Perimenopause or pregnancy: How to tell the difference

If your menstrual cycle is usually pretty reliable and your period is running late this month, it might be troubling you. Anywhere between 21 and 35 days is considered to be a standard cycle length, so small changes to your monthly bleed are generally nothing to worry about. 

But if you’re between your late 30s and your 50s and your period is a no-show around its expected time, you might be wondering: Is it pregnancy? Or could it signal the run-up to menopause (known as perimenopause)?

Whether you’ve already had kids, you’ve had difficulties getting pregnant, you’ve chosen to remain child-free, or you’re hoping to start your family now, pregnancy is always a big deal. But the transition to menopause can also be a huge life adjustment. 

So, are you pregnant, is it perimenopause, or is there something else entirely that’s causing your symptoms? And how do you decode what’s going on? If you suspect either pregnancy or perimenopause, both life stages come with significant hormonal changes that can cause similar symptoms, making it hard to tell if it’s one or the other. But while some of the symptoms can feel like they overlap, there are actually different things going on.

While you’re waiting for the right time to take a pregnancy test, understanding how perimenopause works and what could be going on inside your body in the lead-up to menopause may help you figure out what you’re experiencing. Here, obstetrician and gynecologist Dr. Renita White, Georgia Obstetrics and Gynecology, US, shares the key differences between symptoms of pregnancy and perimenopause. 

As always, if you have any questions or concerns about changes to your menstrual cycle, then speak to your doctor. While you might assume your new symptoms are related to either pregnancy or perimenopause, there’s always a possibility that something else could be causing them, so it’s always best to see a health care professional.

Key takeaways

• Perimenopause usually starts in your 40s, but it can start anywhere between your late 30s and 50s. It’s the transition to menopause (your last ever period).
• Changes to your periods are often one of the first signs of perimenopause.
• Even if your periods are irregular, it’s still possible to ovulate (when your ovary releases an egg), which means you still have a chance of getting pregnant in perimenopause.
• Some pregnancy and perimenopause symptoms can overlap, including missed periods, breast tenderness, and mood swings.
• The first thing to do if you’re wondering if you’re pregnant or in perimenopause is to take a pregnancy test. 
• If you’re not pregnant, it’s best to see your doctor to figure out if perimenopause has started or if there’s something else going on. They will assess you and may tell you to track your symptoms for a while, which you can do using a perimenopause-tracking app like Flo.

Is it possible to get pregnant during menopause?

Once you’ve reached menopause, you won’t be able to get pregnant naturally (without fertility treatment using either frozen or donor eggs). That’s because menopause signals the end of your periods and, therefore, your fertile years. But you do still have a chance of conceiving during the transition toward menopause. This is known as perimenopause, which can go on for several years or up to a decade for some people. 

Perimenopause is a gradual process that can begin anywhere between your late 30s and 50s but most often starts in your 40s. Getting pregnant is often harder by this stage because you have fewer healthy eggs, but it is possible as long as you’re still releasing eggs (ovulating), explains Dr. White. “During perimenopause, hormones [such as estrogen] are declining but are still enough to bring on a cycle,” she says.

Menopause, which is the name given to your last ever period, then marks the end of your menstrual cycle and your years of ovulating. “Menopause is the natural process when a woman’s ovaries stop releasing eggs due to a [change] in reproductive hormones,” explains Dr. White. It can take between four and eight years for you to reach this milestone — everyone’s different — but on average, the menopause transition lasts about four years.

Once your period has stopped for good (which usually happens between the ages of 45 and 55), you’ll have gone through menopause. “Menopause is generally defined as 12 months or more of no periods,” says Dr. White. From then on, you are postmenopausal, and you won’t be able to get pregnant naturally.  

Perimenopause and pregnancy symptoms that might overlap

Some pregnancy and perimenopause symptoms can feel similar, so it is possible to mix up the two. “During perimenopause, cycles begin to spread out and are not always predictable,” Dr. White says. “Because it’s possible to get pregnant during perimenopause, a late period may be due to either pregnancy or perimenopause hormone changes.” Understanding the main similarities and differences may help you to understand better what’s going on inside your body. 

If you’re still unsure, the best thing is to take an at-home pregnancy test. Use our pregnancy test calculator to figure out the best time to test. It’s worth noting, though, that a pregnancy test will only be able to confirm or rule out pregnancy, and there isn’t an equivalent at-home test that gives you a clear answer about whether you’re in perimenopause or not. So, if you think you might be perimenopausal, the best thing to do is see your doctor, who should be able to give you more answers.

Overlapping perimenopause and pregnancy symptoms can include the following (but keep in mind that there might be something else entirely going on, so it’s always best to see a doctor about any new symptom):

Cycle changes

When you become pregnant, your periods (and therefore your menstrual cycles in general) stop until after you’ve had your baby. During perimenopause, your periods can change in any number of ways. Your cycles might become shorter, longer, or hard to track, while bleeding might turn up late, get heavier or lighter, go on for more or less days than you’re used to, or not show up at all. 

