By Sohaib Shams
For the first time in 12 years, the American College of Obstetricians and Gynecologists (ACOG) has updated its guidance on managing menopause symptoms such as hot flashes, night sweats, and sleep disturbances, emphasizing hormone therapy as a primary treatment option for many women.
Hormone Therapy Recommended as First-Line Option
The new guidelines, released this month, state that moderate to severe menopausal symptoms should be treated with hormone therapy as the first line of treatment, according to Dr. JoAnn Manson, a professor of medicine at Harvard Medical School. While not appropriate for all women, hormone therapy is a good option for many, said Dr. Camille Clare, ACOG's president.
FDA Warning Removal Spurs Renewed Interest
The guidance comes after the U.S. Food and Drug Administration removed boxed warnings from more than 20 estrogen and progestin products last year, and approved updated labeling for three additional estrogen-based patches on Friday. The FDA said it is unaware of an imminent nationwide shortage despite reports of supply constraints, noting manufacturers have doubled output over the past year.
Nonhormonal and Non-Drug Alternatives Detailed
For women who cannot or choose not to use hormone therapy, ACOG highlights nonhormonal medications such as fezolinetant and elinzanetant, which target the brain's temperature control center to reduce hot flashes and night sweats. Certain antidepressants can also help manage hot flashes and depression. Non-drug approaches supported by evidence include cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis, and acupuncture, which can be used alone or alongside medications.
Shared Decision-Making Encouraged
ACOG recommends that decisions about hormone therapy be made jointly by doctors and patients, considering benefits and risks based on age and medical history. If appropriate, therapy should start before age 60 or within 10 years of menopause. Dr. Clare urged women to consult their OB-GYNs and be wary of online misinformation, noting that ACOG provides resources to distinguish evidence-based information from false claims.
