ACOG Releases First Major Menopause Treatment Guidelines Since 2014, Expanding Options
The American College of Obstetricians and Gynecologists released new clinical guidelines in October 2026 for managing menopause symptoms, the first major update since 2014. The guidelines expand both hormonal and non-hormonal treatment options and emphasize individualized care and shared decision-making between patients and clinicians.
The American College of Obstetricians and Gynecologists released new clinical practice guidelines for managing menopause-related symptoms on October 15, 2026, marking the first major revision to the organization's menopause guidance since 2014.
The guidelines, designated Clinical Practice Guideline 13, cover the management of vasomotor symptoms such as hot flashes and night sweats, sleep disturbances, and mood changes. They emphasize individualized care and shared decision-making between patients and clinicians.
On hormone therapy, ACOG maintains that systemic hormone therapy is effective for managing vasomotor symptoms and related sleep disturbances. For patients who are candidates, the guidelines recommend initiating hormone therapy before age 60 or within 10 years of the onset of natural menopause. Individuals with a uterus should use both estrogen and a progestogen to reduce the risk of endometrial cancer. Those without a uterus may use estrogen alone.
For patients who cannot take or prefer to avoid hormone therapy, the guidelines provide updated recommendations for non-hormonal treatments. These include fezolinetant and elinzanetant, two neurokinin receptor antagonists, for managing vasomotor symptoms and sleep disturbances. Selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors are recommended for managing vasomotor symptoms and depression. Gabapentin is suggested as an alternative when other non-hormonal options are ineffective.
The guidelines also highlight evidence-based non-pharmacologic approaches, including cognitive behavioral therapy, mindfulness-based interventions, regular exercise, clinical hypnosis, and acupuncture.
ACOG explicitly states that current evidence does not support the efficacy or safety of phytoestrogens or herbal supplements such as soy isoflavones for treating menopause-related symptoms.
The guidelines also address health equity, urging clinicians to recognize and mitigate racial, cultural, and socioeconomic barriers that affect treatment access. ACOG said additional guidance on genitourinary syndrome of menopause is expected in 2027.
