Key Takeaways
- Most comprehensive guidance yet: The American College of Obstetricians and Gynecologists (ACOG) released expanded recommendations on hot flashes, sleep disturbance and mood symptoms on October 15, 2026.
- Hormone therapy: ACOG strongly recommends systemic hormone therapy for hot flashes and sleep problems linked to them, ideally started before age 60 or within 10 years of menopause.
- Other options: SSRIs, SNRIs and neurokinin receptor antagonists are recommended nonhormonal choices, and non-drug approaches like CBT are included.
- Still to come: Separate ACOG guidance on genitourinary syndrome of menopause (vaginal and urinary symptoms) is expected in 2027.
What Happened
On October 15, 2026, ahead of World Menopause Day, ACOG published a new clinical practice guideline on managing menopause-related vasomotor symptoms (hot flashes and night sweats), sleep disturbance and mood symptoms. ACOG calls it its most comprehensive menopause guidance to date. Its last major update came in 2014.
The guideline grades each recommendation using a modified GRADE framework built from systematic reviews, meta-analyses and randomized controlled trials. It also gives practical advice on starting hormone therapy, monitoring it, handling unscheduled bleeding and stopping treatment.
Why It Matters
ACOG says 50% to 92% of women in menopause experience hot flashes or night sweats, 16% to 66% of U.S. women report menopause-related sleep disruption, and more than one-third of perimenopausal and postmenopausal women worldwide report depressive symptoms. Many women have also been wary of hormone therapy since the 2002 Women’s Health Initiative study, and ACOG leaders have said misconceptions about its risks still keep some women from care.
The guideline arrives in the same year the FDA began removing certain boxed warnings from hormone therapy labels (see our coverage of the latest FDA labeling changes).
What This Means for Women in Perimenopause and Menopause
Here is a snapshot of what ACOG recommends:
| Option | What ACOG says |
|---|---|
| Systemic hormone therapy | Strong recommendation for hot flashes and vasomotor-related sleep disturbance; start before 60 or within 10 years of menopause if there are no contraindications |
| SSRIs or SNRIs | Recommended for women who don’t want or can’t use hormone therapy |
| Neurokinin receptor antagonists | Recommended nonhormonal option for hot flashes (fezolinetant is one example) |
| Gabapentin | Suggested when other nonhormonal medications are ineffective or poorly tolerated |
| Estrogen with bazedoxifene (Duavee) | An option for women who can’t use standard hormone therapy |
| CBT, mindfulness, exercise, clinical hypnosis, acupuncture | Non-drug approaches addressed for hot flashes, sleep and mood |
| Herbal supplements and phytoestrogens | Available evidence doesn’t support their effectiveness or safety for hot flashes |
On mood, ACOG found the evidence insufficient to recommend for or against hormone therapy for depressive symptoms. Women who meet criteria for major depressive disorder, or whose main symptom is depression, should be treated according to depression guidelines.
If you’re preparing for an appointment, our symptom trackers make it easier to show your clinician how often symptoms happen and how they affect sleep and daily life.
Access and Availability
These are recommendations for clinicians, not new coverage rules. Every treatment above is already available, but ACOG acknowledged remaining barriers, including inadequate insurance coverage for newer therapies and for evidence-based non-drug treatments, along with persistent disparities in care. If cost is a concern, our HRT price checker can help you compare, and our menopause specialist directory can help you find a clinician who focuses on midlife care.
Benefits and Risks
ACOG’s message is that treatment should be individualized and based on shared decision-making that weighs your symptoms, age, health history and personal risks, including heart disease, breast cancer and blood clots. According to news reports, some women may continue hormone therapy past 60 if symptoms persist. The guidance also moves away from a blanket “lowest dose for the shortest time” approach and puts more emphasis on timing.
Hormone therapy is not right for everyone, and nonhormonal options have their own side effects. ACOG also noted research gaps, including how best to manage symptoms in special populations such as breast cancer survivors. For the basics, see our HRT 101 guide.
Next Steps: What to Watch For
ACOG is developing separate guidance on genitourinary syndrome of menopause, which covers vaginal dryness, painful sex and urinary symptoms, expected in 2027. Meanwhile, other organizations are updating their own guidance. See how the VA and Defense Department approached it in our coverage of their joint menopause guideline.
What This Means for Your Midlife Health
This update confirms that menopause symptoms are worth treating and that you have more than one path. You don’t have to “tough it out,” and you don’t have to choose a single approach forever. If testosterone has come up in your own research, read our testosterone guide and our news coverage of the FDA’s testosterone discussion. We’ll keep following ACOG’s guidance so you’ll know when new recommendations arrive.
Frequently Asked Questions
What did ACOG’s 2026 menopause guideline change?
It expands ACOG’s menopause recommendations to cover hot flashes, sleep disturbance and mood symptoms, gives hormone therapy a strong recommendation for hot flashes and related sleep problems, and adds more detail on nonhormonal and non-drug treatments.
Does ACOG recommend hormone therapy for menopause?
For hot flashes and vasomotor-related sleep problems, yes, after a shared decision-making discussion, with treatment ideally started before age 60 or within 10 years of menopause in women without contraindications.
What are ACOG’s nonhormonal options for hot flashes?
The guideline includes SSRIs and SNRIs, neurokinin receptor antagonists and gabapentin, along with non-drug approaches such as cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis and acupuncture.
Does ACOG recommend herbal supplements for hot flashes?
No. The guideline states that available evidence doesn’t support the efficacy or safety of phytoestrogens such as soy isoflavones or herbal supplements for hot flashes.
This article is for informational purposes only and is not medical advice. Please consult a qualified healthcare provider about your symptoms and treatment options.
References
- ACOG. (2026). ACOG expands recommendations for management of menopause symptoms.
- Contemporary OB/GYN. (2026). ACOG guideline expands menopause VMS, sleep, and mood recommendations.
- Patient Care Online. (2026). ACOG issues expanded guideline on managing menopause-related vasomotor, sleep, and mood symptoms.