Pregnancy or menopause? What you need to know

If your periods have stopped, it’s natural to wonder whether it’s the menopause or a pregnancy. The answer depends on where you are in the change.

What counts as the menopause?

You reach the menopause when you haven’t had a period for 12 months. It usually happens between the ages of 45 and 55, but it can happen earlier. The time before that, when your periods change and become irregular, is called perimenopause, and the time after it is called postmenopause.

Because it’s only counted after 12 months without a period, you can’t know for sure that you’ve reached it until afterwards.

Can you get pregnant after the menopause?

Once your periods have stopped for good, your ovaries no longer release eggs, so a natural pregnancy is extremely unlikely. But you can only be sure of this afterwards. If you’re under 50, the NHS advises using contraception for 2 years after your last period, not 1, because you could still get pregnant during that time. After the menopause, pregnancy is usually only possible with fertility treatment, such as IVF using donor eggs or eggs you had frozen earlier.

You still need contraception until you’ve gone 1 to 2 years without a period, depending on your age, and HRT isn’t a contraceptive. Our guide to pregnancy or perimenopause has the full rules.

How you’ll know you’ve reached it

You’ll only know looking back, once 12 months have passed without a period. Until then, a gap of a few months can be followed by another period.

If you use hormonal contraception, it can stop your periods or give you regular bleeds, so you may not be able to tell when your periods would have stopped on their own. Hormone blood tests aren’t reliable for this while you’re using combined hormonal contraception or HRT. Your GP or a sexual health clinic can help you work out when it’s safe to stop contraception.

Pregnancy or menopause: telling them apart

A missed period, tiredness and mood changes can happen with both. If you’re still within the time you need contraception and you’ve had unprotected sex, a pregnancy test is the quickest way to find out. If your periods are irregular, test at least 21 days after you last had unprotected sex. See pregnancy or perimenopause? for the symptoms they share.

A positive test around the menopause

What a positive result means depends on where you are:

If you’re still having periods, or you’re within the time you need contraception: a positive result usually means you’re pregnant. See your GP or contact your local maternity unit.
If you’ve been through the menopause: a positive result is more likely to have another cause, so see your GP.

Other causes include:

hCG from the pituitary gland. Some people around and after the menopause make a small amount. It usually doesn’t show on a urine test, but in rare cases it can.
Medicines that contain hCG, such as some fertility treatments.
Rarely, some tumours and other medical conditions, which can also raise hCG.

Your GP can arrange blood tests to find out what’s going on.

Bleeding after the menopause

If you haven’t had a period for 12 months or more and you get any vaginal bleeding, see your GP. This includes bleeding that’s only happened once, or that’s only a small amount, spotting, or pink or brown discharge. It’s not usually serious, but it can be a sign of cancer, so it always needs checking.

If your periods stop early

If your periods stop before you’re 45, it’s called early menopause, and before 40, premature menopause. See your GP, as they can talk to you about treatment, contraception and, if you want children, your options.

Questions people ask

Can the menopause cause a positive pregnancy test?

Rarely. Some people around and after the menopause make a little hCG in their pituitary gland, which can occasionally show on a test. Your GP can check with blood tests.

Is spotting after the menopause normal?

It always needs checking. See your GP about any bleeding once you’ve gone 12 months without a period, even if it happened only once or was just spotting or pink or brown discharge. It’s not usually serious.

Can you get pregnant after the menopause with IVF?

It can be possible, using donor eggs or eggs you had frozen earlier. Speak to your GP about a referral if you want to explore this.

I’m 47 and my period is late. Is it the menopause or pregnancy?

It could be either. If you’ve had unprotected sex, take a pregnancy test. If it’s negative and your period still doesn’t come, test again in a few days and speak to your GP.

When to get help

Mild cramps that ease with rest are usually nothing to worry about. But if you’re pregnant, or think you could be, get urgent advice from your maternity unit, an early pregnancy unit or NHS 111 if you have:

any bleeding or spotting, even if it’s light
tummy pain that’s severe, on one side, or hasn’t eased after resting for 30 to 60 minutes
pain in the tip of your shoulder

Call 999 if you have bleeding along with severe tummy pain, pain in your shoulder, or feeling sick, faint or dizzy, or if the bleeding is heavy (soaking a pad soon after putting it on). Also call 999 if you have sudden, sharp and intense tummy pain and you feel very dizzy or faint, feel sick or look very pale. These can be signs of an ectopic pregnancy or a miscarriage that need treating straight away.