Background: The primary cause of lower urinary tract symptoms (LUTS) in perimenopausal women is urethral stenosis. The present study was conducted to compare tamsulosin versus estrogen in the treatment of lower urinary tract symptoms in perimenopausal females. Materials & Methods: 90 perimenopausal females between the age group of 45 and 60 years were divided into 2 groups of 45. Tamsulosin was administered to group I, while topical estrogen (0.5%–1%) was applied to the periurethral area to group II. The International Prostate Symptom Score's voiding components were used for clinical follow-up. Results: Pre- treatment Qmax in group I was 7.5 and in group II was 7.1 and post- treatment Qmax in group I was 17.4 and in group II was 11.6. The difference was significant (P< 0.05). Pre- treatment postvoid residual in group I was 121.3 ml and in group II was 127.2 ml and post- treatment postvoid residual in group I was 35.4 ml and in group II was 108.4 ml. The difference was significant (P< 0.05). Conclusion: Given its obvious advantages over topical estrogen, tamsulosin ought to be the primary line of treatment for perimenopausal women exhibiting LUTS symptoms.