Can I still get pregnant during perimenopause?

Dr Alison Vickers, a Sydney GP with a special interest in the care of women during perimenopause and menopause, answers this very important question.

Short answer

YES. You can still get pregnant during perimenopause. Perimenopause is the time when the ovaries are switching on and off and producing eggs erratically and unpredictably. This makes the perimenopause a high-risk time for women to get pregnant. Women often mistakenly think they can no longer get pregnant and don’t worry about contraception. This makes the forties a high-risk time for unplanned pregnancies. If this is confusing it may help to read What is happening to my body during perimenopause and menopause?

The long answer

It worries me how many perimenopausal women I see who think they can’t get pregnant during perimenopause and no longer worry about contraception. I have had difficult consultations when women have come with no periods for a few months, thinking they are menopausal and finding out that they are actually pregnant.

So YES, YOU CAN! During perimenopause, the ovaries produce eggs erratically, and you can still get pregnant.

When do I probably no longer need contraception?

Double-check with your GP, but you most likely don’t need contraception if you:

• Are over 50 and have had no period for 12 months
• Are between 45 and 50 and have had no period for two years
• Are over the age of 55, then you probably don’t need contraception. Although some guidelines suggest 58!
• Have had your tubes tied or a hysterectomy or your partner has had a vasectomy
• Are not having sex, or are in a same-sex relationship

Can I use barrier methods like condoms till I fit into one of the groups?

Barrier methods like condoms can also provide excellent contraception as long as they don’t stay in the drawer. You can add hormones to manage the symptoms of perimenopause.

Can I use the rhythm method?

The problem with perimenopause is that you no longer have a regular cycle, so it is impossible to know when you are ovulating, and this is a very risky choice that I would never recommend.

How long can I stay on the combined oral contraceptive pill (THE PILL)?

If you don’t have any medical reasons not to be on the pill, then you can safely use the pill until you are 50. The pill is an ideal solution as it can regulate your cycle and stop you from getting pregnant. It can also take away symptoms of perimenopause, like hot flushes because it contains the hormone estrogen.

If I have to stop THE PILL at 50, what can I use instead?

You can use progesterone contraception such as:

• The progesterone IUD (Mirena)
•  Progesterone pills (Minipill or Slinda)
• A Progesterone implant (Implanon)

While these are all very effective contraceptives, progesterone doesn’t help with the symptoms of perimenopause.

Can I take hormones for perimenopause symptoms together with progesterone contraception?

Yes, you can. Depending on which progesterone contraceptive you are using, your doctor can decide which hormone treatment you can take.

But if I am on progesterone contraception, how will I know when I don’t need contraception?

If you’re over 50 and using progesterone-based contraception, a blood test can help your doctor determine when it’s safe to stop using contraception.