Menopause or pregnant? How to tell the difference

Menopause or pregnant: both can make your period stop, and both come from shifting hormones. The quickest answer is a pregnancy test. If your period stays away and you are not sure, test first. Only then look at the rest of your symptoms.

Are you somewhere between 40 and 50? Then both are genuinely possible.

The menopause transition usually starts between 45 and 55. The average age at menopause is about 51. But as long as you still have periods, you can get pregnant. Even when your cycle is already irregular.

Why menopause and pregnancy feel so alike

During the perimenopause, the years before your last period, your ovaries produce oestrogen and progesterone irregularly. In early pregnancy, progesterone and hCG rise quickly instead. Two completely different situations, with the same first signals.

Those shared signals are a missed period, tiredness, mood swings, tender breasts and a bloated feeling. Exactly the things you watch for when you wonder whether you are pregnant. Hence the confusion.

Differences in symptoms

A few symptoms really belong to one of the two. When you are torn between menopause or pregnant, these are the ones to look at.

Watch hot flushes and nausea above all. Hot flushes with night sweats point to the menopause. Morning nausea points to a pregnancy. If you have neither, the table says little and only the test counts.

How can I check whether I am pregnant or in the menopause?

With a pregnancy test, and only after that with a conversation about the menopause. A urine test is reliable from the day your period was due. Test earlier and it can still be negative while you are pregnant.

Want to know sooner, or with more certainty? An hCG blood test shows a pregnancy from about 8 to 10 days after conception. You get an exact value instead of a line. How to read that value is in hCG levels in early pregnancy.

For the menopause there is no such yes-or-no test. Your GP diagnoses the menopause from your age and your cycle, not from a blood value.

Are you 45 or over with menopausal symptoms? Then the Dutch GP guideline says an FSH test is not needed for the diagnosis. Your hormones swing so much in these years that a single result says little.

What a hormone test can do is give you a factual starting point. A perimenopause test measures FSH, oestradiol, TSH and free T4.

The last two are your thyroid values. A slow thyroid causes symptoms that look like the menopause. Read how far am I in the menopause for what those values can tell you.

Can you get pregnant during the menopause?

Yes. During the perimenopause you still ovulate, just not every month. As long as you have periods, however irregular, you can get pregnant. How long you can still get pregnant depends on those ovulations, not on your age alone. Above 45 the chance per cycle is small, but not zero.

After the menopause it is different. You are officially in the menopause once you have gone a year without a period. After that there are no more ovulations, and getting pregnant spontaneously is no longer possible. Pregnancy after the menopause only happens through fertility treatment with donor eggs.

Are you 45 and late? Then menopause or pregnant is a fair question. The first step is the same as at 30: a test.

Do you actually still want to get pregnant? Read getting pregnant after 35.

How long do you still need contraception?

Longer than most women think.

The Dutch GP guideline on contraception uses this rule. If you are 50 or older, stop one year after your last period. If you are under 50, wait two years. For that long, a pregnancy is still possible.

Do you use the pill, a hormonal IUD or the injection? Then your bleeding cannot tell you whether you are in the menopause. The guideline then names 52 as the age at which you can stop. If in doubt, make an appointment with your GP and discuss what fits your situation.

I am in the menopause and feel pregnant: is that normal?

Yes, that is normal. A bloated belly, tender breasts and tiredness all go with a falling oestrogen level. So does fat moving to your waist.

Many women say they feel pregnant without being pregnant. So a menopause with a pregnant feeling is not a sign that something is wrong.

One exception always needs a check: bleeding after you have gone a year without a period. Always have that looked at by your GP, even when it is very little.

Does the menopause affect your blood pressure?

Yes, in many women blood pressure rises in the years around the menopause. That is partly age and partly the loss of oestrogen, which keeps your blood vessels supple. So have your blood pressure measured now and then in these years. More in blood pressure in the menopause.

What can you do?

1. Period not arriving? Take a pregnancy test. If it is negative and your period still stays away, repeat it after a week.
2. Do not want a pregnancy? Keep using contraception until you meet the rule above.
3. Do hot flushes, night sweats and an irregular cycle fit you? Discuss the menopause with your GP, even when your symptoms are mild.
4. Want a factual starting point? Have your hormones and your thyroid measured and discuss the result with your doctor.

Every result with us is assessed by a BIG-registered doctor. A blood test does not replace a talk with your GP. It does give you a solid starting point.

Further reading

• Early pregnancy symptoms: what you feel and when you know
• Which pregnancy test is best?
• First symptoms of the menopause
• Early menopause: 11 symptoms
• Perimenopause: symptoms, age and when to test

Sources

• NHG-Standaard De overgang (2022), the Dutch GP guideline on the menopause, richtlijnen.nhg.org
• NHG-Standaard Anticonceptie, the Dutch GP guideline on contraception, richtlijnen.nhg.org
• Thuisarts.nl: Ik ben in de overgang. Wanneer kan ik stoppen met voorbehoedmiddelen?
• NVOG, degynaecoloog.nl: De overgang