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Here is some information about Dr Lee's natural progesterone cream. Looks like you can still buy it yourself, no prescription. I have no affiliation with them but it is the one thing that worked for me. It was recommended by an MD (a WOMAN MD.)
I'm in menopause -- not perimenopause -- so my problem, as I understand it, is not enough estrogen; that's why these supposed "estrogen equivalents" are supposed to work, and HRT estradiol DEFINITELY works. But I'll look into it! And, yes; I had heard about possible liver damage with black cohosh; that's why I'd want to do my research and get the right kind (?).
What worked for me was avoiding sugar, preservatives and eating a big double serving of regular oatmeal every day. Even now, past menopause, eating excessive sugar or foods with preservatives causes hot flashes. I think it has more to do with the aging system and its ability to process some things.
I get severe intestinal issues from soy so avoid it. In general, drinking an adequate amount of water helps.
I tried Progesterone cream with wild yam (also tried wild yam by itself) and it really made my blood sugar drop like a rock. I only used the cream for about 3 weeks and just felt awful so I stopped. I am taking soy now. I take 50mgs in the morning and other 50mgs at night. I read that it takes almost a year for levels to reach their optimum levels. I wonder if it is worth it or not. I figured that I feel like I have exhausted every other option so what do I have to lose (except my hot flashes I hope and the money it cost ) so I continue with it.
To me, the hot flashes are only one of problems. The weight gain I would say is the worse. It was weird because my weight dropped about 20 pounds and I felt too thin. Before I know it, I gained back those 20 lbs and then another 20 + all within about 7 years or so. Sometimes I will lose a lb or two but it comes right back again. And I NEVER had weight issues in my entire life-until the "BIG M" hit. The moodiness seem to have diminished somewhat. But, there are times when I feel that the hormones are just out of whack and I'm bouncing off the walls.
I used to want the "BIG M" to come because I hated dealing with things every month. You know what they say, "Be careful what you wish for-you just might get." Now, I wish that I only had to deal with this once a month instead of ALL THE TIME! AH! The joys of being a woman.
I'm not a believer in the "sugar connection"; the only thing we can't process anymore is estrogen because, well, we can't produce it anymore! I've noticed a definite improvement -- although not cessation -- of the hot flashes on soy, so will continue (now two months in at 80 mg./day)... If I get desperate enough, may try Black Cohosh, which some women swear by.
And yes, the weight gain! Why some women remain skinny well into old age is beyond me...
Grrrrr!
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) so I continue with it. 
