Can you still get pregnant during perimenopause?

The short answer

Yes. Ovulation becomes unpredictable rather than absent, so pregnancy remains possible until twelve consecutive months without a period. Contraception is generally advised until then, or until age fifty-five if you are on hormone therapy and periods cannot be tracked.

Medically reviewed by Dr Charmaine Thomas

MBBS, BHRT-certified, Kingston, Jamaica

Reviewed 22 August 2026
Updated 29 August 2026

The fuller picture

Irregular periods are frequently read as infertility. They are not the same thing. An erratic cycle can still be an ovulatory cycle, and the unpredictability makes it harder to know which one it was.
Hormone therapy is not contraception. This is one of the most common and most consequential misunderstandings in this whole area.
Guidance in most jurisdictions is contraception for twelve months after the final period if you are over fifty, and for twenty-four months if you are under fifty, because cycles are less reliable at the younger end.

Perimenopause is a decline in fertility, not the end of it, and the two get collapsed together constantly.

What actually happens is that ovulation becomes erratic. Some cycles you ovulate, some you do not, and there is no reliable way to tell from the outside which kind of month you are in. A cycle that arrives at day twenty-one one month and day fifty the next is still capable of producing an egg.

The hormone therapy point, said clearly

Standard hormone therapy does not suppress ovulation and is not contraception. Women are given it, told their symptoms will improve, and reasonably assume the pregnancy question is settled. It is not, and this is worth raising directly at the appointment if nobody raises it with you.

The combined hormonal coil is a useful exception, because it provides contraception and the progestogen half of hormone therapy at the same time. That is a conversation worth having if both things are on your list.

The rule most guidance uses

Contraception until twelve consecutive months without a period if you are over fifty, and twenty-four months if you are under fifty. If you are on hormone therapy and no longer having recognisable periods, the usual advice is to continue to age fifty-five.

What to do next

If you do not want to become pregnant, keep using contraception until the twelve-month mark, not until periods merely become erratic.
Ask specifically about which methods suit this stage. Some, such as the hormonal coil, provide both contraception and the progestogen component of hormone therapy, which suits many women well.
If a period is unusually late and there is any possibility, take a test rather than assuming it is the transition.

Speak to someone rather than reading on if

You think you may be pregnant
You are on hormone therapy and have not had a conversation about contraception alongside it