Can You Get Pregnant on HRT?

Key takeaways:

• Yes, you can get pregnant on HRT if you’re still having regular menstrual cycles.

• But if you’re over age 50 or have reached menopause, the chances of pregnancy are very low.

• Hormone replacement therapy can help with symptoms during perimenopause.

• Talk to your healthcare provider about contraception options if you’re still having regular periods.

Hot flashes, night sweats, vaginal dryness — the most common menopause symptoms can be not-so-fun to deal with.

The good news is that hormone replacement therapy (HRT for short) can be an effective treatment. It works by replacing the estrogen (and sometimes progesterone) the ovaries are no longer making.

At first glance, HRT may seem similar to another type of medication — hormone-based contraceptives like the Pill and some intrauterine devices (IUDs). This may lead you to wonder, Can you get pregnant on HRT?

The short answer is yes. But there are nuances to discuss here. Keep reading to learn if, when, and how pregnancy could happen while on HRT.

HRT is a treatment that helps alleviate certain symptoms associated with perimenopause and menopause.

Perimenopause, also called the menopausal transition, is the time leading up to menopause. It can last several years and typically starts between the ages of 45 and 55. During this time, you might experience irregular periods and start having symptoms like hot flushes and night sweats.

You’ve entered menopause when you haven’t had your period for 12 consecutive months. In the United States, the average age of menopause is 52.

HRT During Perimenopause

During perimenopause, the amount of estrogen and progesterone the ovaries make starts to drop. This natural change in hormone levels is what leads to the symptoms people commonly associate with menopause.

HRT aims to replace the low or missing hormones. There are two types of HRT: estrogen-only and combined (estrogen plus progestin). Many forms of HRT are taken by mouth as a pill. There are also various topical formulations you can apply to your skin.

Hormone replacement therapy can effectively reduce symptoms like hot flashes and night sweats (called vasomotor symptoms). The treatment might also help relieve symptoms like vaginal dryness.

HRT and IVF

You may have heard of hormone therapy for in vitro fertilization (IVF). HRT might also be used in fertility treatments to help prepare the inner lining of the uterus (endometrium) for the transfer of a frozen embryo.

Now that we’ve covered the basics of HRT, let’s answer your burning questions: Does HRT prevent pregnancy? Or can you actually become pregnant while taking it?

HRT isn’t a means of contraception. It doesn’t prevent ovulation from happening.

Researchers have long known about the possibility of pregnancy during HRT. A small study from 1995 of 20 women found that ovulation was unpredictable on HRT.

In this study, women who had either regular or irregular menstrual cycles before starting on HRT ovulated while taking HRT. What’s more, one woman with high follicle-stimulating hormone (FSH) levels on a blood test — typically a measure of low ovarian function — still ovulated while on HRT.

So, if you’re still in perimenopause, you’re still having periods. Even if your periods aren’t regular, you might still be ovulating. This means you could get pregnant on HRT without contraception.

Can You Get Pregnant on Hormone Replacement Therapy After Menopause?

You’re not likely to become pregnant if you’re in the postmenopausal stage. Generally speaking, you’re probably okay if you’re over age 50 and your last period was at least 12 months ago. Ask your provider for personalized guidance, though.

On a side note, you can also still get pregnant if you’re taking HRT for primary ovarian insufficiency (POI) — when the ovaries stop functioning before age 40. That’s because it’s possible for women with POI to spontaneously ovulate.

If you’re concerned about becoming pregnant while on HRT, it’s important to use an effective method of contraception.

In this case, it’s best to avoid using a contraceptive containing estrogen. That’s because HRT also contains estrogen.

The dose of estrogen in the oral contraceptive pill is actually several times higher than what’s used in HRT. So, taking the two together can increase the risk of side effects and other health issues.

Contraception Options While Taking HRT

You might be able to take the mini-pill while on HRT. The mini-pill is a type of oral contraceptive pill containing only progestin. There are also progestin-only IUDs.

There are also several nonhormonal methods of birth control you can explore. These include copper IUDs and barrier methods like condoms and diaphragms.

If you’re not sure how to approach contraception while taking HRT, reaching out to your healthcare provider is always a great idea. They can recommend a method of contraception that works for your individual situation.

Levels of estrogen and progesterone, the two hormones replaced in HRT, naturally rise during pregnancy. Because of this, you’ll no longer need to take HRT while pregnant.

Additionally, though research is limited, some evidence suggests that exposure to HRT during pregnancy could harm a developing fetus.

If you think you might be pregnant while on HRT, stop taking it and contact your healthcare provider right away. They can confirm the pregnancy and advise you on next steps.

The possibility of pregnancy isn’t the only thing to be aware of when it comes to HRT. Before we sign off, let’s take a moment to explore its benefits and risks.

Benefits of HRT

As mentioned, HRT is effective at easing some common symptoms of menopause. It can also improve quality of life during and after perimenopause.

These are big benefits for women’s health and wellness, given how many women are impacted by menopause symptoms. For example, up to 80 percent of women transitioning into menopause experience vasomotor symptoms, including hot flashes or night sweats.

Researchers have found that these symptoms can last more than seven years in many women during the perimenopausal stage. Not only that, but the symptoms can stick around for several years after your final menstrual period.

HRT can also help minimize the bone loss that can happen along with menopause. This can help prevent age-related weakening and brittle bones (osteoporosis), a condition that impacts one in five women over age 50.

Risks of HRT

There are possible risks associated with HRT to be aware of. According to the American College of Obstetricians and Gynecologists (ACOG), HRT can elevate the risk of blood clots and stroke.

The ACOG also notes that combined HRT is associated with a small increased risk of heart attack and breast cancer. Meanwhile, estrogen-only HRT boosts the risk of endometrial cancer for women with an intact uterus.

Hormone replacement therapy generally isn’t recommended for women with a history of blood clots, stroke, or breast or endometrial cancer. And HRT might not be safe for those who have uncontrolled high blood pressure (hypertension) or unexplained vaginal bleeding.

To wrap up our discussion on whether you can get pregnant on HRT, let’s cover some of the main points:

• HRT is prescribed to help reduce menopausal symptoms like hot flashes and night sweats.

• Since HRT doesn’t prevent ovulation, you can still become pregnant if you’re in the perimenopausal stage and taking HRT.

• If you’re over 50 and haven’t had a period in at least 12 consecutive months, you’re not likely to get pregnant on HRT.

• Hormonal contraceptives aren’t typically recommended if you’re on HRT. However, progestin IUDs or nonhormonal methods like copper IUDs and condoms can be used to prevent pregnancy.

• HRT isn’t meant to be used during pregnancy. If you think you may be pregnant, stop using it and contact your healthcare provider.

• HRT is associated with various benefits and risks. Discuss these with your healthcare provider before getting started.

If you’re interested in using HRT or are already on HRT and have concerns about pregnancy or health risks, reach out to your provider to discuss them and get support.