Brief Answer: Drugs exist, effective, require proper review firs Detailed Answer: Hi and thanks for the query, Severe perimenopausal deserve treatment. However, a proper evaluation of your medical history is needed. Some of the drugs are not compatible with specific health states like hypertension and also the intensity of the symptoms matters. Hot flashes, sweating, insomnia, and vaginal dryness and discomfort generally respond well to treatment. Estrogens in low doses is generally effective. Ethinyl estradiol and conjugated estrogens are generally effective. Progestational agents like micronized progesterone and medroxyprogesterone could be used. Due to possible side effects with respect to cardiovascular risk, thromboembolic disease, and at times increases risk if stroke in some cases, the drugs need to be prescribed with caution and require a regular review. The fact that your gall bladder has been removed is no major concern or contraindication for this therapy. Estrogens and Progesterone agents are generally available and effective to manage severe perimenopause. However, baseline clinical reviews and follow up by your doctor are generally needed. Thanks and kind regards as I wish you the best of health. Dr Bain

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