In addition to today’s resource, please review ACOG Clinical Practice Guideline: Management of Menopause-Related Vasomotor, Sleep, and Mood Symptoms [PubMed Abstract] [Full-Text HTML] [Full-Text PDF]. Obstet Gynecol. 2026 Nov 1;148(5):e345-e369. doi: 10.1097/AOG.0000000000006428.
Today, I review, link to, and excerpt from The New York Times’ “New Guidelines Strongly Support Hormone Therapy for Common Menopause Symptoms”.
By Maggie Astor, Oct. 15, 2026
The American College of Obstetricians and Gynecologists said the benefits of the treatment outweigh the harms for many women.
All that follows is from the above resource.
The American College of Obstetricians and Gynecologists released new guidance on Thursday for treating common menopausal symptoms, including a strong recommendation of hormone therapy for many people.
Hormone therapy should be a go-to treatment for hot flashes, night sweats and related sleep disturbances, the group said, except in women with contraindications such as a history of blood clots, stroke or certain cancers. For those patients, it recommended a wider range of alternatives than it previously has.
The new guidelines are similar to ones published last week by the American College of Physicians.
ACOG’s previous guidelines, in 2014, also supported hormone therapy, but encouraged doctors to prescribe it in the lowest effective dose for the shortest amount of time to minimize risks. Its new guidelines recommend reviewing treatment choices regularly, but emphasize flexibility.
The goal is to focus on individual decision-making rather than having “a straight rule” about minimizing the length or intensity of treatment, said Dr. Catherine Cansino, the chair of the ACOG committee that developed the new recommendations.
While the guidance said hormone therapy was best prescribed before age 60 or less than 10 years past menopause, it added that patients already taking it might need to continue past 60 “to manage persistent symptoms.”
The designation of the recommendation as “strong” means that, in ACOG’s view, the benefits of the therapy for women with hot flashes, night sweats and sleep disturbances “clearly outweigh harms and burdens,” and most patients with those symptoms should receive it.
“There’s growing consensus among professional societies that menopausal symptoms should be treated, and that hormone therapy should be the first line of treatment,” said Dr. JoAnn Manson, an endocrinologist and professor of medicine at Harvard Medical School who was not involved in developing the recommendations. That, and growing consensus on options for patients who can’t take hormones, “is good news for women,” she said.
Menopausal hormone therapy has increased in popularity over the past few years, after plummeting in the early 2000s in response to findings from the Women’s Health Initiative, a long-term study that found some forms of it could lead to a small increased risk of breast cancer and cardiovascular problems. (Dr. Manson is a principal investigator for the study.) But it hasn’t returned to pre-W.H.I. levels; only a small minority of women use it.
ACOG’s recommendation comes with caveats, because questions about breast cancer and cardiovascular risk are not fully settled. Patients at high risk of these conditions may not be good candidates for hormone therapy.
For these patients, and those who don’t want to take hormones, the new guidelines recommend two options: a relatively new class of drugs that block certain receptors in the brain, and some types of antidepressants that can reduce hot flashes and night sweats. They also note that options like cognitive behavioral therapy might help with some symptoms, but the evidence is limited.
The decision to start hormone therapy should take into account age and medical history, the guidelines said. They recommend using risk calculators like the American College of Cardiology’s for cardiovascular risk and the National Cancer Institute’s for breast cancer risk, but they don’t specify what thresholds should lead a provider not to prescribe hormones.
More details would be helpful, said Dr. Stephanie Faubion, the director of the Mayo Clinic Center for Women’s Health and medical director of the Menopause Society, because the guidelines tell clinicians to assess risk but don’t help them decide what to do with the results. She added, though, that the recommendations were “quite reasonable” overall.
Both Dr. Faubion and Dr. Cansino noted that risk isn’t black and white. Some patients’ medical details may rule out hormone therapy entirely, but it may be appropriate for others to choose it as long as they are aware of the risks. Hormone therapy also comes in several formulations. Skin patches, for instance, can be safer than pills for women at higher risk of blood clots, Dr. Faubion said.
The new guidance addresses only some potential symptoms: hot flashes and night sweats, related sleep disturbances and mood changes. (It notes that the evidence for hormone therapy to treat mood changes is “insufficient.”) It does not address, for example, genitourinary syndrome of menopause [Link is to the results of a Google search on this condition], [a constellation of symptoms such as vaginal dryness and urinary tract infections. ACOG said it would release guidance on G.S.M. next year.
Some patients use systemic hormone therapy for those symptoms, but for those who aren’t also experiencing hot flashes and night sweats, doctors often prescribe vaginal estrogen, which has more localized effects.
Dr. Manson said she hoped the guidance would encourage doctors and patients to take menopause symptoms more seriously, and to recognize the wide range of available options. Most women experience hot flashes and night sweats around menopause.
At the same time, Dr. Manson emphasized that the latest recommendation, while strongly in favor of hormone therapy, didn’t recommend it for preventing problems like heart disease and cognitive decline in patients without symptoms, which was common before the Women’s Health Initiative report came out in 2002.
It’s “for women who have a clear indication for treatment,” she said.
