New ACOG guidance strongly recommends hormone therapy for eligible people with hot flashes and related sleep problems — and lays out the nonhormonal options alongside it.
By The Wellness Desk — CelebnMusic247
The clearest menopause guidance to date now has a headline recommendation, and it is not a whisper. Per Healthline, the American College of Obstetricians and Gynecologists (ACOG) has released expanded menopause management guidelines that strongly recommend menopause hormone therapy (MHT) for vasomotor symptoms — hot flashes and night sweats — and related sleep disturbances in eligible individuals.
According to the ACOG guidance reported by Healthline, 50% to 92% of females experiencing menopause report vasomotor symptoms. Around 16% to 66% of females in the United States report menopause-related sleep issues, and more than one-third of perimenopausal and postmenopausal females report experiencing depressive symptoms. Those ranges are the reason the guidelines matter: the symptoms are common, and the guidance now walks through hormonal, nonhormonal and non-medication options in one place.
For people who can use hormones, ACOG strongly recommends MHT with estrogen and progestogens — or estrogen alone for people without a uterus — for both vasomotor symptoms and vasomotor-related sleep disturbance, per Healthline. It also conditionally recommends conjugated estrogen plus bazedoxifene (Duavee) as an alternative. ACOG recommends initiating MHT before age 60 or within 10 years of the onset of natural menopause, and says the decision to start should be based on a shared decision-making discussion covering an individual’s symptoms, benefits and risks, age, medical history, baseline risks of cardiovascular disease, breast cancer and venous thromboembolism, and personal treatment priorities and goals, per Healthline.
For people who cannot or do not want to use hormone therapy, the guidelines strongly recommend nonhormonal options, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and neurokinin receptor antagonists, per Healthline. Healthline notes two neurokinin receptor antagonists are FDA-approved for menopause symptoms — fezolinetant (Veozah), approved in 2023, and elinzanetant (LYNKUET), approved in 2025. Gabapentin is conditionally recommended as another nonhormonal option, per Healthline.
The guidelines also conditionally recommend non-medication approaches — cognitive behavioral therapy (CBT), mindfulness-based interventions, regular exercise, clinical hypnosis and acupuncture — typically used alongside medications, per Healthline. On mood, ACOG stated the evidence is insufficient to recommend for or against MHT for menopause-related depressive symptoms, and recommends people who meet the criteria for major depressive disorder be treated under depression management guidelines, per Healthline. ACOG also noted there is not enough evidence to support phytoestrogens, such as soy isoflavones, or herbal supplements, per Healthline.
“In recent years, misconceptions about the risks of hormone therapy have been widespread, which has made some clinicians reluctant to prescribe it and some patients hesitant to use it,” Bruce Pier, MD, a clinical professor at the University of North Carolina and a collaborator on the ACOG clinical practice guidelines, told Healthline. “This guidance offers a comprehensive review of the evidence to support individualized counseling and shared decision making. Our hope is that it clears up those misconceptions and expands access to treatment.” Pier added: “Menopause is finally getting the attention it deserves, and this document shows what evidence-based care should look like in this space. It lays out a range of safe, effective options for managing menopause symptoms. My message to anyone struggling with these symptoms is simple: talk to your clinician. You don’t have to suffer through them.” This article reports the guidelines only and is not medical advice.
The 247 Take — The useful shift here is clarity: one document now ranks the hormonal, nonhormonal and non-medication options side by side, and frames the choice as a conversation with your own clinician — not a rumor to sort out alone.
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Sources: Healthline
