Signs of perimenopause can also look a lot like early symptoms of pregnancy. If you’ve been pregnant before, you might have déjà vu when you first notice perimenopause symptoms. A pregnancy test may not provide the answers you need. That’s because perimenopause hormone changes can sometimes cause false positive pregnancy test results.

If you’re unsure whether your symptoms come from perimenopause or pregnancy, take a look at their similarities and differences.

Understanding Perimenopause

Perimenopause is the transitional phase leading into menopause. During this time, reproductive hormones like estrogen and progesterone begin to decline.

Most women enter perimenopause sometime in their mid-40s. On average, it lasts for four years and begins eight to 10 years before menopause. But every woman’s experience is different.

If you reach menopause before 40, it’s called premature menopause. Between ages 40 and 45, it is called early menopause. Note that you shouldn’t confuse these terms with primary ovarian insufficiency (previously known as premature ovarian failure), which is a different condition that also affects reproductive function.

You’ll know you’ve reached menopause once you’ve gone 12 consecutive months without having a menstrual period. Leading up to this, perimenopause involves unpredictable periods and a wide range of hormone-related symptoms.

Can You Get Pregnant in Perimenopause?

Women surveyed by ThisIsMenopause have wondered if they’re still able to get pregnant during perimenopause. “I was hoping to get pregnant, and now I don’t think that that’s a possibility,” one woman said.

The answer is yes, it’s still possible to get pregnant during perimenopause, but it’s slightly less likely. As long as you’re having periods, you can get pregnant.

Overlapping Symptoms of Pregnancy and Perimenopause

Symptoms of both pregnancy and perimenopause have hormonal roots. That’s why some of the signs are the same or very similar. But while perimenopause involves fluctuating (and eventually declining) levels of estrogen and progesterone, pregnancy involves high levels of these hormones.

Hormone levels increase during pregnancy because of a separate hormone called human chorionic gonadotropin (HCG). HCG drives pregnancy by changing your body to accommodate a growing baby.

Changing hormones in both pregnancy and perimenopause can cause the following symptoms.

1. Missed Periods

Missing a period may be your first indication that something’s going on with your body. Your periods could arrive like clockwork every month for most of your life. Then suddenly they may be irregular or even absent for months at a time. This is often one of the first signs of perimenopause.

A missed period might inspire you to take a pregnancy test, as a missed period is also often a first sign of pregnancy. This is especially easy to notice if your periods have always been regular. If you’ve always had irregular periods, you might not notice a difference until other symptoms show up.

2. Mood Swings

Changes in your mood can also indicate hormone changes. Mood swings are associated with both pregnancy and perimenopause. As one woman said, “[Perimenopause] has made me feel very tired and cranky.”

You might experience dramatic mood shifts during perimenopause. This is especially true if you’ve had premenstrual syndrome (PMS), depression, or anxiety in the past. You might feel more irritable or sad than you typically do.

If you’re pregnant, you might notice yourself crying often. But just like in perimenopause, your moods can change often and dramatically as hormone levels change.

3. Frequent Urination

Do you notice yourself running to the bathroom more often than usual? Frequent urination can signal pregnancy or perimenopause.

During pregnancy, you may pee more often than you normally do. This occurs because the amount of blood in your body increases to accommodate the baby. Your kidneys must work harder and faster to filter this blood. They remove waste and excess fluid, which then fills your bladder before leaving your body as urine.

Perimenopause can also make you pee more often and more urgently. You may also leak urine during this time. That occurs because of hormone-driven changes to your vaginal tissues and bladder. Some women in perimenopause get frequent urinary tract infections (UTIs) and experience pain while urinating.

4. Trouble Sleeping

Insomnia (trouble falling or staying asleep) can occur or get worse due to pregnancy- or perimenopause-related hormone changes.

For some women, trouble sleeping worsens other pregnancy and menopause symptoms like fatigue and mood changes. For others, different symptoms of pregnancy or menopause make it harder to get a good night’s sleep. “I’m tired all of the time because of night sweats,” noted a survey respondent for ThisIsMenopause.

5. Hot Flashes

Pregnant women and women in perimenopause may both experience hot flashes. But they’re better known as a symptom of perimenopause or menopause. Up to 80 percent of postmenopausal women get them.

In both cases, hot flashes are linked to hormone changes. They feel like sudden heat all over your body with sweating. They can be surprisingly intense. As one ThisIsMenopause survey respondent said, “The hot flashes make me sick to my stomach.”

In pregnancy, hot flashes occur when your estrogen levels rise. They may not be one of the first symptoms you notice, but they can occur as early as the first trimester. You’re more likely to have hot flashes in pregnancy if you’re under 30 years old, are overweight, or have depression.

In perimenopause, hot flashes have an opposite cause. Instead of occurring with increased estrogen, they happen when your estrogen levels drop. They can occur at any time, but they often accompany night sweats and make it hard to sleep. Together, hot flashes and night sweats are called vasomotor symptoms (physical symptoms caused by hormone-driven changes in blood vessel activity).

6. Fatigue

In a survey on ThisIsMenopause, respondents talked about how tired they feel all the time. “I’m tired and low energy and have weight gain,” said one. Another stated, “I’m having some bad effects as far as having period pain and fatigue.”

They’re not imagining it — fatigue can be a sign of menopause. You might feel extra fatigued if you often have trouble sleeping due to perimenopause.

Fatigue is also a common symptom of early pregnancy. Health experts don’t know why tiredness is so common in the first trimester. They suspect it may be related to rising progesterone.

Perimenopause-Specific Symptoms

It may be hard to tell whether you’re dealing with perimenopause or pregnancy symptoms. It can be helpful to look at other symptoms that don’t typically apply to both. Signs of perimenopause that aren’t common in pregnancy include:

• Vaginal dryness and discomfort
• Continued periods that are heavier or lighter than usual
• Low libido (low sex drive)
• Loss of bone density and an increased risk of bone fractures
• A change in the way you smell
• Frequent UTIs

Pregnancy-Specific Symptoms

Some symptoms indicate that you’re more likely to be experiencing pregnancy than perimenopause. At the very least, you should take a pregnancy test if you have these symptoms.

Tender, growing breasts can be a sign you’re pregnant. Breast tenderness is also a common sign of perimenopause, but breast growth is not.

Another common sign is morning sickness, or nausea and vomiting that usually starts four to six weeks into your pregnancy. Despite its nickname, it can happen at any time of day.

Morning sickness is a hallmark early sign of pregnancy. But some women in perimenopause might get similar waves of nausea. A ThisIsMenopause subscriber described her nausea in perimenopause, saying, “I wish I had known about the sickness everyday. The cramps and the certain sensitivity to food smells and intense nausea that hits you from nowhere.” Nausea in perimenopause may be linked to anxiety or more extreme PMS symptoms, which can affect the gastrointestinal system.

Talk to Your Doctor

Contact your healthcare provider if you have symptoms but aren’t sure whether you’re pregnant or entering perimenopause. Pregnancy tests can sometimes be inaccurate in perimenopause. For that reason, you must double-check with your doctor or gynecologist to know for sure. It can be helpful to keep track of your symptoms and when they start so your doctor can recommend further testing or treatment.