Menopause hormone therapy gets stronger endorsement from OB-GYNs in expanded guideline

Hormone therapy should be a first choice for easing hot flashes, night sweats and the sleep problems they cause, a leading U.S. doctors’ group says.

The American College of Obstetricians and Gynecologists (ACOG) released the new guidance Thursday. It’s the group’s most detailed menopause advice yet, covering treatments for hot flashes, sleep and mood changes.

ACOG gave hormone therapy a “strong” rating, meaning it believes the benefits outweigh the risks for most women with these symptoms, reports The New York Times.

That doesn’t apply to women with medical reasons to avoid hormones, such as past blood clots, a stroke or some cancers.

Between 50% and 92% of women in menopause have hot flashes or night sweats, according to ACOG. Sleep trouble and depression are also common during this stage of life.

For women who choose hormones, ACOG advises starting before age 60, or within 10 years after menopause begins. The decision should weigh a woman’s symptoms, age, health history and personal risk of heart disease, breast cancer and blood clots.

That’s a shift from ACOG’s 2014 advice, which urged doctors to prescribe the lowest dose for the shortest time. The new guidance calls for regular check-ins rather than strict limits. Some women may need to stay on hormones past 60 if symptoms linger, The Times reported.

“Unfortunately, misconceptions about the risks of hormone therapy have affected some clinicians’ willingness to prescribe it and some patients’ interest in using it,” Dr. Bruce Pier, a co-author of the guidance, said in an ACOG news release.

For women who can’t or don’t want to take hormones, ACOG points to a newer class of nonhormonal drugs that block certain signals in the brain. These include fezolinetant and elinzanetant. Some antidepressants can also ease hot flashes, along with depression.

Nondrug options include cognitive behavioral therapy (a type of talk therapy), mindfulness, exercise, hypnosis and acupuncture. ACOG says these generally work best alongside medication, though The Times noted the evidence for some is limited.

Plant-based estrogens and herbal supplements didn’t make the cut. There’s no evidence they’re safe or effective, and they aren’t tested for safety or purity by the U.S. Food and Drug Administration, ACOG noted.

The guidance also points out that race, culture and income can shape how women experience menopause and the care they get.

“There’s growing consensus among professional societies that menopausal symptoms should be treated, and that hormone therapy should be the first line of treatment,” Dr. JoAnn Manson, a professor of medicine at Harvard Medical School, told The Times.

ACOG plans to release separate guidance in 2027 on genitourinary syndrome of menopause, which includes vaginal dryness and urinary tract infections.

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