How to Feel Like You Again: Perimenopause Treatment
It’s good to have options! Get a tailored perimenopause treatment plan that’s prefect for YOU
Perimenopause Treatments: Finding What Works for You from Hormone Therapy to Non-Hormonal Options
Perimenopause is like puberty’s annoying cousin; it crashes the party uninvited, turns everything upside down, and refuses to follow any kind of schedule. Hot flashes? Mood swings? Restful nights (yeah, right)? Welcome to the club.
But here’s the thing: treatment isn’t one-size-fits-all. What works for your best friend might do nothing for you. And what one doctor swears by, another might barely mention. That’s because perimenopause isn’t just one experience—it’s a transition that shows up differently for everyone.
When it comes to treatment, there are two main approaches: non-hormonal options that help manage symptoms without directly messing with your hormone levels, and hormone therapy (HT) that steps in to support what your body isn’t producing as reliably anymore. Which is better? That depends on you. Your symptoms, your medical history, your risk factors, and, most importantly, what makes you feel your best.
Let’s break it down.
Non-Hormonal Treatments
If hormone therapy isn’t your thing—or it’s just not the best option for you—there are other ways to manage perimenopause symptoms effectively. Some of these medications weren’t originally designed for menopause, but science (and real-life experience) have shown they can work surprisingly well.
Hormones aren’t the only option for treating hot flashes and night sweats!
SSRIs and SNRIs: Not Just for Mood
Antidepressants like SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are surprisingly powerful options for mood swings. But here’s a little-known bonus: they also help with hot flashes.
How? These medications tweak brain chemistry in ways that seem to reset the body's internal thermostat, making hot flashes less intense and less frequent. But it’s not just about serotonin! The quick action of these meds (sometimes within hours to days for symptoms of PMDD and hot flashes) suggests there’s a broader hormonal cascade at play, one that goes beyond traditional serotonin effects. Researchers believe these meds help regulate the complex interplay between estrogen, norepinephrine, and thermoregulation in the brain.
Who might benefit? Women* dealing with mood swings, anxiety, or depression alongside classic perimenopause symptoms like hot flashes and sleep disturbances. These meds pull double duty helping regulate both your brain chemistry and body temperature.
Examples:
Paroxetine (Brisdelle, Paxil): The only FDA-approved SSRI for treating hot flashes. Also helps with mood, anxiety, and irritability (short fuse, anyone?).
Venlafaxine (Effexor) + Desvenlafaxine (Pristiq): SNRIs that target both serotonin and norepinephrine, making them powerful options for mood, focus, energy, and vasomotor symptoms (hot flashes and night sweats).
Sertraline (Zoloft) + Fluoxetine (Prozac): While not specifically approved for hot flashes, many women still find them helpful. The trick is finding the right one for you while balancing maximum benefits with minimal side effects.
How long does it take to work?
Mood effects: Typically 4-6 weeks to fully kick in.
Hot flashes: Some women notice improvement in days to a week, thanks to that rapid hormonal cascade effect.
Side effects + what to expect:
Possible nausea, headache, drowsiness, or sexual side effects (though these often fade within a few weeks).
The waiting game: Most side effects go away with time, so unless they’re not tolerable (or getting worse), it’s best to give it a few weeks before deciding if a switch is needed.
Gabapentin and Clonidine: Off-Label All-Stars
These meds weren’t originally intended for menopause, but they’ve earned a spot in the perimenopause symptom-management toolkit.
Gabapentin (Neurontin): Originally used for seizures and nerve pain, but research shows it significantly reduces hot flashes, especially for women who can’t take estrogen. Bonus? It may also help with anxiety and sleep.
How long does it take to kick in? Usually within a few days to a week.
Side effects? Dizziness, drowsiness, and fatigue, but lower doses are often well tolerated.
Clonidine: A blood pressure medication that can also reduce hot flashes, though its effectiveness is hit-or-miss.
Who might benefit? Women who can’t take the other options and maybe have borderline high blood pressure. But this medication might drop your blood pressure too much if you’re already taking meds to treat hypertension.
Downside? It can cause dizziness especially from dropping blood pressure, which isn’t ideal as we age (no one wants to risk a fall). For postmenopausal women, avoiding lightheadedness and fractures is key.
Other Non-Hormonal Medications
Oxybutynin: Originally used for overactive bladder, this anticholinergic drug surprisingly reduces hot flashes by blocking certain nerve signals involved in temperature regulation and sweat gland activity.
Who might benefit? Women experiencing moderate to severe hot flashes who need an alternative to hormone therapy. Also convenient if you have to pee really often or some annoying leakage.
Side effects? Dry mouth, constipation, and dizziness but at lower doses, it’s usually well tolerated.
Cognitive Behavioral Therapy (CBT): Okay, not a medication, but CBT is scientifically proven to help with hot flashes, anxiety, mood swings, and sleep disturbances.
Why it works: CBT reframes the way your brain interprets symptoms, lowering distress and reducing the intensity of hot flashes.
