When I reached perimenopause, I tried many standard pharmaceutical and herbal treatments for my menopausal symptoms and none gave relief. The pharmaceuticals caused massive and terrible side effects.
Then I followed my mother's advice and got a prescription for compounded HRT. It alleviated my symptoms, allowed me to sleep again, cleared my depression and brain fog and I once again became very good at my demanding job (software development) and started to enjoy life again. Prior to the treatment, I thought about death every day. My mom used compounded hormones for over 20 years. And they allowed her to have a great health and quality of life especially since she also deals with health problems due to post-polio syndrome.
I'll buy these on the black market or from another country if they become "illegal".