Everyone experiences perimenopause differently, but if your perimenopausal period changes mean your periods arrive less often, it can be easily confused with pregnancy. That’s why it’s always a good idea to take a pregnancy test on the first day of a missed period (and there’s no harm in repeating the test a few days after that, just to be sure).

Mood changes

Mood swings can be a sign of early pregnancy — in fact, some women report symptoms as early as three weeks after conception. You can put that down to high hormone levels. 

But keep in mind that your hormones also change during perimenopause. So, if you’re feeling tearful or cranky for no obvious reason, there’s a chance it could be a symptom of perimenopause instead. 

Tiredness

For some people, fatigue can be an early sign of pregnancy, and it’s common to feel drained of energy in the 1st trimester generally as your body puts so much of its energy into growing a new human.

But if you’re not pregnant, and you still feel exhausted? You guessed it, perimenopause can be a pretty tiring time, too. In fact, research shows that up to 40% of women struggle to sleep during the menopause transition, which can leave you feeling tired.

Breast tenderness 

Sore, swollen, and tender breasts can be a telltale sign that it’s time to pee on a stick. But breast pain, also known as mastalgia, can also be linked to shifting hormones during the run-up to your period and perimenopause.

Either way, taking care of your breasts is important, so if you notice any changes or unusual lumps, make sure you get them checked out by your doctor.

A need to pee more often

If you’re desperate to pee all the time, it’s useful to know that bladder issues can be a perimenopause symptom. Thanks to a drop in levels of the hormone estrogen, some people notice changes to their bladder and vagina, which can cause a range of urinary symptoms, plus an increased risk of urinary infections. 

But if this feeling is combined with other symptoms such as nausea and swollen breasts, it could be pointing toward pregnancy. An increased need to pee can happen when you’re pregnant because your body produces more urine. That’s because, during pregnancy, your blood supply increases to help grow your baby. In turn, your kidneys need to do more work filtering the extra blood, removing the excess waste as urine. 

If you’ve noticed any other symptoms alongside needing to pee more often (think pain or burning when you pee or a foul smell), then book an appointment to see your doctor right away. You may have a urinary tract infection that will require a course of antibiotics.

Symptoms that are mainly associated with pregnancy

The most obvious sign of pregnancy is a missed period, but early pregnancy symptoms can vary from person to person. And, sometimes, women report no symptoms at all. That’s why taking a pregnancy test after the first day of a missed period is so important. It’s the only way you’ll know for sure if you’re expecting.

That said, there are some symptoms that generally point to pregnancy rather than perimenopause. They include:

• Pregnancy sickness: Nausea and sickness are not typically associated with perimenopause, but remember that symptoms can be different for different people. On the other hand, if you’re pregnant, a common sign is pregnancy sickness or nausea (often referred to as morning sickness, even though it doesn’t just happen in the morning). It doesn’t usually begin until around week five or six of pregnancy, and in most cases, it eases by about week 12 or 14.
• Swollen breasts: Sore breasts can be linked to both pregnancy and perimenopause, but if your breasts feel like they’ve swollen up in size, it might be time to consider taking a pregnancy test. This is all thanks to your body’s adjustment to the hormonal changes of pregnancy — it usually settles down after a few weeks.
• Changed tastes in certain foods: Cravings and food aversions are common symptoms you hear about during pregnancy. Why does it happen? Your change in hormones can make you more sensitive to certain smells, and smell has a lot to do with taste. The fluctuation (and later the drop) in hormones during perimenopause doesn’t generally cause the same interference with food tastes and smells, so this would be more likely to signal pregnancy.

Figuring out if you’re pregnant or in perimenopause

Everyone experiences both pregnancy and the menopause transition differently, so trying to make sense of your symptoms can be a challenge. And it can be a particularly difficult time if you’re hoping to start a family and actively looking for clues that might signal a positive result. If you’re feeling the stress of this hoping and waiting, go easy on yourself and lean on your network for support. It’s always a good idea to see your doctor if you’re hoping to become pregnant and it’s not happening as quickly as you hoped. If you’re over the age of 35 and have been trying for six months, schedule an appointment. If you’re 40 or over, the advice is to go and see your doctor right away.

We’ve seen that some symptoms overlap between pregnancy and perimenopause, while other physical changes might point strongly in one direction or the other. So, if you’re still feeling confused, a good place to start is to take a pregnancy test. If you’re not pregnant and you’re still not sure what’s causing your symptoms — perimenopause or otherwise — now would be a good time to check in with your doctor. They’ll be able to assess you to find out whether it could be perimenopause (and they’ll recommend ways to manage any symptoms you’ve got if it is) or something else completely. 

It can be hard to keep track of irregular periods and other symptoms at any point in life, which is where a cycle-tracking app like Flo can help. And when you’re going through perimenopause, the app lets you log symptoms like brain fog and vaginal dryness alongside tracking your periods. Premium subscribers even get cycle and symptom reports each month to help with any conversations they might want to have with their doctor. If you're pregnant, keep track of your baby's growth milestones, learn how your body is changing and share the information with your partner with Flo for Pregnancy.