Verbatim response from Perplexity
Several non-hormonal options actually help, especially for hot flashes/night sweats, sleep, mood, and vaginal dryness. The best-supported choices are prescription medicines like paroxetine (FDA-approved), fezolinetant, gabapentin, and oxybutynin, plus CBT, weight loss, and some lifestyle changes.[1][7][8][10][11]
What tends to help most, by symptom:
- Hot flashes / night sweats: Paroxetine, fezolinetant, gabapentin, oxybutynin, and in some guidelines clonidine; CBT and clinical hypnosis also reduce symptom impact.[1][8][9][10][11]
- Sleep disruption: Gabapentin can be useful when night sweats are waking you up, and CBT can help with sleep disturbance tied to vasomotor symptoms.[1][7][9][10]
- Mood symptoms: SSRIs/SNRIs may help low mood, anxiety, and irritability during perimenopause.[3][9][10][11]
- Vaginal dryness: Water-based lubricants and moisturizers are first-line non-hormonal treatment.[4][14]
- Bladder symptoms: Oxybutynin may help if hot flashes and overactive bladder symptoms happen together.[1][12]
Lifestyle approaches with some evidence include exercise, weight loss, reducing alcohol, smoking cessation, sleep hygiene, and mind-body practices such as mindfulness, yoga, meditation, or hypnosis.[3][7][8][10][12][13]
A practical way to think about it:
- If the main problem is hot flashes/night sweats, the strongest non-hormonal options are fezolinetant, paroxetine, gabapentin, and oxybutynin.[1][8][11]
- If the main problem is sleep or anxiety, CBT, gabapentin, and sometimes an SSRI/SNRI are commonly used.[7][9][10][11]
- If the main problem is dryness, use lubricants/moisturizers first.[4][14]
If you want, I can turn this into a “best option by symptom” cheat sheet or help compare fezolinetant vs gabapentin vs SSRIs.