Perimenopause at 44: A Practical Guide to the Mid-Forties Transition

Why 44 Is a Common Age for Perimenopause to Begin or Intensify

For many women, 44 marks the point at which perimenopause symptoms that had been mild or intermittent start to become more noticeable and more consistent. Oestrogen production from the ovaries becomes increasingly variable during the mid-40s, and the body is less able to smooth out the hormonal fluctuations it was managing more quietly a few years earlier. If you are 44 and starting to wonder whether your cycle changes, poor sleep, or mood shifts are connected to perimenopause, the answer is very likely yes. This is one of the most statistically common ages for the transition to become apparent, even though every woman's experience is individual.

The Symptom Landscape at 44

At 44, the symptoms of perimenopause often include a mix of cycle irregularity, vasomotor symptoms like hot flashes and night sweats, and psychological changes. Cycles may shorten initially before eventually becoming longer and more unpredictable. Hot flashes, if they have not appeared before, often begin in the mid-40s. Night sweats can disrupt sleep significantly, leaving many women in a cumulative state of fatigue that affects every area of life. Weight changes, particularly around the abdomen, are common at this stage and partly reflect the metabolic changes that accompany shifting oestrogen levels. Brain fog, reduced concentration, and low motivation are also frequently reported by women in this age group.

Understanding Your Cycle During This Phase

The menstrual cycle is often the most visible measure of where you are in the perimenopause transition. At 44, you might notice cycles that vary in length from month to month, periods that are heavier than they used to be, or occasional spotting between periods. In some months the pattern might look almost normal, followed by a cycle that is very different. This unpredictability is driven by the irregular ovulation that characterises perimenopause: some months ovulation occurs normally, in others it does not occur at all, leading to an anovulatory cycle with altered bleeding patterns. Tracking your cycles carefully, including flow, duration, and symptoms, gives you useful data to share with a healthcare provider if needed.

Talking to Your Doctor at 44

Exercise and Movement at 44

Physical activity is one of the most powerful tools available to women in their mid-40s navigating perimenopause. Resistance training is particularly valuable because it preserves muscle mass and bone density at a time when oestrogen's protective effect on both is diminishing. Aim for two to three strength sessions per week, covering major muscle groups. Aerobic exercise supports cardiovascular health, mood, and weight management. Yoga and Pilates can help with flexibility, stress reduction, and sleep quality. The most important thing is consistency rather than intensity: regular moderate movement across the week is more beneficial than occasional intense effort. Finding activities you genuinely enjoy makes consistency far more achievable.

Nutrition for the Mid-Forties Body

Nutritional needs shift during perimenopause in ways that are worth understanding. Protein becomes increasingly important as muscle synthesis becomes less efficient: most evidence suggests aiming for around 1.2 to 1.6 grams of protein per kilogram of body weight per day. Calcium and vitamin D support bone health at a time when bone density begins to decline more rapidly. Reducing ultra-processed foods, added sugars, and alcohol can ease hot flashes, improve sleep, and support weight management. Many women in their mid-40s notice that their body responds differently to carbohydrates than it did previously: a diet that moderates refined carbs and prioritises fibre-rich whole foods often supports more stable energy and fewer blood sugar swings.

Making Peace with the Transition

There is a version of 44 in which perimenopause is something happening to you, and a version in which it is something you are navigating with increasing skill. The women who tend to report the most positive experiences of this phase are those who got informed early, built relationships with healthcare providers who took them seriously, and made practical adjustments to their lifestyle and environment. This does not mean perimenopause stops being difficult: many symptoms are genuinely hard. But approaching the transition as a phase that can be managed rather than something to simply suffer through changes the experience in meaningful ways. You have more options and more information available to you than any previous generation of women in the same position.