US clinical guidelines for menopause management

Medical organizations in the United States have issued updated clinical guidelines regarding the management of menopause symptoms, such as vasomotor symptoms, insomnia, and mood changes.

The American College of Physicians (ACP) recommended hormone therapy as a first-line treatment for perimenopausal and postmenopausal females experiencing vasomotor symptoms. The ACP suggested second-line treatments like SNRIs and third-line options including SSRIs, gabapentin, or NK receptor antagonists for patients unable to tolerate estrogen. In response, the Physicians Committee for Responsible Medicine advocated for prioritizing dietary changes, citing research such as the WAVS trial which suggests plant-based diets rich in soy can be as effective as hormone replacement therapy.

The American College of Obstetricians and Gynecologists (ACOG) released guidelines emphasizing individualized approaches. ACOG stated that the safety of hormone replacement therapy is “well established” for recent menopausal patients without contraindications, recommending combined estrogen and progestogen for those with a uterus. ACOG suggests starting hormone replacement therapy before age 60 or within 10 years of natural menopause to maximize benefits.

Non-hormonal medical options highlighted by ACOG include neurokinin receptor antagonists like fezolinetant and elinzanetant, as well as certain antidepressants and gabapentin. Behavioral and lifestyle interventions, such as cognitive-behavioral therapy, mindfulness, aerobic exercise, and acupuncture, are also noted, though clinical evidence for some varies. 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. Additionally, research in The American Journal of Clinical Nutrition has examined the impact of whole-food-based dietary changes and caloric restriction on quality of life.