Journal / Menopause

Effective Perimenopause Treatments

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated October 14, 2021

“Am I in perimenopause?” This can be a very troubling question for many women. Most women want to hold onto their youth as long as possible and let’s face it, menopause just feels ‘old.’  Don’t let the stigma of menopause keep you from receiving effective perimenopause treatments. At Winona, we are creating modern menopause that is not old, not even close! Winona understands the continued need to feel relevant, desirable, valued, and yes – young.

Winona Women can continue to grow, but we don’t have to ‘grow old.’ Effective treatments, like hormone replacement therapy (HRT), are available to help you view this stage as a positive beginning, with opportunities to take preventive action against health risks associated with the ever-decreasing hormones as we age.

What is Perimenopause?

Starting in their 30s or 40s, women will produce less of the hormones estrogen, progesterone, and testosterone. This stage is called perimenopause. Eventually, with the continued drop of estrogen, progesterone, and testosterone levels, menstrual periods will stop entirely, and menopause will officially begin.

Suddenly, waking up at night in a sweat, or having heavy, irregular periods is a new normal. These symptoms indicate the arrival of perimenopause. Just like every woman is unique, so are perimenopause symptoms. Some women feel overwhelmed by hot flashes and exhausted by heavy periods, while others have no obvious perimenopause symptoms. The average duration of perimenopause is 3-4 years, but the duration can range from a few months to a decade. Once a woman has had 12 consecutive months of no menstrual period – then menopause begins.

By denying the onset of perimenopause, women will also deny themselves of all the relief opportunities and benefits they can achieve from the effective treatments for perimenopause available at Winona. Treatments can relieve perimenopause symptoms including hot flashes, night sweats, anxiety, weight gain, mood swings, hair loss, wrinkles, loss of libido, insomnia, joint pain, UTIs, and depression.1-4

Perimenopause starts earlier than most people expect. About 10% of women go through perimenopause before they turn 40! If the drop in hormones that occur in perimenopause is not corrected, women are at a greater risk of heart attack, diabetes, colon & breast cancer, stroke, bone disease, dementia, and even suicide.1

The Top 10 Perimenopause Symptoms and Treatments:

  1. Hot Flashes (Vasomotor symptoms) – Hot flashes are likely the most obvious sign of perimenopause. They are caused by a decreased production of the hormone estrogen and occur naturally as women approach perimenopause.  Hot flashes are a sudden feeling of warmth that spreads over the body, creating flushing and sweating, especially on the face and upper body.

    • Try to avoid triggers such as warm weather, hot beverages, and spicy foods.

    • Keep a record of your hot flashes to figure out what may be triggering them.

    • Dress in layers so you can remove clothes as needed.

    • Some antidepressants (SSRIs or SNRIs) can help reduce hot flashes.

    • Yoga and slow deep breathing techniques may help.

  2. Night Sweats & Sleep Disorders – Severe hot flashes that occur during sleep and accompanied by profuse sweating are ‘night sweats.’  Many women experience severe night sweats, which cause disruptions to sleep and can lead to increased irritability, depression, and weight gain.

    The drop in hormones during perimenopause can cause women to wake-up many times during the night, tossing, turning, and suffering from insomnia. Women going through perimenopause may find that their sleep is less restful and actually getting to sleep becomes increasingly difficult.

    Hormone replacement therapy is THE most effective natural treatment for night sweats, but women can also think about the type of bedding they use and find sheets and looser-fitting sleepwear that are cool such as cotton. Layered blankets that are easy to remove can help too. Some women have tried a ‘chill pillow’ filled with water. An old favorite is a fan or multiple fans.

  3. Weight Gain & Metabolism Changes – Hormonal changes during perimenopause influence weight gain and the redistribution of fat.  With perimenopause, not only are the hormones estrogen and progesterone decreased but so is testosterone. A decrease in testosterone can lead to less lean muscle and increased fatigue. These factors combined can result in a decreased metabolic rate. From perimenopause onwards, women need fewer daily calories. Hormone treatment can revitalize metabolism and assist with weight loss.

