What the New Menopause Guidelines Mean for Hormone Therapy

Written by Rachel Murphy · October 22, 2026

Not sure if it’s perimenopause? Check your symptoms and find out.

Key Takeaways

The American College of Obstetricians and Gynecologists recently released updated guidance that strongly recommends hormone therapy for people experiencing hot flashes, night sweats, and related sleep problems during perimenopause.
The new guidance advises starting hormone therapy before age 60 or within 10 years of menopause, and notes that timing can play an important role in treatment decisions. For those who prefer not to use hormones, there are other options available, including certain antidepressants, newer nonhormonal medications, and lifestyle approaches like exercise and mindfulness.
Hormone therapy is not right for everyone, and the best choice depends on a person's age, health history, and individual circumstances, so talking with a healthcare provider is a great first step to finding the right path forward.

A shift is happening in how we consider hormone therapy (HRT) as an option for perimenopause symptoms. The latest move comes from the leading organization for women’s health clinicians, which issued much stronger guidance on this treatment.

On October 15, the American College of Obstetricians and Gynecologists (ACOG) released an expanded guideline that strongly recommends hormone therapy, also called menopausal hormone therapy, for vasomotor symptoms (hot flashes and night sweats) and the sleep problems they cause.

ACOG's 2014 guidance already called hormone therapy the most effective treatment for hot flashes. The update goes further. It extends that recommendation to sleep symptoms and advises starting HRT before age 60 or within 10 years of menopause.

What the New Guideline Recommends

Key takeaways from ACOG’s guidance include:

Hormone therapy is strongly recommended for hot flashes and related sleep problems — This means estrogen plus a progestogen for people with a uterus, or estrogen alone for people without one.
Timing matters — ACOG recommends starting hormone therapy before age 60 or within 10 years of menopause.
Shared decision-making is key — Choices about starting and stopping hormone therapy should be made together with a healthcare provider, based on each person’s symptoms, health history, and personal risks.
There are nonhormonal options — For those who can’t or prefer not to use hormones, treatments can include certain antidepressants and newer nonhormonal medications.

🗳️ Have you tried hormone therapy for menopause-related hot flashes or night sweats?

Yes, and it helped

Yes, but it didn’t help

No, but I’m interested

No, and I’m not interested

A Shift in How Hormone Therapy Is Viewed

The guidance follows other recent changes. In November 2025, the U.S. Food and Drug Administration (FDA) announced it would remove the “black box” warnings on most hormone therapy products. Those warnings had cautioned about risks of cardiovascular disease, breast cancer, and probable dementia.

Updated labels are being rolled out product by product. A boxed warning about endometrial cancer remains on estrogen-only products.

An Official Guide for Nonspecialists

Many OB-GYNs have championed hormone therapy for years. But the new guidance may be especially helpful for primary care providers, said Dr. Angela McCool-Pearson, an OB-GYN and medical advisor to ThisIsMenopause.

“Historically, non-OB-GYN providers have taken their patients off of hormone therapy or told patients that they don’t need it,” Dr. McCool-Pearson said. “This gives us more credence as gynecologists to say to our other specialty colleagues, we’re not just touting this on social media. This is what our college is now saying.”

Dr. McCool-Pearson added that she appreciates the new guidelines about first-line treatment for vasomotor symptoms. “I’m glad they finally came out and said the first-line treatment for VMS is estrogen and [a progestogen] if the patient has a uterus. They didn’t really say that before,” she said.

Options Beyond Hormones

For those who can’t, or prefer not to, take hormones, ACOG’s guidance includes:

SSRIs or SNRIs — Certain types of antidepressants are strongly recommended for hot flashes.
Neurokinin receptor antagonists — These include elinzanetant (Lynkuet) and fezolinetant (Veozah), which can treat hot flashes and night sweats. Some people may also sleep better as symptoms improve.
Gabapentin — This is an option if other nonhormonal medications don’t work or aren’t tolerated.
Nonhormonal and nonmedication approaches — These include exercise, cognitive behavioral therapy, acupuncture, mindfulness, and clinical hypnosis. They’re often recommended alongside medication rather than in place of it.

“We now know the biochemistry behind vasomotor symptoms. That’s where drugs like [Veozah] come in,” Dr. McCool-Pearson said.

For mood symptoms, ACOG found that the evidence isn’t strong enough to recommend or discourage specific treatments. People whose main menopausal symptom is depression should be treated according to standard depression treatment guidelines.

What the Guideline Says About Supplements

The guideline also addresses the flood of menopause supplements promoted on social media by wellness influencers and even some physicians.

According to ACOG:

Phytoestrogens and herbal supplements are not recommended — Current evidence doesn’t support phytoestrogens, such as soy isoflavones, or herbal supplements for menopause symptoms.
Supplements are regulated differently than medications — The FDA doesn’t approve supplements for safety and effectiveness before they’re sold. Products may also vary in purity and quality.

Learn more about menopause myths that experts say are hurting women. ❯

Less Fear for Healthcare Providers and Patients

Dr. McCool-Pearson said the biggest gain from the new guidelines may be confidence in prescribing hormone therapy.

“It takes away the fear of hormone therapy as a first-line treatment for these symptoms. If I were reading these as a primary care provider, I would feel confident writing hormone therapy scripts for patients that are suffering so badly,” she said.

“Most patients are asking their primary care provider about this first. We’re going back to where we were [before] 2002, where just about every menopausal patient was offered hormone therapy.”

Is Hormone Therapy Right for You?

Hormone therapy isn’t right for everyone. Its risks depend on a person’s age, health history, and the type, dose, and length of treatment.

Possible risks include blood clots and stroke, while combined estrogen-progestogen therapy may slightly increase breast cancer risk with longer use. Hormone therapy generally isn’t recommended for people with a history of breast cancer, blood clots, stroke, heart attack, active liver disease, or unexplained vaginal bleeding.

If you’re considering hormone therapy:

Talk with your healthcare provider about your symptoms, health history, and personal risks.
Ask about nonhormonal options if hormone therapy isn’t a good fit.
Contact your provider if you have unexpected or ongoing bleeding after starting hormone therapy, because it should be checked.

References

Read full article