New Menopause Treatment Rules Back Hormones

For the first time since 2014, the nation's leading obstetricians and gynecologists have overhauled their guidance on menopause treatment, giving hormone therapy a strong endorsement for easing hot flashes, night sweats and insomnia. The American College of Obstetricians and Gynecologists, known as ACOG, released its most detailed menopause advice yet on October 15, covering treatments for night sweats, sleep disruption and mood changes.

The new guidance marks a significant shift in how doctors approach menopause treatment. Where the group's 2014 advice urged physicians to prescribe the lowest dose of hormones for the shortest possible time, the updated recommendations call for an individualized approach with regular check-ins rather than strict limits. Some women may need to stay on hormones past age 60 if symptoms persist.

What Changed in Menopause Treatment Rules

ACOG gave hormone therapy a strong rating, meaning the group believes the benefits outweigh the risks for most women with moderate to severe symptoms. The guidance focuses on specific symptoms and underscores that the safety of hormone replacement therapy is now well established, according to the doctors who wrote it. Between 50 and 92 percent of women in menopause experience hot flashes or night sweats, while sleep trouble and depression are also common.

For women who choose hormones, the new menopause treatment guidance advises starting before age 60, or within 10 years after menopause begins. The decision should weigh a woman's symptoms, age, health history and personal risk of heart disease, breast cancer and blood clots. The recommendation does not apply to women with medical reasons to avoid hormones, such as past blood clots, a stroke or some cancers.

Who Benefits From the New Menopause Treatment Guidance

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, said Robert Kauffman, a co-author of the guidelines, during a press briefing. Catherine Cansino, chair of the group's Committee on Clinical Practice Guidelines, said the breadth of options now available lets doctors take a more individualized approach for patients.

The update reflects a reassessment of the 2002 Women's Health Initiative study, which had suggested hormone replacement therapy increased the risk of heart disease, breast cancer, stroke and pulmonary embolism. Researchers later found limitations in that data, including that most participants were 60 or older, making it hard to generalize the findings to younger women experiencing menopause or perimenopause. With more and better quality studies, physicians can now make better-informed recommendations.

Nonhormonal Menopause Treatment Options

For women who cannot or do not want to take hormones, the new menopause treatment guidance points to a newer class of nonhormonal drugs that block certain signals in the brain. These include fezolinetant and elinzanetant, a newer class of nonhormonal medicines that block certain signals in the brain. Fezolinetant is aimed at the brain pathways involved in temperature regulation. Some antidepressants can also ease hot flashes along with depression, giving doctors additional tools for patients who need alternatives.

Misconceptions about the risks of hormones have affected some clinicians' willingness to prescribe it and some patients' interest in using it, said Bruce Pier, another co-author of the guidance. The new recommendations aim to correct that, emphasizing that menopause treatment should be tailored to each woman's symptoms and risks rather than shaped by outdated fears.

Doctors welcomed the update as the most comprehensive menopause treatment framework American physicians have produced. With sleep problems and mood changes affecting the majority of midlife women, the guidance is expected to change conversations in exam rooms across the country. Clinicians say the clarity of the new framework should make it easier to start those conversations and follow up over time.