  4. Irregular periods and heavy bleeding- HRT or Low-dose birth control pills can help reduce bleeding by modulating menstrual flow, regulate periods, and stabilize endometriosis. They also can decrease the number of hot flashes, reduce vaginal dryness, and prevent bone loss. Oral contraceptives can be taken until menopause.

  5. Skin Changes – When estrogen and testosterone levels drop during perimenopause it shows in your skin almost immediately. Collagen is what keeps skin toned, fresh-looking (plump), and prevents wrinkles. As estrogen and testosterone drop, so does the production of collagen. During perimenopause, a woman may notice her skin getting thinner, drier, less youthful-looking, and small wrinkles deepening. Hormone replacement therapy can help correct for the drop in estrogen and testosterone and help your skin to remain youthful-looking.

  6. Fatigue &  Achy Joints – Joint pain is one of the most common symptoms of menopause. Joint pain is often related to the effects of fluctuating hormone levels on your immune system. Estrogen and testosterone work together to help prevent inflammation in the joints. When there are lower levels of estrogen and testosterone during perimenopause you can experience increased inflammation and joint pain.

    One of the most common perimenopause symptoms is an ongoing, persistent feeling of weakness, tiredness, and low energy. When fatigued, you might become more irritable, with a decreased attention span. There is nothing wrong with you, the hormones estrogen and testosterone help to regulate energy use at a cellular level and have simply dropped. So, when estrogen and testosterone levels drop during perimenopause, so do your energy levels. Adding back these natural hormones can give you back the energy that you would like to restore.

  7. Loss of Sex Drive & Vaginal Dryness/Atrophy – In perimenopausal, the main cause of low sex drive and vaginal changes are hormonal imbalances. Libido can also be impacted by other perimenopause symptoms such as vaginal dryness, pain during intercourse, and/or depression that can be treated with hormone replacement therapy. When estrogen and testosterone levels drop, the vaginal tissue becomes drier, thinner, less elastic and the vagina can become smaller.

    Lack of lubrication can lead to sex becoming uncomfortable, and the vagina is frequently itchy, easily irritated, and more prone to infections. Hormone replacement therapy (HRT), Low-dose contraceptives, or vaginal estrogen (in a cream) can help relieve vaginal dryness. Vaginal moisturizers can also increase vaginal moisture and elasticity. Continued sexual activity will improve vaginal tone and protect against infections. Lubricants can make intercourse less painful.  Adding testosterone back to your body can significantly increase your interest in sex and your ability to have an orgasm.

  8. Mood Swings, Anxiety, Irritability, and Depression – Perimenopausal mood swings are very common. Depression, anxiety, and irritability during perimenopause can be caused by the sudden drop in estrogen, progesterone, and testosterone levels. When these three hormones drop, so does the production of chemicals responsible for mood regulation, called serotonin and dopamine.

    Some women in perimenopause can try hormone replacement therapy (HRT) or Low-dose birth control pills to suppress the erratic hormonal ups and downs of perimenopause. Some women say they feel more even-tempered using hormones. Fixing the underlying hormonal imbalance is one of the most effective ways of reducing perimenopausal mood swings. It is vitally important to seek the advice of a healthcare professional to help mitigate these changes in mood and to recognize these changes as symptoms of perimenopause.

  9. Difficulty with Concentration, Memory, Fogginess, and Even Dizziness – Many women are alarmed to discover they have trouble remembering things, experience mental blocks, or have difficulty concentrating as they enter perimenopause. This can be a concerning time for women and can have an adverse impact on all aspects of daily life.

    Caused by fluctuating estrogen levels, women can experience a dizzying spinning sensation, that may be accompanied by a feeling of light-headedness or unsteadiness, which are unfortunate perimenopause episodes.

  10. Incontinence – Estrogen replacement can return the vaginal tissue to a more youthful state giving better support to the bladder and urethra. Additional testosterone replacement (at very low levels) can also help strengthen the vaginal tissues. The addition of these hormones can go a long way to improve urinary incontinence. Incontinence in menopausal women can be divided into three types. As estrogen and testosterone levels drop, vaginal tissues supporting the bladder and urethra thin and become weaker. This can manifest in several ways.