Bonus? No annoying side effects!
The Pros and Cons of Non-Hormonal Options
✔️ Pros:
Safe for women who can’t take hormones (like those with a history of breast cancer or clotting disorders).
Can improve mood, sleep, and energy along with peri/menopause symptoms.
Some options work quickly (within days for hot flashes).
Can be combined with other treatments – Many non-hormonal options work well together or alongside lifestyle changes, giving you more flexibility in symptom management.
❌ Cons:
Not specifically designed for menopause, so effectiveness can vary.
Side effects (like nausea, dizziness, or fatigue) are possible.
Some options (like SSRIs/SNRIs) take a few weeks to fully kick in.
Trial and error; finding the right med with the fewest side effects can take time.
Final Non-Hormonal Thoughts
Non-hormonal treatments can be hot flash tamers with bonus benefits for other perimenopause symptoms, especially for women who want or need an alternative to hormone therapy. While they might not work exactly the same as estrogen, they still pack a powerful punch against hot flashes, anxiety, mood swings, and sleep issues. The key is finding the right fit for you and giving it a little time to work its magic.
Not hormone replacement therapy (HRT), just HT because we’re not fixing something that’s broken!
Hormonal Treatments: What You Need to Know
If non-hormonal options aren’t cutting it, hormone therapy (HT) might be the missing puzzle piece. It works by replenishing the estrogen and progesterone your body is producing less of, helping to ease symptoms like hot flashes, brain fog, mood swings, and vaginal dryness.
Notice we’re saying “hormone therapy” (HT) instead of “hormone replacement therapy” (HRT)? That’s because menopause isn’t a disease, it’s a natural transition. The term replacement makes it sound like we’re fixing a deficiency the way you would with insulin for diabetes. But menopause isn’t a disorder, it’s a phase of life. We use hormone therapy to manage symptoms and reduce long-term health risks, not to “fix” something broken.
This section isn’t a deep dive into every hormone therapy option (that’s what your doctor is for!), but here’s an overview of the many ways you can take hormones because there are a lot. And the good thing here? Even though it may take a little while to get everything juuuuust right, it can really be tailored specifically to you!
The Many Forms of Hormone Therapy
Not all HT is created equal! There are different ways to take hormones, each with their own pros and cons.
Transdermal (patches, gels, sprays):
Absorbed through the skin, which bypasses the liver, lowering risks of blood clots and stroke compared to oral forms.
Provides consistent hormone levels, avoiding the ups and downs of oral dosing.
Complaints? Some patches don’t stick well (or too well leaving a super sticky residue) and gels/sprays can have person to person contact before they’re fully absorbed.
Combined oral contraceptive pills:
Often used for younger perimenopausal women who still need contraception.
Can help regulate periods, reduce PMS symptoms, and improve cycle-related mood swings.
Downside? Higher estrogen doses than standard HT can slightly increase blood clot risk in some women.
Oral estrogen + progesterone (non-contraceptive):
Can be used alone or with other delivery methods depending on individual needs.
Oral progesterone (like Prometrium) is often used at night because it can improve sleep—but for some, it worsens headaches or body pain.
If you have a uterus, estrogen must be balanced with progesterone to protect against endometrial overgrowth and cancer risks.
Vaginal (creams, rings, suppositories):
Best for localized symptoms: dryness, painful sex, or frequent UTIs.
Minimal systemic absorption, meaning lower risks for women with a history of breast cancer or blood clot concerns.
IUD (hormonal intrauterine device):
Provides progesterone therapy for women also taking estrogen.
Prevents pregnancy (bonus!).
Can lighten or eliminate periods (usually within the first year of use) especially helpful if your cycle is unpredictable or heavy.
Which Hormones Are We Talking About?
Each hormone plays a specific role in balancing your symptoms:
Estrogen: The star player for hot flashes, mood, vaginal health, and even skin elasticity. When levels are right, it helps maintain cognitive function, bone strength, and overall well-being.
Progesterone: Essential for balancing estrogen if you have a uterus. It can also support sleep and calm the nervous system, but in some women, it may trigger headaches or joint pain.
Testosterone: The often-overlooked hormone that can boost energy, libido, and muscle mass. But getting a prescription? That’s a different story.
Testosterone Therapy: Why Is It So Hard to Get?
Even though testosterone is crucial for women’s health, it’s not FDA-approved for women in the U.S. (despite plenty of evidence that it can help). Why? Because standard testosterone treatments are formulated for men, and there’s no FDA-approved low-dose version for women.
How is it used? Some doctors prescribe compounded formulations (custom-made versions of medications that aren’t mass-produced), but these are unregulated, meaning dosing can be inconsistent and more expensive.
Common benefits: Energy, libido, motivation, and muscle strength.
Potential downsides: Acne, hair growth, voice deepening, mood changes, and long-term unknowns.
Cost factor: Specially compounded formulations can be pricey and they aren’t covered by insurance.
