The American College of Obstetricians and Gynecologists (ACOG) has issued new guidance that places hormone replacement therapy (HRT) at the forefront of treatment for common menopause and perimenopause symptoms. The recommendation marks the first shift in more than a decade by the nation’s leading OB‑GYN professional organization, and it specifically targets women experiencing vasomotor issues such as hot flashes, night sweats and sleep disturbances.
Hormone therapy becomes first‑line option
Dr. Kameelah Phillips, an OB‑GYN and menopause specialist, explained on “CBS Mornings” that HRT is now considered the primary treatment for vasomotor symptoms. She contrasted the new stance with previous guidance that often suggested antidepressants, increased exercise, or even a glass of wine—options she described as “not helpful.” According to Dr. Phillips, the updated approach reflects a move to mainstream use of hormones for symptom relief.
Eligibility and safety considerations
While ACOG’s guidance expands the use of HRT, it also outlines clear contraindications. Women with a personal history of blood clots, stroke, liver disease, or breast cancer are advised against hormone therapy. The organization cites a 2002 long‑term study that linked hormone use to higher breast cancer rates, noting that the study focused on older patients who began therapy roughly a decade after menopause. Dr. Céline Gounder, a CBS News medical contributor, emphasized that age, timing and dosing influence safety, and a 2024 study of more than 10,000 women suggests that appropriately timed treatment can be safe for many patients.
ACOG recommends initiating HRT before age 60 or within ten years of the onset of menopause, aligning with evidence that earlier use may reduce risks while improving symptom control.
Delivery methods and alternatives
HRT can be administered through several routes, including oral pills, transdermal patches, nasal sprays, gels and a vaginal ring that delivers hormones directly into the bloodstream. Some women also benefit from low‑dose vaginal estrogen therapy aimed at local symptoms. The therapy works by addressing the steep declines in estrogen and progesterone that typically occur in a woman’s late 40s or early 50s, declines that are responsible for hot flashes, night sweats and can also lower bone density, raising the risk of osteoporosis and fractures.
For women who are not eligible for hormone therapy, Dr. Phillips advises consultation with a menopause‑trained specialist to explore non‑hormonal options. She emphasized that effective alternatives exist, but selecting the right approach requires a personalized conversation with a healthcare provider.
ACOG’s statement underscores that menopause is a natural life stage, yet it does not have to be endured without relief. By positioning hormone replacement therapy as the first‑line treatment for vasomotor symptoms, the organization aims to provide clinicians and patients with clearer guidance while maintaining vigilance about contraindications and individualized care.
Steve Lopez is a Senior Editorial Columnist and Health & Public Policy reporter for News Raise. Steve focuses on healthcare advancements, medical technologies, and public health policies.
