Short answer
Yes, you can get pregnant during perimenopause, even when your periods are irregular. It is less likely than at 30, but not impossible. CDC guidance, citing ACOG and The Menopause Society, says to keep using contraception until menopause or age 50 to 55 if you want to avoid pregnancy. Menopausal hormone therapy is not approved as birth control.
Why it can still happen
The Menopause Society says women in perimenopause can still get pregnant even when cycles are irregular. The CDC's 2024 contraception guidance goes further: the age at which a person is no longer at risk of pregnancy is not known.
Fertility does fall. The CDC guidance gives a median age of 41 for the definitive loss of natural fertility, with a range up to 51. It also says no reliable lab test can confirm that you are no longer fertile, and that hormone (FSH) tests for this purpose might not be accurate.
How many births happen in the 40s
CDC birth data for 2025, released in April 2026, counted 142,927 births to women aged 40 to 44, a rate of 12.8 per 1,000 women. Women 45 and older had 11,319 births, a rate of 1.1 per 1,000 women aged 45 to 49.
These figures count births only, not all pregnancies, and do not say how many were planned. They do show that pregnancy in the mid-40s is uncommon but real. The CDC guidance notes that pregnancy at this age carries higher risks for both mother and baby, including hemorrhage, blood clots, miscarriage and stillbirth.
When you can stop birth control
The CDC guidance says people over 44 who want to avoid pregnancy still need contraception. It notes that ACOG and The Menopause Society recommend continuing until menopause or age 50 to 55. Menopause is confirmed 1 year after your final period.
Hormonal birth control can hide that milestone, because it changes or stops bleeding. The Menopause Society says the average age of menopause is 52, and about 90% of women have reached it by 55. For that reason, many clinicians suggest continuing hormonal contraception until the mid-50s. Your clinician can help you decide when to stop.
Hormone therapy is not birth control
Menopausal hormone therapy and birth control are different products. The label for an FDA-approved estradiol patch lists four uses: hot flashes, vaginal atrophy, low estrogen from ovarian failure or removal, and preventing postmenopausal osteoporosis. Preventing pregnancy is not one of them, and the label says the patch is not indicated for use in pregnancy.
If you need symptom relief and birth control at the same time, The Menopause Society says combined hormonal contraceptives (pill, patch or ring) are often used, or a levonorgestrel IUD plus estrogen therapy. Which fits you is a decision to make with your prescriber.
Related questions
Can a blood test show I can't get pregnant anymore?
No. The CDC guidance says no reliable lab test confirms the loss of fertility, and FSH testing for this might not be accurate.
I'm on HRT. Am I protected from pregnancy?
Not by the hormone therapy itself. Estradiol labels do not list contraception as a use, so ask your prescriber whether you still need birth control.
How long after my last period should I keep using birth control?
The Menopause Society says until menopause is confirmed, 1 year after your final period.
Read next
Sources
- CDC, MMWR Recommendations and Reports: U.S. Selected Practice Recommendations for Contraceptive Use, 2024
- CDC National Center for Health Statistics: Births, provisional data for 2025 (Vital Statistics Rapid Release No. 43, April 2026)
- The Menopause Society: Perimenopause (patient education page, accessed 7 Oct 2026)
- The Menopause Society: Menopause symptoms (patient education page, accessed 7 Oct 2026)
- DailyMed (NIH): Estradiol Transdermal System prescribing information
Published 2026-10-07 · Last checked 2026-10-07
Educational content, not medical advice. Made for the United States.