Perimenopause at 44: What to Expect and What to Do Now

You Are Not Imagining It

You are 44 and your period is suddenly showing up a few days earlier than expected. Your PMS feels more intense than it used to. Sleep is less reliable. You are more irritable in ways that surprise you.

If you have started wondering whether this is perimenopause, you are likely right. And if your doctor brushed off that question because you are "too young," you are not alone in that experience either.

Perimenopause commonly begins in the mid-40s, with many people noticing clear hormonal shifts between 42 and 46. At 44, you are in a very typical window for the early stages of this transition.

What Is Happening Hormonally at 44

Perimenopause begins when the ovaries start producing estrogen less consistently. The key word is consistency. Your body is not simply running low on estrogen yet. Instead, estrogen levels are fluctuating more widely than they used to, swinging higher and lower within a single cycle.

At the same time, progesterone levels, which are tied to ovulation, start declining. When ovulation becomes less reliable, progesterone drops, and this imbalance between estrogen and progesterone is often behind symptoms like heavier periods, worsened PMS, breast tenderness, and mood changes.

These hormone fluctuations are real and measurable, though standard blood tests (like FSH levels) are often unhelpfully variable at this stage and are not the most reliable diagnostic tool for early perimenopause.

Symptoms That Are Common at This Age

At 44, the symptom picture often looks different from what most people associate with menopause. Hot flashes and night sweats may be present but are frequently milder or intermittent at this stage.

What tends to be more prominent in early perimenopause is cycle changes. Shorter cycles are one of the first signs, meaning your period might arrive 21 to 24 days after the last one instead of the usual 28 or so. Heavier or clottier periods are also common.

Mood and cognitive changes often emerge early too. You might notice more anxiety, lower resilience to stress, word-finding difficulties, or a general sense that your emotional baseline has shifted.

Fatigue, disrupted sleep (especially waking in the second half of the night), and reduced libido are also part of the picture for many people at this age.

The Gap Between Symptoms and Diagnosis

One of the most frustrating realities of perimenopause at 44 is that many healthcare providers are still slow to connect the dots. Because average menopause occurs at 51, perimenopause at 44 can feel unfamiliar to providers who work from a narrower framework.

You may be told your blood tests are normal, that your symptoms are stress-related, or that you are too young for perimenopause. These responses are increasingly out of step with the evidence, but they are still common.

If that happens to you, you are allowed to advocate for yourself. Bringing a symptom log to your appointment can help. Specific observations, like "my cycle has shortened from 29 days to 23 days over the last six months," are more concrete than describing how you feel in general terms.

Seeking a second opinion, or specifically requesting a referral to a gynecologist or menopause specialist, is a reasonable step if your concerns are being dismissed.

Tests Worth Asking For at 44

There is no single blood test that definitively confirms perimenopause, especially in the early stages when hormone levels fluctuate day to day. But several tests can be useful for building a broader picture of your health.

FSH (follicle-stimulating hormone) and estradiol can give some information, but results vary significantly depending on when in your cycle the test is done. A single result is rarely definitive.

An AMH (anti-Mullerian hormone) test reflects your ovarian reserve and declines more steadily than FSH. It can be a more stable indicator of where you are in the hormonal transition.

A thyroid panel (TSH at minimum) is worth requesting because thyroid dysfunction can cause symptoms nearly identical to perimenopause, and it is common in this age group. You want to rule it out.

If you have not had a bone density scan (DEXA scan), this is a reasonable age to ask about a baseline, particularly if you have risk factors like low dairy intake, smoking history, or a family history of osteoporosis.

Decisions Worth Making Now

At 44, you are in a valuable window: early enough that proactive decisions have the most impact, and informed enough to make them thoughtfully.

If you are considering HRT, earlier in perimenopause is often when the risk-benefit balance is most favorable. The "timing hypothesis" in current research suggests that starting estrogen closer to the onset of the hormonal transition (rather than years into menopause) is associated with better cardiovascular and cognitive outcomes. This is a conversation worth initiating with your provider now rather than waiting until symptoms become severe.

Strength training, if you are not already doing it, becomes meaningfully more important starting in your mid-40s. Estrogen protects bone density and muscle mass. As levels fluctuate and eventually decline, proactive resistance training helps protect both.

Reviewing your cardiovascular risk factors, including blood pressure, cholesterol, and blood sugar, is also worth doing in your mid-40s, as estrogen's protective cardiovascular effects begin to shift.

What to Expect in the Next Few Years

Perimenopause is not a switch that flips. It is a transition that unfolds over years, and the early stage you are likely in at 44 is just the beginning of that arc.

For most people, the most intense symptoms come in the later stages of perimenopause, typically around 47 to 50, when cycles become significantly more irregular and vasomotor symptoms (hot flashes, night sweats) often intensify.

At 44, you have time on your side. Starting to track your cycle, symptoms, and patterns now gives you, and your healthcare provider, a clearer picture of how your transition is progressing.

PeriPlan lets you log symptoms and cycle patterns daily so you can identify trends across weeks and months. That kind of longitudinal data can be genuinely useful in appointments.

The next few years will likely involve more noticeable changes. Being informed now means you will not be caught off guard.

When to Seek Professional Support

If your symptoms are meaningfully affecting your sleep, your mood, your relationships, or your work, that is enough reason to ask for support. You do not need to wait until things are worse.

Specifically, seek evaluation if you are experiencing very heavy bleeding (soaking through a pad or tampon in an hour or less), cycles shorter than 21 days, significant breakthrough bleeding, or mood changes severe enough to affect daily functioning.

A menopause-informed GP or gynecologist is the best starting point. If access is limited, dedicated menopause clinics and telehealth providers specializing in this area are increasingly available.

You are at the beginning of a transition that many people navigate well with the right information and support. Getting informed at 44 is one of the best things you can do.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.