You wake up puffy. Your belly is bloated by afternoon no matter what you ate, you are tired in a way sleep does not fix, and your brain feels like it is wading through fog. You are not imagining it, and you are not doing anything wrong. There is something real happening under the surface in perimenopause, and it has a name. The good news is that the things that calm it are not more restriction or harder workouts. Here is what is driving inflammation after 40, and what actually helps.