I Kid You Not

Unexpected pregnancy in perimenopause

Jun 27, 2025

A perimenopause-aged women who is pregnant. — Perimenopause and pregnancy? Are you kidding me?!

Outside of teenage pregnancy, the 40s are a time when women can find themselves unexpectedly pregnant. It’s important to mention that not everyone knows that we can still get pregnant in perimenopause, and it isn’t until postmenopause that our reproductive years are over.

So, birth control is still important during this time if you want to prevent pregnancy.

Change of Life Baby

Decades ago, I worked with a 43-year-old woman who was about to have a baby. It was a large office, and I hadn’t seen her in a while, so I was a little surprised when I saw she was “suddenly” pregnant. I know not to say anything to anyone who looks like they are sporting a baby bump, but she mentioned it to me.

I asked her if this was her first pregnancy. It was not. She already had a 26-year-old son who was married with a kid of his own, and then explained to me that this was an “Oops” baby. She was not planning on ever having any more children, having had her son at such a young age. She wanted to live it up in her 40s, making up for what she missed in her 20s.

She was on the birth control pill, but didn’t realize that being on antibiotics could make the pill less effective, and should use a backup contraceptive method.

This scenario is more common than you think.

It’s a myth that women over 40 or in perimenopause (or breastfeeding, for that matter) can no longer get pregnant. However, this is a very real possibility. The odds decrease in the peri crowd, but it could still happen.

My own grandmother had my father after 40. This was in the 1940s. She had lost her 12-year-old daughter due to an illness and decided to have what they used to call a “change of life” baby.

A change of life baby refers to a woman in perimenopause or her 40s who has a baby. The fact that it has its own name tells you something.

It Could Happen To You

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"Keep an eye on spring
Run when church bells ring
It could happen to you
All I did was wonder
How your arms would be
And it happened to me."

- From the song It Could Happen To You (this is a really sweet song that I first heard sung by Blair Brown on the TV show The Days and Nights of Molly Dodd.)

This is also a confusing time for feeling pregnant when we’re not. Spiking levels of estrogen can make us feel pregnant, and we may recognize some of the symptoms we’re having as ones that we had during pregnancy. Things like nausea and vomiting, diarrhea and constipation, food aversions and mood swings, heartburn and acid reflux are common, as well as having a bloated belly.

The other day, right before my period arrived, I looked like I was 4 months pregnant (or 2 months with twins 🤣). I complained to anyone who would listen.

We so closely associate skipped periods with pregnancy that this may be one of the first things we think of when we miss a period. Of course, who wouldn’t, right?! Several months ago, I wrote an article, 5 Reasons Skipping Periods Will Surprise You, that details how easy it is to jump to the conclusion you’re pregnant even if you haven’t had sex 😁.

My mother, at around the same age as my friend from work, thought she might be pregnant and asked ME, her unmarried college-aged daughter, to go to the pharmacy in our small town because she was too embarrassed to buy her own pregnancy test. In her mind, it was far better for the neighbors to think that I could be pregnant than her.

As weird as this is, I can understand this. My husband doesn’t know this (he will now), but I almost went out to buy a pregnancy test recently. I couldn’t tell if I was overreacting about thinking I could be pregnant or not (the mind plays games on you in perimenopause), but the thought of having to go buy the test was too overwhelming, and yeah, I probably would have considered sending my daughter instead.

The oldest woman on record, Dawn Brook, who conceived without assistance, was 59 according to the Guinness Book of World Records. Knowing my weird luck, that could happen to me. This was after her last period, which brings me to another point.

The number 365 for the number of days we need to be period-free before reaching menopause is completely arbitrary. It’s a made-up number like 10,000 steps per day. No one seems to know where the number came from, but it must have sounded good at the time to have a final line in the reproductive sand.

The problem with this, though, is that there really is nothing magical about reaching the 365-day mark. So maybe don’t start having unprotected sex the following day after menopause to celebrate. Sure, the chances are low, but as Dawn Brook provided, anything can happen.

What’s the Dealio with Birth Control Pills in Perimenopause?

Sometimes I see a bit of an uproar on the internet by women who wanted to be put on hormone therapy, but instead were offered birth control pills by their doctor. They felt like they were being placated instead of listened to.

Let me provide some context.

Hormone therapy for menopause symptoms was traditionally given to women after they had reached menopause. Perimenopause women were given birth control pills because they help manage the symptoms of the menopause transition AND because they prevent pregnancy. It was a two-for-one benefit.

But, over time, physicians began prescribing hormone therapy for women in perimenopause. There’s been some debate about whether women in perimenopause need more estrogen because our estrogen can spike so high naturally during this time. Birth control pills shut down our natural estrogen production, so you don’t get the spikes that occur. But that long story is for another day.

Women are seeing other women get offered hormone therapy and want in instead of automatically being offered birth control pills. It’s a personal decision that should be discussed with your physician. There’s no right or wrong answer - it’s based on what works best for you.

If you opt for birth control pills, at some point around the average age of menopause (52), your doctor may suggest stopping them to see if you are in menopause and/or to prevent the complications of taking birth control pills at an older age. But this is a decision between you and your healthcare provider.

You won’t know if you’ve reached menopause while taking birth control pills since the “period” you get if you have a placebo week isn’t a true period, a true period means you’ve ovulated. You’ll have to see what happens when you stop the pills - does your period come back or is it done for good?

Pickles and Ice Cream

For some women, the good news is that it’s still possible to get pregnant in your 40s. Many women delay having children to establish their careers or achieve other life goals before becoming mothers. I can understand. Although I got married at 30, I waited until I was 34 to start a family. When I delivered at 35, I was considered a “geriatric pregnancy.” That’s a fun term.

For me personally, I wasn’t one who craved pickles and ice cream, and I don’t want to take any chances that I will in the future.

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