Can You Get Pregnant During Perimenopause? What To Know about Irregular Periods After Age 40
Plus, doctors weigh in on the two best types of birth control
If you’re going through perimenopause, you’re likely familiar with the irregular periods and hormone fluctuations that happen during this time. Still, a missed period or tender breasts can make you wonder: Can you get pregnant during perimenopause? We asked the experts to weigh in, plus explain how to differentiate between symptoms of perimenopause and pregnancy.
What is perimenopause?
“Perimenopause is the time leading up to menopause,” explains Mary Jane Minkin, MD, a gynecologist and clinical professor at Yale University School of Medicine. “Menopause is defined as one full year of no periods, without another cause like pregnancy.”
“[Perimenopause] can last for several years and is usually noted by erratic changes in the menstrual cycle, such as periods occurring closer together, occasionally skipping a period or heavier periods,” she adds.
Hormonal fluctuations in estrogen and progesterone are behind these menstrual period changes. “As menopause approaches, these fluctuations become more pronounced until menstruation ceases entirely,” says Tamara Guichard, MD, a gynecologist at Modern Urology in New York City. “It’s like your body is playing a guessing game, causing uncertainty and unpredictability in your menstrual cycle.”
Can you get pregnant during perimenopause?
“Many perimenopausal women assume ‘once I hit age 40, I can’t get pregnant’, but that’s not the case,” says Bruce Dorr, MD, a board-certified ob-gyn and BioTE senior medical advisor. “I’ve had women aged 55 get pregnant.”
Even so, your chances of becoming pregnant during perimenopause are relatively low — about 3-5 percent for women up to age 44, and about 1-2 percent for women ages 44-49, according to Dr. Dorr. Some studies suggest the likelihood is higher, though.
Perimenopause and pregnancy: Symptoms to be aware of
“Perimenopause presents many symptoms common to the first trimester of pregnancy, including breast tenderness, irregular bleeding, nausea and weight gain,” Dr. Dorr says. “So, if you develop these symptoms and you’re sexually active and not using birth control, ask your doctor to complete a pregnancy test along with your hormonal labs.”
An over-the-counter pregnancy test can be just as effective if you don’t want to schedule a doctor’s appointment. “Urine pregnancy tests are very sensitive and pretty accurate for the most part,” Dr. Dorr assures. “Still you may want to confirm with a blood test just to be sure.”
The two best birth control options for perimenopause
If you’re sexually active and interested in using a contraceptive during perimenopause, several options exist. Our experts break down some of the top picks:
1. The Opill
Also called the mini-pill, “this over-the-counter birth control pill is progesterone-only,” explains Dr. Dorr. “You’ve gotta take it at the same time every day for it to be 96-98 percent effective. If you don’t, it’s only about 90-92 percent effective.”
Dorr says Opill is preferable to other types of oral birth control because it usually presents fewer side effects. Since there’s no estrogen, you’re less likely to experience weight gain, libido loss and headaches.
Further, the North American Menopause Society says estrogen-containing birth control may increase the risk of more serious health problems for women who smoke or have a family history of estrogen-dependent cancer, heart disease, diabetes or blood clots.
2. Hormonal intrauterine devices (IUDs)
You may want to consider a hormonal intrauterine device (IUD) if you’re worried about taking a pill at the same time every day. “Hormonal IUDs are more effective than tubal ligation or vasectomy as far as not getting pregnant,” Dr. Dorr says.
“These provide birth control for up to eight years and they cause a 90 percent reduction in menstrual flow,” Dr. Dorr adds. “It’s great for irregular periods and heavy bleeding, and is more effective than sterilization.”
Several brands of hormonal IUDs exist, including Mirena, Lilleta and Kyleena. After a physical exam and hormone testing, your healthcare provider can prescribe an IUD that aligns with your needs.
Can you get pregnant during perimenopause? The bottom line
“I have so many stories of women who didn’t think they could get pregnant during perimenopause,” Dr. Dorr says. “It’s important not to assume that because your menstrual cycle isn’t regular or because you’re middle-aged, it can’t happen.”
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