Here’s something that surprises many women: you can still get pregnant during perimenopause.
Fertility declines significantly, yes. Ovulation becomes irregular and eventually stops. But until you’ve had 12 consecutive months without a period, pregnancy remains possible. And perimenopausal pregnancies do happen—sometimes to women who thought they were “past all that.”
If preventing pregnancy matters to you, this conversation matters.
When Can Contraception Stop?
The conventional guidance:
- 12 months without a period confirms menopause (if you’re not using hormonal contraception that suppresses periods)
- Age 55 is considered a reasonable point to stop contraception even without confirming menopause—pregnancy after 55 is extremely rare
- If you’re using hormonal contraception that suppresses or alters your periods, you may need FSH testing to help determine your menopausal status
The complication: if you’re on hormonal birth control, you may not know what your natural cycle is doing. The contraception can mask perimenopause entirely—which some women appreciate (fewer symptoms) and others find frustrating (not knowing where they are in the transition).
Your Options
Non-Hormonal Methods
Copper IUD (Paragard):
- Highly effective
- No hormonal effects—so you experience your natural perimenopause (for better and worse)
- Your cycle remains visible, making it easier to know when you’re approaching menopause
- Can stay in place for up to 10 years
Barrier methods: Condoms, diaphragms. Lower effectiveness but no hormonal effects.
Sterilization: Permanent option. Doesn’t affect hormones—you’ll still experience natural perimenopause.
Hormonal Methods
Low-dose combined pills:
- Can actually help with perimenopausal symptoms—regulating cycles, reducing hot flashes, evening out mood
- But they mask your natural cycle, making it harder to know where you are in the transition
- Generally safe for healthy non-smokers into their early 50s
- Contains more estrogen than menopausal hormone therapy
Progestin-only options:
- Mini-pill, implant, Depo-Provera injection
- May or may not suppress periods
- Different side effect profiles
Hormonal IUD (Mirena):
- Highly effective contraception
- Provides local progestogen that protects the uterus
- If you later transition to hormone therapy, the IUD can continue as your progestogen component
- Periods often become very light or stop—which means you may not be able to track your natural cycle
The Masking Problem
Hormonal contraception can mask perimenopause symptoms. For some women, this is a benefit—they sail through with minimal symptoms because the contraception provides stable hormones.
For others, it creates frustration: you don’t know where you are in the transition, whether you’re having symptoms that would otherwise be present, or when it’s safe to stop.
If you want to know what’s happening “underneath,” you can:
- Switch to a non-hormonal method for a period of observation
- Work with your provider to test FSH levels during a pill-free interval (though this is imperfect—FSH fluctuates)
- Continue your current method and plan to reassess at age 50-55
There’s no wrong choice here. What matters is understanding the trade-offs.
Transitioning to Menopause Hormone Therapy
Some women want to shift from contraception to hormone therapy as they approach menopause. This requires some planning:
If you’re on combined pills:
- You may need a “washout” period (usually a few weeks to months off hormonal contraception) to see where your natural hormones are
- FSH testing during a pill-free week can help, though it’s not always definitive
- Some providers transition directly from low-dose pills to HT at an appropriate age without a gap
If you have a hormonal IUD (Mirena):
- The IUD can remain in place to provide the progestogen component of HT
- Add estrogen (transdermal patch, gel, or spray) when needed
- This is actually a convenient approach—you don’t need to change much
If you’re on progestin-only methods:
- Similar considerations—may need a gap to assess menopausal status
- Discuss with your provider based on your specific method
A Note on Unintended Pregnancy
Perimenopausal pregnancies carry higher risks—both for conception difficulties and for pregnancy complications. Many are also unintended.
If you’re sexually active with someone who could cause pregnancy, and you don’t want to become pregnant, please don’t assume irregular periods mean you’re safe. The erratic ovulation of perimenopause is unpredictable, and a pregnancy can happen on any cycle where ovulation occurs.
If an unintended pregnancy does occur, you have options. Discuss with your healthcare provider.
Contraception during perimenopause is a personal decision that depends on your pregnancy goals, your symptom experience, and your preferences. What I want you to have is the information to make that decision thoughtfully—not a prescription for what you should do.