If you’ve started waking up sweaty at night, feeling sudden waves of heat during the day, or noticing vaginal dryness that makes intimacy uncomfortable, you’re not alone. These are some of the most common—and most frustrating—symptoms women experience as they move through perimenopause and menopause. Mental health changes, sleep disturbances, brain fog, skin, hair and weight changes can also be part of this change.
The good news: you have options to help you manage symptoms. Below is a practical, patient-friendly guide to what’s happening in your body and what can help—especially for hot flashes, night sweats, and vaginal dryness.
(Quick note: This is general education, not medical advice for any one person. Your best treatment depends on your health history and symptoms—your Premier Women’s Health provider can help you choose the safest, most effective plan.)
What’s the difference between perimenopause and menopause?
- Perimenopause is the transition leading up to menopause, when hormones fluctuate. Periods may become irregular. Symptoms can come and go.
- Menopause is defined as 12 months without a period. After that, you’re in post-menopause.
Both stages can bring symptoms related to changing estrogen levels—and your “normal” can shift month to month, and be different from what friends and family are experiencing.
Menopause Society-certified OBGYN Dr. Robin Prugno offers this summary. Watch now.
Hot Flashes & Night Sweats: Why they happen
Hot flashes are sudden feelings of heat (often in the face, neck, and chest) that can come with flushing, sweating, and a racing heartbeat. When they happen at night, they’re often called night sweats—and they can seriously disrupt sleep.
These symptoms are thought to be tied to how hormonal changes affect the body’s temperature regulation.
Lifestyle changes that can help (often worth trying first)
Small changes can make a big difference, especially if your symptoms are mild to moderate:
- Dress in layers; choose breathable fabrics
- Keep the bedroom cool; use a fan
- Avoid common triggers (often: alcohol, spicy foods, hot beverages)
- Cut back on nicotine (if applicable)
- Manage stress (mindfulness, yoga, walking, therapy)
- Prioritize sleep habits (consistent bedtime, limit screens before sleep)
If symptoms are frequent, intense, or disrupting your quality of life, it’s reasonable to consider medical options.
Non-hormonal Medications for Hot Flashes & Night Sweats
Not everyone can—or wants to—use hormone therapy. There are non-hormonal prescription options that may reduce hot flashes and night sweats for some women. These are often used when symptoms are significant, sleep is suffering, or quality of life is taking a hit.
Common non-hormonal categories
SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are commonly used for mood, but certain ones can also help reduce hot flashes.
Examples you may hear about:
- Venlafaxine (Effexor®) — an SNRI
- Desvenlafaxine (Pristiq®) — an SNRI
- Gabapentin — often used for nerve pain; can help night symptoms for some women
- Fezolinetant (Veozah®) — a non-hormonal medication specifically for moderate to severe hot flashes
A few important notes:
- These medications aren’t “one-size-fits-all.” What works well for one person may not help another.
- Side effects and interactions matter (especially if you take other medications).
- Your provider will help weigh your symptoms, medical history, and goals.
If you’re unsure whether you’re a candidate, a conversation with your clinician is the best next step.
Vaginal Dryness: common, treatable, and worth talking about
Vaginal dryness is extremely common in perimenopause and menopause—and it can show up as:
- Dryness, burning, or irritation
- Pain with sex
- Light bleeding with sex
- Increased urinary symptoms (frequency, urgency, recurrent UTIs for some)
This cluster of symptoms is often related to reduced estrogen’s effects on vaginal tissue.
First-line, Over-the-Counter relief (OTC)
For many women, a consistent routine with moisturizers plus a lubricant during sex helps a lot.
OTC options include:
- Vaginal lubricants (used at the time of sex)
- Example: Uberlube®
- Vaginal moisturizers (used regularly, like a skincare routine)
- Example: Replens®
- Products with hyaluronic acid (a hydrating ingredient found in some vaginal moisturizers)
- Coconut oil (some people like it as a lubricant)
Safety tip: Oil-based products (including coconut oil) can break down latexcondoms and may increase condom failure. If you rely on condoms for pregnancy or prevention of sexually transmitted infections (STI), choose a condom-compatible lubricant.
When Over-the-Counter Isn’t Enough
If dryness is persistent, painful, or affecting intimacy and confidence, ask your provider about additional options. There are effective prescription treatments available (including local therapies) and your clinician can guide what’s appropriate for you.
When to Call Your Provider
Reach out if:
- Hot flashes or night sweats are disrupting sleep, mood, or daily functioning
- Vaginal dryness is painful, persistent, or affecting intimacy
- You have bleeding after sex, new bleeding after menopause, or symptoms that worry you
- You want to review your risks/benefits for different treatment options
You don’t have to “push through” these symptoms. There are real solutions—and you deserve support.
Quick FAQ
Is it normal for symptoms to come and go in perimenopause?
Yes. Fluctuating hormones can make symptoms unpredictable.
Do I have to take hormones to feel better?
No. Many women find relief with lifestyle changes, over-the-counter vaginal products, and/or non-hormonal prescriptions.
How do I know what’s right for me?
That depends on your symptoms, health history, and personal preferences. A quick visit focused on menopause symptoms can help you leave with a clear plan.
Premier Women’s Health Can Help
If hot flashes, night sweats, or vaginal dryness are affecting your quality of life, we’re here to help you sort through options and find a plan that feels right for you. Call your clinic to schedule a visit and discuss symptom relief—including telehealth when appropriate.
Blog content review by menopause-certified Premier Women’s Health board-certified OBGYN physicians Robin Prugno, DO, and Katie Toft, MD.