Perimenopause is that wild rollercoaster ride your hormones take you on as you approach menopause. Usually hitting in your 40s (although some people will hit it earlier or later), this transitional period is marked by fluctuating oestrogen and progesterone levels, which can lead to irregular menstrual cycles and an array of symptoms like mood swings, fatigue, and those infamous hot flashes.

But what happens if you’re trying to conceive during this time? You might be wondering if it's even possible to get pregnant during perimenopause. Spoiler alert: the answer is yes, but it’s not without challenges. Let’s dive into what you need to know about perimenopause and fertility.

First off, signs of Perimenopause

We touched on a few of the symptoms of perimenopause earlier, but for more clues that you’ve entered this phase of life, hallmark symptoms of perimenopause can include: 

• Irregular Periods: Your cycle may become unpredictable, with periods showing up early, late, or being skipped entirely.
• Hot Flashes: Sudden waves of heat can strike, leaving you feeling flushed and sweaty without warning. This happened to Drew Barrymore for the first time on TV in 2023. 
• Night Sweats: Similar to hot flashes, they happen at night, often disturbing your sleep with intense sweating.
• Trouble sleeping: Sleep difficulties can become more common, leaving you feeling unrested.
• Brain Fog: You might find it harder to focus, remember things, or think clearly—commonly referred to as “brain fog.”
• Vaginal Dryness: A lack of natural lubrication may cause discomfort or dryness, particularly during intercourse.
• Changes in Libido: Hormonal fluctuations can lead to a decrease or shift in sexual desire.
• Joint and Muscle Aches: Soreness or stiffness in the joints and muscles may creep in.
• Headaches: Hormone changes may trigger more frequent headaches or migraines.
• Mood Swings: Emotional highs and lows can occur unexpectedly, leading to irritability or sensitivity.
• Depression: Feelings of sadness or hopelessness might become more prominent as your hormones fluctuate.
• Anxiety: Increased worry, nervousness, or tension may accompany other mood changes.
• Frequent Urination: No, it’s not a UTI, but you may notice the need to urinate more often than usual.

Some of these symptoms are also the same symptoms experienced in early pregnancy. Some of the above symptoms can also be those experienced in early pregnancy (such as a missed period and mood swings). So don’t immediately assume that if you’re experiencing some of the above that you’re in perimenopause!   

Yes, You Can Get Pregnant During Perimenopause

It might seem counterintuitive—your periods are irregular, and you may go weeks or even months without one. You could even think you’ve entered menopause, only for your period to make a surprise comeback. Remember, menopause is only official after you’ve gone a full 12 consecutive months without a period. Until then, your ovaries are still in the game, which means pregnancy is still on the table.

Although it might be more difficult to conceive during perimenopause than it is in your 20s or 30s, it’s certainly possible. At age 37, the average egg count is around 25,000. Your body might still release one of these eggs, and if one of those eggs meets up with sperm at the right time, you could find yourself with a Big Fat Positive (BFP). As we know, with eggs, it’s all about the quality and not the quantity of eggs.

Factors That Affect Fertility During Perimenopause

If you’re actively trying to conceive during perimenopause, there are a few factors that could influence your fertility:

• Age: The earlier you are into perimenopause, the better your chances are. As you age, the quality and quantity of your eggs decrease, making it harder to conceive.
• Diet: A diet rich in folate, CoQ10, antioxidants, and omega-3 fatty acids can boost your fertility. On the flip side, diets high in trans fats, processed meats, and sugary drinks might have the opposite effect.
• Sleep: Getting a solid 7-8 hours of sleep each night can help regulate your menstrual cycle and support fertility.
• Smoking: Smokers may hit menopause about a year earlier than non-smokers, which means a shorter window for potential pregnancy.
• Alcohol: Even moderate alcohol consumption can throw off your menstrual cycle, making it harder to predict ovulation and get pregnant.
• Medical Conditions: Conditions like polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids can all impact fertility.
• Medical Treatments: Treatments like chemotherapy and radiation, as well as certain surgeries, such as pelvic surgery, can negatively affect fertility.

Is It Risky to Get Pregnant During Perimenopause?

Let’s be honest: pregnancy during perimenopause (assuming you’ve hit this stage in your late thirties/early forties) comes with some added risks. As we age, our bodies become more prone to chronic conditions like obesity, risk of heart disease, diabetes, and high blood pressure, which can complicate pregnancy. There’s also an increased risk of miscarriage, ectopic pregnancy, gestational diabetes, and even stillbirth.

Additionally, eggs released during perimenopause may be of lower quality, which can increase the chances of chromosomal abnormalities like Down Syndrome. The need for a C-section might also be higher for women and people in this age group.

Given these risks, if you’re thinking about trying to conceive during perimenopause, it’s crucial to work closely with your GP or Doctor. They’ll monitor both you and your baby closely, helping to reduce potential risks and guiding you every step of the way. 

It is possible to conceive through assisted reproductive technology, such as IVF, both during perimenopause and after menopause. Freezing your eggs or donor eggs may be an option. If you’re looking for an IVF clinic, we recommend researching carefully and looking for a clinic with extra support available to you. It is worth raising the issue that successful IVF cycles also decrease with age.

What about Hormone Replacement Therapy and TTC?

To cope with the symptoms of perimenopause and menopause, many will be prescribed Hormone Replacement Therapy (HRT). HRT typically contains oestrogen and progesterone to replicate the hormones that are fluctuating. Oestrogen-only or combined HRT are unlikely to impact fertility, and HRT does not act as a contraceptive. The guidance around HRT varies based on personal circumstances, and we always recommend checking in with a doctor if you’re on HRT and looking to conceive.

Preventing Pregnancy During Perimenopause

On the flip side, if you’re not looking to get pregnant during perimenopause, contraception is your best friend. Since your period might go on hiatus for months and then suddenly return, it’s a good idea to use contraception. Unplanned pregnancies in those undergoing perimenopause can happen, and women and people aged 40–44 years old can have a 10% fertility rate if they’re having regular sex. In general, contraception can be stopped at age 55, but this differs based on the age you undergo menopause. 

Recommended contraception for those who are perimenopause include the progesterone-only-pill, copper coil and contraceptive implant, which have lower levels of hormones (and in the case of the copper coil, is hormone free) and can be used safely alongside HRT. 

Key Takeaway

If you’re unsure about where you stand—whether you think you might be pregnant or have questions about your symptoms—don’t hesitate to reach out to your GP. They can provide personalised advice and help you confidently navigate this transitional time.