The short answer is yes — and it catches more women off guard than you might think.

Women over 40 represent one of the highest risk age groups for unintended pregnancy. Despite a decline in fertility during the perimenopause stage, you can still become pregnant. If you do not want to become pregnant, you should use some form of birth control until you reach menopause — meaning you have gone 12 months without having your period.

THE RULE

You are not considered to have reached menopause until 12 full consecutive months without any period. Until that anniversary passes, ovulation can still occur — even if your cycles are many weeks apart. One unexpected period resets the 12-month clock entirely.

Fertility decline vs. pregnancy risk

Two things are true simultaneously: fertility declines significantly during perimenopause (making conception harder for those trying), and unintended pregnancy remains a real possibility (because ovulation is unpredictable, not absent). Irregular cycles can actually create a false sense of safety — a woman who hasn't had a period in three months may assume she cannot conceive, but a spontaneous ovulation can occur without warning.

Contraception choices during perimenopause

If pregnancy prevention is the goal, the following options remain effective during perimenopause:

• Low-dose combined oral contraceptives

• Progestogen-only pill

• Hormonal IUDs (e.g. Mirena) — may also relieve heavy bleeding

• Birth control skin patch or vaginal ring

• Barrier methods (condoms, diaphragm)

If you want to conceive

Perimenopause reduces fertility, but pregnancy is possible — often with medical assistance. Options include ovarian stimulation with fertility medications, IVF with your own eggs (while viable), or donor egg IVF. The earlier you seek a fertility consultation in this window, the more options you have. An AMH test is particularly useful here, as it gives the clearest estimate of remaining ovarian reserve.

External Resource: Perimenopause & fertility — WebMD ↗