Perimenopause without HRT: what can help with symptoms?

Yes, there is support for perimenopause symptoms without HRT. Habits around sleep, temperature and exercise, CBT (cognitive behavioral therapy) and some non-hormonal prescription medicines can ease hot flashes, poor sleep and low mood.[1][3] The research on herbs and acupuncture is mixed, and herbal products can interact with other medicines.[2][4][5]

I often get asked whether you have to choose: HRT or something else. You don’t. The decision about hormone therapy is one you make with your doctor. I work in parallel with your doctor, whether or not you take HRT, and the plan for sleep, food and stress works either way.

Why many people look for support without HRT

The reasons vary. Some people can’t take hormones for medical reasons. Others want to wait, or want to see first what changes in sleep, food and stress can do. And some already take HRT and still have symptoms they want more support with.

All three are common among my clients. There’s no right or wrong here, only what fits you and your health right now.

Perimenopause can also last a long time. The NHS says symptoms usually last 7 to 9 years, sometimes longer, and that they can change along the way.[6] So it helps to have a few things that work for you in daily life, whatever you decide about hormones.

If you live in Sweden, 1177 notes that you take part in decisions about your care.[7] Bring a list of your symptoms to your vårdcentral (local primary care clinic) or gynecologist. It makes the conversation about HRT, or about alternatives, more concrete. You can read more in the guide to menopause care in Sweden.

Daily habits that can ease symptoms

The NHS has a list of things you can do yourself.[1] It looks simple, but for many people it makes a difference day to day.

For hot flashes and night sweats:

• light, breathable clothing and a cool bedroom
• a cool shower, a fan or a cold drink when a flash comes
• fewer triggers, like spicy food, caffeine, hot drinks, smoking and alcohol
• regular exercise and less stress

For sleep:

• plenty of rest and regular sleep routines

For mood:

• rest when you can and regular exercise
• something that helps you unwind, such as yoga, tai chi or meditation
• talking to others going through the same thing

For your bones:

• weight-bearing exercise, like walking, running or dancing, and strength training
• calcium-rich food, some sunlight on your skin and, if needed, vitamin D
• stopping smoking and cutting down on alcohol

There’s more about the nights in the articles on night sweats in perimenopause and perimenopause insomnia.

CBT and other options from your doctor

CBT is a talking therapy. According to the NHS, it can help with hot flashes, sleep problems, low mood and anxiety.[1] In Sweden, 1177 mentions CBT for sleep problems, counseling for worry or low mood, mindfulness for stress and physiotherapy for pain.[7]

There are also non-hormonal medicines. The NHS mentions clonidine, a prescription tablet that can reduce hot flashes and night sweats, and antidepressants if you’ve been diagnosed with depression or anxiety.[3] These are prescribed by a doctor, so they’re a conversation to have at your vårdcentral.

Herbs and supplements: what the research says

I want to be honest here. The NHS says some herbal remedies may help with certain symptoms, but that this is not supported by scientific evidence.[2] It’s also unclear what doses to use and whether any benefit lasts.

One example is black cohosh. A Cochrane review of 16 trials with 2,027 women found no difference from placebo in how often hot flashes came.[4] The authors concluded there is not enough evidence to support black cohosh for menopause symptoms.

The NHS also points to quality. Herbal products are not tested and regulated the same way as medicines, and their quality, purity and ingredients can’t always be guaranteed.[2] “Natural” doesn’t mean free of side effects. Some, especially St John’s wort, can cause serious side effects together with other medicines.

Chinese and Western herbs are among the tools I use in perimenopause and menopause. That’s exactly why we always go through the medicines and hormones you take before I recommend anything, and I explain why each part of your plan is there.

Acupuncture for hot flashes

Japanese-style acupuncture is my main style, and I often get questions about the research. A 2013 Cochrane review included 16 trials with 1,155 women, most of them small and short.[5]

• Compared with sham acupuncture: no clear difference in how often hot flashes came
• Compared with no acupuncture at all: fewer and milder flashes, but the evidence was low quality
• Compared with hormone therapy: more flashes per day with acupuncture

The authors concluded there wasn’t enough evidence to say whether acupuncture works for hot flashes. If you’re curious, we can look together at whether acupuncture fits your plan. You can read more on acupuncture for menopause symptoms.

If you already take HRT

HRT doesn’t always take away every symptom. Sleep can still be restless, digestion can act up and energy can dip. You can follow a plan for sleep, food and stress while you take HRT.

Questions about your dose, switching or stopping HRT go to your doctor or gynecologist. With me, we go through everything you take, so that what I recommend fits with it.

How I work

Your first visit is 60 minutes and costs 3,500 SEK, at Kommendörsgatan in Östermalm or online, in English or Swedish. I listen to your whole story: sleep, cycle, stress, food, digestion and what you’ve already tried. After the visit, you get a written plan. It can include advice on food, sleep and stress, herbs, supplements and acupuncture.

If needed, we add lab tests, both conventional and functional, through a private lab. Your results become a basis for your plan and for your conversations with your doctor. Read more about the first visit and prices, or start on the perimenopause page.

When to see a doctor

Contact your vårdcentral, a gynecology clinic or 1177 (Sweden’s health advice line) if you have:[6][7]

• any vaginal bleeding after 12 months or more without a period
• periods that have become heavier, or bleeding that changes in a way that worries you
• a fast or pounding heartbeat (palpitations)
• new, severe or unclear symptoms
• low mood or worry that doesn’t lift

If you have thoughts of not wanting to live, or in an emergency, call 112.

Sources

1. NHS. Menopause: things you can do. Accessed 2026-11-09. https://www.nhs.uk/conditions/menopause/things-you-can-do/
2. NHS. Herbal remedies and complementary medicines for menopause symptoms. Accessed 2026-11-09. https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/herbal-remedies-and-complementary-medicines-for-menopause-symptoms/
3. NHS. Other medicines for menopause symptoms. Accessed 2026-11-09. https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/alternatives-to-hormone-replacement-therapy-hrt/other-medicines-for-menopause-symptoms/
4. Leach MJ, Moore V. Black cohosh (Cimicifuga spp.) for menopausal symptoms. Cochrane Database of Systematic Reviews, 2012. https://www.cochrane.org/CD007244/MENSTR_black-cohosh-cimicifuga-spp-for-menopausal-symptoms
5. Dodin S, Blanchet C, Marc I, et al. Acupuncture for menopausal hot flushes. Cochrane Database of Systematic Reviews, 2013. https://www.cochrane.org/CD007410/MENSTR_acupuncture-menopausal-hot-flushes
6. NHS. Symptoms of menopause and perimenopause. Accessed 2026-11-09. https://www.nhs.uk/conditions/menopause/symptoms/
7. 1177. Klimakteriebesvär. Accessed 2026-11-09. https://www.1177.se/sjukdomar--besvar/hormoner/klimakteriet/klimakteriebesvar/