Did you know that you can get pregnant during perimenopause?  It may be unlikely, however, it is possible. At this time in your life, you have more time, money, and freedom. You have plans and although it’s still some years away you are looking forward to retirement. Having a child now is NOT part of the plan! So, it is essential to learn how to manage fertility during perimenopause.

The average age of menopause in the United States is 51. The years leading up to menopause, or the perimenopause years, can last for decades. Yes, even a woman in her early thirties could be classified as being in perimenopause.3


What does this really mean?


Perimenopause sounds like a scary term and for many women, it’s added pressure to have a child sooner rather than later. All perimenopause means, though, is that our hormone levels are changing. This is a normal part of our development.

Estrogen is one of the main fertility hormones and it is estrogen that is largely responsible for causing changes in our menstrual cycles in the perimenopause period. Estrogen rises as an egg develops before ovulation and then falls after ovulation. In perimenopause, estrogen rises and falls more unevenly. This leads to shortened or lengthened menstrual cycles. It can also result in cycles where ovulation doesn’t occur at all.

Many women decide to wait until they’ve been married without kids for a few years or until their career is established before trying to conceive. An article looking at birth certificate data found the average age of a mother at her first birth in the United States in 2016 was 26 years, and in cities like New York and San Francisco, their average age was 31 and 32 years, respectively.  This is true for many women I work with, who choose to start tracking their menstrual cycles in their 20s to avoid pregnancy with plans to achieve pregnancy in their 30s or 40s.

How do I know if I am in perimenopause?


There are no strict diagnostic criteria for perimenopause, rather this is a normal phase of life for women. A common sign a woman may notice first is having irregular periods.  As mentioned above, this could mean longer cycles, shorter cycles, or cycles where ovulation does not occur. Other symptoms of perimenopause include hot flashes, changes in sleep patterns, or vaginal dryness.

The best way to identify if you are starting to enter your perimenopause years is to track your cycles. Track when your period comes, but also track your body’s natural signs of fertility so you can identify if you are ovulating or not. Estrogen is tied most closely to the phase of your cycle between your period ending and ovulation starting, so when you look at your cycle charts, you can get an idea of how your estrogen levels may be fluctuating.


Can I get pregnant during perimenopause?


The short answer is yes. If you are still having periods, you can still get pregnant.

However, the evidence shows that a woman’s ability to get pregnant decreases over time.

So, if you are intending to avoid pregnancy during perimenopause, you still need to rely on a form of contraception, whether that’s a medication, device, barrier, or a natural family planning method.

If you are intending to achieve pregnancy during perimenopause, there is still hope for you. One way you can increase your chances of getting pregnant is to be sure you are being intimate at a time when you are fertile. While there are many period-tracking and fertility-tracking apps available, a study published in 2021 showed the majority of these apps rely on menstrual cycle dates alone, which has been previously shown to be unreliable for assessing fertility. Educate yourself on fertility-tracking apps, as well as on fertility awareness methods, which teach you to monitor your fertility signs in real-time. The Fertility Appreciation Collaborative to Teach the Sciences, or FACTS organization, provides descriptions of your fertility signs and various fertility awareness-based methods.8

Perimenopause is a natural part of our womanhood. Having this mindset can help us accept the changes we experience. Your body was designed to go through cycles that change over time. We can work with and support our bodies throughout our lifetime and we should feel empowered to do so.