Yes, premenopause and pregnancy is still very possible. Premenopause (most commonly referred to as perimenopause) is a period of years that occurs before menopause when your hormone levels start to fluctuate and you may begin to experience menopausal symptoms. The average age for premenopausal onset is 51, but this varies woman to woman.

Women in type 1: premenopause have one of the highest rates of unintended pregnancies in the U.S.--second only to teenagers. Mind blown, right? And while the rate of teen pregnancies has been dropping, peri-pregnancies are on the rise. So, to answer the question, yes, premenopause and pregnancy go together like, well, two things you really didn’t think would. We know that this is welcome news for some women who’ve waited to have children. While it’s terrifying for others who either never wanted kids, or have already turned their son’s bedroom into a she-cave and are ready for the next chapter. So let’s talk through this (hint: Birth control is still your friend), because a woman armed with information is a woman prepared to take on anything. Even a baby.

And, as always, be sure to include your doctor in any conversation concerning your physical, mental, and emotional health--three things pregnancy is sure to impact.

If you don’t already have a doc, get connected with a Gennev menopause-certified gynecologist who will give you a trusted opinion. Book an appointment here.

Pregnancy Midlife: Yes, It’s a Real Thing

Yes, your estrogen and progesterone levels are decreasing and the quality of your eggs is not what it was during your traditional child-bearing years. And yet, everything necessary to conceive is still working--in a somewhat wonky way, sure.

But working enough that it’s possible to get pregnant. Yes, this will feel like an insult added to injury for some women. We’re right there with you.

Some premenopause pregnancies are intentional, as fertility treatment makes it possible for women to push childbearing back and concentrate on their careers. However, women pre-menopause can still have as high as a 5 – 10% chance each month of finding themselves on “the plus side of the pee stick,” as one older mom described it, even if the pregnancy is unwanted.  

Signs You May Be Pregnant

Oddly enough, premenopause and pregnancy share many of the same symptoms, which can make it more difficult to figure out just what, exactly, is going on with your body. Some women might find this ironic--and some would simply throw those women and their irony a seering side-eye. We never said this was going to be easy. But the truth is, any of the symptoms below,** combined with your age, means a check-in with your doc would be a good idea.*

Testing for Premenopause

You may be wondering if there’s a test you can take to determine if you’re premenopausal. The answer is, no, not really. Hormone menopause tests are essentially useless because your hormone levels naturally change during the menstrual cycle.

Follical-stimulating hormone (FSH) testing is used to confirm menopause, but is not reliable to diagnose premenopause. According to menopause.org, “a single FSH level can be misleading in perimenopause because estrogen production does not fall at a steady rate from day to day. Instead, both estrogen and FSH levels can vary greatly during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), a FSH test is not valid.” 

The Rabbit Died. Now What?

If you discover that you are indeed pregnant, there’s a lot to think about. We can’t, nor would we want to, make any decisions for you. Your body is your body, meaning you control who has a say in how to proceed. But we can provide information so that you’re able to make an informed decision.

Risks For Pregnancy During Premenopause

Let’s look at the risks you might encounter as a midlife mom-to-be. Notice we said “might.”* None of what you’re about to read is going to fill your heart with joy. Also, it’s entirely possible that none of what you’re about to read will come up during your pregnancy. Or one will, but the rest won’t. Or five will--you get the point. We’re providing a starting point for the conversation you’ll have with your doctor once the pregnancy is confirmed. Nothing more.

  • Pregnancy loss
  • Delivery complications requiring a cesarean delivery
  • Congenital abnormalities
  • Gestational diabetes
  • Low birth weight and premature babies
  • Preeclampsia

If You’re Not Pregnant, Consider Your Birth Control Options

The prevailing wisdom is that until you’ve gone 12 full months without a period, you should use some sort of birth control if you don’t want to get pregnant. Read that again. Got it? Good. Depending on your health and history, you have a pretty wide range of choices at your disposal, all listed below. Also, you’ll see that there are some issues to consider when choosing a method.

Birth Control Choices

Odds are you’ve been taking a birth control that works for you, and that’s great. It is possible, though, that a different form might address some of your premenopausal symptoms better than your current method, so it’s worth checking in with your doctor to see if a tweak or two might help.

Considerations with Premenopause Birth Control

Oral, hormonal birth control that contains a combination of estrogen and progestin can help manage perimenopausal symptoms like irregular periods, hot flashes, acne, and bone loss. They may also help prevent uterine and ovarian cancer. However, because combination oral contraceptives do help manage perimenopause symptoms, it can be hard to tell where you are in the transition. When you stop taking birth control pills, you’ll have withdrawal bleeding, which mimics a period--even after menopause. You may need to stop for some time and then have FSH levels tested, but obviously use another method during that pause.

Additionally, estrogen-containing contraceptives are not appropriate for women who have a history (personal or family) of estrogen-dependent cancer, high blood pressure, diabetes, blood clots, or heart disease.

Women who are over 35 and smoke shouldn’t. And they shouldn’t take hormonal contraceptives, either.

Studies have shown that contraceptive injection may increase the risk of osteoporosis. Women who are at high risk or who smoke should probably find another option.

Sterilization and/or long-term contraception such as implants may not be the best options as they are rather invasive for a woman at a low risk of unintended pregnancy.

Female condoms can be awkward to use for the inexperienced, but they are well lubricated and may reduce or eliminate the pain of intercourse for a woman with vaginal dryness. Male condoms have to be used consistently and according to instructions to be effective, and breaks do happen. If you’re using a lubricant, be sure your condoms and your lubricant are compatible.

The rhythm method (also “natural family planning”) may not be appropriate for a woman in premenopause as irregular periods can make it hard to track your cycle and establish when you’re fertile or not.

Premenopause and Pregnancy

Bet you never thought those three words would ever cross your mind. Join the club. Years of women’s issues, especially midlife transitions, have been ignored for far too long, leaving intelligent, capable women asking questions they should have been taught the answers to decades ago. So we have some catching up to do. That’s ok. We learn fast. And we have each other to stay informed, supported, and understood.

Going through premenopause and feel like you need to vent? Leave a comment below, or talk to us on our Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.

*It is not Gennev’s intention to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and Gennev urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.

**We are providing these links for informational purposes only; they do not constitute an endorsement or an approval by Gennev of any of the products, services, or opinions of the corporation, or organization, or individual. Gennev bears no responsibility for the accuracy, legality or content of the external site or for that of subsequent links.

Have you taken our menopause assessment? Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey.

Join 100,000 other women and take our Menopause Assessment today

Have you taken our Menopause Assessment?

Join over 100,000 women to learn more about your symptoms and where you are in the menopause journey.