ACP recommends hormone therapy first for menopausal hot flashes

The American College of Physicians recommends hormone therapy as the first-line treatment for people in perimenopause or after menopause who seek care for hot flashes and night sweats, known as vasomotor symptoms. Its guideline, published in Annals of Internal Medicine, recommends estrogen with progestogen for patients with a uterus and estrogen alone for those without one.

For patients who cannot take or do not tolerate estrogen therapy, ACP suggests desvenlafaxine or venlafaxine as second-line options. Third-line options include escitalopram, paroxetine, gabapentin, or the neurokinin receptor antagonists elinzanetant and fezolinetant. ACP says clinicians should discuss benefits, harms, contraindications, other health conditions, patient preferences, financial burden, and access when choosing treatment. It also encourages clinicians to ask patients about their symptoms, since they may not bring them up on their own.