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News
The American College of Physicians (ACP) has issued a new clinical guideline naming estrogen — alone or combined with progestogen — as the first-line treatment for menopausal hot flashes and night sweats. The guidance, published in Annals of Internal Medicine, provides a tiered treatment roadmap and emphasizes shared decision-making. It aligns with existing recommendations from ACOG and the Menopause Society.
The American College of Physicians (ACP) has released a new clinical guideline making hormone therapy the official first-line treatment for menopausal vasomotor symptoms (VMS) — think hot flashes and night sweats. Published in Annals of Internal Medicine, the guideline recommends estrogen combined with progestogen for women with a uterus, or estrogen alone for those without. It arrives as menopause care gains broader attention, including the first-ever U.S. Senate hearing on the condition and recent FDA label updates removing warnings for CVD, breast cancer, and probable dementia from six hormone therapy products.
The guideline lays out a clear treatment ladder: SNRIs (desvenlafaxine or venlafaxine) as second-line options, followed by SSRIs, gabapentin, or neurokinin receptor antagonists (elinzanetant or fezolinetant) as third-line choices. Notably, the ACP used a formal GRADE-based framework and factored in cost, access, and patient values — not just clinical efficacy.
Key Takeaways:
Why it matters: This guideline gives primary care providers and ob/gyns a standardized, evidence-based framework for managing a condition that significantly impacts quality of life — and has historically been undertreated.
