Harvard Health

Besides hormones, nonhormonal medications, mind-body therapies, and specific lifestyle changes are the most evidence-backed ways to help with perimenopause symptoms, particularly hot flashes and night sweats. Nonhormonal Prescription Medications These are the most effective options for vasomotor symptoms (hot flashes/night sweats): Paroxetine (Brisdelle): The only FDA-approved nonhormonal medication for hot flashes. It is a low-dose SSRI (7.5 mg) that reduces symptom frequency by 10%–25% [1] [3] [6]. Fezolinetant (Veozah): A newer FDA-approved neurokinin-3 (NK3) receptor antagonist that targets the brain's temperature regulation system, reducing moderate-to-severe symptoms by 20%–25% [1] [2] [7]. Gabapentin: An anti-nerve pain drug that can reduce hot flashes, though it may cause dizziness [1] [2] [3] [6]. Oxybutynin: An antimuscarinic drug (often for bladder issues) that off-label use shows 30%–50% improvement in hot flashes, especially if you also have overactive bladder symptoms [1] [2]. Other SSRIs/SNRIs: Medications like citalopram, escitalopram, and venlafaxine are commonly used and effective for vasomotor symptoms [1] [2]. Mind-Body and Behavioral Therapies These approaches help reduce the impact of symptoms and improve sleep/anxiety: Cognitive Behavioral Therapy (CBT): Demonstrated efficacy in reducing hot flash frequency and severity while significantly improving sleep, anxiety, and mood [1] [2] [3] [4]. Clinical Hypnosis: Shown to reduce hot flash frequency compared to no treatment; self-delivered versions are now available [1] [2]. Mindfulness-Based Stress Reduction: Growing evidence suggests it lowers hot flash severity [3] [5]. Acupuncture: May modulate neurotransmitters to ease hot flashes, insomnia, and depressive symptoms [2] [5]. Lifestyle Changes Weight Loss: Overweight women report more intense hot flashes; losing weight can lower intensity [1] [3] [5]. Dietary Choices: Soy: Some evidence supports soy products (containing phytoestrogens) for alleviating hot flashes, though relief varies [1] [2] [3]. Flaxseed & Black Cohosh: Flaxseed has mild estrogen-like effects; black cohosh has conflicting evidence but may* help some women [1] [2] [6]. Sleep Hygiene: White noise machines, aromatherapy (lavender), and calming bedtime environments help manage night sweats [2] [6]. Supplements with Mixed or Poor Evidence Be cautious with products that lack strong support: Evening Primrose Oil: Evidence is mixed; may help breast pain but not consistently for hot flashes [1] [2]. Black Cohosh: While popular, evidence is conflicting [1] [2]. General Phytoestrogens & Adaptogens: Some benefit from ashwagandha has been shown, but many other products have poor or inconsistent evidence [1] [2]. Note: The NHS and other bodies state that none of the unproven herbal products can be recommended as evidence-based therapies for hot flashes [1]. Summary Recommendation If you are seeking relief, start by discussing Paroxetine or Fezolinetant with your doctor as they are FDA-approved and most effective. For holistic support, combine medication with CBT and weight management, as these have the strongest clinical backing for improving quality of life. Brands/Services to consider: Midi Health and Harvard Health provide robust guides on these nonhormonal options; Brisdelle and Veozah are the specific drug names to ask your physician about.

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