The American College of Obstetricians and Gynecologists (ACOG) has issued updated guidelines for treating menopause-related symptoms, marking the first revision since 2014. The new recommendations endorse hormone replacement therapy (HRT) as a primary option for managing hot flashes, night sweats, insomnia, and mood swings, alongside nonhormonal alternatives such as certain antidepressants and other medications. The guidance emphasizes an individualized approach to treatment, reflecting advancements in research and clinical understanding.
The updated guidance was released on Thursday by ACOG, the leading OB-GYN professional organization in the United States. It follows a decade of evolving evidence regarding the safety and efficacy of HRT, which was previously scrutinized after the 2002 Women’s Health Initiative (WHI) study linked it to increased risks of heart disease, breast cancer, stroke, and pulmonary embolism. Subsequent analyses, however, identified limitations in the WHI study—such as the majority of participants being 60 years or older—which limited its applicability to younger women experiencing menopause or perimenopause.
Dr. Catherine Cansino, chair of ACOG’s Committee on Clinical Practice Guidelines and co-author of the new guidance, stated that the safety of HRT is now well-established for symptomatic women within 10 years of their final menstrual period or before age 60. The guidelines also highlight that HRT can help address reduced bone density, lowering the risk of osteoporosis or fractures.
The recommendations come as menopause symptoms—primarily driven by steep drops in estrogen and progesterone—affect many women in their late 40s or early 50s. Dr. Kameelah Phillips, an OB-GYN and menopause specialist, noted that HRT is now considered the first-line treatment for vasomotor symptoms, replacing previous suggestions such as antidepressants or lifestyle changes like exercise or alcohol moderation. HRT can be administered via pills, patches, sprays, gels, or vaginal rings, with some women benefiting from low-dose vaginal estrogen therapy.
ACOG emphasized in a statement that while menopause is a normal stage of life, women should not endure symptoms without support. However, the guidelines specify that HRT is not suitable for women with a history of blood clots, stroke, liver disease, or breast cancer. The organization underscored the importance of personalized care, noting that treatment decisions should be made in consultation with a healthcare provider based on individual health profiles and symptom severity.