Hi OP - I’m a consultant gynaecologist specialising in contraception and menopause. I’m sorry you are in this difficult situation. I worked in termination services for 20 years.
For clarity (and to correct some info given by PPs):
- HRT or perimenopause cannot cause a false positive pregnancy test
- positive PTs are invariably correct in my 26 year experience in this field -apart from when someone has done the test incorrectly (reading after 30 mins, for example, or using an ovulation test in error
- PT can be a false negative after 16 weeks of pregnancy, but I find this is not the case for many pregnancies
- Contraception is advised up to 55y if a woman is sexually active, whether on HRT or not, but this should have been explicitly discussed with you and an appropriate method supplied by your HRT provider, which would usually be your GP. It is a failing on their part not to have done so
- Chances of conceiving at 49y are however much lower than at 19y or 29y … you’ve been unlucky
Your positive test means there is pregnancy tissue producing BhCG, the initial pregnancy hormone. However, because perimenopause and HRT can cause irregular or no bleeds, and because any scheduled bleeds on HRT are not periods (but withdrawal bleeds, similar to being on the combined contraceptive pill), it’s difficult to date your pregnancy from last bleed accurately.
Also, as with any pregnancy, there is a chance it may not continue, and miscarriage is much more likely at 49y than when younger. This could mean you have a heavy bleed at some stage, no bleed, or what feels like a late normal period, depending on type of miscarriage and gestation.
Ectopic pregnancy must always be considered and excluded too - please, if you have any symptoms of this (dark or watery vaginal loss, low abdominal or pelvic pain, especially if on one side, shoulder tip pain, feeling unwell or faint) please attend A&E without delay, calling an ambulance or someone driving you there. Not trying to alarm you, but ectopics are common and can be dangerous if not treated https://www.nhs.uk/conditions/ectopic-pregnancy/
You absolutely need a scan for gestation and site of the pregnancy; if you are early (less than 6 weeks, dated from LMP which is not so helpful here) it may be that the first ultrasounds scan is inconclusive.
Depending on where you live and how your local services are arranged, some Early Pregnancy Units would see you for a scan, and you may need GP to refer or be able to self-refer. My local area EPAU would not see you unless you had symptoms of and ectopic or miscarriage, and don’t take self-referrals (sorry not helpful I know!).
Most termination services in England are provide by third-sector organisations (BPAS, MSI or NUPAS) and most take self-referrals. They are usually your quickest option for a scan, and attending there does not mean you need to proceed with a termination. A termination sounds like an extremely valid option for you, and you will not be judged.
.Another caution - may terminations are now carried out remotely if a woman chooses a tablet option (Early Medical Abortion = EMA). It is not safe for you to have an EMA without a scan as explained above; sometimes TOP nursing staff do not have much gynaecology/menopause knowledge and may be unaware.
Sounds like your best bet is to see GP tomorrow if possible, who can advise on local TOP and EPAU access, and best way to arrange a scan. I hope you can access what you need without delay, and that care is good.
Wishing you all the best.