It’s widely known that fertility declines with age, especially after 40. But you may wonder if it’s still possible to get pregnant when you’re in perimenopause, when hormone levels fluctuate and periods become irregular.

Several women shared similar thoughts in a survey by ThisIsMenopause. One said, “Not getting my period so often leads to pregnancy scares.” Another shared, “I was hoping to get pregnant, and now I don’t think that’s a possibility.”

Whether you hope to get pregnant or want to avoid it, it’s important to understand your fertility as you approach menopause. Here’s what to know about getting pregnant during perimenopause.

Signs You’re in Perimenopause

Perimenopause is the stage before menopause when the ovaries begin making fewer hormones and hormone levels fluctuate. This phase often begins several years before menopause, usually in the mid-40s — but it can also start either earlier or later.

One of the most noticeable signs of perimenopause is irregular periods. As estrogen levels decline and other hormone levels change, your menstrual cycle may change.

These hormonal changes can also cause other symptoms of perimenopause, including:

• Hot flashes
• Night sweats
• Vaginal dryness
• Low sex drive
• Mood swings
• Heavier or lighter periods than usual
• Missed periods

Likelihood of Pregnancy During Perimenopause

Unpredictable or light periods might make you question your fertility. It’s important to know that you can still get pregnant during perimenopause despite hormone changes.

If you’re still having periods, you may still ovulate (release an egg). If you’re ovulating, pregnancy is possible.

In your early to mid-40s, you have about a 10 percent chance of getting pregnant in any given month. By your late 40s, the chance drops to 2 percent or 3 percent. These numbers might sound low, but the possibility of pregnancy shouldn’t be overlooked.

Pregnancy during perimenopause may also be different from pregnancy earlier in life. For example, you may be more likely to have twins or develop pregnancy complications.

Pregnancy With Multiples

Fluctuating hormones during perimenopause may cause the ovaries to release more than one egg in a short time. Because of this, the chance of having fraternal twins increases with age, roughly doubling by age 35 and tripling by age 40.

Pregnancy Complications

It’s possible to get pregnant and have a healthy pregnancy during perimenopause. However, the risk of pregnancy complications is higher. These include:

• Miscarriage
• Preeclampsia (high blood pressure during pregnancy)
• Gestational diabetes (diabetes that develops during pregnancy)
• Cesarean section (C-section) complications
• Complications from chronic conditions

Pregnancy complications are more likely during perimenopause for a couple of reasons. First, if you’re older, you’re more likely to have health conditions such as diabetes and high blood pressure that can make pregnancy riskier.

Egg quality also declines with age, which can affect the baby and increase the risk of:

• Low birth weight
• Premature birth
• Chromosomal abnormalities

Use of Contraception in Perimenopause

If you’re in perimenopause and don’t want to get pregnant, you should continue using birth control until you reach menopause (12 consecutive months without a period). Don’t assume you can’t get pregnant, even if it’s been months since your last period.

Which Types To Consider

Some birth control methods may work better than others during perimenopause. Natural family planning isn’t reliable at this time because menstrual cycles can be unpredictable.

Talk with your gynecologist or another healthcare provider about which method may be right for you. Options may include:

• Long-acting reversible contraception — This includes hormonal and nonhormonal intrauterine devices (IUDs) and hormonal implants. Hormonal IUDs can also help control heavy bleeding, which is common during perimenopause.
• Oral contraceptives — Birth control pills contain either estrogen and progestin or just progestin. Progestin-only pills may be a better option if you have health conditions such as high blood pressure, but they must be taken at the same time every day.
• Hormonal patches or rings — These convenient options don’t require a daily pill, but they might not be recommended if you have certain health risks.
• Condoms — Condoms help prevent pregnancy and also reduce the spread of sexually transmitted infections.
• Surgery — Procedures such as tubal ligation (sometimes called “getting your tubes tied”) may be an option if you don’t want to become pregnant in the future. A male partner may also have a vasectomy to help prevent pregnancy.

Ways To Improve Your Chances of Pregnancy

If you’re hoping to get pregnant during perimenopause, your gynecologist or obstetrician can help improve your chances of conceiving and carrying a pregnancy to term. Fertility treatments may be available to help if you’re over 35 and have been trying to get pregnant for at least six months.

Your healthcare provider will likely encourage healthy habits that support your overall well-being and a successful pregnancy, such as:

• Eating a balanced diet
• Avoiding harmful substances
• Exercising regularly

A fertility specialist can explain your options for fertility treatments, which may include medications or procedures.

Ovulation-Stimulating Medications

Some prescription medications use natural hormones such as follicle-stimulating hormone and luteinizing hormone to help your ovaries release eggs. Your doctor may recommend medications to treat underlying conditions that can make ovulation or pregnancy less likely, such as insulin resistance.

Intrauterine Insemination

Intrauterine insemination is a procedure in which a doctor places healthy sperm from a partner or donor directly into the uterus around the time of ovulation.

In Vitro Fertilization

In vitro fertilization (IVF) is a type of assisted reproductive technology. Eggs are removed from the ovaries and then fertilized with sperm in a laboratory.

The fertilized eggs are then placed in the uterus. This process may need to be repeated to improve the chances of pregnancy.

Surgery

Some surgeries aim to restore fertility or make conception more likely. They’re used less often today because modern fertility treatments are very effective. However, minimally invasive surgeries may remove growths or scar tissue in the uterus that can interfere with pregnancy or open blocked fallopian tubes before IVF.

Talk to Your Doctor

If you have irregular periods and are wondering what that means for your fertility, get in touch with your doctor. They can help review or update your birth control if you want to prevent pregnancy or discuss fertility treatment options if you’re hoping to get pregnant.

If you’re not in perimenopause, a pregnancy test can help confirm whether pregnancy is causing your missed period.