If you are in menopause, the last thing you are probably concerned about is pregnancy. After all, you have made it! You are no longer having regular periods and therefore are no longer fertile, right? Sort of. Here’s the thing: menopause is divided into roughly three categories: perimenopause, menopause, and postmenopause. If you are in postmenopause, your hormone levels have changed permanently and you cannot get pregnant naturally. However, if you are in perimenopause and it has not been a full 12 months without a period, you can still get pregnant.

How long after menopause can pregnancy occur?

It is common to assume that once you start having signs of menopause, you think your fertile window has closed. However, you are still able to conceive as long as your body is ovulating, or releasing eggs. As women age, the number of eggs available for fertilization decreases. Similarly, the likelihood that available eggs have chromosomal anomalies increases. Therefore, fertilization becomes much harder as we get closer to menopause. However, even if you are suffering from some of the 34 symptoms of perimenopause and you haven’t had a period in months, you can still get pregnant if your ovaries release an egg

The cutoff for pregnancy risk in menopause is when you have not had a period in 12 months. At that point, your hormones no longer can naturally support ovulation, fertilization, and pregnancy. Therefore, if you are thinking of tossing the birth control with confidence, you may do so after being period-free for 12 months. However, you can still get sexually transmitted infections (STI) so it is important to use a barrier method to prevent STIs.

Hormones in pre-menopause and pregnancy

In order for fertilization to occur, your body must first release follicle-stimulating hormone (FSH) to tell the ovaries to signal the eggs to mature for ovulation. Typically, this window of time is between day 6-14 of a 28-day cycle. Between days 10-14 of your cycle, your ovaries will signal for only one egg to complete maturation.

A surge of luteinizing hormone (LH) then signals the ovaries to release the mature egg into the fallopian tubes for fertilization. The egg usually takes around 5 days to travel through the fallopian tube where it may or may not meet sperm before entering the uterus. During the egg’s travels, progesterone levels increase to prepare the uterine lining for pregnancy.

Hormone changes in menopause

As we enter menopause, our FSH levels tend to rise because our ovaries are not producing enough estrogen to signal our pituitary gland in our brains to “turn off” FSH. Therefore, after menopause, FSH remains high. Indeed, menopause is typically confirmed when a woman reports having no period for 12 months and FSH levels are consistently elevated to 30mIU/ml or higher. Progesterone, which is made by the ovaries and is critical in maintaining pregnancy, ceases to be produced after menopause. These key hormonal changes make getting pregnant harder in pre-menopause (or perimenopause) and unattainable in postmenopausal.

How to tell if it’s menopause or pregnancy

You may be thinking that there is a lot of overlap in menopause symptoms and pregnancy, and you are right! It can make it seem pretty daunting when you are mentally prepared for starting menopause and all of a sudden think, “Actually, I could be pregnant instead…” Pregnancy and menopause can exhibit the following symptoms:

• Absent periods
• Breast soreness or tenderness
• Fatigue
• Insomnia
• Mood changes
• Weight gain
• Bloating and cramping
• Changes in sex drive
• Headaches
• Hot flashes and night sweats
• Frequent urination or incontinence

Unsure if you are pregnant or entering menopause? Take a home pregnancy test! However, home pregnancy tests can display false negatives and false positives so meet with your OB/GYN to confirm whether or not you are pregnant or starting your menopause journey. If you are not pregnant, this may be a great time to talk with your doctor about navigating perimenopause and also discussing contraception options until you are in postmenopause. 

Disclaimer: This is not medical advice, does not take the place of medical advice from your physician, and is not intended to treat or cure any disease. Patients should see a qualified medical provider for assessment and treatment.