ACOG updates menopause guidance, reinstates hormone therapy as first-line treatment

The American College of Obstetricians & Gynecologists released updated clinical guidance on managing menopause symptoms this month. This release marks the first revision to the group's recommendations in twelve years. The new advice addresses disruptive symptoms such as hot flashes, night sweats, and sleep changes.

ACOG states that more than half of women in menopause report vasomotor issues. As many as two-thirds report sleep disruption related to menopause. More than a third of perimenopausal and postmenopausal women worldwide report depressive symptoms. The guidelines emphasize that these symptoms should be treated rather than endured.

Dr. Camille Clare, the president of ACOG, encouraged patients to advocate for their needs during medical appointments. She urged women to speak with their OB-GYNs about menopause questions. Dr. JoAnn Manson, a professor of medicine at Harvard Medical School, noted that the new consensus empowers women to discuss symptoms with healthcare providers. She stated that moderate to severe or bothersome symptoms should be treated with hormone therapy as the first line of treatment.

Hormone therapy remains the primary recommendation for many patients, though it is not appropriate for all women. The group advises that decisions be made jointly by doctors and patients, considering age and medical history. When appropriate, ACOG suggests starting treatment before age 60 or within 10 years of menopause.

The FDA removed boxed warnings from more than 20 hormone-based products last year. On Friday, federal officials approved updated labeling for three additional estrogen-based patches. These regulatory changes have increased demand for these treatments. FDA officials said they are unaware of an imminent risk of a nationwide shortage, noting that manufacturers have doubled output over the last year by adding production shifts.

Dr. Stephanie Faubion, medical director at The Menopause Society, described hormone therapy as the most effective option for hot flashes. She highlighted that whole-body therapies, including pills, patches, and gels, deliver hormones into the bloodstream to manage symptoms. Low-dose vaginal estrogen is recommended for women whose primary complaint is vaginal dryness.

For patients who choose or need to avoid hormonal medications, the guidelines list several nonhormonal alternatives. Fezolinetant and elinzanetant are medicines that work in the brain to block the source of hot flashes and night sweats. Certain antidepressants may also help manage symptoms of hot flashes and depression.

ACOG also cites evidence supporting non-drug treatments such as cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis, and acupuncture. These approaches can be used alone or alongside medications. Dr. Clare warned patients to seek professional advice to navigate misinformation online. Faubion concluded that women have numerous hormonal and nonhormonal options and should not be told nothing can be done.