For now, testosterone therapy for women remains controversial, but in the right dose and with proper monitoring, it can be a powerhouse hormone for some women.
The Evidence-Based Benefits and Risks of Hormone Therapy
✔️ Benefits:
Dramatically reduces hot flashes, night sweats, and vaginal dryness.
Can improve mood, sleep, and even cognitive function (goodbye, brain fog!).
Helps prevent osteoporosis and bone loss.
May lower risk of heart disease when started in the right age window (usually within 10 years of menopause).
Can improve joint pain and overall quality of life in many women.
❌ Risks:
Not recommended for women with certain cancer risks or clotting disorders.
Some forms (especially oral estrogen) may slightly increase blood clot or stroke risk.
Requires careful balancing; too much or too little of a hormone can cause problems (think bloating, mood swings, or breast tenderness).
Compounded formulations aren’t FDA-regulated, meaning quality, consistency, and dosing accuracy can vary between pharmacies making it harder to guarantee you’re getting the exact amount your body needs.
The Key Takeaway?
Work with a provider who actually knows menopause medicine. The right hormone therapy can be life-changing, but it needs to be tailored to your body, symptoms, and risk factors. This isn’t a one-size-fits-all deal so finding the right provider and taking the time to figure out your “magical” hormone cocktail really matters.
Vitamin D, Omega 3 fatty acids, magnesium, and probiotics are great (and safe) place to start
The Role of Supplements: Be Wary
There’s a lot of hyper around “natural” remedies for perimenopause, but here’s the deal: supplements are barely regulated, and most don’t have solid scientific backing. That doesn’t mean they’re all useless, but it does mean you should be selective about what you take and pay close attention to how it helps (or doesn’t).
What to Watch Out For:
Popular options like black cohosh, evening primrose oil, and soy isoflavones show some promise, but research is mixed. Some women swear by them, while others see zero improvement.
Lack of oversight means quality and potency can vary wildly between brands. Just because a label says it contains something doesn’t mean it actually does or that it’s in an effective dose.
If a supplement actually worked as well as HT, pharmaceutical companies would be all over it. That’s just how the industry works.
What Might Be Worth Taking?
Some standard dietary supplements have been shown to support overall health during perimenopause:
Vitamin D3 + Magnesium – Supports bone health, mood, and sleep. (Most women are deficient in vitamin D—if you’re not sure, ask your doctor for a blood test!)
Omega-3 Fatty Acids (Fish Oil or Algal Oil) – May help with brain function, heart health, and inflammation.
Probiotics – Some strains may help with gut health and hormone metabolism, though research is ongoing.
If you’re considering supplements, talk to a knowledgeable provider before spending money on trendy menopause “cures.” And if you’ve heard the term “bioidentical” a lot lately, you should check out this YouTube video. It’s not as fancy as the marketers want us to believe!
If you can’t find an in-person doctor, telemedicine is also an option!
Who Should You Work With?
Unfortunately, finding a doctor who really understands perimenopause can be like getting through a Target run without buying at least one thing you don’t need. Many doctors aren’t trained in menopause care, and it’s barely covered in medical school. But you can find providers who specialize in this transition, it just takes a little digging.
Primary Care Providers or Family Doctors: A good first stop, but not all are well-versed in menopause care. Some may refer you to a specialist if they’re not confident managing your symptoms.
OB/GYNs: They should know their stuff, but many focus more on pregnancy and childbirth than perimenopause. Still, some OB/GYNs have a special interest in menopause management, so it’s always worth asking.
Endocrinologists: Since hormones are literally their thing, some endocrinologists specialize in menopause-related hormonal shifts. They’re particularly useful if you have thyroid issues, PCOS, or other endocrine conditions alongside perimenopause.
Reproductive Psychiatrists: Great for addressing mental health shifts that come with hormonal changes, including mood swings, anxiety, depression, and sleep disturbances.
Pro tip: Look for providers certified by the North American Menopause Society (NAMS) or those who explicitly list menopause management as a specialty on their website. (You can even search the NAMS provider directory!)
You’ve got this!
Conclusion: It’s About Feeling Like You Again
There’s no “right” way to treat perimenopause, only the way that makes you feel better. Whether it’s tweaking lifestyle habits, trying non-hormonal meds, or opting for hormone therapy, your treatment should be about living well, not just enduring symptoms.
And here’s the thing: You don’t have to figure it all out alone. If your current doctor isn’t listening or keeps telling you to “just wait it out,” it’s time to find someone who will take your symptoms seriously.
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You deserve to feel good in your body—now and in the years ahead.
*In this article, I’ll often use the term 'women' to describe people born with a uterus and/or ovaries, as they are the group most commonly affected by perimenopause and menopause. However, I want to acknowledge that not everyone with these biological traits identifies as a woman, and not all women experience menopause. While I’ll use 'women' for simplicity and clarity, this information is meant for anyone navigating the hormonal changes associated with this life stage, regardless of how they identify.
