3 articles · Updated · Contemporary Obgyn · Oct 15
Summary
Clinical Practice Guideline No. 13 replaces ACOG’s 2014 bulletin with its broadest menopause advice yet, covering vasomotor symptoms, sleep disturbance and mood symptoms.
Systemic menopausal hormone therapy won strong recommendations for hot flushes and vasomotor-related sleep problems, with ACOG advising use before age 60 or within 10 years of menopause onset when no contraindications exist.
SSRIs or SNRIs and neurokinin receptor antagonists also received strong backing for patients who cannot or do not want hormone therapy; fezolinetant and elinzanetant are FDA-approved options, both requiring liver monitoring.
Conditional recommendations extended to CBT, mindfulness, exercise, hypnosis and acupuncture, while clonidine was not recommended as a primary treatment and evidence did not support phytoestrogens or herbal supplements.
The update responds to common symptoms affecting 50% to 92% of menopausal women and aims to counter persistent hormone-therapy misconceptions while ACOG prepares separate guidance on genitourinary syndrome for 2027.