If you've been told you're in perimenopause, you might assume your chances of getting pregnant are over. That's a really common belief — and it's not quite right.

Perimenopause is the transition leading up to menopause. Your hormones fluctuate, your cycles become irregular, and ovulation gets harder to predict. But you can still ovulate. And if you can still ovulate, pregnancy is still possible.

This article walks through what perimenopause actually means for your fertility, the real risks involved if you do conceive, and your options — whether you're trying to avoid pregnancy or hoping to start or grow your family.

What is perimenopause?

Perimenopause is the stage when your body starts its transition toward menopause, but your periods haven't stopped yet. It can begin years before your periods actually stop, and symptoms like irregular cycles, hot flushes, mood changes and brain fog are all common during this time.¹

You reach menopause when you've gone 12 consecutive months without a period. Until that point, you're still in perimenopause and still potentially fertile. Perimenopause most commonly affects women between the ages of 45 and 55, though it can happen earlier.¹

Symptoms of ovulation during perimenopause

Ovulation during perimenopause can be hard to spot. Your cycles are irregular, which means the usual pattern of tracking is less reliable. That said, some signs of ovulation can still appear:

• Changes in cervical mucus (becoming clearer and stretchy around ovulation)

• A slight rise in basal body temperature after ovulation

• Mild pelvic discomfort or bloating around mid-cycle

• A brief increase in libido

Ovulation predictor kits (OPKs) can still be useful, but they're less reliable during perimenopause because your LH levels can fluctuate in ways that mimic an ovulation surge without one actually occurring. If you're trying to conceive, tracking multiple signs together gives a more complete picture than relying on any single method.

Can you get pregnant during perimenopause?

Yes. Pregnancy during perimenopause is possible.

Even though ovulation becomes less frequent and less predictable, it doesn't stop entirely. You only need to ovulate once for conception to be possible. The unpredictability of your cycle can actually make this tricky to track.

The NHS advises using contraception for at least one year after your last period if you're over 50, and for two years if you're under 50, precisely because pregnancy remains a possibility until menopause is confirmed.² This guidance exists for a reason: unintended pregnancies in this age group are more common than many people expect.

If you're on hormonal contraception, it's worth knowing that this can mask perimenopause symptoms and make it harder to know where you are in the transition. The NHS notes that hormonal contraception like the pill, coil, or implant can make it difficult to tell when you're no longer ovulating.³

Chances of getting pregnant during perimenopause

The honest answer is: it depends on your age and how far along in perimenopause you are. Fertility naturally declines from the mid-30s. By the early 40s, the chances of conceiving naturally each cycle are lower, and they continue to fall as you approach menopause. The rate of congenital anomalies in babies born to mothers over 40 can be significantly higher than for mothers in their 20s and early 30s, which reflects the impact of egg quality declining with age.⁴

Miscarriage risk also rises considerably with age. NHS sources show that at age 30, the risk of miscarriage is around 1 in 5. Over 40, that rises to around 1 in 2.⁵ This happens mainly because the likelihood of chromosomal problems during fertilisation increases as eggs age.⁶

None of this means pregnancy is impossible or that it won't result in a healthy baby. But it's important to go in with a clear picture of what you're working with.

Is it dangerous to get pregnant during perimenopause?

Pregnancy during perimenopause carries more risk than pregnancy in your 20s or 30s — that's worth being clear about. The key risks are:

Higher miscarriage rate. As noted above, the risk of miscarriage over 40 is around 1 in 2. This is largely due to chromosomal abnormalities that become more common as eggs age.⁵ ⁶

Increased chance of chromosomal conditions. The risk of conditions like Down's syndrome increases with maternal age. NHS data on congenital anomalies shows the birth rate of babies with any anomaly is significantly higher for mothers aged 40 and over compared to younger age groups.⁴

Higher risk of pregnancy complications. Older mothers face higher rates of gestational diabetes, high blood pressure, and the need for caesarean delivery. These are manageable with good antenatal care, but they are real considerations.

None of this means you shouldn't pursue pregnancy during perimenopause. Many women in their 40s have healthy pregnancies. It does mean you should speak to your GP before trying to conceive, so you can get the right support and monitoring in place.

How to naturally improve the chances of pregnancy during perimenopause

If you're hoping to conceive during perimenopause, here's what can support your efforts:

See your GP first. This is the most important step. They can check your hormone levels, assess your ovarian reserve, and refer you to a fertility specialist if needed. Don't wait until you've been trying for a year as earlier consultation can be helpful.

Track ovulation carefully. Use a combination of methods: basal body temperature, cervical mucus monitoring, and OPKs. No single method is definitive during perimenopause.

Focus on general health. A balanced diet, regular moderate exercise, a healthy weight, and not smoking all support fertility. The NHS recommends taking 400mcg of folic acid daily when trying to conceive to reduce the risk of neural tube defects.

Time intercourse around your fertile window. Even with irregular cycles, aiming for regular sex every two to three days throughout the cycle means you're more likely to catch your fertile window.

Fertility treatment options in the UK

If natural conception isn't working, assisted conception is an option. Here's what's available:

IVF (in vitro fertilisation): According to the NHS, you may be eligible for NHS-funded IVF if you're aged 42 or under. Women aged 39 or under may qualify for up to three funded cycles, and women aged 40 to 42 may qualify for one funded cycle, depending on their local integrated care board (ICB).⁷ Your GP can advise what's available in your area.

IVF with donor eggs: If your own egg quality or supply is a significant factor, donor eggs are an option. The NHS notes that treatment with donor eggs is usually done via IVF.⁸

Private treatment: If you're not eligible for NHS funding, private fertility clinics offer a range of treatments. Costs and eligibility criteria vary by clinic, so it's worth researching carefully and choosing a clinic licensed by the HFEA (Human Fertilisation and Embryology Authority).⁷

twoplus Fertility: Supporting your conception journey

If you're trying to conceive during perimenopause, timing can be everything. 

Trying to conceive can quickly start to feel like a chore. Timed sex, misaligned schedules, and even performance pressure often add up. The twoplus Applicator Extra takes that pressure off, so every fertile window becomes an opportunity again, not an obligation.

The twoplus Applicator Extra is a self-assisted artificial insemination kit that can be used from the comfort of your home. In just 3 simple steps, the Applicator Extra helps deposit sperm close to the cervix, giving nature a helping hand.

• No medical help or clinic visit needed

• Deposits semen close to the cervix, giving sperm a more direct path

• Designed for comfort with soft tip made of 100% medical grade silicone 

• Make your fertile window count

• Affordable alternative to try now: 3 steps. 15 minutes

In addition: What if you want to avoid pregnancy during perimenopause

This side of the question matters too. If you're in perimenopause and not trying to conceive, contraception is still necessary. 

The NHS recommends using contraception until you reach confirmed menopause: for at least one year after your last period if you're over 50, or two years if you're under 50.² After the age of 55, the NHS advises that getting pregnant naturally is very rare, and contraception is no longer needed.³

All contraceptive methods are suitable for women over 40 based on age alone, though your GP can advise on the best option for you given your wider health picture.

Sources:

1. NHS — Menopause overview 

2. NHS — Pregnancy with HRT

3. NHS — Menopause symptoms and contraception

4. NHS England Digital — NCARDRS 

5. Northern Care Alliance NHS — Miscarriage and options of treatment

6. NHS — Miscarriage causes

7. NHS — IVF

8. NHS — Treatment for infertility