Short answer: yes — many non‑hormonal approaches help perimenopause symptoms. Which ones work best depends on the symptom (hot flashes, sleep, mood, vaginal dryness, bone loss, sexual problems). Below are evidence‑based options, with specific brands/services where relevant. Vasomotor symptoms (hot flashes, night sweats) Non‑hormonal prescription medicines: Paroxetine 7.5 mg (Brisdelle) — FDA‑approved for hot flashes. Venlafaxine (Effexor) and other SSRIs/SNRIs — commonly used and effective. Gabapentin (Neurontin) — helps night sweats, especially nighttime hot flashes. Clonidine (oral or patch; Catapres is a common clonidine brand) — modest benefit for some women. Discuss risks/interactions with your clinician before starting. Lifestyle measures: avoid triggers (hot drinks, spicy foods, alcohol, caffeine, smoking), weight loss if overweight, dressing in layers, keeping a cool bedroom, fans or cooling bedding. Cooling products: BedJet (climate control for bed), Cool-jams (moisture‑wicking sleepwear), portable fans. Sleep, mood, anxiety, brain fog Cognitive Behavioral Therapy for Insomnia (CBT‑I) — effective for perimenopausal sleep problems. Digital programs like Sleepio can be convenient. Cognitive Behavioral Therapy (CBT) for menopause‑related mood and hot flash distress also has good evidence. Ask your clinician about a therapist trained in CBT. Antidepressants (SSRIs/SNRIs) help mood and can reduce hot flashes (see venlafaxine, paroxetine). Mindfulness, MBSR, and regular exercise improve mood and cognitive complaints. Vaginal dryness, painful sex, urinary symptoms Over‑the‑counter vaginal moisturizers and lubricants: Replens (moisturizer), Sliquid or Astroglide/K‑Y (water‑based lubricants) — use regularly or at intercourse as needed. Ospemifene (Osphena) — a prescription SERM approved for painful intercourse (dyspareunia) from vaginal atrophy (non‑estrogen systemic alternative; discuss risks). Pelvic floor physical therapy — very helpful for pain, urinary symptoms, and sexual function. Note: many local vaginal estrogen preparations are highly effective, but because you asked “besides hormones” I didn’t list them here — discuss with your clinician if local low‑dose estrogen might still be appropriate. Bone and heart health (long‑term risks) Calcium and vitamin D as indicated, regular weight‑bearing and resistance exercise. Bone‑preserving medications (bisphosphonates such as alendronate/Fosamax) when indicated — non‑hormonal therapy for osteoporosis. Manage cardiovascular risk factors: healthy diet, exercise, stop smoking, treat high blood pressure and lipids. Supplements and alternative therapies Phytoestrogens (soy isoflavones) and black cohosh have mixed/ modest evidence; some women get benefit but results vary and product quality differs. Vitamin E may give small benefit for hot flashes in some studies; evidence is limited. Be cautious — supplements can interact with medications. Prefer reputable brands and check with your clinician or pharmacist. Procedures and devices (use cautiously) Vaginal laser treatments (e.g., MonaLisa Touch) are marketed for vaginal atrophy; evidence is mixed and regulatory agencies advise caution — discuss risks/benefits carefully. Sexual aids (vibrators, pelvic floor devices) and sex therapy can improve sexual satisfaction. Practical next steps Identify the symptom bothering you most (hot flashes, sleep, mood, vaginal dryness, bone/heart risk). Different problems have different best non‑hormonal options. Talk to your clinician about prescription options (Brisdelle, venlafaxine, gabapentin, Osphena, etc.) and interactions/contraindications. Add lifestyle measures (exercise, sleep hygiene, trigger avoidance) and consider CBT‑I or CBT for menopause; Sleepio is a digital CBT‑I option. For vaginal symptoms try Replens or water‑based lubricants; consider pelvic floor PT. If you tell me which symptoms bother you most, I can suggest a focused plan and specific product or medication options to discuss with your clinician.
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