Verbatim response from Perplexity
Yes—several nonhormonal options can help, but what works best depends on the symptom. The strongest evidence is for hot flashes/night sweats, where SSRIs/SNRIs, gabapentin, oxybutynin, fezolinetant, CBT, and weight loss have the best support.[1][4][9][13]
For hot flashes and night sweats, the most useful nonhormonal treatments are:
- Fezolinetant: a newer nonhormonal medication that targets neurokinin signaling and is recommended for vasomotor symptoms.[1][9][13]
- SSRIs/SNRIs: antidepressants such as paroxetine, escitalopram, citalopram, venlafaxine, and others can reduce hot flash frequency and intensity.[4][5][9][13][15]
- Gabapentin: can help hot flashes and may be especially useful if night symptoms are disrupting sleep.[4][5][13]
- Oxybutynin: may reduce hot flashes, though side effects can limit use.[3][9][13]
- CBT or clinical hypnosis: both have evidence for reducing the burden of hot flashes and improving coping.[5][9][14]
For sleep problems, mood changes, and stress, these can help:
- CBT for insomnia or anxiety/depressed mood related to perimenopause.[5][6][14]
- Exercise: regular aerobic activity and strength training can improve mood, sleep, and overall wellbeing.[3][8][12][14]
- Mindfulness, meditation, yoga, and stretching: may help with stress regulation and mood.[3][8][14]
For vaginal dryness or painful sex, the most effective nonhormonal options are:
- Lubricants during sex and vaginal moisturizers used regularly.[2][5][7]
- Hyaluronic acid suppositories/moisturizers can also provide relief.[2]
For heavy or irregular bleeding, nonhormonal options sometimes used include:
- NSAIDs and tranexamic acid for some people, with clinician guidance.[3]
Options with mixed or limited evidence include:
- Acupuncture: may help hot flashes for some people, but research is not conclusive.[7][8][15]
- Soy products: some evidence suggests benefit for hot flashes, but results vary.[5]
- Herbal supplements like black cohosh, red clover, and evening primrose oil: evidence is mixed or conflicting.[10][15]
If you want, I can turn this into a symptom-by-symptom shortlist of what tends to help most for hot flashes, sleep, mood, libido, or heavy periods.