Pregnancy is still possible during perimenopause—the phase leading up to menopause marked by hormonal changes and irregular periods.
While fertility naturally declines during this time, ovulation doesn’t stop completely, so pregnancy can occur, even if cycles are sporadic.
That said, pregnancy during perimenopause can carry higher risks than at younger ages. These can include gestational diabetes, high blood pressure, preterm birth, and a greater likelihood of complications during labor and delivery. There’s also an increased risk of chromosomal abnormalities in the fetus.
Whether you’re planning a pregnancy or want to prevent one, this stage of the menopause transition is a good time to reevaluate your reproductive health and make informed choices with medical support.
How Does Perimenopause Affect Fertility?
Perimenopause is the stage leading up to menopause, when the ovaries gradually decrease estrogen production.
It typically begins in your 40s, though it can start as early as the mid-30s, and continues until menopause—the point when your periods have stopped for 12 consecutive months.
Perimenopause can last anywhere from a few months to over a decade, with an average duration of about four years.
During this time, hormone levels—particularly estrogen and follicle-stimulating hormone (FSH)—fluctuate a lot. These changes can affect both your menstrual cycle and fertility. Periods may become irregular, and perimenopause symptoms like hot flashes, night sweats, mood changes, and vaginal dryness often come up as your hormone levels shift.
Hormones and Ovulation
In a typical cycle, estrogen rises early in the month, triggering a big surge in the luteinizing hormone (LH) that prompts ovulation (the release of an egg). But during perimenopause, the ovaries produce less estrogen and don’t typically support regular ovulation. As a result, some cycles may not include the release of an egg at all.
Lower estrogen levels mean that follicles may develop improperly or not at all, making it difficult to conceive naturally.
Even when ovulation does occur, the quality of the eggs released may be lower than in earlier reproductive years, which can contribute to a decline in fertility and a higher risk of miscarriage and chromosomal abnormalities in pregnancy.
Can You Still Become Pregnant Naturally?
Yes—as long as you’re still menstruating, pregnancy is still possible. However, the chances of conceiving naturally decline with age and as perimenopause progresses. By the mid-40s, the odds of becoming pregnant without fertility assistance drop to less than 5% per cycle.
That said, some women do conceive during perimenopause. If you’re trying to become pregnant, tracking your ovulation using methods like basal body temperature or ovulation predictor kits may be helpful. If you're trying to avoid pregnancy, it's important to continue using contraception until menopause is confirmed.
Because the menopause transition involves so much hormonal variability, it’s a good idea to talk with a medical provider about your fertility goals and any concerns you have, whether you're hoping to conceive or trying to prevent an unplanned pregnancy.
Are There Risks of Getting Pregnant During Perimenopause?
Pregnancy during perimenopause is possible, but it does come with increased health risks, both for the mom and the baby.
While many people in their 40s have healthy pregnancies, the likelihood of complications is higher compared to younger reproductive years, which is important to know when considering family planning at this stage.
Health Risks for Moms
People over 35 are at greater risk of developing gestational diabetes, preeclampsia, and other placental conditions.
Gestational diabetes is a temporary form of diabetes that occurs during pregnancy. This condition can increase the chance of high blood pressure both during and after pregnancy, increases the need for cesarean delivery, and raises the long-term risk of developing type 2 diabetes later in life.
Preeclampsia is another, related concern. It’s a serious pregnancy complication marked by high blood pressure and signs of organ dysfunction, often involving the liver or kidneys. It can lead to preterm delivery, a low birth weight for your baby, or more urgent medical interventions if it's not managed early.
Placental problems are also more common in pregnant people over the age of 35. These include:
- Placenta previa, when the placenta partially or completely covers the cervix
- Placental abruption, when the placenta detaches from the uterine wall before delivery
Both can cause bleeding and may require early delivery or emergency C-section.
Health Risks for Babies
According to Dr. Molly Siegel, the risks to the baby during a perimenopausal pregnancy depend on several factors, including how the pregnancy occurred (for example, through assisted reproductive technology) and what triggered perimenopause in the first place.
If perimenopause is age-related, there may be different risk considerations than if someone goes into early menopause due to a genetic condition or a medical issue that leads to early ovarian decline.
