Verbatim response from Perplexity
For perimenopause symptoms, the things with the best evidence besides hormones are nonhormonal prescription medicines, cognitive-behavioral therapy (CBT), and some lifestyle measures; what helps most depends on whether the main problem is hot flashes, sleep, mood, or vaginal symptoms.[1][3][7]
- Hot flashes/night sweats: paroxetine is the only FDA-approved SSRI for this in the U.S., and it can also help sleep a bit; other options with evidence include escitalopram, venlafaxine, gabapentin, oxybutynin, and fezolinetant.[1][3][5][7]
- Sleep, stress, and symptom coping: CBT has good evidence for reducing how disruptive vasomotor symptoms feel, and it can also improve sleep and anxiety during the menopausal transition.[3][5]
- Vaginal dryness/pain with sex: vaginal lubricants and moisturizers help with comfort; for some people, ospemifene is an FDA-approved nonhormonal prescription option for painful sex and dryness.[4][7]
- Lifestyle changes: weight loss may reduce hot flash intensity in people who are overweight, and exercise can help with sleep, mood, weight, and overall menopause-related quality of life.[3][4]
- Mind-body approaches: mindfulness-based stress reduction, clinical hypnosis, yoga, and acupuncture may help some people, with the strongest evidence among these for CBT and hypnosis; results for acupuncture are more mixed.[3][4][5]
- Herbal supplements: evidence is generally weak or inconsistent; one review found that many supplements were not more effective than placebo for hot flashes and night sweats.[5]
A practical way to think about it is:
- If the biggest issue is hot flashes/night sweats, ask about fezolinetant, paroxetine, venlafaxine/escitalopram, gabapentin, or oxybutynin.[1][3][7]
- If the biggest issue is sleep or anxiety around symptoms, CBT is one of the most useful non-drug options.[3][5]
- If the biggest issue is vaginal dryness, use lubricants/moisturizers first and ask about ospemifene if needed.[4][7]
If you want, I can turn this into a “best options by symptom” cheat sheet or help you compare which nonhormonal option fits your specific symptoms and medical history.