Key Takeaways
Understanding the relationship between fertility and menopause is crucial for women navigating their reproductive years, as pregnancy remains possible until true menopause is reached.
• Pregnancy is possible during perimenopause - Women can conceive until 12 months after their last period, despite irregular cycles and declining fertility rates.
• Fertility drops dramatically after 40 - Monthly conception chances fall from 20% in early 30s to less than 5% at age 40, with only 44% conceiving within a year.
• Contraception remains essential during perimenopause - Over 75% of pregnancies in women over 40 are unplanned, making birth control necessary until menopause is confirmed.
• Pregnancy risks increase significantly with age - Women over 40 face higher rates of gestational diabetes, preeclampsia, miscarriage, and chromosomal abnormalities requiring specialized medical care.
• Symptoms overlap between pregnancy and menopause - Missed periods, fatigue, mood swings, and hot flashes occur in both conditions, making pregnancy tests essential for sexually active women.
The key insight: fertility doesn't end abruptly at menopause but gradually declines throughout perimenopause, requiring informed decision-making about contraception, conception attempts, and medical monitoring for optimal reproductive health outcomes. Many women ask if pregnancy is possible during menopause. The numbers tell an interesting story - more than 28,000 women aged 40-44 and over 2,000 women aged 45+ had babies in England and Wales in 2021 . People often think fertility stops when perimenopause starts, but that's not true. Your fertility does drop by a lot during this time.
The average woman goes through menopause at age 51 . The transition phase, which experts call perimenopause, usually begins between ages 40-44 . You can still get pregnant during this time, though it becomes harder. Your chances of getting pregnant within a year change with age. A 30-year-old woman has a 75% chance, but this drops to 44% at age 40 . The numbers paint a clearer picture - at age 25, only 4.5% of women can't conceive naturally. This number jumps to 50% at 41 and reaches 90% at 45 .
This piece breaks down everything about menopause and pregnancy. We'll look at how fertility decreases, your chances of conception during perimenopause, and what risks you might face. You'll learn about options available at this life stage. This knowledge helps you make better choices about your reproductive health, whether you want to have a baby or avoid pregnancy.
Understanding Menopause and Perimenopause
Menopause represents a most important biological milestone in a woman's life that affects physical health and fertility. The difference between menopause and perimenopause helps us better understand reproductive potential during this transition.
What is menopause?
Menopause marks the permanent end of menstruation. Doctors diagnose it after 12 consecutive months without a period [1]. A woman can no longer get pregnant naturally once she reaches this stage [1]. Women in the United Kingdom experience menopause between ages 45 and 55, typically around 51 [2]. American women reach this stage slightly later, at an average age of 52 [1].
The body's reduced production of estrogen and progesterone, two vital reproductive hormones from the ovaries, triggers this natural biological process [1]. These hormonal changes explain many symptoms women experience during this time.
Age naturally brings on menopause, but medical procedures can also trigger it. These include surgical removal of both ovaries, chemotherapy, or radiation therapy [1][1]. Doctors call this "induced menopause," which usually causes immediate menopausal symptoms [1].
How perimenopause is different from menopause
Perimenopause means "around menopause" and describes the years leading up to menopause [3]. Women still have periods during this phase, though they often become irregular [3].
Menopause happens at a specific point, but perimenopause typically lasts 4-8 years [4]. This phase can be as short as a few months or extend beyond a decade [5]. Women usually enter perimenopause in their mid-40s, with symptoms starting around age 47 [3]. Some women notice changes as early as their mid-30s [2].
The body produces less estrogen during perimenopause, which leads to several physical changes:
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Changes to menstrual cycle (irregularity, varying intensity)
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Hot flashes and night sweats
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Sleep disturbances
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Vaginal dryness and changes in sexual function
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Mood fluctuations [5]
Hormonal patterns create the biggest difference: perimenopause shows unpredictable hormone surges and drops, while menopause maintains consistently low reproductive hormone levels [6].
