OB-GYNs endorse hormone therapy in first menopause guideline since 2014

Overview

Updated 1 hour ago

For the first time since 2014, the American College of Obstetricians and Gynecologists (ACOG) has rewritten how doctors should treat menopause symptoms. Its October 15 update makes hormone replacement therapy the first-line option for most recently menopausal women and adds nonhormonal medications plus behavioral therapies to the toolkit.

The change matters because an estimated 50–92% of menopausal women report hot flashes and night sweats, and more than a third report depressive symptoms. ACOG now says hormone therapy safety is "well-established" for women under 60 or within 10 years of menopause, a reversal of the deep caution that followed a 2002 study linking hormones to breast cancer and heart risk.

Why it matters

Millions of women with hot flashes, night sweats and insomnia now have hormone therapy as first-line care, plus new nonhormonal drugs.

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Key Indicators

Years between ACOG menopause guideline updates (2014–2026)

The last comprehensive ACOG menopause guidance predates the two new nonhormonal drug approvals.

50–92%

Share of menopausal women reporting hot flashes or night sweats

Wide range reported across studies cited in the new ACOG guidance.

New FDA-approved nonhormonal drugs for hot flashes since 2023

Fezolinetant (Veozah, 2023) and elinzanetant (Lynkuet, 2025) target the brain's temperature-control center.

Voices

Curated perspectives — historical figures and your fellow readers.

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People Involved

Catherine Cansino

Obstetrician-gynecologist and chair of ACOG's Committee on Clinical Practice Guidelines

Co-author of the new menopause guidance

Robert Kauffman

Physician and co-author of the ACOG menopause guideline

Co-author presenting the new guidance

Organizations Involved

American College of Obstetricians and Gynecologists (ACOG)

Medical professional association

Publisher of the new menopause guideline

The United States' main professional association for obstetricians and gynecologists, whose guidance shapes how doctors treat women's health conditions.

American College of Physicians

Medical professional association

The largest medical specialty society in the United States, representing internal medicine physicians.

U.S. Food and Drug Administration

Federal regulatory agency

Approved the two nonhormonal drugs cited in the new guideline

The US agency that approves and regulates drugs and medical devices.

Timeline

2014 October 2026

5 events Latest: Yesterday

Tap a bar to jump to that date

October 2026
ACOG publishes expanded menopause guideline
Latest Guideline

ACOG releases Clinical Practice Guideline 13, its first menopause update since 2014, endorsing hormone therapy and new nonhormonal options.
Yesterday
ACP endorses hormonal therapy as first-line
Guideline

American College of Physicians publishes its own guideline recommending estrogen-based therapy as first-line for vasomotor symptoms.
October 5th, 2026
2025
FDA approves second neurokinin receptor blocker
Regulatory

FDA approves elinzanetant (Lynkuet), adding another nonhormonal option for hot flashes.
2025
2023
FDA approves first new-class hot flash drug
Regulatory

FDA approves fezolinetant (Veozah), a nonhormonal treatment for hot flashes.
2023
2014
ACOG last updates menopause guidance
Guideline

ACOG's prior comprehensive menopause management guidance, the baseline for the 2026 overhaul.
2014

Scenarios

Hormone therapy prescriptions climb as doctors shed post-2002 caution

Likely Resolves by Oct 15, 2027

Discussed by: ACOG and ACP guideline authors, who argue benefits outweigh risks for recently menopausal women

Backed by two major medical societies, physicians prescribe hormone therapy more freely to women under 60 or within 10 years of menopause. Growth would show up first in national prescription claims data within a year.

Veozah and Lynkuet become widely covered, routine options

Possible Resolves by Oct 15, 2027

Discussed by: ACOG guideline authors, who cite both drugs as new nonhormonal alternatives

The guideline's endorsement pushes insurers and Medicare to cover fezolinetant and elinzanetant without prior authorization, making them routine alternatives for patients who cannot take hormones. Resolution would appear in formulary listings.

Coverage gaps and lingering caution keep access uneven

Possible Resolves by Oct 15, 2028

Discussed by: Observers noting that past guideline updates took years to change real-world practice

Despite the endorsement, cost barriers, clinician reluctance and gaps in insurance coverage slow adoption. A survey of practicing OB-GYNs would reveal whether the guideline changed routine prescribing or mostly reinforced existing practice.

Historical Context

2 moments from history that rhyme with this story — and how they unfolded.

July 2002

Women's Health Initiative trial halted (2002)

A landmark US government-funded trial was stopped early when combined estrogen-progestin therapy showed increased risks of breast cancer, heart attack, stroke and blood clots. Hormone therapy prescriptions in the United States plummeted in the years that followed.

Then

Doctors stopped prescribing HRT broadly and millions of women stopped taking it.

Now

Two decades of caution followed, with later analysis finding risks depended heavily on a woman's age when she started therapy.

Why this matters now

The new ACOG guideline directly confronts this legacy, declaring hormone therapy safety 'well-established' when started within 10 years of menopause or before age 60.

2014

ACOG's previous menopause guidance (2014)

ACOG last published comprehensive menopause management guidance, reflecting the conservative approach to hormones that followed the 2002 Women's Health Initiative findings.

Then

The guidance governed US menopause practice for 12 years.

Now

During that period the FDA approved the first nonhormonal drugs in a new class for hot flashes.

Why this matters now

The October 2026 update replaces this 2014 baseline with a broader, more individualized treatment approach.