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Fertility

Perimenopause, pregnancy and contraception: what you still need to know

You can still get pregnant during perimenopause. Fertility falls as you approach menopause, but it does not switch off until your periods have genuinely stopped, which is why contraception is still advised through the transition.

Fertility falls but does not vanish

Perimenopause is a gradual loss of ovulation, not an immediate one. Cycles become irregular and many are no longer ovulatory, so pregnancy is less likely than it was in your 30s. Less likely is not the same as impossible, though. As long as you are still having periods, even irregular ones, ovulation can still happen, and so can pregnancy (Journal of Clinical Endocrinology & Metabolism, 2021). This is exactly why a missed or late period in perimenopause is worth a pregnancy test rather than an assumption, and why the changes in your cycle are worth understanding.

How long contraception is advised

UK guidance gives clear categories, and the detail is worth knowing. Contraception is generally advised until age 55, by which point a natural loss of fertility can be assumed for almost all women (FSRH guideline, 2023). Before then, it can usually be stopped once you have gone without periods for a defined time, two years if you are under 50, or one year if you are 50 or over, when using non-hormonal methods (FSRH guideline, 2023). Some methods are handled differently with age. The combined pill, for example, is usually switched to a lower-risk option from 50, and hormonal methods can mask the very periods you would otherwise use as your guide.

Because the rules depend on your age, your method, and your pattern of periods, this is a conversation to have with a doctor or a sexual health clinic rather than a decision to make alone. anna does not give contraceptive advice.

When to talk to a doctor

Talk to a doctor or sexual health clinic about which method suits you now, and before stopping contraception, so the timing fits your age and circumstances. See a doctor promptly if there is any chance you are pregnant, or if you have bleeding that is unusual for you. anna does not diagnose, and this article is not medical advice.

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Where anna fits

What anna does with this

anna does not manage contraception, and it is honest about that boundary. What it does is help you see your own cycle and the signals around it, from the data your wearable and Apple Health already record, so the irregularity that makes this question confusing becomes something you can actually see. It works by pattern recognition over that data, reviewed by a clinician, and it does not diagnose. A clearer view of your pattern is something you can bring to the clinic conversation.

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Sources

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  1. Faculty of Sexual and Reproductive Healthcare. Contraception for women aged over 40 years. FSRH guideline, 2017, amended 2023. Link
  2. Santoro N, Roeca C, Peters BA, Neal-Perry G. The menopause transition: signs, symptoms, and management options. J Clin Endocrinol Metab, 2021. DOI
This article summarises general research and is not a substitute for personal medical advice. anna does not diagnose.