In general, once a pregnancy is established, the risks to the baby aren't significantly higher than in other pregnancies. The main concern is ensuring that the baby has a normal genetic profile, which is why additional genetic screening or diagnostic testing may be recommended.
Later in pregnancy, your care team might also suggest extra fetal growth monitoring in the third trimester to confirm that the baby is developing as expected.
That said, it's true that increasing maternal age is linked to a higher risk of chromosomal abnormalities, such as Down syndrome. For example, the chance of conceiving a child with Down syndrome is about 1 in 1,500 at age 20 and increases to around 1 in 100 by age 40.
Other potential concerns—such as premature birth, low birth weight, or developmental delays—are slightly more common in later pregnancies but can vary widely in severity and likelihood. Most of these risks can be monitored and managed with appropriate prenatal care.
Why Risk Increases With Age
Several factors contribute to the increased risk of complications during perimenopause:
- Egg quality declines with age, making chromosomal abnormalities and miscarriage more likely
- Pre-existing health conditions, such as hypertension, diabetes, or obesity, are more common and can complicate pregnancy
- Hormonal fluctuations in perimenopausal women may affect the uterine lining and reduce the body’s ability to support a pregnancy
- Lower natural fertility may lead some people to explore assisted reproductive options like fertility treatments, which carry their own risks
Pregnancy during perimenopause isn’t necessarily unsafe, but it is more medically complex. Regular prenatal care, early screenings, and honest conversations with your medical provider can help you manage these risks and support better, healthier outcomes.
Common Complications of Pregnancy During Perimenopause
Pregnancy during perimenopause can come with a slightly higher likelihood of certain complications. You don't need to be fearful, but understanding the risks in more detail can help you make informed decisions, whether you're trying to conceive or managing an unplanned pregnancy.
Miscarriage and Chromosomal Abnormalities
As people age, the risk of miscarriage increases, especially after age 40. This is largely due to a rise in chromosomal abnormalities in eggs, which can lead to early pregnancy loss or, in some cases, congenital conditions if the pregnancy continues.
For people in their 40s, the estimated miscarriage rate is about 33%, compared to around 10–12% for those under 35. Most of these miscarriages happen during the first trimester.
Genetic testing—including chorionic villus sampling (CVS) or amniocentesis—can detect chromosomal abnormalities early in pregnancy. These tests are diagnostic, but they do carry a small risk of miscarriage themselves, so discussing options with a healthcare provider is important.
Gestational Diabetes and High Blood Pressure
The likelihood of developing gestational diabetes also increases with age. While it affects roughly 7% of all pregnancies, older pregnant women are at higher risk. Gestational diabetes can lead to complications like:
- Macrosomia (a larger-than-average baby), which may require a C-section
- Preeclampsia
- A higher long-term risk of developing type 2 diabetes
High blood pressure, or chronic hypertension, is also more common during later pregnancies. If unmanaged, it can also lead to complications, including:
- Preeclampsia
- Placental abruption (when the placenta separates from the uterus before delivery)
- Preterm birth (baby born before full term)
Consistent prenatal monitoring plays an important role in managing both gestational diabetes and high blood pressure.
Premature Birth and Low Birth Weight
Premature birth (defined as delivery before 37 weeks) is more likely in pregnancies after the age of 40. Babies born early are at higher risk for:
- Breathing problems
- Feeding difficulties
- Long-term developmental concerns
Low birth weight (under 5 pounds, 8 ounces) is also more common. It’s often linked to prematurity, but it can occur independently due to other pregnancy complications. Both conditions can lead to health challenges that may require specialized care after birth.
Routine prenatal check-ups and growth scans help identify these risks early and guide clinical decisions throughout your pregnancy.
How to Reduce Your Pregnancy Risks
Pregnancy during perimenopause does carry a higher risk of complications, but there are steps you can take to support a healthier outcome. Early medical care, thoughtful planning, and consistent monitoring make a difference.
Start Prenatal Care Early
If you’re pregnant in your 40s, getting early and regular prenatal care is critical. Your healthcare provider will monitor your health, track fetal development, and watch for complications that are more common with age.