Why pregnancy is still possible during perimenopause
Fertility and menopause overlap during perimenopause, despite what many believe. Women can still get pregnant until they reach full menopause, even with irregular cycles and declining fertility [5].
The ovaries release eggs throughout perimenopause, just not as predictably [5]. Nurse practitioner Jean Marino explains this well: "In perimenopause, ovulation still occurs, it's just unpredictable. Some women may even ovulate multiple times in a short span due to hormonal fluctuations" [5].
Hormonal changes make ovulation less regular but don't stop it completely. Fertility decreases with age but only reaches zero after menopause [5]. Women who don't want to get pregnant should use contraception during perimenopause[4].
Each woman transitions from perimenopause to postmenopause at her own pace. The average age menopause starts hovers around 51, though some women experience early menopause before 45 or premature menopause before 40 [1].
Keep in mind that pregnancy remains possible until you've gone 12 months without any menstrual bleeding. Women who don't plan to conceive should continue using contraception during this time [1].
How Fertility Declines with Age
A woman's fertility naturally declines with age, though the timeline varies for each person. Women can make better choices about their reproductive future by understanding how fertility changes as they approach perimenopause and menopause.
Fertility timeline from 30s to 50s
Women gradually lose their ability to conceive throughout their adult years. Their fertility stays strong in the early 30s, and about 75% of women get pregnant within a year of trying [7]. But after 35, getting pregnant becomes harder.
Around age 35, about 66% of women conceive within a year [1]. This number drops to 44% by age 40 [1]. The chances of getting pregnant each month fall from about 20% in the early 30s to less than 5% by age 40 [2].
The numbers paint a clearer picture after 40:
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Ages 40-41: Fertility drops to half of what it was before 30 [3]
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Ages 41-42: Only 15-18% of women can conceive naturally [3]
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Ages 45+: Natural pregnancy becomes rare
These changes help explain why many women find it hard to get pregnant during perimenopause, even before reaching postmenopause.
What happens to egg quality and quantity
Both egg numbers and quality decline with age. These biological changes are the foundations of fertility and menopause.
Men make new sperm throughout their lives, but women are born with all the eggs they'll ever have—about 1-2 million [2]. This egg supply keeps dropping throughout life:
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At birth: 1-2 million eggs [8]
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At puberty: 300,000-500,000 eggs [2]
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By age 30: Only 12% of the original egg supply remains [1]
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By age 37: Around 25,000 eggs remain [7]
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By age 40: Just 3% of the original eggs are left [1]
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By age 51 (average menopause age): About 1,000 non-fertile eggs remain [8]
Egg quality drops with age too. By 30, about 25% of eggs have chromosomal problems [2]. This rises to 40% between ages 30-35 and goes up sharply after that [2]. Up to 75% of eggs have chromosomal issues by the early 40s [2]. This is why older mothers face higher risks of miscarriage and birth defects.
These changes explain why FSH levels go up during perimenopause. The body makes more follicle-stimulating hormone to try to work with the fewer remaining eggs.
When fertility truly ends
Many people think fertility ends when menopause starts. The truth is that most women can't get pregnant several years before their final period.
Studies of natural fertility populations show that women typically have their last birth around age 40 [1], even though age of menopause averages 51 [7]. This shows how fertility usually ends long before actual menopause.
Research shows how infertility increases with age:
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By age 30: About 7% of couples can't conceive [1]
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By age 35: About 11% of couples are infertile [1]
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By age 40: Nearly 33% of couples can't get pregnant [1]
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By age 45: About 87% of couples are infertile [1]
Most women lose their fertility 8-10 years before menopause [2]. Women who have early menopause or premature menopause might lose their fertility earlier than expected.
Women who still have irregular periods could technically get pregnant. That's why contraception during perimenopause remains vital for women who don't want to get pregnant until they reach true menopause—which means going 12 months without a period.
