Drug therapy is often used to treat perimenopausal symptoms.

  • Hormone therapy. Systemic estrogen therapy — which comes in pill, skin patch, gel or cream form — remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose needed to provide symptom relief for you. If you still have your uterus, you'll need progestin in addition to estrogen. Systemic estrogen can help prevent bone loss.
  • Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal tablet, ring or cream. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissue. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
  • Antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may reduce menopausal hot flashes. An antidepressant for management of hot flashes may be useful for women who can't take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
  • Gabapentin (Neurontin). Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can't use estrogen therapy for health reasons and in those who also have migraines.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.

Alternative medicine

In addition to conventional therapies, many women transitioning toward menopause want to know more about complementary and alternative approaches to treating symptoms. Researchers are looking into these therapies to determine their safety and effectiveness, but evidence is still often lacking.

Some of the options studied include:

  • Black cohosh. This herb extract is used by some women to treat hot flashes and other menopausal symptoms. There's not enough evidence to support its use. Experts also are unsure of what risks taking black cohosh poses. Past studies suggested that black cohosh was harmful to the liver, but a more recent review of studies found no evidence that this is true. Researchers also question whether the herb extract is safe for women with or at risk of breast cancer.
  • Phytoestrogens. These estrogens occur naturally in certain foods. Two main types of phytoestrogens are isoflavones and lignans. Isoflavones are found in soybeans, chickpeas and other legumes. Lignans occur in flaxseed, whole grains, and some fruits and vegetables. There are also plant-derived compounds that have estrogen-like properties.

    Isoflavone supplements generally come from soy or red clover. Lignans come mainly from flaxseed. Studies on phytoestrogens — whether from food or supplements — conflict on whether they help reduce menopausal symptoms. Studies also conflict on whether it's possible that phytoestrogens could increase the risk of breast cancer or interfere with the effectiveness of tamoxifen.

  • Bioidentical hormones. The term "bioidentical" implies the hormones in the product are chemically identical to those your body produces. However, compounded bioidentical hormones aren't regulated by the Food and Drug Administration (FDA), so quality and risks could vary. There's also no evidence that compounded bioidentical hormones are safer or more effective than convention hormone therapy.
  • Dehydroepiandrosterone (DHEA). This natural steroid produced by your adrenal gland is available as a dietary supplement and has been used by some to improve sexual interest. But evidence on its effectiveness is mixed, and there are some concerns about possible harmful effects.

Low-risk complementary therapies, such as acupuncture, yoga and paced breathing may help reduce stress and improve psychological well-being. Research on acupuncture for decreasing hot flashes is inconclusive, but promising. Relaxation can help reduce stress, which may in turn help improve menopausal symptoms.

Talk with your doctor before taking any herbal or dietary supplements for perimenopausal or menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.