The American College of Obstetricians and Gynecologists (ACOG) released its first revision of menopause‑treatment guidance in more than a decade, expanding the range of therapies physicians can offer. The updated recommendations, published Thursday, endorse systemic hormone replacement therapy (HRT) for symptomatic women in early menopause and introduce two recently approved non‑hormonal drugs for hot flashes.
Broader hormone options and safety reassurance
According to ACOG chair Catherine Cansino, MD, MPH, the new guidance reflects a wider menu of choices that enable clinicians to tailor care to individual patients. The committee now states that the safety profile of HRT is “well‑established,” a shift from earlier concerns sparked by the 2002 Women’s Health Initiative, which linked hormone use to heart disease, breast cancer, stroke and pulmonary embolism. Subsequent analyses highlighted limitations of that study, notably that most participants were over 60, making the findings less applicable to younger women experiencing menopause or perimenopause.
Robert Kauffman, MD, MSCP, a co‑author of the guidelines, emphasized that hormone therapy is likely the preferred option for symptomatic women who are within ten years of their final menstrual period or younger than 60. The recommendation specifies combined estrogen‑progestogen therapy for women with an intact uterus, citing the need to counteract estrogen‑driven growth of the uterine lining, which can increase endometrial cancer risk. For women who have had a hysterectomy—about 500,000 annually—estrogen alone is advised.
New non‑hormonal medicines join the toolkit
Beyond traditional HRT, the ACOG update highlights two novel agents that target the brain pathways governing temperature regulation and sleep. Fezolinetant, marketed as Veozah, received FDA approval in 2023, while elinzanetant (Lynkuet) was cleared in 2025. Both drugs block specific neurochemical messengers, reducing the frequency and severity of hot flashes.
The guidelines also endorse gabapentin, an anticonvulsant, as an alternative for patients who cannot tolerate hormones or the newer agents. These additions provide clinicians with options for women who experience classic menopausal symptoms—hot flashes, night sweats, insomnia, and mood swings—but prefer non‑hormonal routes.
Non‑pharmacologic strategies and patient‑centered care
ACOG continues to recognize behavioral and complementary approaches, noting that cognitive‑behavioral therapy, mindfulness‑based interventions, regular exercise, clinical hypnosis, and acupuncture can alleviate certain symptoms. However, the evidence supporting these methods is described as weaker than that for pharmacologic treatments.
Cansino explained that many of her California patients favor lifestyle‑first strategies, prompting her to discuss diet, physical activity, and stress‑reduction techniques before introducing medication. She cautioned against oversimplifying treatment hierarchies, comparing medication choice to contraception decisions—patients may knowingly select a less effective option if it aligns with their preferences.
The update arrives as demand for HRT rises. The FDA recently removed a black‑box warning from several estrogen products, and pharmacies have reported shortages of transdermal estrogen patches. Cansino warned that heightened focus on hormone therapy should not eclipse other viable options, urging patients to have open conversations with trusted clinicians.
Statistically, roughly two million women in the United States enter menopause each year, with the average age of onset at 49.9 years. Symptoms often begin years before the final menstrual period, underscoring the importance of early, individualized intervention. The revised ACOG guidance aims to equip obstetricians and gynecologists with a broader evidence base to navigate these complex decisions and combat misinformation surrounding hormone therapy.
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.
