7 Effective Perimenopause Treatments

Perimenopause is a natural and transformative phase in a woman’s life. While this stage can bring symptoms like hot flashes, night sweats, vaginal dryness, menstrual irregularities, and mood changes, these are manageable with the right approach.

This article highlights effective ways to address perimenopause symptoms, helping women navigate this transition with confidence and comfort. From lifestyle adjustments and hormone replacement therapy (HRT) to alternative therapies, there are many strategies to find relief and maintain a high quality of life. 

Seven Best Treatments for Perimenopause

Before exploring effective treatment options for managing perimenopausal symptoms, it’s essential to know that this phase can affect each woman differently, and no single treatment works for everyone. A holistic approach, combining lifestyle adjustments, medical treatments, and alternative therapies, provides the best chance for relief and balance.

1. Lifestyle Changes

Lifestyle changes form the foundation of managing perimenopause symptoms. Adopting healthier habits can ease discomfort and enhance physical and emotional well-being:

• Balanced Nutrition: Leafy greens contain folate that’s seen to support serotonin levels, improving mood and soothing anxiety. A diet rich in omega-3 fatty acids, including fatty fish, flaxseeds, and walnuts, can boost mood and may help alleviate menopausal symptoms like anxiety. Fiber-filled choices like whole grains, fruits, and legumes are great for digestive health and may help manage weight changes during menopause.⁽¹⁾

• Regular Exercise: Physical activity boosts energy, improves mood, and supports heart and bone health. Low-impact exercises like walking, yoga, and swimming are ideal for maintaining fitness and reducing stress. Engaging in at least 60 minutes of physical activity a day has been shown to improve menopausal symptoms and overall well-being.⁽²⁾

• Quality Sleep: Sleep challenges are common during perimenopause, often a result of night sweats and anxiety. This makes good sleep an essential self-care practice in this phase. Establishing consistent sleep routines, avoiding screens before bed, and creating a calm, dark environment can help improve sleep disrupted by night sweats or insomnia.⁽³⁾

• Stress Management: Mindfulness practices, such as meditation or deep breathing, can reduce anxiety and help women feel more balanced during this transitional phase.

• Moderate Use of Stimulants: Excessive alcohol intake can exacerbate symptoms like hot flashes and disrupt sleep quality. Limiting alcohol and avoiding smoking are crucial self-care steps.⁽⁴⁾

2. Cognitive Behavioral Therapy (CBT)

CBT is a therapeutic approach that helps identify and reframe negative thought patterns, providing tools to cope with stress, mood swings, and anxiety. By improving emotional well-being, CBT enables individuals to navigate this phase with greater confidence and resilience.⁽⁵⁾

3. Non-Hormonal Medications

Some non-hormonal medications can help manage symptoms like hot flashes and mood swings:

• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can help alleviate mood disorders. Research highlights their benefits for hot flashes as well. For instance, paroxetine, an SSRI, reduced hot flashes by 62% in a study of women experiencing two to three hot flashes daily, compared to a 37.8% reduction with a placebo.⁽⁶⁾

• Fezolinetant: This medication targets neurokinin B receptors in the brain, reducing signals that trigger hot flashes and night sweats. A 12-week study showed that women taking fezolinetant experienced a 63% reduction in hot flashes, compared to a 42% reduction with a placebo.⁽⁷⁾

• Clonidine: Clonidine helps expand the thermoneutral zone, allowing the body to stabilize its core temperature more effectively. Studies have shown that oral clonidine reduces hot flash frequency by 46%.⁽⁶⁾

These treatments should always be prescribed and monitored by a physician to ensure safety and effectiveness.

