Doctors update menopause guidance, endorse hormone therapy for hot flashes

A leading United States medical organisation has updated its guidance on managing menopause symptoms for the first time in 12 years, placing renewed emphasis on hormone therapy while outlining several nonhormonal treatment options.

The American College of Obstetricians and Gynecologists (ACOG) says moderate to severe menopause symptoms, including hot flashes and night sweats, should be treated, with hormone therapy recommended as the first-line option for many women.

The updated guidance comes amid renewed interest in hormone treatments following the US Food and Drug Administration's decision last year to remove longstanding boxed safety warnings from more than 20 hormone-based menopause medications.

ACOG President Dr Camille Clare is encouraging women experiencing disruptive symptoms to consult their obstetricians and gynaecologists and seek appropriate treatment.

More than half of menopausal women experience hot flashes and night sweats, while as many as two-thirds report sleep disturbances associated with menopause, according to ACOG.

The organisation defines menopause as the point when a woman has gone 12 consecutive months without a menstrual period. It typically occurs around age 50.

Harvard Medical School professor Dr JoAnn Manson said hormone therapy is an effective option for many women experiencing moderate to severe symptoms, although it is not suitable for everyone.

Concerns about hormone treatment date back to a major 2002 study that linked a combination of estrogen and progestin to increased risks of breast cancer, blood clots and other serious health problems.

However, subsequent research has shown that the benefits of modern hormone therapies outweigh the risks for many women.

ACOG recommends that decisions about hormone treatment be made jointly by patients and their doctors, taking into account individual medical histories and potential risks. For women who are suitable candidates, the organisation advises starting treatment before age 60 or within 10 years of menopause.

For women who cannot or prefer not to use hormone therapy, ACOG has identified alternatives, including medications such as fezolinetant and elinzanetant, which target brain mechanisms involved in regulating body temperature and reducing hot flashes and night sweats.

Certain antidepressants may also help manage hot flashes and depression.

The guidance also highlights non-drug approaches, including cognitive behavioural therapy, mindfulness, exercise, clinical hypnosis and acupuncture, which may be used alone or alongside medication.

Medical director of The Menopause Society Dr Stephanie Faubion said women should not be left believing that nothing can be done to relieve their symptoms, stressing that both hormonal and nonhormonal treatments are available.

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