  • Stress Incontinenceyou pee while laughing, coughing, sneezing, or with exertion. This usually happens when the internal muscles fail due to age, surgery, or childbirth.

  • Urge Incontinence you are trying to ‘hold it,’ but your bladder doesn’t listen and empties.

  • Overflow Incontinence you are not fully aware your bladder is full and accidentally urinate.

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Why Is Fitness Important In Perimenopause? 

Hot flashes can absolutely be treated and tamed. Beyond taking hormone replacements, small lifestyle changes can make a big difference in the number, and severity of hot flashes. Some of these changes can help reduce many menopause symptoms, while others will simply contribute toward overall feelings of wellness:

  • Exercise! Regular, vigorous exercise may decrease hot flashes but exercise in a cooler environment. Exercise can improve metabolism, energy levels, and improve joint health which can greatly improve physical and mental health. Exercise can also help treat osteoporosis — especially weight-bearing exercises. Women who don’t exercise regularly, and are sedentary suffer more from perimenopause symptoms.  You choose what you prefer, mix it up, but try to get in some exercise regularly.

  • Yoga, meditation, and relaxation have been shown over and over to help reduce perimenopause symptoms.

  • Try to quit smoking. Smokers tend to experience more hot flashes, and smoking is linked to early signs of menopause.

  • Acupuncture may help to limit the severity and frequency of symptoms.

  • Maintaining a healthy weight can help to minimize menopausal symptoms. Women who are overweight tend to have more trouble with hot flashes, sleep, and anxiety. Therefore weight loss can be helpful.

  • Practice deep breathing exercises in the morning and evening.

Other Effective Treatments for Perimenopause:

The good news is that perimenopause and menopause have been studied for over 30 years! It is clear that estrogen,  progesterone, and even testosterone therapy, or hormone replacement therapy (HRT), is the best natural remedy and effective treatment for perimenopause symptoms. Scientists have yet to identify a more effective remedy for perimenopause symptoms, specifically hot flashes treatment, than HRT.

As we learn more about aging, we are able to provide specific, effective treatment options for perimenopause symptoms. HRT can restore proper hormone levels using bioidentical hormones that are indistinguishable from what the body used to produce on its own.
There are other options for women who are not candidates for hormone replacement due to their medical history. Whether you are able to take HRT or not, focusing on a healthful diet, regular exercise, and using menopause-focused multivitamins can all help reduce perimenopause symptoms.

General Remedies for Perimenopause Symptoms

Each woman’s nutrient needs change with age so it is important to choose supplements that are tailored for your age. Women in perimenopause have to be proactive about regularly taking key vitamins and minerals to support their overall health. But the process of deciding which vitamins and supplements to take can be challenging.

The truth is, the best way to get necessary vitamins, minerals, and antioxidants is through a well-balanced and colorful diet, but most people’s diets have gaps. If you do not consistently reach the daily nutritional requirements, you could be missing out on vital elements your body needs to help lessen or alleviate everything from hot flashes to mood swings, and to protect you from cardiovascular disease, and mental declines. Multivitamins can ensure that all of the needed nutrients are provided daily.

Winona provides safe, regulated vitamin supplements that are specially designed to ease menopausal symptoms, and support healthy aging. We recommend trying our nutritious and tasty gummy vitamins designed specifically for peri- and menopause.2 

Herbal Supplements: Many women use herbal supplements to manage their menopause symptoms including the root of Black Cohosh, Soy, and flaxseed. While these herbal supplements are sold widely, Winona does not suggest using them. Botanicals and herbs may have side effects, poor oversight, or change how other medications work.

The list of alternative therapies include:

  • Ginseng: (Panax ginseng or Panax quinquefolius) Research has shown that ginseng may help with some menopausal symptoms, such as mood symptoms and sleep disturbances, and with one’s overall sense of well-being.

  • Soy. Including soy products in moderation in your diet may ease your perimenopause symptoms. Soy contains a plant-based estrogen called isoflavones, so it may help adjust the lowered estrogen in your body, but the evidence is unclear.

