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Background and Aim: Nowadays, because of the concern about risks of hormone-therapy, many physicians and women prefer phyto-estrogens for the treatment of menopausal symptoms. Hop is a plant with potent phyto-estrogenic ingredients. However, its effect on the symptoms has been evaluated only in one clinical trial. The purpose of this study was to evaluate the efficacy of hop (Humuluslupulus L.) in the treatment of early menopausal symptoms and hot flashes (primary outcomes). Material and Method: In this randomized, double-blind, placebo controlled trial, 60 perimenopausal women were randomly assigned to two equal groups (n=30). One group received hop tablets, 500 mg/day and other group received placebo tablets 500 mg/day, for 90 days. Early menopausal symptoms were assessed by means of Greene Scale (0-63) before and at the 4th, 8th and 12th weeks after intervention. ANOVA was used for data analysis. Result: There was no loss to follow-up during the 12 weeks of intervention. The mean Greene total score was significantly lower in the hop group in comparison to the placebo group at the 4th (adjusted difference: -8.3, 95% confidence interval: -9.7 to -6.9),8th (-14.6, -16.5 to -12.7) and12th (-18.2, -20.5 to -16.0) weeks after intervention. No side effects were reported in this study. Conclusion: Hop effectively reduced the early menopausal symptoms and the number of hot flushes in perimenopausal women. Therefore, phytoestrogens can be used for the treatment of climacteric symptoms in the perimenopausal women. Keyword: Early menopausal symptoms, Hop (Humuluslupulus L.), Perimenopause, Randomized clinical trials