Hormone therapy is the most effective treatment for hot flashes and night sweats. For women who can’t or won’t take it, the best-supported options are cognitive behavioral therapy, clinical hypnosis and some prescription nonhormone drugs. Herbs and supplements are not on that list.
This page covers what has evidence for perimenopause symptoms, what doesn’t, and what to ask your doctor. If your main problem is mood, see our page on herbal supplements for perimenopause mood swings.
What is perimenopause and how long does it last?
Perimenopause is the time leading up to menopause, also called the menopausal transition. Most women start between ages 45 and 55. Estrogen and progesterone decline greatly during it, and symptoms can last between two and eight years. The NIA also calls menopause a normal part of aging (NIA).
Symptoms include hot flashes, night sweats, trouble sleeping, moodiness and irritability, forgetfulness, trouble concentrating and pain during sex. Some women have none or only mild ones, and many don’t need treatment.
Which treatments have the best evidence?
The Menopause Society’s 2023 position statement graded nonhormone options for hot flashes and night sweats. Level I means good and consistent evidence (Menopause Society 2023).
| If you want | What the panel said |
|---|---|
| The most effective treatment | Hormone therapy, considered for women within 10 years of their final period |
| A nonhormone option with Level I evidence | Cognitive behavioral therapy, clinical hypnosis, SSRIs or SNRIs, gabapentin, fezolinetant |
| A non-drug option | Weight loss, recommended at Levels II to III |
| To try supplements or herbs | Not recommended (Levels I to II) |
Some options were also not recommended for hot flashes. That includes paced breathing, exercise, yoga, mindfulness, relaxation, soy foods and acupuncture. Most of those were rated Level II, meaning the evidence was limited or inconsistent.
The statement covers hot flashes and night sweats only. It also says hormone therapy isn’t suited to everyone, for example women with estrogen-dependent cancers or cardiovascular disease. Your doctor can weigh that for you.
Do natural remedies work for perimenopause?
The evidence is mixed. A 2024 meta-analysis of 67 studies of plant-derived supplements (28 soy, 6 red clover and 28 other), found improvement over placebo in hot flash frequency and symptom scores. The authors still called the evidence generally suboptimal and heterogeneous, with 24% of studies rated low quality (Oh et al., 2024).
Individual herbs look weaker. The Cochrane review of black cohosh pooled 16 trials with 2,027 women. It found no difference from placebo in hot flush frequency or menopausal symptom scores (Leach and Moore, Cochrane 2012).
One 8-week trial of 100 perimenopausal women found an ashwagandha extract improved menopausal symptom scores more than placebo (Gopal et al., 2021). It is one trial.
Are natural remedies safe?
Not automatically. LiverTox rates black cohosh category A, a well-established cause of clinically apparent liver injury. It lists more than fifty cases, some ending in liver failure needing a transplant or in death (LiverTox).
Ashwagandha is category B, a likely cause of liver injury, with rare fatal cases and transplants, particularly in people with existing liver disease (LiverTox).
If your skin or eyes turn yellow on either one, stop and get medical care. The mood-herb details, including St John’s wort and birth control, are on our mood swings page.
The NHS adds that herbal products aren’t tested and regulated like medicines. It says quality, purity and ingredients can’t always be guaranteed. It also says red clover contains plant hormones that can act like estrogen, and “natural” doesn’t necessarily mean safe (NHS).
What can you do day to day?
For mild symptoms, the NIA suggests avoiding caffeine, dressing in layers and carrying a portable fan. See your doctor if you have:
- Periods very close together
- Heavy bleeding
- Bleeding or spotting after sex or between periods
- Periods lasting more than a week
- Bleeding again after a full year with no period
Don’t treat these as normal perimenopause without checking.
What should you ask your doctor?
- Is hormone therapy an option for me, given my history?
- If not, would cognitive behavioral therapy, hypnosis or a nonhormone drug help?
- Is it safe to add a supplement to what I already take?
- Which symptoms should I track before my next visit?
The NIA says to see your doctor every year to review your treatment plan. Don’t stop a prescribed medicine to try a herb.
Questions
Do natural remedies work for perimenopause?
Evidence is mixed. A 2024 meta-analysis found improvements over placebo, but called the evidence suboptimal and heterogeneous. The Menopause Society did not recommend supplements for hot flashes.
What is the most effective treatment for hot flashes?
The Menopause Society calls hormone therapy the most effective treatment and says to consider it for women within 10 years of their final period. Talk to your doctor about whether it fits you.
What nonhormone treatments are recommended?
The 2023 statement recommends cognitive behavioral therapy, clinical hypnosis, SSRIs or SNRIs, gabapentin and fezolinetant at Level I.
Is black cohosh safe?
LiverTox documents more than fifty cases of liver injury linked to products sold as black cohosh, some severe. Stop and get medical care if your skin or eyes turn yellow.
How long does perimenopause last?
The NIA says symptoms can last between two and eight years, and the timing varies widely.