4. Pelvic Floor Exercises

Pelvic floor exercises like Kegels can strengthen the pelvic floor muscles, which are essential for maintaining bladder control and preventing urinary incontinence. To locate these muscles, individuals can try stopping their urine flow midstream. However, this should only be done as a one-time test. Regularly doing so during urination can lead to incomplete bladder emptying and increase the risk of infections.⁽⁸⁾

These exercises can be performed in any position — standing, sitting, or lying down. The process involves contracting the pelvic muscles, holding the contraction for three to five seconds, and then fully relaxing for the same duration. Repeating this cycle 10 times per session and aiming for three sessions daily can significantly improve muscle strength and bladder function.⁽⁸⁾

5. Vaginal and Urinary Health Best Practices

Maintaining vaginal health is essential during perimenopause, especially for managing symptoms like dryness and discomfort. Practical tips include the following:^(9)(10)

• Avoiding products with perfumes, powders, or chemicals around the vulva and urethra to reduce irritation

• Wearing loose clothing and minimizing prolonged use of sanitary or continence pads to prevent discomfort

• Using vaginal moisturizers, lubricants, or estrogen creams to support hydration and alleviate dryness

• Practicing double voiding (emptying the bladder twice) to ensure complete bladder emptying and reduce the risk of urinary incontinence

6. Alternative Therapies

Alternative therapies can provide additional support for managing perimenopause symptoms:⁽¹¹⁾

• Acupuncture: Some women find that acupuncture helps reduce the intensity and frequency of hot flashes.

• Massage Therapy: Regular massages can relieve muscle tension, reduce stress, and improve sleep quality.

• Relaxation Techniques: Practices like yoga, deep breathing, and mindfulness can help manage stress and improve overall well-being.

While evidence for these approaches may vary, many women find them beneficial as part of a holistic treatment plan.

7. HRT

HRT is a viable and effective option for managing perimenopause symptoms by restoring hormonal balance. It addresses a variety of concerns, from hot flashes and mood swings to bladder discomfort and vaginal dryness. With several types of HRT available, it offers flexible and personalized solutions to meet the unique needs of women during this transitional phase.

Systemic estrogen is one of the most effective treatments for managing hot flashes during menopause, with studies showing it can reduce their frequency by up to 75%.⁽¹²⁾ Estrogen also supports bladder health by improving the thickness and elasticity of urogenital tissues.

For women with a uterus, progesterone is added to HRT to protect the endometrium (uterine lining). Estrogen alone can cause the endometrium to thicken, increasing the risk of endometrial hyperplasia. Progesterone balances this effect, ensuring that HRT is effective and safe.

Types of HRT

HRT can be categorized based on its delivery method and the types of hormones used. Understanding these types helps tailor treatment to individual symptoms and preferences.

Systemic HRT

Systemic HRT delivers hormones throughout the body and is commonly administered via patches, tablets, or creams. It’s effective in relieving widespread symptoms like hot flashes, night sweats, mood swings, and urinary issues like urgency and painful urination.

Localized HRT

Localized HRT targets specific areas, such as vaginal or urinary tissues, using treatments like vaginal creams. This approach is particularly effective for addressing genitourinary symptoms, including vaginal dryness, discomfort, and stress incontinence. It also helps prevent further atrophy and reduces the risk of recurrent urinary tract infections.

Synthetic vs. Bioidentical HRT

There are two main types of HRT, classified by the types of hormones used:

• Synthetic HRT: These hormones are created in laboratories to mimic the body’s natural hormones. 

• Bioidentical HRT: Bioidentical hormones have the same molecular structure as the hormones naturally produced by the body, making them more closely aligned with the body’s biological processes. Because of this similarity, bioidentical HRT is often perceived as more natural and may be associated with fewer adverse effects in some cases.

Embracing a Holistic Approach to Perimenopause

Perimenopause affects each woman differently, making it essential to adopt a holistic and personalized approach to treatment. HRT offers versatile options, from systemic solutions that address broad symptoms like hot flashes and mood swings to localized treatments for specific concerns like vaginal dryness or urinary discomfort. By consulting a healthcare provider, women can determine the most suitable HRT options or other treatments for their unique needs.

A well-rounded approach that combines lifestyle changes, medical treatments, and alternative therapies provides the best chance for relief and balance. This ensures that both physical and emotional challenges are addressed, empowering women to navigate this phase with confidence and well-being.