The American College of Obstetricians and Gynecologists (ACOG) has released new guidelines recommending hormone therapy as a first-line treatment for menopause symptoms like hot flashes and night sweats. This marks a shift from ACOG’s 2014 advice, which emphasized lower doses and shorter durations.
Hormone Therapy: Benefits Outweigh Risks for Most
ACOG now gives hormone therapy a “strong” recommendation, indicating that its benefits outweigh risks for most women experiencing these symptoms. The guidance advises starting treatment before age 60 or within 10 years of menopause onset.
This recommendation comes with caveats. Women with a history of blood clots, stroke, or certain cancers should avoid hormone therapy. ACOG stresses the importance of personalized risk assessment, considering factors like age, health history, and individual risk of heart disease and breast cancer.
Beyond Hormones: Expanding Treatment Options
For those who cannot or choose not to take hormones, ACOG highlights newer nonhormonal medications like fezolinetant and elinzanetant. Antidepressants can also be effective for both hot flashes and depression, a common menopause symptom.
The guidelines also acknowledge the role of non-drug interventions. Cognitive behavioral therapy, mindfulness, exercise, hypnosis, and acupuncture are mentioned as potential options, though the evidence for some of these is still limited.
Notably, ACOG discourages the use of herbal supplements and plant-based estrogens due to a lack of safety and efficacy data. These products are not regulated by the FDA, raising concerns about their purity and consistency.
The guidelines further emphasize the impact of social factors on menopause experiences. Race, culture, and income can influence symptom severity and access to care, highlighting the need for a more inclusive approach to menopause management.
A Shift in Perspective
This updated guidance reflects a growing consensus among medical professionals that menopause symptoms should be actively treated. Dr. JoAnn Manson of Harvard Medical School notes a wider recognition that hormone therapy should be the primary treatment option for many women.
Looking ahead, ACOG plans to release separate guidelines in 2027 focusing on genitourinary syndrome of menopause, addressing issues like vaginal dryness and urinary tract infections.
For more information on menopause treatment options, visit the U.S. Food and Drug Administration website.