ACOG's new menopause guideline covers hot flashes, sleep and mood: what's in it

What it is

Clinical Practice Guideline No. 13, "Management of Menopause-Related Vasomotor, Sleep, and Mood Symptoms," replaces ACOG's 2014 practice bulletin on the same subject.¹ ACOG says the guideline rests on a systematic review of the evidence, using a modified version of the GRADE method. Each recommendation is graded by strength and by quality of evidence.¹ It covers symptoms of natural menopause and of menopause caused by surgery or medical treatment at age 40 or later.¹

ACOG puts numbers on how common these symptoms are. In menopause, 50% to 92% of women report hot flashes or night sweats, and 16% to 66% of US women report menopause-related sleep disruption. More than a third of perimenopausal and postmenopausal women worldwide report depressive symptoms.²

What it recommends

• Hormone therapy, decided together. ACOG recommends basing the decision on shared decision-making. That means weighing your symptoms, your age and medical history, your baseline risks of heart disease, breast cancer and blood clots, and your own goals.² If hormone therapy is chosen, ACOG recommends starting it before age 60, or within 10 years of the start of natural menopause, for people without reasons they shouldn't use hormones.² ACOG says decisions about when and how to stop should be made individually, as an ongoing conversation about benefits and risks.²
• Non-drug approaches. ACOG makes recommendations for mindfulness-based approaches, exercise and acupuncture for hot flashes, sleep and mood symptoms. It says these can be used alone but are generally recommended alongside hormonal or other medicines.²
• Supplements. ACOG says the evidence does not support the safety or effectiveness of phytoestrogens (plant estrogens such as soy isoflavones) or herbal supplements for hot flashes or other menopause symptoms. It adds that they aren't regulated by the FDA and haven't been tested for safety, effectiveness or purity.²

Where it fits

The Menopause Society also doesn't recommend herbal supplements for hot flashes. But its 2023 statement does not recommend exercise or acupuncture for hot flashes,³ while ACOG's new guideline includes both among its non-drug options.² The two groups graded the evidence separately, so it's worth asking how your clinician weighs them.

ACOG says separate guidance on genitourinary syndrome of menopause (vaginal and urinary changes, including discomfort with intimacy) is due in 2027.²

The limitation

The full guideline is open only to ACOG members, so this summary uses ACOG's public guideline page and its announcement.^{1, 2} We don't list the strength grade for each recommendation here, because we couldn't check the full text.

One thing to try, one thing to ask

For two weeks, track your hot flashes, sleep and mood on our printable tracker. Then bring this question to your appointment: "ACOG's new guideline covers hormone and non-hormone options for hot flashes, sleep and mood. Which ones fit my history, and why?"

Talk to a menopause-trained provider