Can You Get Pregnant During Perimenopause?
Many women nearing perimenopause are amazed to learn they can still get pregnant until they reach true postmenopause. The common belief that reduced fertility means no chance of pregnancy is wrong.
Chances of natural conception in your 40s
The biological clock keeps ticking through perimenopause, just slower than before. Women in their early 40s have about a 44% chance of natural conception within a year [6]. These odds decrease significantly as they get closer to 45.
Here's what the monthly conception chances look like:
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At age 40: Less than 5% chance each menstrual cycle [6]
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At age 45: About 5 out of 100 women per year [4]
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At age 50: Natural conception becomes rare [4]
The numbers tell a clear story about fertility rates. Women between 20-30 years have peak fertility rates around 1. This drops to 0.6% by age 35 and falls to 0.1% at 40 [1].
Fertility and menopause overlap throughout perimenopause. Women can still ovulate despite irregular periods and hormone changes, which means pregnancy remains possible until what age does menopause start plus 12 months without periods.
Ground statistics and NHS data
The National Health Service stresses the need for contraception during perimenopause until periods stop for 12 straight months. This advice comes from actual pregnancy rates in older women.
NHS data reveals some striking numbers. During 2021, England and Wales recorded over 28,000 births to women aged 40-44, and more than 2,000 to those 45 and older [9]. About 75% of pregnancies in women over 40 happen unexpectedly [10]. These numbers highlight why contraception matters until menopause confirmation.
The NHS shares these pregnancy rates for perimenopausal women who don't use contraception:
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10-20 pregnancies per 100 women yearly at age 45 [4]
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Women aged 45-49 have a 12% chance of pregnancy within a year [4]
Irregular periods make it hard to track ovulation during perimenopause. This can lead to unexpected pregnancies.
Unexpected pregnancy stories
Take Vikki Jenkins's story. She was 45 when she confused her pregnancy symptoms with what is menopause. The hot flashes, mood swings, and irregular cycles seemed like typical menopause signs. Her relief at missing periods turned to shock when she learned she was 11 weeks pregnant [11].
Doctors often see women in their mid-to-late 40s who don't realize they're pregnant until around 18-20 weeks. They mistake the signs for early menopause or premature menopause [5].
These stories spread quickly on social media. "My aunt thought she was in menopause but she was pregnant," one woman wrote. Another shared, "My 41-year-old coworker is pregnant - she thought it was menopause!" [5].
Doctors confirm these aren't just random stories. Similar symptoms like weight gain, stopped periods, and hormone changes often delay pregnancy detection. Late discovery can increase health risks for both mother and baby [5].
Testing Fertility During Perimenopause
Women who want to get pregnant during perimenopause can benefit from fertility testing, though these tests have their limits. These tests help set realistic expectations about having a baby as menopause gets closer.
What FSH and AMH tests can (and can't) tell you
Follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH) tests show how many eggs remain in the ovaries [1].
FSH testing:
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The NHS uses this test to check hormone imbalances [12]
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Higher FSH levels (above 20-40 IU/l) usually mean fewer eggs are left [8]
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Women over 50 can use these results to decide when to stop hormone-based birth control [2]
AMH testing:
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This newer test has strong clinical backing [12]
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Results stay stable throughout the menstrual cycle [13]
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You can take this test any time, unlike FSH tests [12]
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Many private clinics pair this with antral follicle count scans [1]
These tests can't guarantee if you can or cannot get pregnant. Normal FSH levels don't always mean you have enough eggs [14]. High FSH or low AMH doesn't rule out pregnancy completely.
Limitations of hormone testing
Testing hormones during perimenopause comes with several challenges:
FSH levels can change drastically from one day to the next during perimenopause [7]. One test might not tell the whole story.
These hormone panels can cost hundreds of dollars but might not give much useful information [7]. Many doctors now support checking symptoms instead of routine hormone tests.
