ACOG expands menopause treatment guidance and recommends hormone therapy

The American College of Obstetricians and Gynecologists has updated its menopause treatment guidance, replacing its 2014 recommendations. ACOG strongly recommends systemic hormone therapy for eligible patients with hot flashes, night sweats and related sleep problems.

For patients with a uterus, ACOG recommends estrogen with a progestogen. For those who do not need endometrial protection, it recommends estrogen alone. The guidance says treatment should begin before age 60 or within 10 years of the start of natural menopause. ACOG’s recommendations do not apply to patients with contraindications to hormone therapy.

For patients who cannot take hormones, ACOG recommends certain antidepressants and neurokinin receptor agonists for symptoms. Cognitive behavioral therapy, mindfulness, exercise, hypnosis and acupuncture received conditional recommendations for some symptom relief. ACOG plans to publish separate guidance on genitourinary syndrome of menopause in 2027.