Can You Get Pregnant During Perimenopause? Understanding Fertility in Transition

Many women assume that once perimenopause begins, pregnancy becomes impossible. The reality is more nuanced, and understanding fertility during this transition matters for both family planning and overall well-being.

What Is Perimenopause?

Perimenopause marks the transition toward menopause, the point when menstrual cycles end permanently. Most women enter perimenopause in their mid-to-late 40s, though some begin as early as their mid-30s. The transition typically lasts four to eight years, though individual experiences vary widely.

During perimenopause, the ovaries gradually produce less estrogen and progesterone. Ovulation becomes irregular rather than stopping completely. Periods might skip for months, then return unpredictably. This hormonal fluctuation affects not only fertility but also brain function, mood regulation, and overall well-being.

Common signs of perimenopause include irregular menstrual cycles with varying flow, hot flashes and night sweats, mood changes and increased anxiety, sleep disruptions, brain fog, and difficulty concentrating, and changes in physical comfort.

The Samphire App helps track these patterns with personalized symptom tracking. Based on individual health history, including conditions like endometriosis, PMDD, or PCOS, the app suggests relevant symptoms to monitor and offers personalized meditation, visualization, and breathwork practices tailored to cycle phase and symptom needs.

Can Pregnancy Occur During Perimenopause?

Yes, pregnancy during perimenopause is entirely possible. As long as periods are still occurring, even irregular ovulation can happen. According to the American College of Obstetricians and Gynecologists, fertility declines significantly after age 35, but pregnancy remains possible until menopause is confirmed.

Menopause is only confirmed after 12 consecutive months without a period. Until that milestone, the body may still release eggs, making conception possible. Women aged 45 to 49 have approximately a 5% chance of conceiving naturally per cycle, compared to about 20% for women in their early 30s.

Debunking Common Myths

Myth: Irregular Periods Mean Pregnancy Cannot Occur

Irregular periods indicate that ovulation is unpredictable, not absent. The menstrual cycle may vary dramatically in length during perimenopause, yet ovulation might occur during any of these cycles. Understanding the four phases of the menstrual cycle helps recognize that even irregular cycles can include fertile windows.

Myth: Perimenopausal Symptoms Signal the End of Fertility

Hot flashes and mood swings signal hormonal shifts, not necessarily the end of fertility. Many women experience intense perimenopausal symptoms while still ovulating regularly enough to conceive. The presence of symptoms reflects hormonal fluctuation rather than complete cessation of reproductive function.

Myth: Women Over 45 Do Not Need Contraception

Until menopause is confirmed through 12 consecutive months without menstruation, contraception remains necessary if pregnancy prevention is the goal. The National Institutes of Health reports that unintended pregnancies among women over 40 have increased, partly due to assumptions about reduced fertility during this life stage.

Myth: The Exact Moment When Fertility Ends Is Obvious

The final ovulation happens before the final period, making it impossible to identify the last fertile cycle in real time. Only looking back after 12 period-free months confirms that fertility has ended.

Fertility Facts During Perimenopause

• Egg quality declines with age. Women over 40 face higher rates of chromosomal abnormalities in eggs, which affects both conception rates and pregnancy outcomes.
• Ovulation becomes unpredictable. Standard fertility tracking methods become less reliable when cycles vary significantly. Using a comprehensive period tracking app can help identify patterns even during irregular cycles.
• Pregnancy risks increase with maternal age. Women over 40 have higher rates of gestational diabetes, pregnancy-induced hypertension, and cesarean delivery. Preconception health optimization becomes especially important.
• Fertility treatments remain an option. IVF and other assisted reproductive technologies can help women conceive during perimenopause, though success rates decline with age.

Managing Wellbeing During Perimenopause

Whether hoping to conceive or simply navigating the transition, supporting overall well-being matters. Perimenopause affects more than fertility; mood changes, sleep disruption, and cognitive shifts can impact every aspect of daily life.

Research has explored how hormonal fluctuations affect neural circuits governing mood and stress response. The brain regions most sensitive to estrogen and progesterone fluctuations include those involved in emotional processing and stress management. Understanding how the brain controls hormones provides valuable context for why perimenopause affects so many aspects of well-being simultaneously.

Brain-Based Support During Hormonal Transitions

A brain-first approach recognizes that many perimenopausal symptoms connect through neurological pathways. Hormonal fluctuations affect brain chemistry, influencing mood, pain perception, and sleep quality.

For women in the United States, Canada, and other international markets, Lutea™ offers a wellness approach designed to support emotional regulation during hormonal transitions like perimenopause. The device uses gentle neurostimulation to promote calm and balance without adding hormones.

For those in the UK and European Union, Nettle™, a Class IIa medical device, is clinically proven to reduce menstrual pain and relieve low mood while supporting focus and emotional regulation. Research registered with ClinicalTrials.gov (NCT06974773) is investigating neurostimulation's efficacy for menstrual health conditions, with implications for managing perimenopausal symptoms. Learn more about the science behind this approach.

The technology works by boosting neuroplasticity in brain regions affected by hormonal fluctuations, helping women navigate transitions without hormonal interventions.

Contraception Considerations During Perimenopause

If pregnancy is not the goal, reliable contraception throughout perimenopause is essential. The unpredictability of ovulation during this transition makes natural family planning methods particularly unreliable.

Options to discuss with a healthcare provider include hormonal methods (pills, patches, hormonal IUDs) that may also help manage symptoms, non-hormonal options like copper IUDs or barrier methods, and permanent solutions if family planning is complete.

When to Seek Medical Guidance

Consulting a healthcare provider becomes important when planning to conceive after age 40, for help distinguishing perimenopause from other conditions, for severe symptoms affecting quality of life, for questions about contraception needs, or for unusual bleeding patterns.

Understanding signs of hormonal imbalance at any age supports appropriate health management.

Moving Forward With Confidence

Perimenopause brings uncertainty, but knowledge empowers navigation. Whether planning for pregnancy, preventing it, or simply managing the transition's effects on wellbeing, understanding changing fertility supports informed decision-making.

Track cycles using tools like the Samphire App, stay informed about options, and prioritize overall well-being during this transition. The app's personalized approach, suggesting relevant symptoms to track based on health history and offering cycle-specific meditation and breathwork practices, provides targeted support throughout the perimenopausal journey.

For those experiencing mood swings or brain fog during this transition, brain-based approaches offer promising support.