The American College of Obstetricians and Gynecologists has released new, comprehensive guidelines for treating menopause symptoms, including hormone therapy and nonhormonal alternatives.

The American College of Obstetricians and Gynecologists (ACOG) has released expanded clinical guidelines for managing menopause symptoms, including hot flashes, night sweats, and sleep disturbances. The new guidance strongly recommends hormone therapy for eligible individuals, while offering nonhormonal and nonpharmacological options for those who cannot or prefer not to use hormones.

Hormone and Nonhormonal Treatments

ACOG strongly recommends hormone therapy (MHT) using estrogen and progestogens, or estrogen alone for individuals without a uterus, to manage vasomotor symptoms (VMS) and related sleep issues. The guidelines suggest initiating MHT before age 60 or within 10 years of the onset of natural menopause. For those unable to use hormones, the organization strongly recommends nonhormonal options, such as SSRIs, SNRIs, and neurokinin receptor antagonists like Fezolinetant and elinzanetant.

Nonpharmacological Approaches

The guidelines conditionally recommend nonpharmacological interventions, including cognitive behavioral therapy, mindfulness, regular exercise, clinical hypnosis, and acupuncture. ACOG advises that these methods are typically used alongside medications. The organization noted that there is currently insufficient evidence to support the safety or efficacy of herbal supplements or phytoestrogens, such as soy isoflavones.

Depression and Menopause

Regarding depressive symptoms, ACOG stated that current evidence is insufficient to recommend MHT as a treatment. Individuals who meet diagnostic criteria for major depressive disorder are advised to follow standard depression management guidelines, which include therapy, medication, or a combination of both.