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What are the most effective treatments for perimenopause symptoms?
HRT, non-hormonal medications, and finding relief
Part 4 of 5: Perimenopause Awareness Month Series
While lifestyle changes can help with some perimenopause experiences, they aren’t the only choice. Medical treatments, including hormonal and non-hormonal options, can offer effective relief when symptoms are impacting your quality of life.
Because everyone’s experience of perimenopause is different, the right approach will depend on your symptoms, health, and individual needs. A healthcare provider can help you understand your options and decide what’s right for you.
In this article, we break down how hormone replacement therapy (HRT), non-hormonal medications, and lifestyle adjustments work, so you can explore your options.
How does hormone replacement therapy (HRT) work for perimenopause?
Hormone replacement therapy (HRT) is also known as menopausal hormone therapy (MHT). MHT is increasingly used in medical guidelines because it describes the treatment more precisely: hormones are used to manage symptoms associated with menopause, rather than to restore hormone levels to what they were before perimenopause.
However, HRT remains widely used and recognized, so we’ll use HRT throughout this article.
HRT usually involves taking estrogen, with or without a progestogen, to relieve perimenopause symptoms like hot flashes and night sweats. Progestogen is an umbrella term that includes progesterone and synthetic forms called progestins.
If you have a uterus and use systemic estrogen (treatments like pills, patches, gels, or sprays that enter the bloodstream and have effects throughout the whole body), you’ll usually also need a progestogen to protect the lining of the uterus. People who have had their uterus removed can often use estrogen on its own.
HRT can reduce symptoms associated with changing hormone levels during perimenopause and menopause. It is the most effective treatment for hot flashes and night sweats. It may also help with sleep problems related to these symptoms and can prevent bone loss while it is being used.
Systemic HRT can also help with vaginal dryness and pain during sex. However, if these are the main symptoms, a low-dose vaginal estrogen may be recommended instead. This acts primarily on vaginal and urinary tissues, with minimal absorption into the bloodstream, and generally does not need to be combined with a progestogen. Some people choose to use both vaginal estrogen alongside systemic HRT.
HRT has been the subject of extensive research, and the understanding of its benefits and risks has changed over time. Earlier studies raised concerns about links between HRT and conditions such as breast cancer, stroke, and cardiovascular disease.
We now know, however, that the balance of benefits and risks is more complicated. It depends on factors such as age, health history, the type and dose of HRT used, how it’s taken, and when treatment is started.
For many healthy people who are younger than 60 or within 10 years of menopause, the benefits of HRT are likely to outweigh the risks when it’s used to treat bothersome symptoms.
However, HRT isn’t suitable for everyone.
There is no single age to start or stop HRT. Treatment should be tailored to your specific needs and reviewed regularly with a healthcare provider to ensure the benefits still outweigh the risks.
Note on birth control: While HRT can be used to relieve perimenopause symptoms, it does not prevent pregnancy. If you want to avoid pregnancy during perimenopause, you may still need birth control. If you do need birth control, certain hormonal contraceptives can double as symptom relief—especially for heavy or unpredictable bleeding. A healthcare provider can help you choose the most appropriate option.
What non-hormonal medications can help manage perimenopause symptoms?
Several non-hormonal treatments can also help manage specific perimenopause symptoms. These may be an option for people who can’t use HRT or prefer not to.
Antidepressants and anti-seizure medications
Some medications that are primarily used to treat depression, seizures, and other conditions can also reduce hot flashes and night sweats. These include antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), as well as gabapentin.
For those who experience mood changes, anxiety, or depression during perimenopause, antidepressants may also be recommended to help treat these symptoms.
Neurokinin receptor antagonists
A newer group of non-hormonal medications called neurokinin receptor antagonists can also reduce moderate to severe hot flashes and night sweats. One example is fezolinetant. It requires liver-function testing because it has been associated with a rare risk of serious liver injury.
Selective estrogen receptor modulators (SERMs)
Another option is a group of medications called selective estrogen receptor modulators (SERMs). These affect estrogen receptors differently in different parts of the body. Ospemifene, for example, can be used to treat moderate to severe pain during sex caused by vaginal changes associated with menopause.
Some treatments combine a SERM with estrogen. For example, estrogen with bazedoxifene can treat hot flashes and help prevent bone loss in some postmenopausal people who have a uterus. Because this treatment contains estrogen, it is a form of hormone therapy rather than a non-hormonal treatment.
Vaginal treatments and lubricants
For localized symptoms such as vaginal dryness, irritation, or pain during sex, non-hormonal options include over-the-counter vaginal moisturizers and lubricants. Healthcare providers may also discuss targeted options like low-dose vaginal estrogen or vaginal prasterone when localized relief is needed.
Menopause-specific Cognitive Behavioral Therapy (CBT)
Menopause-specific cognitive behavioral therapy (CBT) can also help some people manage hot flashes, sleep problems, and depressive symptoms associated with menopause. It can be used alongside HRT or when someone can’t or prefers not to use it.
What about side effects and tracking?
As with any medication, these treatments can have unwanted side effects. It's important to discuss their possible benefits and risks with your healthcare provider before taking them.
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Tracking your experiences in the Clue app after starting a new treatment can help you notice changes, possible side effects, and whether your symptoms are improving. This information can also be useful when reviewing treatment with your healthcare provider.
Can lifestyle changes help perimenopause symptoms?
While lifestyle changes support overall health and may improve sleep, mood, strength, and balance, there is limited clinical evidence that they consistently reduce primary perimenopause symptoms, like hot flashes, on their own.
Some people find that alcohol, caffeine, spicy foods, or hot environments trigger their hot flashes, so it may be helpful to avoid these things, but triggers vary from person to person. Tracking your experiences may help you identify whether anything makes your own symptoms worse.
Eating a varied, balanced diet that provides enough calcium and vitamin D, alongside weight-bearing and resistance exercise, can help support bone health. These approaches are important for general health, but they are not treatments for all perimenopause symptoms.
Do complementary remedies or perimenopause supplements actually work?
Complementary treatments such as acupuncture, reflexology, vitamins, and herbal supplements are available. However, there isn’t strong evidence that most of these treatments reduce perimenopause symptoms. “Natural” does not necessarily mean safe, and some supplements can cause side effects or interact with medications.
It’s worth being cautious about products promoted on social media, including those endorsed by celebrities, as well as supplements and products marketed as (peri)menopause "cures".
There’s a long history of products being promoted for (peri)menopause without strong evidence that they work. When you’re looking for relief from difficult symptoms, it can be tempting to try anything that promises an answer.
This includes custom-compounded products sometimes marketed as “bioidentical hormones.” These products are not proven to be safer or more effective than regulated hormone treatments, and their strength and purity may be less consistent. Regulated HRT products that contain hormones chemically identical to those produced by the body are already available.
Before spending your money or starting a new treatment or supplement, check the evidence and, if possible, talk with a qualified healthcare provider about what is safe and likely to help
Up next → Part 5: Early & premature menopause —what happens when it starts earlier than expected.
