Share on Pinterest The ACOG released updated recommendations for the management of various menopause symptoms. MoMo Productions · DigitalVision/Getty The American College of Obstetricians and Gynecologists (ACOG) released expanded menopause management guidelines strongly recommending menopause hormone therapy (MHT) for vasomotor symptoms (VMS) and related sleep disturbances in eligible individuals. For individuals who can’t or don’t want to use MHT, ACOG strongly recommends nonhormonal options, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and neurokinin receptor antagonists, to manage VMS.
The guidelines also conditionally recommend nonpharmacologic approaches like cognitive behavioral therapy (CBT), mindfulness-based interventions, regular exercise, clinical hypnosis, and acupuncture, typically used alongside medications to manage menopause symptoms. These expanded recommendations are the most comprehensive guidance to date. They include new clinical guidelines for menopause hormone therapy (MHT) , nonhormonal medications, and nonpharmacological treatment of vasomotor symptoms (VMS), which include hot flashes and night sweats, and sleep and mood changes.
According to the ACOG guidance, 50%–92% of females experiencing menopause report VMS . Around 16%–66% of females in the United States report menopause-related sleep issues, and more than one-third of perimenopausal and postmenopausal females report experiencing depressive symptoms. “In recent years, misconceptions about the risks of hormone therapy have been widespread, which has made some clinicians reluctant to prescribe it and some patients hesitant to use it,” Bruce Pier , MD, clinical professor and associate fellowship director at the University of North Carolina and collaborator on the ACOG clinical practice guidelines, told Healthline.
“This guidance offers a comprehensive review of the evidence to support individualized counseling and shared decision making. Our hope is that it clears up those misconceptions and expands access to treatment.” The ACOG strongly recommends the use of MHT with estrogen and progestogens (or estrogen alone for people without a uterus) for both VMS and vasomotor-related sleep disturbance, in individuals who can use hormones. It also conditionally recommends conjugated estrogen plus bazedoxifene ( Duavee ) as an alternative for these issues.
According to a meta-analysis from 2021 that was cited by the guidelines, estrogen therapy, with or without progestogens, significantly reduced VMS frequency and severity compared to a placebo or no treatment. A 2017 meta-analysis ranked transdermal estradiol plus a progestogen as the most effective option for reducing VMS frequency. A 2022 systematic review and meta-analysis , also cited by the guidelines, found that MHT was associated with improved self-reported sleep quality.
Once again, transdermal therapies showed some of the largest effects. The ACOG recommends initiating MHT before age 60 or within 10 years of the onset of natural menopause.. It also suggests that the decision to start MHT for VMS and vasomotor-related sleep disturbances should be based on a shared decision making discussion about an individual’s symptoms and the benefits and risks of therapy.
Consideration should also be taken regarding an individual’s: age medical history baseline risks of cardiovascular disease , breast cancer , and venous thromboembolism (VTE) individualized treatment priorities and goals The ACOG stated in the guidelines that, “The available evidence is insufficient to recommend for or against the use of estrogen–progestogen or estrogen-only MHT for the treatment of menopause-related depressive symptoms.” It recommends that perimenopausal and postmenopausal individuals who meet the diagnostic criteria for major depressive disorder (MDD) or those whose most noticeable symptom is depression should be treated according to depression management guidelines. Current treatment guidelines for depression include therapy, medication, or a combination of the two. The ACOG also strongly recommends the use of neurokinin receptor antagonists to manage VMS and vasomotor-related sleep disturbances in people who don’t desire hormone therapy or can’t use it.
There are currently two neurokinin receptor antagonists approved by the FDA to manage menopause symptoms. Fezolinetant (Veozah) was approved in 2023 to help manage hot flashes. In 2025 , the FDA approved elinzanetant (LYNKUET) for the management of moderate to severe VMS due to menopause.
Another nonhormonal treatment for VMS that the ACOG conditionally recommends is gabapentin . There are various nonpharmacologic treatments that the ACOG conditionally recommends for the management of VMS, vasomotor-related sleep disturbances, and mood changes. These are treatments that don’t involve the use of medications.
The nonpharmacologic treatments conditionally recommended include: CBT mindfulness-based interventions regular exercise clinical hypnosis acupuncture It is generally recommended that these interventions are used alongside hormonal or nonhormonal medications. The ACOG noted that there is not enough evidence to support the efficacy or safety of phytoestrogens, such as soy isoflavones, or herbal supplements, which are not regulated by the FDA in the same way medications are for safety, purity, or efficacy. “Menopause is finally getting the attention it deserves, and this document shows what evidence-based care should look like in this space.
It lays out a range of safe, effective options for managing menopause symptoms. My message to anyone struggling with these symptoms is simple: talk to your clinician. You don’t have to suffer through them,” said Pier.
Source: Healthline
