The heart beats out of rhythm. The eyes are dry and irritated. Inside the ear - an inaudible whine, a quiet ring that doesn't stop. Those three symptoms are not a panic attack. They are not a disease. They are the first three signs of menopause - and they start in a phase that can last from four to ten years.

Perimenopause is the quiet phase that gynaecologists often explain in technical terminology that says little. The simple translation: the body shifts hormone production from the ovaries to the adrenal glands, fatty tissue, skin and brain. The shift is quiet, but the symptoms come with it. The 2023 IVHP study confirms it: perimenopause is a global reorganisation of physiology, not only a hormonal change.

Palpitations most often come at night or when the body is at rest. They are not cardiac problems - they are oestrogen fluctuations that destabilise the sympathetic nervous system. Women go to the cardiologist, the ECG is normal, doctors say „everything is fine". It is not - and the reason is simpler than expected.

Tinnitus - the sound in the ear - is a quiet symptom rarely written about. Hormonal fluctuations affect the inner ear. It can be continuous or intermittent. It is not solved with ear medication - the answer is to work with an endocrinologist, not an ENT specialist.

Dry eyes are perhaps the least dramatic symptom - but the most often forgotten. The drop in oestrogen directly lowers tear production. Women think it's an allergy or computer use. Drops with hydration substitutes give visible improvement - but the root is hormonal.

What can be done? First step - don't stay silent. Second - look for an endocrinologist, not just a gynaecologist. Third - food, sleep, movement. Fourth - a doctor who understands perimenopause, not only classic menopause. In the Balkans those doctors are rare. But they are starting to appear.