The American College of Obstetricians and Gynecologists (ACOG) has released updated menopause guidelines that strongly recommend systemic hormone therapy for vasomotor symptoms and related sleep disturbances in women without contraindications. The guidance, published in Obstetrics & Gynecology, specifies that estrogen plus progestogen should be used for women with a uterus, and estrogen alone for those without, based on moderate-quality evidence.
A key element is the timing: ACOG strongly recommends initiating hormone therapy before age 60 or within 10 years of natural menopause onset. The guidelines also strongly recommend SSRIs or SNRIs for vasomotor and depressive symptoms, and neurokinin receptor agonists for vasomotor symptoms and sleep disturbances, in patients who cannot take hormones.
The new guidance replaces 2014 recommendations and joins a growing cross-specialty consensus. JoAnn E. Manson, a Harvard researcher not involved in the guidelines, noted that ACOG's recommendations are very similar to those from the American College of Physicians and other societies, calling the convergence "good news." She added that hormone therapy remains underutilized, partly due to lingering fears from the Women's Health Initiative, which ACOG officials say they are trying to allay.
ACOG's committee noted that 50% to 92% of women experience hot flashes or night sweats during menopause, and 16% to 66% experience sleep disruptions. The guidelines focus on peri- and postmenopausal people assigned female at birth with symptoms related to natural or induced menopause. Complementary guidance on genitourinary syndrome is expected in 2027.