American College of Obstetricians updates menopause treatment guidelines, endorses hormone therapy

The American College of Obstetricians and Gynecologists (ACOG) issued new menopause‑treatment guidelines on Thursday, the first update since 2014. The guidelines give doctors a wider range of options for women who experience hot flashes, night sweats, insomnia and mood swings after menopause. The release comes after a decade of research that has clarified the safety and effectiveness of hormone replacement therapy (HRT) and introduced new non‑hormonal drugs.

The update follows a re‑examination of the 2002 Women’s Health Initiative study, which had warned that HRT could raise the risk of heart disease, breast cancer, stroke and blood clots. Newer studies show that the original data were limited because most participants were over 60 and many were already past the age when menopause starts. The new evidence indicates that HRT is safe for women who are within ten years of their last period or who are under 60. ACOG now recommends HRT as the first choice for women who have significant symptoms, while also encouraging doctors to tailor treatment to each patient’s health profile.

In addition to HRT, the guidelines list several non‑hormonal drugs that target the brain’s temperature and sleep centers. Fezolinetant, sold as Veozah, was approved by the FDA in 2023 to treat hot flashes, and elinzanetant, sold as Lynkuet, received approval in 2025. These medications block specific chemical messengers that influence body heat and sleep cycles. ACOG also notes that antidepressants and other medications can help with mood swings and sleep problems. With about two million women entering menopause each year and an average age of 49.9, the new guidance offers a clearer, evidence‑based framework for clinicians and patients alike.

The guidelines are expected to change how doctors discuss menopause treatment. Patients will now have more options that are backed by recent research, and clinicians can personalize therapy based on age, risk factors and symptom severity. As the population ages, the updated recommendations aim to improve quality of life for millions of women while reducing the risk of adverse outcomes from poorly chosen treatments.