Standard hormone ranges don't help much. Your levels might be normal one day and off the charts the next [8].
Doctors can't rely on hormone levels alone to decide who needs treatment [7]. This means some patients might not get the care they need if decisions depend only on test results.
When to seek help from a fertility clinic
Don't wait to see a fertility specialist if you're trying to conceive during perimenopause. You should get professional help if:
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Your periods are irregular but you want to get pregnant [8]
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You're over 40 and haven't conceived after 6 months [7]
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You show signs of early menopause or premature menopause [2]
A fertility specialist will give you:
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Full testing (AMH, FSH, LH, and antral follicle count) [15]
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Results that make sense for your age [2]
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Clear information about your options and chances [15]
Your doctor might run some tests before sending you to a fertility clinic if you're taking folic acid and trying to conceive [2]. Quick action gives you more options before reaching postmenopause.
Risks of Pregnancy During Menopause
Pregnancy risks rise as women enter their perimenopausal years. Anyone thinking over pregnancy during menopause or facing an unexpected pregnancy during this transition should know these risks.
Health risks for the mother
Perimenopause brings higher pregnancy complications compared to younger women. Pre-existing conditions like diabetes and high blood pressure often get worse [16]. The chance of getting gestational diabetes increases after age 25 [16]. Women at this stage also face a higher risk of developing high blood pressure during pregnancy (preeclampsia) [1].
Key maternal risks include:
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Placental abruption, when the placenta detaches from the womb too early [1]
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Placenta previa, where the placenta blocks the cervix [1]
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Higher likelihood of needing a cesarean delivery [17]
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Greater chance of heavy bleeding after birth [18]
Risks to the baby
Perimenopause affects egg quality, which creates several risks for the baby. Chromosome problems become more common as mothers age [1]. By 42, genetic changes affect up to 80% of remaining eggs [19].
Babies born during this time may face:
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Higher chances of miscarriage and stillbirth [1]
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Greater risk of ectopic pregnancy [17]
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More likely to arrive early [3]
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Possible growth restrictions leading to low birth weight [1]
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Risk of larger babies due to gestational diabetes [1]
Why extra monitoring is needed
These risks make pregnancies during perimenopause need closer watching. Doctors usually recommend:
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Early scans between 8-10 weeks to check baby's health [19]
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Special blood tests for chromosome conditions [1]
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Diabetes screening in the first three months [19]
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Regular blood pressure checks [3]
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Growth scans to watch baby's development [3]
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Urine tests to spot early signs of preeclampsia [3]
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Daily low-dose aspirin to help prevent preeclampsia [3]
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Care led by specialist consultants throughout pregnancy [3]
This extra care helps protect women experiencing pregnancy during early menopause or approaching postmenopause. The goal is keeping both mother and baby healthy throughout the journey.
Fertility Treatments and Contraception Options
Fertility treatments are still an option even as reproductive potential declines. Women going through perimenopause who face fertility challenges have several paths ahead, along with key decisions about contraception to make.
IVF and egg donation after 40
Women over 40 who want to conceive should know that conventional IVF becomes less effective. Birth rates through IVF with a woman's own eggs drop substantially—patients aged 43-50 see just 5% success [20]. Donor egg IVF offers much better odds with over 30% success [21]. This approach works well, especially when you have early menopause or reduced egg quality [21].
Is IVF possible during menopause?
Postmenopausal women can achieve pregnancy through IVF using donor eggs [22]. Yes, it is possible for carefully selected candidates to achieve pregnancy rates similar to younger recipients [22]. In spite of that, cardiovascular health, metabolic status, and uterine responsiveness play crucial roles in determining eligibility [22].
When to stop contraception (NHS guidance)
NHS guidelines state that women under 50 should use contraception for two years after their last period. Those over 50 need to wait just one year [6]. Women can safely stop at age 55 whatever their menstrual status [23]. It's worth mentioning that HRT doesn't work as contraception [24].
