Waking up drenched in sweat at 3 a.m., heart pounding, or noticing your eyes feel gritty and dry by midday can leave you wondering what’s really going on with your body. These subtle, often confusing changes creep in quietly during your 40s, and many women brush them off as stress, aging, or “just life.” But when they start piling up—brain fog that makes work harder, joint aches that slow you down, or a strange metallic taste that ruins your favorite meals—the uncertainty can feel exhausting and isolating. The good news? These aren’t random; they’re often tied to the hormonal shifts of perimenopause, the transition leading to menopause. And recognizing them early can give you back control.

Here’s what’s coming: ten lesser-known signs that research links to declining estrogen, explained simply with practical ways to feel better—plus a few surprises that might finally connect the dots for you.
Understanding Perimenopause and Early Menopause

Perimenopause typically begins in the mid-40s, though it can start earlier, and lasts several years before menopause (defined as 12 months without a period). The average age of menopause in the U.S. is 51, but about 5% of women experience early menopause (before age 45) and 1% premature menopause (before 40). During this time, estrogen and progesterone levels fluctuate dramatically, affecting systems far beyond reproduction—brain, eyes, joints, ears, and more.

Many women only hear about hot flashes and night sweats. Yet studies, including those published in journals like Menopause and Climacteric, show a wide range of underrecognized symptoms. Let’s dive in.