Can you get pregnant during perimenopause? Contraception, signs and when to test

Your periods have gone all over the place. One is late, the next is early, and then one doesn't come at all. You feel tired, a bit sick and teary. And a thought you haven't had for years pops into your head: could I be pregnant?

Yes, you can get pregnant during perimenopause. The NHS says it's possible to get pregnant during perimenopause, so you still need contraception. Fertility does fall as you get older, but UK advice is to keep using contraception until after menopause if you don't want to get pregnant.

This guide explains how long you need contraception, why HRT doesn't count, how to tell perimenopause from early pregnancy, and when to do a test.

Can you still get pregnant in perimenopause?

Yes. Perimenopause is the time before your periods stop for good. You're still releasing eggs some of the time, even if your periods are irregular.

Women's Health Concern, the patient arm of the British Menopause Society, says many women know their fertility falls from their mid-30s. Some then assume they can stop contraception in their 40s. But it says women do still get pregnant in their late 40s, and even into their 50s, without any fertility treatment.

Irregular periods make this harder to judge, not easier. Women's Health Concern says periods can start again even after several months with no bleeding. It also says "natural" methods, like tracking your cycle, become unreliable in perimenopause, because cycles vary and you can't predict when you'll release an egg. It says withdrawal isn't reliable either.

Can you get pregnant at 50?

It's possible, but rare. The UK guideline for health professionals, from the Faculty of Sexual and Reproductive Healthcare (FSRH), says fertility falls naturally with age and that pregnancy without fertility treatment is rare after 50. It still says you need contraception until menopause if you want to avoid pregnancy.

After 55, the guideline says, pregnancy without fertility treatment is exceptionally rare, even if you still have some bleeding.

How long do you need contraception?

This is the key question. The NHS says you still need contraception:

Your age when your periods stop	How long to keep using contraception
Under 50	2 years after your last period
50 or over	1 year after your last period
55	You can usually stop at 55, even if you still have the odd period

The NHS page gives the under-50 advice for women aged 40 to 49. Women's Health Concern, following the UK guidance, gives the same rule for anyone under 50. It says that if you can't be sure you've reached menopause, carry on until 55. At that age it says contraception can be stopped, because the risk of pregnancy is extremely low.

Why your periods might not tell you

Some contraception changes your bleeding, so you can't use your periods as a guide. Women's Health Concern explains:

• Progestogen-only methods (the mini-pill, implant, injection or hormonal coil) can cause irregular bleeding or no bleeding at all. Having no periods doesn't mean you've reached menopause. It's just a side effect of the method.
• The combined pill, patch or ring usually gives you a monthly bleed, which hides whether your own periods have stopped. Women's Health Concern says blood tests aren't reliable while you're using a combined method.
• Current UK guidance is to stop combined contraception at 50 and switch to another method.

If you're on a progestogen-only method, your doctor or nurse may suggest a blood test to help decide how much longer you need it. If you're not sure where you are, a GP, practice nurse or sexual health clinic can help.

Which contraception suits you now?

The FSRH guideline says no method is ruled out by age alone for women in their 40s. Things change at 50, when combined methods should stop and the injection usually isn't the best choice.

Women's Health Concern says some methods can also help with perimenopause problems, such as heavy periods. A coil put in after a certain age can often stay in until you no longer need contraception. The details depend on the type, so ask your GP or sexual health clinic what suits you.

Is HRT a contraceptive?

No. This catches a lot of women out.

The NHS says there's a chance you could get pregnant while taking HRT, because it does not act as contraception. It also says HRT doesn't affect your fertility.

Women's Health Concern says that if your periods haven't stopped before you start HRT, you should use contraception as well. Some types of HRT cause a monthly bleed, so it can be hard to know when your own periods have stopped. It says it's best to carry on with contraception alongside HRT until 55.

The NHS suggests talking to your doctor or a family planning service about which contraception to use with HRT. If you're on HRT and think you might be pregnant, speak to your doctor straight away.

Is it perimenopause or am I pregnant?

The two can feel surprisingly alike. The NHS lists pregnancy, stress and the start of perimenopause as common causes of a missed or late period.

