ACOG updates menopause treatment guidelines

The American College of Obstetricians and Gynecologists (ACOG) has released its first updated guidance on menopause management since 2014. The new clinical recommendations outline various pharmacological and non-drug approaches to managing symptoms such as hot flashes, sleep disturbances, and mood swings.

For hormone replacement therapy (MHT), ACOG suggests starting treatment before age 60 or within 10 years of natural menopause to maximize benefits and minimize risks. While MHT can help prevent cardiovascular disease, it may not be suitable for individuals with a history of stroke or certain types of breast cancer.

For those seeking non-hormonal options, the guidance highlights several alternatives: • Neurokinin receptor antagonists, such as fezolinetant and elinzanetant, which target the brain’s temperature-regulation system. • Certain antidepressants (SSRIs and SNRIs) to ease hot flashes. • Gabapentin for cases where other treatments are ineffective.

Additionally, medical experts note that physical activity, specifically aerobic and mind-body exercises, can significantly decrease self-reported depression and improve quality of life. Regarding supplements, ACOG stated that current evidence does not support the efficacy or safety of phytoestrogens or herbal products, such as soy isoflavones and black cohosh, for treating menopause symptoms.