OB-GYN Group Updates Menopause Guidance, Backs Hormone Therapy

The American College of Obstetricians and Gynecologists has updated its menopause treatment guidance for the first time since 2014, backing hormone therapy for many people with hot flashes and night sweats while outlining medication and non-drug alternatives.

The guidance recommends systemic hormone therapy for eligible patients and emphasizes choosing treatment based on symptoms, medical history and preferences. About 2 million women begin menopause each year, and symptoms can start years before the final menstrual period, according to NPR.

“Hormone therapy is probably the best option for symptomatic, newly menopausal women within 10 years of the final menstrual period or before the age of 60,” Dr. Robert Kauffman, a co-author of the guidance, said at a briefing, according to NPR.

Hot flashes, night sweats and sleep problems can follow declines in estrogen and progesterone. Dr. Kameelah Phillips, an OB-GYN and menopause specialist, told CBS News that hormone therapy is now a first-line treatment for those symptoms. Treatment can come as pills, patches, sprays, gels or a vaginal ring. Some patients may also benefit from low-dose vaginal estrogen, CBS News reported.

The guidance recommends estrogen combined with progestogen for eligible patients who have a uterus. Estrogen alone can stimulate growth of the uterine lining and raise the risk of endometrial cancer; progestogen reduces that risk, according to NPR. For patients without a uterus, ACOG recommends estrogen alone. Another recommended option, sold as Duavee, combines estrogen with bazedoxifene, a drug that changes how estrogen acts in different parts of the body.

Hormone therapy is not appropriate for everyone. Reasons to avoid it include a history of blood clots, stroke or liver disease, as well as certain cancers. NPR reported that the guidance also lists unexplained abnormal genital bleeding, heart attack and known or suspected pregnancy among the reasons to avoid treatment.

A 2002 Women’s Health Initiative study raised concerns that hormone therapy could increase the risks of heart disease, breast cancer, stroke and pulmonary embolism. Researchers later identified limits to applying its findings to younger patients: Most participants were at least 60, NPR reported. Dr. Céline Gounder, a CBS News medical contributor, said some older participants may not have started therapy until about a decade after menopause. The updated guidance reflects a larger body of evidence on treatment risks and benefits.

For people who cannot or do not want to take hormones, the guidance includes certain antidepressants and other medications. NPR reported that two nonhormonal drugs for hot flashes — fezolinetant, sold as Veozah, and elinzanetant, sold as Lynkuet — received U.S. approval in 2023 and 2025, respectively. Gabapentin, commonly used to treat seizures, is another option.

ACOG says cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis and acupuncture may improve some symptoms, though the evidence for those approaches is weaker than for hormone therapy, according to NPR.

“Menopause is a normal and natural stage of life, but that doesn’t mean that women must suffer through the symptoms without help,” ACOG said in a statement reported by CBS News. Dr. Catherine Cansino, who chaired the committee behind the guidance, told NPR that the wider range of treatments allows clinicians and patients to take an individualized approach.