

Could it be pregnancy rather than perimenopause?

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.

When should you speak to a clinician?

• You want to review your contraception in your 40s or 50s.
• You are unsure whether you still need contraception.
• You want to try for a pregnancy.
• You think you might be pregnant.
• You are thinking about HRT and still need contraception.

Our guide to preparing for an appointment can help you get the most from the conversation.

Frequently asked questions

Can you get pregnant if you haven’t had a period for six months?

Yes. Periods can return after long gaps, and ovulation happens before a period. You still need contraception until you meet the criteria for stopping.

Can you get pregnant after menopause?

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.

Can you get pregnant while on HRT?

Yes, if you are still in perimenopause. HRT does not work as contraception, so you need a separate method if pregnancy is possible.

Do I need contraception at 52 if my periods are irregular?

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.

Is the combined pill safe in your 40s?

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.

References

1. FSRH Contraception Choices: Perimenopause and menopause
2. FSRH guideline: Contraception for women aged over 40 years
3. NHS: Symptoms of menopause and perimenopause (contraception section)
4. GPnotebook: Contraception in women aged over 50 years (summarizing FSRH guidance)
5. GPnotebook: Contraception during perimenopause (summarizing FSRH guidance)
6. Norfolk and Norwich University Hospitals NHS: Guidelines on perimenopausal contraception
7. ACOG: Having a baby after age 35: how aging affects fertility and pregnancy
8. ACOG Obstetric Care Consensus: Pregnancy at age 35 years or older
9. UPMC HealthBeat: Managing challenges of pregnancy after 40 (citing ACOG)
10. Age among women and men, time to pregnancy and risk of miscarriage, PMC
11. Maternal and perinatal complications according to maternal age: systematic review and meta-analysis, PMC
12. UNFPA: Menopause and human rights: frequently asked questions
13. Mayo Clinic Press: Menopause symptoms? It could be a copycat
14. My Menopause Centre: Choosing contraception during the menopause transition

Editorial status: evidence-based educational article. Last evidence check: September 10, 2026.