What causes a 44-year-old woman to have her period twice a month?

Having two menstrual periods within one month at age 44 is most likely due to endocrine factors, possibly caused by declining ovarian function, poor ovulation, or anovulation. A lack of progesterone in the body fails to trigger regular shedding of the endometrium. Under the continuous influence of unopposed estrogen, the endometrium undergoes persistent proliferation, which may lead to breakthrough bleeding and result in two menstrual episodes in one month. In such cases, it's advisable to continue observing the next menstrual cycle. If the next period remains similar but stops completely within 5–7 days after onset, observation can continue.

If associated discomfort symptoms occur, patients should undergo blood and urine HCG tests to rule out special conditions such as pregnancy, miscarriage, ectopic pregnancy, or retained embryonic tissue. After excluding pregnancy, a pelvic ultrasound should be performed to check for organic diseases such as uterine fibroids, endometrial thickening, or endometrial polyps. When necessary, a curettage procedure may be considered. Conditions like endometrial hyperplasia or even endometrial cancer must be ruled out, as organic lesions often require surgical treatment.

Women are advised to avoid excessive stress, maintain a regular lifestyle, and keep a positive mood.