I'm going to sound like an absolute shill, but through a lot of experimenting with the typical otc perimenopause/hot flash pills, they just don't work. What worked for me is traditional Chinese Medicine Geng Nian An Pian and a wild yam cream. My hot flashes were out of control, like 20 times an hour, just constantly rolling. And all the other symptoms. It was the end of the world and I was losing my mind. After a month, I felt like a normal person again. It's been 3 months since I last had a hot flash.