Two leading medical organizations — ACOG and ACP — have each released updated clinical guidance affirming hormone therapy (estrogen alone or combined with progestogen) as the most effective first-line treatment for menopausal vasomotor symptoms like hot flashes and night sweats. ACOG's guidance, released October 15, is broader in scope, also addressing sleep disturbances, mood symptoms, and practical guidance on when to start and stop treatment. Both groups emphasize shared decision-making tailored to each patient's health history, risk factors, and preferences.

For women who can't or won't use hormones, both guidelines support nonhormonal options. ACP uses a tiered approach — SNRIs second, then SSRIs, gabapentin, and neurokinin receptor antagonists (like fezolinetant and elinzanetant) third. ACOG takes a less hierarchical stance, recommending SSRIs/SNRIs and neurokinin antagonists alongside nonpharmacologic options like CBT, acupuncture, and mindfulness. Both organizations caution against unregulated herbal supplements like soy isoflavones.

Key Takeaways:

• Hormone therapy should generally be initiated before age 60 or within 10 years of natural menopause onset
• SSRIs/SNRIs and neurokinin receptor antagonists are recommended nonhormonal alternatives
• Black women, LGBTQ+ individuals, and gender-diverse people face greater symptom burden and care barriers — ACOG explicitly flags this
• Phytoestrogens and herbal supplements lack evidence and carry safety risks due to lack of FDA regulation

Why it matters: Menopause affects up to 80% of women and can last years, yet it remains undertreated — partly due to lingering misconceptions about hormone therapy risks. These updated guidelines from two major bodies give clinicians a clearer, evidence-based roadmap and may help close the gap between available treatments and actual patient care.