The American College of Obstetricians and Gynecologists (ACOG) has issued its first updated menopause treatment guidelines since 2014, officially recommending hormone replacement therapy as a primary option for managing symptoms like hot flashes and night sweats. The new guidance aims to modernize clinical care and reduce long-standing stigma surrounding menopause treatments.
ACOG Updates Hormone Therapy Recommendations
For the first time since 2014, ACOG has revised its clinical framework for addressing perimenopause and menopause. The updated guidance positions hormone replacement therapy (HRT) as a frontline treatment for vasomotor symptoms, including hot flashes and night sweats.
The move represents a significant shift in the medical community’s approach to midlife health. The level of care that OB/GYNs provide by helping individual patients find the right treatment is one of the most important aspects of the new guidance,
said Cansino. Experts emphasize that the treatment landscape has evolved to focus on personalized care rather than rigid protocols.
Clinical Guidance and Treatment Options
The new recommendations provide a structured, practical framework for clinicians.
- Hormone Therapy: Recommended for symptomatic women, particularly those within 10 years of their final menstrual period or younger than 60.
- Non-Hormonal Medicines: Includes antidepressants, nonhormonal medicines, and other treatments for patients who cannot or choose not to use hormones.
- Lifestyle Interventions: Suggests a healthy diet and regular physical exercise to help manage symptoms.
Meanwhile, the FDA has recently signaled a shift in safety communication by removing boxed warnings for cardiovascular disease, breast cancer, and probable dementia from MHT labeling, a move that some providers say helps clear years of clinical controversy.
The Legacy of the 2002 Health Initiative
Much of the current clinical debate traces back to the 2002 long-term study on women’s health, which raised concerns that the use of hormones could be linked to an increase in breast cancer. Experts now argue that the study’s findings were often misinterpreted because the participants averaged 63 years old—a group already at higher risk for cardiovascular issues.
In the WHI, the Women’s Health Initiative, you had women who on average were 63 years old, so they had been in menopause for probably 10 years or longer.
Elizabeth R. Lapeyre, MD, via American Medical Association
Modern research suggests that age and dosing are critical factors in the safety profile of these treatments. The new ACOG guidance explicitly emphasizes shared decision-making, encouraging patients to discuss their individual health history, including risks like blood clots, stroke, liver disease, or breast cancer, with their providers.
Department of Veterans Affairs and Department of Defense Joint Guidelines
The push for updated standards extends beyond civilian healthcare. The Department of Veterans Affairs and the Department of Defense have jointly released the 2026 Clinical Practice Guideline on Menopause. This initiative aims to help clinicians provide consistent and unified standards of high-quality care for women experiencing perimenopause and menopause.
By identifying symptoms, officials hope to optimize care. The guidelines stress that true patient care requires an open, individualized dialogue.
Individualized Care and Future Monitoring
Because every patient’s experience is unique, the guidelines suggest that providers must remain flexible. Patients are encouraged to work with their clinicians to monitor their symptoms, as a treatment regimen that works today may require adjustments in the future.
For women who prefer to avoid pharmacologic therapy, providers like Kameelah Phillips emphasize that a healthy lifestyle remains a foundation, though it is often not enough on its own. A healthy diet and regular physical exercise is going to go a long way. So let’s start with that,
said one expert, while noting that the ultimate goal is to ensure no patient feels forced to suffer in silence.