Safe contraception options in the UK
Here are the contraceptive choices during perimenopause:
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Combined hormonal contraceptives aren't recommended after age 50 [23]
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Progestogen-only methods work well as alternatives [23]
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Copper IUDs inserted after 40 can stay until age 55 [24]
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The strongest hormonal IUDs (Mirena, Levosert, Benilexa) placed after 45 can remain until 55 [24]
Note that fertility and menopause overlap—condoms are essential for STI protection whatever your pregnancy risk [23].
Symptoms of Pregnancy vs Menopause
Pregnancy and perimenopause share many symptoms that make them hard to tell apart. Both conditions result from hormone changes in the body.
Common overlapping symptoms
These conditions share many symptoms that might confuse you:
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Missed or irregular periods
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Fatigue and sleep disturbances
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Mood swings and emotional changes
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Weight fluctuations
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Hot flashes
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Breast tenderness [9]
How to tell the difference
Symptoms give away important clues about your condition. Pregnancy symptoms get stronger each week. Perimenopause symptoms come and go over months or years [9]. The hormone changes work differently in each case. Pregnancy raises hCG, progesterone and estrogen levels. What is menopause leads to lower reproductive hormones and higher FSH levels [9].
Pregnancy brings unique symptoms like nausea, frequent urination, and food cravings [25]. Perimenopause has its own signs such as vaginal dryness and night sweats [25].
When to take a pregnancy test
Women who are sexually active should take a home pregnancy test if they miss their period [26]. Wait until the day after your missed period to test. Negative results need a second test after a few days if symptoms continue [9]. Blood tests can measure hormone levels [27] and ultrasounds detect fetal heartbeats [27] to give definitive answers.
This approach will help you avoid mixing up pregnancy with early menopause symptoms.
Conclusion
The link between fertility and menopause plays a vital role for women as they direct their reproductive path through midlife. This piece shows that pregnancy during perimenopause can happen, though it becomes harder as women age. A woman's fertility doesn't stop suddenly - it slowly declines until she reaches postmenopause.
Pregnancy stays possible until a woman goes 12 months without menstruation. Each year, thousands of UK women over 40 give birth. Many of these pregnancies aren't planned because women mistake their irregular periods for infertility instead of recognizing them as perimenopause hormone changes.
Medical experts stress the need for contraception during perimenopause when pregnancy isn't desired. Women who want to conceive should get fertility help quickly. The success rate of fertility treatments drops as age advances.
Pregnancy after 40 comes with serious health considerations. Medical complications increase for both mother and baby, making expert care necessary. Women who face early menopause or premature menopause have extra hurdles, though donor egg IVF might offer family-building options.
Many women find it hard to tell the difference between pregnancy signs and what is menopause. Some women don't know they're pregnant until their second trimester because symptoms like missed periods, tiredness, and mood changes overlap with perimenopause.
Knowledge about what age does menopause start and FSH levels during this change helps women make smart choices about their reproductive health. Women can handle this important life change confidently when they understand how fertility and menopause work together, whether they want to get pregnant or not.
FAQs
Q1. What are the chances of getting pregnant during perimenopause? While pregnancy is possible during perimenopause, the odds decrease significantly. For women in their early 40s, the chance of conceiving naturally within a year is about 44%, dropping further as they approach menopause. Monthly conception probability falls to less than 5% per cycle by age 40.
Q2. At what age does perimenopause typically begin? Perimenopause usually starts in a woman's mid-40s, with symptoms beginning around age 47 on average. However, some women may experience changes as early as their mid-30s or as late as their mid-50s. The duration of perimenopause can vary from a few months to over a decade.
Q3. Is contraception necessary during perimenopause? Yes, contraception is essential during perimenopause for women who wish to avoid pregnancy. The NHS recommends continuing contraception until you've gone 12 months without a period if you're under 50, or 24 months if you're over 50. This is because pregnancy remains possible until you reach full menopause.
