Perimenopause is associated with unpleasant symptoms which affect quality of life. As hormone replacement therapy (HRT) is associated with certain adverse events including life threatening effects there is a need for alternate forms of treatment for relieving menopausal symptoms. As a pilot project we prospectively studied 200 perimenopausal women aged between 40 to 55 years at the Government Maternity Hospital, Tirupati in South India. They were allocated to receive the following interventions: HRT; omega-3- fatty acids and vitamin E; isoflavones; diet and exercise; and placebo. The effect of these therapies in relieving menopausal symptoms was analyzed. Women who received omega-3- fatty acids, isoflavones, diet and exercise and HRT had beneficial effect on all groups of menopausal symptoms and (placebo had beneficial effect) on urogenital and somatic symptoms. Weight was influenced by HRT and calcium levels by omega-3-fatty acids. No significant change was noted in serum levels of hormones with HRT for six months. Reassurance and diet and exercise can be advised initially to prevent or treat perimenopausal symptoms. Omega-3- fatty acids and isoflavones appear to be potentially beneficial alternate therapies if there is no relief. HRT is to be reserved as a final short term therapy to relieve perimenopausal symptoms.