Here's how the signs compare, using the NHS lists for early pregnancy and perimenopause:

Sign	Early pregnancy	Perimenopause
Missed or late period	Yes	Yes, periods can come less often
Light bleeding or spotting	Yes, sometimes around when your period is due	Yes, periods can change in many ways
Mood changes	Yes	Yes
Needing to pee more often	Yes	Yes
Feeling very tired	Yes	Poor sleep can leave you worn out
Feeling or being sick	Yes	Not on the NHS list
Sore, larger breasts	Yes	Not on the NHS list
Metallic taste, strong sense of smell, cravings	Yes	Not on the NHS list
Hot flushes and night sweats	Not on the NHS list	Yes

There's a lot of overlap. So you can't tell by symptoms alone. If there's any chance you could be pregnant, the only way to know is a test.

The NHS says early pregnancy signs usually start around 4 to 6 weeks, and not everyone gets them all. For more on how perimenopause usually begins, see when does perimenopause start.

When should you do a pregnancy test?

The NHS says most tests work from the first day of a missed period.

That's tricky when your periods are irregular. The NHS has advice for this: if you don't know when your period is due, do the test at least 21 days after you last had unprotected sex.

• A positive result is almost certainly right.
• A negative result is less reliable, especially if you test too early.
• If it's negative but you still think you might be pregnant, wait a few days and test again.
• If the second test is negative and your period still hasn't come, see your GP.

You can buy tests from pharmacies and supermarkets. The NHS says sexual health services give them out free, and your GP may too.

If the test is positive

The NHS says to get in touch with NHS pregnancy care as soon as you can. You can refer yourself to a midwife. If you're not sure about continuing the pregnancy, you can talk to a healthcare professional in confidence about your options.

Women's Health Concern says pregnancy later in life is more often linked to problems such as miscarriage, high blood pressure, diabetes and chromosome problems in the baby. That's not a reason to panic. It's why you'll be offered closer care, so it's worth getting in touch early.

Ectopic pregnancy: the warning signs

The NHS explains that an ectopic pregnancy is when a fertilised egg implants outside the womb, usually in one of the fallopian tubes. It's not possible to save the pregnancy, and it can be serious for you.

The NHS says symptoms usually start between the 4th and 12th weeks of pregnancy. Some women have no symptoms at all. Signs include:

• vaginal bleeding that may be irregular, watery or dark brown, and can be mistaken for a period
• tummy pain, usually low down on one side
• shoulder tip pain, an unusual pain where your shoulder ends and your arm begins
• discomfort when you pee or poo

This matters in perimenopause, because odd bleeding is easy to put down to your periods. If you could be pregnant and have a mix of these, contact your GP or call NHS 111.

Call 999 or go to A&E straight away if you have sudden, severe tummy pain, feel very dizzy or faint, or feel sick. The NHS says these can be signs of a burst fallopian tube.

If your contraception fails

Emergency contraception still works in your 40s and 50s. Women's Health Concern says there's no upper age limit.

The NHS says there are two types:

• the emergency IUD (copper coil), which can be fitted up to 5 days after sex and is the most effective
• the emergency contraceptive pill, which needs to be taken within 3 or 5 days, depending on the type

Both are free from most sexual health clinics and GP surgeries. The pill is also free from most pharmacies. Because of the time limits, don't wait to get help.

Don't forget about infections

The FSRH guideline says women over 40 should be told about condoms and protecting themselves from sexually transmitted infections (STIs), even after they no longer need contraception. Women's Health Concern says condoms are a good idea with any new partner, even if you're using another method.

Bleeding when your periods have stopped

Light bleeding is common in perimenopause. Our pages on perimenopause spotting and perimenopause period changes explain what's usual.

But once you've gone 12 months with no period, any bleeding needs checking by a GP, the NHS says. See bleeding after menopause.

When to see a GP or sexual health clinic

Get advice if:

• you're not sure whether you still need contraception, or which type suits you now
• you're starting HRT and need to sort out contraception
• you've had a negative pregnancy test twice and your period still hasn't come
• you've had unprotected sex and need emergency contraception
• your periods have changed and you'd like to know whether it's perimenopause

For the full picture, see our guide to perimenopause symptoms. Our pages on menopause mood swings and perimenopause fatigue may also help.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.