Q4. How can I distinguish between pregnancy and perimenopause symptoms? Distinguishing between pregnancy and perimenopause can be challenging due to overlapping symptoms like missed periods, fatigue, and mood swings. However, pregnancy symptoms typically intensify over weeks, while perimenopause symptoms appear irregularly over months or years. Unique pregnancy signs include nausea and frequent urination, while vaginal dryness is more common in perimenopause.
Q5. What are the risks associated with pregnancy during perimenopause? Pregnancy during perimenopause carries increased risks for both mother and baby. Maternal risks include higher chances of gestational diabetes, hypertension, and cesarean delivery. For the baby, there's an elevated risk of chromosomal abnormalities, miscarriage, and premature birth. Due to these risks, perimenopausal pregnancies require extra monitoring and specialized care.
References
[1] - https://www.spirehealthcare.com/health-hub/specialties/womens-health/fertility-and-pregnancy-during-perimenopause/
[2] - https://www.mymenopausecentre.com/gp-resources/fertility-and-the-menopause/
[3] - https://www.menopausecare.co.uk/blog/perimenopause-fertility
[4] - https://gpnotebook.com/en-GB/pages/gynecology/contraception-during-perimenopause/perimenopausal-pregnancy-rate
[5] - https://www.independent.co.uk/news/world/americas/menopause-pregnancy-abortion-womens-health-b2657427.html
[6] - https://www.nnuh.nhs.uk/publication/download/perimenopausal-contraception-g15-v6-792/
[7] - https://www.contemporaryobgyn.net/view/experts-warn-menopause-hormone-tests-often-unnecessary
[8] - https://pmc.ncbi.nlm.nih.gov/articles/PMC1767292/
[9] - https://shop.miracare.com/en-gb/blogs/resources/pregnant-or-menopausal-quiz?srsltid=AfmBOoo4u3jS9LWTNlJw7Rm6gpo45jUTIQbfVYOp3Y5w-OFh7vW3D6Cb
[10] - https://www.businessinsider.com/these-doctors-have-seen-many-pregnancies-after-40-during-perimenopause-2022-10
[11] - https://www.mirror.co.uk/news/us-news/woman-welcomes-surprise-baby-45-29670754
[12] - https://www.bournhall.co.uk/fertilityblog/fertility-testing-using-fsh-or-amh-test/
[13] - https://progyny.com/education/fertility-testing/ovarian-reserve-fsh-amh-afc/
[14] - https://www.advancedfertility.com/infertility-testing/follicle-stimulating-hormone-testing
[15] - https://www.evewell.com/support/perimenopause-fertility-and-ivf/
[16] - https://www.hopkinsmedicine.org/health/conditions-and-diseases/advanced-maternal-age
[17] - https://pubmed.ncbi.nlm.nih.gov/19933469/
[18] - https://www.uhhospitals.org/blog/articles/2025/08/can-you-get-pregnant-during-perimenopause
[19] - https://www.institutobernabeu.com/en/blog/obstetric-monitoring-in-high-risk-pregnancies/
[20] - https://www.evewell.com/support/ivf-over-40/
[21] - https://www.bournhall.co.uk/fertilityblog/is-donor-egg-ivf-right-for-me/
[22] - https://ivflondon.co.uk/ivf-after-menopause-can-women-conceive-post-menopause/
[23] - https://www.nhs.uk/conditions/menopause/symptoms/
[24] - https://www.devonsexualhealth.nhs.uk/contraception/contraception-aged-over-40/
[25] - https://www.oova.life/blog/pregnancy-or-menopause?srsltid=AfmBOorN9lACpNCYEoXin-UtBAsxPrmSX4E0YzQR0lZfVPaWdMGwPoQU
[26] - https://drhaddad.org/menstruation-periods/perimenopause-doctor-dearborn/
[27] - https://www.medicalnewstoday.com/articles/320137
