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The American College of Obstetricians and Gynecologists has released new guidance for the treatment of common menopause and perimenopause symptoms, including recommending hormone replacement therapy for many women with hot flashes and night sweats.
It’s the first time in more than a decade that the group, which is the leading OB-GYN professional organization in the United States, is changing its advice on the use of hormone therapy for menopause and perimenopause.
“Hormone replacement therapy is now the first line” for vasomotor symptoms including hot flashes, night sweats and sleep issues, said Dr. Kameelah Phillips, an OB-GYN and menopause specialist.
“Before, we used to say, ‘Here’s an antidepressant. Make sure you work out. Why don’t you try a glass of wine?’ All of those were not helpful,” Phillips said in an interview on “CBS Mornings.” “We’re using hormones mainstream now.”
How hormone replacement therapy for menopause works
Most menopause symptoms are caused by steep drops in the hormones estrogen and progesterone, typically in a woman’s late 40s or early 50s. Those hormone drops result in hot flashes, night sweats and other symptoms. Low levels of estrogen and progesterone can also lead to reduced bone density, increasing the risk of osteoporosis or fractures.
Hormone replacement therapy can help “eliminate these symptoms,” Phillips said.
Hormone replacement therapy can be delivered in a number of ways, including options like pills, patches, sprays or gels, or a vaginal ring that can deliver doses of hormones directly into the bloodstream. Some women also benefit from low-dose vaginal estrogen therapy.
“Menopause is a normal and natural stage of life, but that doesn’t mean that women must suffer through the symptoms without help,” ACOG said in a statement about the new recommendations.
Who is eligible for hormone replacement therapy?
Not every person going through menopause is eligible for hormone replacement therapies. Women with a history of blood clots, stroke and liver disease should not use them. People with a personal history of breast cancer should also avoid these therapies, according to ACOG.
A 2002 long-term study on women’s health raised concerns that the use of hormones could be linked to an increase in breast cancer. But that study was focused on older patients who may not have started hormone replacement therapy until about a decade after undergoing menopause, explained Dr. Céline Gounder, CBS News medical contributor and editor-at-large for public health at KFF Health News.
Newer research shows that factors like age and dosing can make treatment safe for many patients. It may also help slow biological aging, according to a 2024 study of over 10,000 women.
The ACOG recommendations say women should begin hormone replacement therapy before the age of 60 or within 10 years of starting menopause.
Women who are not eligible for hormone replacement therapy may be able to benefit from other treatment options. Phillips recommended consulting with a menopause trained specialist.
“There are really good options that are non-hormonal for these women,” Phillips said. “But that’s why this requires conversation with your healthcare provider.”