  • Black Cohosh: (Actaea racemosa, Cimicifuga racemosa) Is an herb that has received quite a bit of attention for its possible effects on hot flashes. However, studies looking at its effectiveness in reducing hot flashes have produced mixed results. 
    Recent research suggests that black cohosh does not act like estrogen (the hormone you are losing during perimenopause) to reduce hot flashes. Black cohosh has been linked to liver problems and this connection continues to be studied. Winona does not offer or recommend Black Cohosh for these reasons.

  • Red Clover: (Trifolium pratense) In controlled scientific studies, there has been no consistent or conclusive evidence that shows that red clover leaf extract reduces hot flashes. However, some women claim that red clover has helped them. Some studies report few side effects, but other studies have raised concerns that red clover may have harmful effects. Winona does not offer or recommend Red Clover for these reasons.

  • Dong Quai: (Angelica sinensis) Dong quai has been used in traditional Chinese Medicine to treat gynecologic conditions for more than 1,200 years. Clinical studies conducted on dong quai have determined that this botanical therapy was not found to be useful in reducing hot flashes. Dong quai should never be used by women with fibroids or blood-clotting problems, or by women taking drugs that affect clotting such as warfarin (Coumadin) as bleeding complications can result. Winona does not offer or recommend Dong quai for these reasons.

  • Kava: (Piper methysticum) Kava may decrease anxiety, but there is no evidence that it decreases hot flashes. Warning: Kava has been associated with liver disease. The FDA has issued a warning to patients and providers about kava because of its potential to damage the liver. Winona does not offer or recommend Kava for these reasons.

  • Evening Primrose Oil: (Oenothera biennis) This botanical is also promoted to relieve hot flashes. However, scientific studies found there is no benefit to reducing hot flashes. Reported side effects include inflammation, problems with blood clotting and the immune system, nausea, and diarrhea. Evening primrose oil should not be used with anticoagulants. Winona does not offer or recommend Evening Primrose Oil for these reasons.

*Please note: Herbal supplements are not regulated, so you don’t know for sure what the ingredients are and how they are produced. Just like other medicines, herbal medicines also have side effects and risks. So talk with your doctor or nurse before you take any herbal supplements. Research hasn’t proven that these therapies are safe or effective. Be aware of any potential interactions of herbal supplements before you try any remedy. Soy products can interact with antidepressants and synthetic estrogen and may increase your risk of other health conditions. Ginseng can cause insomnia and headaches if you take too much of it. If you feel the need to try natural remedies for your perimenopause symptoms, try one at a time and communicate with your physician.


While perimenopause is a normal phase of life, there are ways to treat the often-chronic symptoms that result from it. Winona encourages women to try various treatment options whether HRT, diet, or lifestyle changes to identify what works best for them. Perimenopause is a positive beginning, with the opportunity to take preventive action against major health risks associated with the decreasing hormones associated with menopause.

For perimenopause symptoms,  estrogen and progesterone therapy are the best perimenopause treatments and the most effective natural remedy treatment. Hormone replacement is a safe and physiologically natural way for a woman to regain her vitality, and HRT can restore proper hormone levels using substances that are bioidentical to those produced by your own body.

Winona offers our female patients a unique experience. Winona’s healthcare platform is a place to safely connect with a healthcare provider to receive care, to ask sometimes difficult and maybe even embarrassing questions. Winona is not just a site to get a quick prescription. The decision to treat and whether to prescribe a product available through Winona is up to the patient and their Winona affiliated providers who are all licensed, board-certified, and never financially motivated to prescribe.

Winona is proud of our doctors, providers, and scientists who work tirelessly to treat all of the symptoms of menopause in the most effective way. That treatment might be a prescription or it could be one of our many over-the-counter treatments, but it will be the treatment that the patient and their doctor devise together.

Whether experiencing severe or minor symptoms, natural remedies may help ease the side-effects of menopause.  If women embrace their evolving bodies by providing the nutrients their body needs they can move through this sometimes precarious phase with grace and wellness.

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”