What actually helps with perimenopause symptoms besides hormones?

Several nonhormonal treatments actually have evidence for perimenopause symptoms, especially hot flashes, night sweats, mood changes, sleep disruption, and vaginal dryness.[4][9][12][14]

• SSRIs/SNRIs: These antidepressants can reduce hot flashes and can also help low mood/anxiety linked to perimenopause.[4][9][14]
• Fezolinetant: A newer nonhormonal prescription option specifically for vasomotor symptoms like hot flashes and night sweats.[1][6][9]
• Gabapentin: Can help night sweats/hot flashes, and is sometimes useful when sleep is a major problem because it can be sedating.[4][6][9]
• Oxybutynin: Another prescription option with evidence for hot flashes, though side effects like dry mouth and constipation are common.[2][6][9]
• CBT and clinical hypnosis: These have the best evidence among non-drug approaches for reducing the bother and sometimes the frequency of hot flashes.[4][9][14]
• Weight loss: If someone is overweight or obese, losing weight can reduce hot flash and night sweat severity.[4][9][12]
• Vaginal lubricants and moisturizers: These are first-line for vaginal dryness and painful sex.[3][4][12]
• Tranexamic acid or NSAIDs: These can help if the issue is heavy bleeding during perimenopause, but they should be used with clinician guidance.[2]

A few popular options are less well supported by stronger evidence. The North American Menopause Society lists exercise, yoga, mindfulness-based interventions, paced respiration, soy, supplements/herbal remedies, and acupuncture as not recommended for vasomotor symptom treatment based on the evidence reviewed in its 2023 position statement, even though some people report subjective benefit.[9]

If you want the most evidence-based nonhormonal short list, it is:

1. SSRIs/SNRIs
2. Fezolinetant
3. Gabapentin
4. Oxybutynin
5. CBT
6. Vaginal moisturizers/lubricants[4][6][9][12][14]

If you tell me your main symptoms — hot flashes, sleep, anxiety, heavy periods, brain fog, or vaginal dryness — I can narrow this to the most useful options for that symptom cluster.