Hot flashes, night sweats, insomnia – OB-GYNS set new rules for menopause treatment
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GYNS → set → treatment
For the first time since 2014, the American College of Obstetricians and Gynecologists has updated its guidelines for the treatment of symptoms commonly associated with menopause.
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College → update → menopause
The doctor's group, known as ACOG, recommends hormone replacement therapy alongside certain antidepressants, nonhormonal medicines, and other treatments to address symptoms like hot flashes, insomnia and mood swings.
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group → know → flashes
"What's changing is the breadth of options that we now have …
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we → change → that
And the benefit of that is that we are better equipped to be able to take an individualized approach for patients," said Catherine Cansino, MD, MPH, an obstetrician/gynecologist, chair of ACOG's Committee on Clinical Practice Guidelines and co-author of the new guidance.
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Cansino → equip → guidance
The guidance, released Thursday, focuses on specific menopausal symptoms and underscores that the safety of hormone replacement therapy is now "well-established," Cansino said.
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Cansino → release → therapy
In 2002, the Women's Health Initiative suggested that hormone replacement therapy increased the risk of heart disease, breast cancer, stroke and pulmonary embolism.
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therapy → suggest → disease
However, as researchers revisited that data years later, they noticed certain limitations, (including that a majority of participants were 60 years or older) making it difficult to generalize the findings to younger women experiencing menopause or perimenopause.
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it → revisit → menopause
With more and better quality studies, physicians are able to review the evidence and make better-informed recommendations, Cansino said.
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Cansino → review → recommendations
"Hormone therapy is probably the best option for symptomatic, newly menopausal women within 10 years of the final menstrual period or before the age of 60," said Robert Kauffman, MD, MSCP, a co-author of the guidelines, during a press briefing on Thursday.
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Kauffman → say → Thursday
In addition to hormone replacement therapy, the guidelines highlight new nonhormonal options for treating menopausal symptoms, including the drug fezolinetant, brand name Veozah, which the Food and Drug Administration approved to treat hot flashes in 2023 and elinzanetant, brand name Lynkuet, which was approved in 2025.
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which → highlight → 2025
"What's so exciting about these treatment options is they were specifically studied based on the understanding that we have of the physiology of thermoregulation and sleep," Cansino said.
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Cansino → study → thermoregulation
The medications work by blocking certain chemical messengers in the part of the brain that regulates body temperature and manages sleep/wake cycles, according to the guidance.
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that → work → guidance
About 2 million women begin menopause each year.
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women → begin → menopause
The average age of a woman experiencing menopause is 49.9 years, according to the guidelines.
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age → experience → guidelines
However, symptoms of menopause can begin years before a woman's final menstrual period.
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symptoms → begin → period
The new recommendations support the use of systemic hormone replacement therapy, or HRT, with a combination of estrogen and progestogen in women with a uterus who have no contraindications to hormones.
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who → support → hormones
Reasons to avoid hormone therapy include undiagnosed abnormal genital bleeding, and current or past histories of certain gynecologic cancers, blood clots, stroke, heart attack, liver disease or a known or suspected pregnancy.
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Reasons → avoid → cancers
The reason progestogen is recommended in women with a uterus is because estrogen can stimulate growth of the uterine lining and increase the risk of endometrial cancer.
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estrogen → recommend → cancer
Progestogen therapy helps mitigate that risk, Cansino explained.
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Cansino → help → risk
Around half a million women have hysterectomies each year, and for women without a uterus, ACOG recommends estrogen alone.
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ACOG → have → estrogen
As an alternative to estrogen-progestogen therapy, ACOG also recommends a pill, sold under the brand name Duavee, that combines estrogen and a drug called bazedoxifene.
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that → recommend → estrogen
Bazedoxifene is a "selective estrogen receptor modulator," which blocks the estrogen from working in certain areas of the body, such as breast tissue, while mimicking estrogen's benefit for bone density, for instance.
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which → block → instance
Another drug recommended in the new guideline is gabapentin, an anticonvulsant typically used to treat seizures.
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drug → recommend → seizures
It can also manage menopause symptoms for people who can't tolerate hormones or the other new medicines.
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who → manage → hormones
Cognitive behavioral therapy, mindfulness-based interventions, exercise, clinical hypnosis, and acupuncture can all improve some symptoms, ACOG says, however the guidelines also note that the evidence for these interventions is weaker than the evidence for HRT.
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evidence → base → HRT
Still, patients may have their own preferences and goals, Cansino said.
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Cansino → have → preferences
"I live in California, and I have a practice where many patients don't necessarily want pharmacologic therapy," Cansino said.
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Cansino → live → therapy
So, she tends to have a lot of conversations about non-pharmacologic treatment options with her patients.
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she → tend → patients
"A healthy diet and regular physical exercise is going to go a long way.
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diet → go → way
So let's start with that," and then discuss what other interventions to add to the regimen, she said.
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she → let → regimen
Asked, in a follow-up email, whether Cansino recommended one medication or tool over another, she warned against "over-simplifying treatment based on tiers.
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she → ask → tiers
Just like with contraception, she noted that patients may choose a certain method, knowing that it's less effective.
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it → note → method
"As long as they understand the pros and cons, such a decision is perfectly OK."
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decision → understand → pros
Meanwhile, demand for HRT is already rising.
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demand → rise → HRT
Last year, the FDA scrapped the "black-box warning" on labels for certain estrogen therapies.
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FDA → scrap → therapies
In recent months, estrogen products like transdermal patches have been hard for pharmacies to keep in stock.
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pharmacies → keep → stock
"I think the shortage of transdermal estrogen therapy highlights the fact that we have all of this attention about hormone therapy, and not necessarily enough about other treatment options," Cansino told NPR.
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Cansino → think → NPR
She also stressed the need for patients to talk to trusted clinicians about the pros and cons of treatments and to avoid having "tunnel vision" about a single option.
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patients → stress → option
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, Cansino said.
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Cansino → provide → guidance
…and 1 more, not listed.
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