You may need more frequent ultrasounds, blood tests, and screenings to assess both your and your baby’s well-being.
Managing Existing Health Conditions
Chronic conditions like diabetes, high blood pressure, and obesity can increase the risk of complications. Managing them well before and during your pregnancy can help lower that risk.
This might include adjusting medications, improving diet and exercise habits, and working closely with your healthcare team to track progress. Good blood sugar control, stable blood pressure, and reaching a healthy weight are especially important for reducing risks like preeclampsia, preterm birth, and gestational diabetes.
Healthy Lifestyle Tips for a Safer Pregnancy
Small, consistent lifestyle changes can support your health throughout pregnancy, too. Here’s what most providers recommend:
- Eat a balanced diet with fruits, vegetables, whole grains, and lean proteins. Avoid high-mercury fish, unpasteurized dairy, and undercooked meat.
- Take a prenatal vitamin with at least 400 mcg of folic acid daily to reduce the risk of neural tube defects.
- Stay active, aiming for 30 minutes of moderate exercise most days. Walking, swimming, and prenatal yoga are usually safe options.
- Avoid smoking, alcohol, and recreational drugs, which increase the risk of birth defects and other complications.
- Prioritize rest and use stress-reduction techniques like deep breathing or meditation, especially in later pregnancy.
Know What to Watch For
Being alert to certain symptoms can help you catch complications early. Contact your provider right away if you notice:
- Vaginal bleeding or spotting
- Severe abdominal pain or cramping
- Ongoing headaches or changes in vision
- Swelling in the face, hands, or feet
- Decreased fetal movement
- Contractions or leaking fluid before 37 weeks
Increased risks during perimenopausal pregnancy, such as hormone shifts, irregular cycles, or existing health conditions, make early evaluation even more important if any of these occur.
When to Reach Out to a Professional
If you’re considering pregnancy during perimenopause, a preconception visit with your healthcare provider is a good place to start. They’ll assess your current health, review any risk factors, and recommend steps to help prepare your body for pregnancy.
This might include adjusting medication, starting prenatal vitamins, or making lifestyle changes to improve your overall health. If you do become pregnant, regular prenatal care is essential. Keep an open line of communication with your provider, especially if something feels off.
Navigating Pregnancy During Perimenopause
Pregnancy during perimenopause comes with higher risks, but with the right care and information, many women go on to have safe and healthy pregnancies. Early prenatal care, managing your existing health conditions, and maintaining a healthy lifestyle can all play a key role in reducing complications.
Access to reliable, expert-led information can make a difference, too. Staying informed, asking the right questions, and working closely with your healthcare provider will help you make decisions that are right for your body and your health.
So, is it dangerous to get pregnant during perimenopause? It can be, depending on your specific health factors. But with careful monitoring and appropriate medical care, it’s very possible to have a safe and healthy pregnancy in your 40s.
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Frequently Asked Questions (FAQ):
How do I know what stage of perimenopause I'm in?
The stage of perimenopause is usually identified by changes in your menstrual cycle, like longer or shorter cycles, missed periods, or heavier or lighter bleeding. Other common signs include hot flashes, sleep disruptions, and mood changes. A healthcare provider may also use hormone testing or a review of your symptoms to help assess where you are in the transition.
What is the fertility rate during perimenopause?
Fertility declines during perimenopause, but pregnancy is still possible as long as you’re ovulating. Ovulation becomes less frequent and more unpredictable with age, which lowers the chances of conceiving, but it doesn’t eliminate the possibility entirely.
Does perimenopause mean no more eggs?
No. Perimenopause means your supply of eggs is decreasing, and the remaining eggs may be of lower quality, but ovulation can still occur. This is why pregnancy is still possible, even if it’s less likely.
Can perimenopause cause miscarriage?
Yes. The risk of miscarriage is higher in women over 40, largely due to age-related declines in egg quality and hormone fluctuations that affect the uterine lining and early pregnancy development.
Do I still need to use birth control during perimenopause?
Yes. As long as you’re still ovulating—even if irregularly—there’s still a chance of getting pregnant. If you don’t want to become pregnant, it’s important to continue using birth control until you’ve gone 12 consecutive months without a period, which marks the official start of menopause.
