Fertility During Perimenopause: Myths vs. Facts

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On September 26, 2025

Perimenopause is the transitional period in a woman’s reproductive years when the ovaries produce less estrogen and periods become more unpredictable. Although it generally begins in a woman’s mid-forties, perimenopause can start as early as the mid-thirties or as late as the mid-fifties.

As menopause symptoms like hot flashes and night sweats appear, it’s natural to wonder whether your fertile years are a thing of the past. Stories about perimenopause abound, including that it’s impossible to get pregnant during this three- to four-year period. Read on to learn which ones are true and which are myths.

1. Myth: Once You Reach Perimenopause You’re Too Old to Conceive

Can you get pregnant during perimenopause? The answer is yes. Although the words “perimenopause” and “menopause” are often used interchangeably these days, they’re not the same thing. While fertility during perimenopause does decline, the reproductive years aren’t over yet.

“When you are in perimenopause, it means that your hormone levels are starting to fluctuate because your ovaries are essentially getting old. But you’re still making the reproductive hormones estrogen and progesterone,” says Monica Christmas, MD, an associate professor of obstetrics and gynecology and director of the Menopause Program at the University of Chicago, and associate medical director of the Menopause Society.

You still ovulate during perimenopause. Some women ovulate more than once in a short space of time, which is why those over 40 are more likely to give birth to twins or other multiples.

2. Myth: Your Odds of Getting Pregnant in Perimenopause Are So Low, You Don’t Need Birth Control

The chance of getting pregnant is lower during perimenopause, but it’s not zero. Fertility doesn’t end until menopause. “Somebody who is perimenopausal who does not want to be pregnant really should be using some form of either barrier protection or hormonal birth control to prevent pregnancy,” says Dr. Christmas.

Barrier methods include the condom, cervical cap, and diaphragm.

The copper IUD doesn’t block sperm from reaching an egg, but it is toxic to sperm and prevents implantation.

The birth control pill, injection, patch, hormonal IUD, and ring are examples of hormonal birth control. Some women choose to have their tubes tied to prevent pregnancy.

3. Fact: Perimenopause Symptoms Are Easy to Confuse With Pregnancy Symptoms

Skipping periods, needing to pee more often, and feeling moody are all symptoms that come with perimenopause.

Because these can also be symptoms of early pregnancy, it’s easy to confuse the two conditions if you’re still getting periods.

The only way to confirm whether you’re pregnant or not is by taking a pregnancy test.

Some symptoms need further evaluation by a doctor. “Anybody experiencing persistent nausea or fatigue should seek care to make sure there’s not some other underlying medical condition that’s contributing,” Christmas says.

4. Myth: Fertility Treatments Will Increase Your Chance of Getting Pregnant

If you waited to start a family, you might worry about your chance of conceiving now that you’re in perimenopause. In vitro fertilization (IVF), which combines your eggs with your partner’s sperm in a lab dish, is one way to get pregnant. But since egg quality declines with age, using your own eggs may not increase your odds of a pregnancy. Your fertility specialist may recommend using a donor egg to help you conceive.

5. Fact: Pregnancy Is Riskier to Your Baby and You

Getting older affects the number and quality of your eggs. “Because the quality of the eggs goes down, it can increase the risk of a pregnancy that is impacted by a chromosomal or genetic abnormality,” says Christmas. For example, the odds of giving birth to a child with Down syndrome is about 1 in 1,250 for women who conceive at age 25, but around 1 in 100 for those who get pregnant at age 40. The risk for miscarriage also increases.

And you’re more likely to develop pregnancy complications like high blood pressure, preeclampsia, and gestational diabetes after age 35.

It’s still possible to have a healthy pregnancy in perimenopause. Following a healthy diet, exercising, and avoiding drugs and alcohol can help, along with getting seen by an ob-gyn.

The Takeaway

Perimenopause is the time leading up to menopause, usually in a woman’s forties, when estrogen production slows and periods become more erratic.
While it’s more difficult to get pregnant during perimenopause, it’s not impossible. Anyone who doesn’t want a pregnancy still needs to use some form of birth control during this time.
The risk of chromosomal and genetic problems in the baby, and complications in the mother, are higher during perimenopause, but it’s still possible to have a healthy pregnancy.