ACOG Just Updated Its Menopause Guidelines After 12 Years — Here’s What Women Should Know

Menopause symptoms often overlap, making them tricky to manage. You can wake up drenched in sweat, struggle to sleep, or feel unusually anxious without knowing why.

For the first time since 2014, the American College of Obstetricians and Gynecologists (ACOG) has updated its guidance on treating these symptoms, outlining the medications and non-drug approaches clinicians can consider to help women through this confusing time.

Medication & menopause symptoms

Menopausal hormone therapy (MHT) is one of the most effective treatments for symptoms, like hot flashes and night sweats, that can disrupt sleep.

ACOG recommends generally starting MHT before age 60 or within 10 years of natural menopause to get the most out of it while minimizing side effects. Your clinician can help you weigh the benefits and risks but hormone therapy may not suit people who’ve had a stroke or certain forms of breast cancer.

If MHT isn’t the right fit, or you would rather skip the hormones, ACOG recommends non-hormonal medications:

• Certain antidepressants: SSRIs and SNRIs can ease hot flashes even in people who aren’t being treated for depression.

• Neurokinin receptor antagonists: This newer class of medication is one of the more notable updates to the guidance. The category includes fezolinetant (Veozah) and elinzanetant (Lynkuet), which target the brain’s temperature-regulation system to reduce hot flashes and related sleep disruption.

• Gabapentin: Also used for nerve pain and seizures, this medication may be considered if other non-hormonal treatments don’t work well or cause troublesome side effects.

What the guidance says about supplements

If you are wary of medication, you may have been inclined to try one of the many natural solutions marketed for menopause symptoms. Soy isoflavones, black cohosh, and other herbal products for menopause have flooded the market in recent years.

However, ACOG states that the available evidence doesn’t support the efficacy or safety of phytoestrogens (such as soy isoflavones) or herbal supplements for treating hot flashes or other menopause symptoms. The guidelines also note that these products don’t need to be approved by the FDA before hitting the market, so they haven’t necessarily been tested for safety, efficacy, or purity.

This doesn’t automatically mean every supplement is harmful, but it’s a reminder that “natural” does not guarantee effectiveness or safety. Tell your clinician about any supplements you’re considering, especially if you take other medications.

Therapy & lifestyle approaches can help, too

Beyond pills and patches, ACOG suggests cognitive behavioral therapy (CBT) to improve sleep and mood. CBT teaches people to recognize and change thought patterns that can affect how they cope with symptoms.

Mindfulness practices and regular exercise may also help with menopause-related sleep problems and mood changes. ACOG also lists clinical hypnosis and acupuncture among non-drug options.

Depending on your symptoms and preferences, these approaches may complement, or in some cases replace, medical treatment. Either way, talk with your doctor before making major changes.

Find the right approach for you

If menopause is affecting your quality of life, ACOG wants you to know that you don’t have to simply put up with it. Before your next appointment, think about which symptoms are bothering you most and how they’re affecting your sleep, mood, or daily routine. Here’s a list of a few things to do before your next appointment.

• Keep a symptom journal: Track how often symptoms happen, how intense they are, and how they affect your sleep, work, and relationships. Note any changes in your period’s length and flow.

• Share your medical history: It’s especially important for your doctor to know about any history of heart disease, stroke, blood clots, or breast cancer in you or your family.

• Ask about a variety of treatments: There are lots of options to treat your symptoms, including hormone therapy, non-hormonal medications, and supportive approaches such as CBT or mindfulness. Your options will depend on your medical history, preferences, and which symptoms you want to address most.

• Schedule a follow-up visit: Before you leave the office, schedule a follow-up visit to ensure you receive continuous care.

The takeaway

ACOG’s new guidelines recognize that menopause care isn’t one-size-fits-all. Symptoms vary greatly from woman to woman, and cultural, socioeconomic, and ethnic differences can affect timeliness and quality of care.

That’s why it’s so important to advocate for yourself when it comes to getting the treatment you need for menopause. You shouldn’t have to figure it all out on your own, but arming yourself with knowledge about your options before your next doctor’s appointment can help you get the care you deserve. Use ACOG’s guidance as a starting point for a conversation with your clinician about what could help you feel better.