Perimenopause at 43: You're Not Too Young, and You're Not Imagining It

Something shifted, and you can't quite name it

You're 43. Your period started showing up a few days early. Your PMS is suddenly brutal when it never used to be. You're waking up at 3 a.m. for no clear reason, and by Thursday afternoon you're running on empty in a way that coffee doesn't fix.

You mention this to your doctor. And then comes the phrase that so many women at your age hear: "You're too young for perimenopause."

You're not. And that response, while common, can delay answers by years. Perimenopause can begin in the late 30s for some women and the early 40s for many. The average age of menopause is 51, which means the transition before it, the perimenopause phase, often starts in the early-to-mid 40s. At 43, you are squarely in the window.

What's actually happening hormonally at 43

Perimenopause is not a single event. It's a gradual transition during which your ovaries begin producing less estrogen and progesterone, and they do it unevenly. That's the key word: unevenly.

In early perimenopause, progesterone often drops first. Progesterone is the hormone that stabilizes the second half of your cycle and promotes calm, steady sleep. When it falls, cycles can shorten, PMS can intensify dramatically, and sleep gets lighter and more fragmented.

Estrogen levels in early perimenopause can actually spike erratically before they begin their overall decline. Those spikes can cause breast tenderness, bloating, and mood swings. This erratic pattern, rather than a steady drop, is part of why early perimenopause can feel so destabilizing. Your body is fluctuating, not declining in a predictable slope.

Your FSH (follicle-stimulating hormone) may be starting to rise as your brain pushes harder to stimulate ovulation. A single FSH test is not enough to diagnose perimenopause, because levels vary from cycle to cycle. But tracking your symptoms over time tells a clearer story.

The symptoms that tend to show up first at this age

At 43, the symptoms of early perimenopause are often subtle enough to be explained away. But they form a pattern worth paying attention to.

Cycle changes are usually the first signal. Your period may come earlier than usual, cycles may shorten from 28 days to 24 or 25, or you may notice your period is heavier or lighter than it once was. Irregular cycles are a hallmark of the transition.

Intensified PMS is another early sign. If you used to have mild premenstrual symptoms and now find yourself with significant mood shifts, cramps, breast tenderness, or headaches in the week before your period, that shift in severity matters. It's not in your head.

Sleep disruption is common even before hot flashes begin. Many women at 43 notice they wake easily, can't fall back asleep, or feel unrested despite spending enough hours in bed. This is often tied to falling progesterone.

Anxiety or a sense of low-grade dread, especially in the premenstrual window, can also emerge. Progesterone has a calming effect on the nervous system through its conversion to a compound called allopregnanolone. When progesterone drops, that buffer shrinks.

The fertility question: can you still get pregnant at 43?

Yes. This is one of the most important points to understand at this stage. Perimenopause and infertility are not the same thing. You are still ovulating during perimenopause, just less predictably.

Fertility does decline with age, and at 43 the chances of conception per cycle are lower than they were at 33. But ovulation is still happening, which means pregnancy is possible. Many women in perimenopause are surprised by an unplanned pregnancy precisely because they assumed their symptoms meant their fertile years were behind them.

If you are not trying to conceive, continue using contraception until you have been without a period for 12 consecutive months, which is the clinical definition of menopause. Your healthcare provider can help you navigate contraception options that may also ease perimenopause symptoms.

If you are considering pregnancy, or facing the emotional complexity of that question at 43 during perimenopause, a reproductive endocrinologist can give you the most accurate picture of your current ovarian reserve.

Getting taken seriously by your doctor

The career and family pressure layer

Forty-three often comes with a specific kind of life pressure. You may be at a demanding point in your career, parenting school-age children, or managing the early stages of caring for aging parents. You may be doing all three.

Navigating perimenopause symptoms in this context is a real challenge. Fatigue affects your capacity at work. Sleep disruption amplifies every emotional difficulty. Brain fog, the difficulty finding words or holding complex thoughts, can be alarming and professionally embarrassing.

Giving yourself accurate information is the first act of self-advocacy. Understanding that what you're experiencing is physiological, not a personal failure, matters. It also helps to start identifying which symptoms are most affecting your quality of life, because those are the ones worth treating first.

Tracking your cycles, sleep, energy, and mood in an app like PeriPlan can help you connect the dots between your symptoms and your cycle phase. That kind of data also becomes useful when you talk to your doctor, giving you concrete observations rather than a vague sense that things have changed.

What you can do right now

You don't have to wait for a diagnosis to start managing what you're feeling. Several evidence-supported approaches can help ease early perimenopause symptoms.

For sleep, prioritizing a consistent sleep and wake schedule, even on weekends, helps anchor your circadian rhythm. Keeping your bedroom cool can reduce the light night sweats that may be disrupting your sleep even before classic hot flashes begin. Limiting alcohol in the evenings is worth trying, as alcohol is a known sleep disruptor and can worsen night sweats.

For mood and PMS intensity, aerobic exercise has solid evidence behind it. Even three to four sessions of moderate movement per week can reduce premenstrual mood symptoms and improve sleep quality. Strength training also supports hormonal balance and bone density, which becomes increasingly important across your 40s.

For anxiety, magnesium glycinate is one of the more studied options for perimenopausal anxiety and sleep. Studies have examined doses in the range of 200 to 400 mg, and some women find it helpful. Talk to your healthcare provider about the right dose for your situation.

For the broader picture, reducing inflammatory foods like refined sugar, ultra-processed foods, and excess alcohol supports hormonal metabolism. Increasing fiber from vegetables, legumes, and whole grains supports estrogen clearance through the gut.

If lifestyle approaches are not enough, a conversation about hormonal options is worth having. Low-dose progesterone is sometimes prescribed in early perimenopause specifically to address sleep and PMS intensification. Your provider can walk you through the options.

You are not too young, and this is manageable

Perimenopause at 43 can feel like a rug being pulled out from under you, especially when you weren't expecting it and nobody around you is talking about it. But what you're experiencing is real, it's physiologically explainable, and it's navigable.

The transition ahead is not a single cliff. It's a gradual shift, and you have time to learn your patterns, try approaches, and build a care team that takes you seriously. Many women find that understanding what's happening actually reduces anxiety significantly. Knowledge gives you options.

You're not too young. You're right on time.

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