It sounds as if you have ruled out HRT, which is probably a wise thing considering the health risks involved...But here's what I experienced at age 41:
I was having lots of emotional upheaval, and had missed 6 periods. I began experiencing some very frightening health symptoms, like dizzyness, light hurting my eyes to the point of having to wear sunglasses even at work, and extreme depression (though I didn't recognize it as such at the time). I went to many doctors, including a hearing specialist who suggested I might have a brain tumor or Cerebral Palsy! At that time, I also went to my gynecologist, who immediately diagnosed my menopause. Prior to that, I had had many years of perimenopausal symptoms that I had just tried to live with. He put me on HRT, and it was like a miracle drug...truly. At the same time, my GP diagnosed my depression and put me on Prozac, which also helped my thinking immensely. In the past 4 years, I went of fhe HRT, now age 56, but I don't regret for a minute taking the hormones at the time, which I took for over 10 years. I don't regret taking it one bit, as it was very beneficial.
About HRT, though, I should add, that my mother, who had never taken hormone supplements, started taking Primarin a few years ago, and within a year, was diagnosed with breast cancer. After that, my sister (2 years younger) and I both stopped HRT. Since then, she has resumed taking the HRT. I have not, and have not felt any adverse side effects at my age. I don't think it hurt me when I took it in my 40's with early menopause, but would not do so now.
I took Estrace.
Patty