Can you get pregnant during perimenopause?
Yes. Fertility drops a lot in your 40s, but you can still get pregnant during perimenopause because you still ovulate in some cycles, often unpredictably. Until you've gone 12 months without a period after age 50, or 2 years if under 50, UK guidance advises keeping contraception. A late period at this age can be perimenopause or pregnancy, so take a test.
Why pregnancy is still possible
Perimenopause is the transition before menopause, often starting in your 40s and lasting several years. Your ovaries don't switch off in one go. Some cycles skip ovulation, others still release an egg, sometimes earlier or later than you'd expect. As long as you ovulate occasionally, pregnancy is possible, even if periods are irregular.
Fertility does fall: egg numbers and quality decline, and miscarriage rates rise with age. But "less likely" isn't "impossible", and unplanned pregnancies in the 40s are more common than many people assume.
When can you stop contraception?
| Your situation | UK guidance (FSRH) |
|---|---|
| Last natural period at 50 or older | Keep contraception for 1 year after your last period |
| Last natural period before 50 | Keep contraception for 2 years after your last period |
| On hormonal contraception that hides your periods | Often continue until about 55, or ask about testing |
| Taking HRT | HRT is not contraception; you may need both |
Guidance differs a little between countries, so check with your own doctor. In the US, ACOG advises talking with your provider about when it's safe to stop.
Lulu's perimenopause mode helps you follow irregular cycles and symptoms. Its predictions are estimates, and in perimenopause they're even less certain. Never use them to decide when you can't get pregnant.
Perimenopause or pregnancy? Overlapping signs
- Missed or late periods
- Tiredness and poor sleep
- Mood swings and irritability
- Breast tenderness
- Nausea, bloating or weight changes
- Hot flashes (more typical of perimenopause, but pregnancy can make you feel warm)
Because the signs overlap so much, the only way to know is a pregnancy test. Home tests work the same at 45 as at 25. See when to take a pregnancy test and our first signs of perimenopause.
Contraception that suits this stage
Many options work well in the 40s. Hormonal IUDs can reduce heavy perimenopausal bleeding, the progestogen-only pill or implant suit people who can't take estrogen, and the combined pill may ease hot flashes if you have no risk factors. Condoms still matter for STIs with new partners, at any age.
See a doctor if you have a positive test, if you bleed after 12 months without a period, if bleeding is very heavy or comes every 2 to 3 weeks, or if you're unsure which contraception is right for you now. Get urgent help for severe one-sided pelvic pain with a missed period.
Frequently asked questions
How likely is pregnancy at 45?
Much lower than in your 20s or 30s, but not zero. It's enough of a chance that contraception is still recommended if you don't want to conceive.
Can a pregnancy test be wrong in perimenopause?
Home tests detect hCG and are reliable at any age when used after a missed period. Rarely, perimenopausal hormone levels can cause a faint false positive; a doctor can check with a blood test.
Can you ovulate without having a period in perimenopause?
Yes. You can ovulate after a long gap, so pregnancy can happen before you notice a period. See can you ovulate without a period.
Does HRT prevent pregnancy?
No. HRT doses don't stop ovulation, so you need separate contraception if you could still get pregnant.
Sources
- NHS: Menopause
- ACOG: The Menopause Years FAQ
- ACOG: Perimenopausal Bleeding and Bleeding After Menopause FAQ
- FSRH: Contraception for Women Aged Over 40 Years (2017, amended 2023)
This page is for information only and isn鈥檛 medical advice. If something worries you, please talk to a doctor.
Keep reading
What are the first signs of perimenopause?The first signs of perimenopause are usually changes in your period, plus new mood swings, sleep trouble and hot flashes. What to watch for in your 40s.Perimenopause: what it is, when it starts and how it feelsPerimenopause explained kindly: what's happening to your hormones, when it usually starts, how long it lasts, how it can feel, and what really helps.
Perimenopause periods: what's normal and what isn'tPerimenopause periods can come closer together, skip, flood or barely show. What's typical at each stage, coping with heavy bleeding, and when to get checked.
When should you take a pregnancy test?How soon can you take a pregnancy test? Most work from the first day of a missed period. When early tests work, best time of day, and when to test again.Perimenopause quiz: am I in perimenopause?Perimenopause quiz: a 15-point self-check of cycle, body and mood changes, what your answers might mean, and how to bring them to your doctor.
Can you ovulate without having a period?Can you ovulate without a period? Yes: before a first period, after birth, after the pill, in perimenopause. Why it happens and why pregnancy is possible.