Pregnancy or perimenopause? How to tell, and why you can still get pregnant

Perimenopause is the time leading up to the menopause, when your hormones start to change. It can bring irregular periods, mood changes and tiredness, all of which can also be signs of pregnancy.

What is perimenopause?

Perimenopause is the time when your hormone levels start to fall and your periods change, before they stop altogether. It ends when you reach the menopause, which is when you haven’t had a period for 12 months. The menopause usually happens between 45 and 55, so perimenopause symptoms often start in the years before that. Some people reach it earlier.

Symptoms they can share

a late, missed or irregular period
tiredness
mood changes
needing to pee more often

Symptoms that point more one way

More typical of perimenopause: hot flushes, night sweats, trouble sleeping, brain fog and memory problems, vaginal dryness, headaches that are worse than usual, joint aches, a faster or more noticeable heartbeat, and periods that become heavier or lighter than usual.

More typical of early pregnancy: feeling or being sick, sore breasts, a metallic taste, being sensitive to smells, and going off foods you usually enjoy.

There’s a lot of overlap, and you can have symptoms from both lists either way. So symptoms alone can’t tell you which it is.

Can you get pregnant during perimenopause?

Yes. It’s possible to get pregnant until you’ve reached the menopause, even if your periods are irregular. That’s why you still need contraception if you don’t want to get pregnant.

The NHS advises using contraception:

for 2 years after your last period, if you’re 40 to 49
for 1 year after your last period, if you’re 50 or over

These timings are for people who aren’t using hormonal contraception. Hormonal methods can stop your periods or give you regular bleeds, which can hide when your periods would have stopped on their own. If you use one, ask your GP or a sexual health clinic when it’s safe to stop. UK guidance says everyone can stop using contraception at 55, as getting pregnant after that is extremely rare.

HRT is not a contraceptive. It’s still possible to get pregnant while taking it.

How to find out

If there’s any chance you could be pregnant, take a pregnancy test. If your periods are irregular and you don’t know when one is due, test at least 21 days after you last had unprotected sex.

If it’s negative and your period still doesn’t come, wait a few days and test again. If you get a second negative and still haven’t had a period, speak to your GP.

A positive test in perimenopause

While you’re still having periods, a positive result almost certainly means you’re pregnant. Very occasionally, people around the menopause make a small amount of hCG in their pituitary gland, not from a pregnancy. Levels are usually too low for a urine test, but in rare cases it can cause a positive result. If you get a positive and aren’t sure, see your GP, who can arrange blood tests. See pregnancy or menopause? for more on this.

If you’re trying to get pregnant

Fertility falls with age, so it often takes longer to get pregnant in your 40s. The NHS says more than 8 in 10 couples get pregnant within a year when the woman is under 40. If you’re 36 or over, see your GP sooner rather than waiting a year, especially if you know of something that might affect your fertility. Take 400 micrograms of folic acid every day while you’re trying and until you’re 12 weeks pregnant.

If your periods stop before 45, it’s called early menopause, and before 40, premature menopause. It can make it harder to get pregnant, but options such as IVF with your own frozen eggs or donor eggs may be possible, so talk to your GP.

When to see a GP

You think you have perimenopause symptoms and want to know your options.
You have a fast or noticeable heartbeat (palpitations).
Your bleeding pattern has changed and you’re bleeding more, not less, than before.
You haven’t had a period for 12 months or more and have any vaginal bleeding.
You’ve had a positive pregnancy test and want advice.

Questions people ask

Can perimenopause cause a false positive pregnancy test?

Very rarely. Some people around the menopause make a little hCG in their pituitary gland, which a sensitive test may pick up. Your GP can check with blood tests.

Do I still need contraception if my periods are irregular?

Yes. If you’re not using hormonal contraception, keep using contraception until you’ve gone 2 years without a period (if you’re 40 to 49) or 1 year (if you’re 50 or over). If you use hormonal contraception, ask your GP or a sexual health clinic when you can stop. Everyone can stop at 55.

Can you have pregnancy symptoms in perimenopause without being pregnant?

Yes. Tiredness, mood changes, needing to pee more and changes to your periods can all be perimenopause.

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.