Key Takeaways
- First joint guideline: The Department of Veterans Affairs and the Defense Department released a shared clinical practice guideline for menopause with 43 evidence-based recommendations.
- Broad scope: It covers diagnosis and treatment of hot flashes, sleep problems, depression, anxiety and brain fog, along with hormonal and nonhormonal options.
- Individualized care: Treatment is meant to be matched to each woman’s symptoms, health history and priorities through shared decision-making.
- Who it affects: It guides care in military hospitals and clinics and in VA facilities, including for service members moving from military to VA care.
What Happened
The Department of Veterans Affairs and the Defense Department (also styled the Department of War) jointly released the 2026 Clinical Practice Guideline on Menopause. The Defense Health Agency announced it in early October 2026, and it is the first menopause guideline the two health systems have issued together.
The guideline contains 43 recommendations on diagnosing and managing menopause symptoms, including hot flashes and night sweats, sleep problems, depression and anxiety, and cognitive concerns such as brain fog. It also addresses areas like sexual health, bone health, weight and cardiovascular risk. The working group built it using patient focus groups, key clinical questions and systematic evidence reviews. Quick-reference tools came with it, including a diagnostic algorithm and pocket card, plus separate summaries for patients and for clinicians.
Why It Matters
Menopause care has been uneven for years, and clinicians often receive little training on it. A single shared standard gives providers across two large health systems the same starting point. Defense Health Agency officials said the goal is to help clinicians recognize symptoms earlier and treat them rather than expecting women to simply cope.
The guideline also follows a June 2026 Government Accountability Office report that found nearly half of women veterans receiving VA care are at an age when menopause is most likely, and that the VA did not yet have a completed menopause guideline.
What This Means for Women in Perimenopause and Menopause
If you receive care through a military facility or the VA, you can expect clinicians to be working from the same playbook. Based on clinical summaries of the guideline, some of its main points include:
- Diagnosis is clinical: Typical perimenopause and menopause can be diagnosed from symptoms and history, without routine hormone testing.
- Hot flashes and night sweats: For women with a uterus, the guideline strongly recommends systemic estradiol combined with progesterone, with an estrogen and bazedoxifene combination as a conditional alternative. Nonhormonal options such as certain antidepressants and gabapentin are also covered for women who can’t or prefer not to use hormones.
- Vaginal symptoms: Local vaginal estrogen is suggested, including for breast cancer survivors after individualized counseling and coordination with their oncology team.
- Mood and thinking: Cognitive behavioral therapy is recommended for hot flashes and mood symptoms, and hormone therapy is not recommended solely to treat cognitive complaints.
Not sure what your symptoms point to? Our menopause symptoms list and symptom trackers can help you organize what to bring to an appointment.
Access and Availability
The guideline is written for clinicians and applies to care delivered in military hospitals and clinics and in VA facilities. It does not create a new benefit. Coverage and access still depend on your eligibility and the services your facility offers. A patient summary was released alongside the guideline, so you can read the main points yourself and bring questions to your provider.
If you’re looking for a clinician with menopause training outside these systems, see our menopause specialist directory.
Benefits and Risks
The main benefit is consistency: clearer standards, earlier recognition of symptoms and a wider menu of treatment options. A guideline is not a rule, though. Recommendations vary in strength, and the document emphasizes individualized treatment based on your health history, your uterine status and your preferences. Hormone therapy is not right for everyone, and the benefits and risks should be discussed with your clinician. Our HRT 101 guide and HRT at a Glance page explain the basics.
Next Steps: What to Watch For
A guideline only helps if it reaches the exam room. The GAO report recommended that the VA use performance measures tied to the guideline to track whether facilities follow it, and that it build a strategy to educate women veterans about menopause and VA menopause care. As of the GAO’s latest update, those recommendations remained open. Watch for how the VA and Defense Health Agency roll out training and monitoring.
What This Means for Your Midlife Health
Menopause affects sleep, mood, bone health, weight and heart health, and a growing number of institutions are treating it as a whole-health issue. For more on related topics, read our article on why menopause weight gain happens, and see how other major groups are approaching care in our coverage of the ACOG guideline update and the FDA’s latest hormone therapy labeling changes. We’ll keep following these stories so you know when something changes.
Frequently Asked Questions
What is the VA/DoD menopause guideline?
It is a joint clinical practice guideline from the Department of Veterans Affairs and the Defense Department with 43 evidence-based recommendations for diagnosing and treating perimenopause and menopause symptoms.
Does the guideline recommend hormone therapy?
It includes hormone therapy as a treatment option for hot flashes and night sweats, and also covers nonhormonal medications and non-drug approaches. Treatment is meant to be individualized.
Does menopause need a hormone test to diagnose?
According to clinical summaries of the guideline, typical perimenopause and menopause can be diagnosed based on symptoms and history without routine hormone testing.
Who can use this guideline?
It is written for clinicians in military and VA health systems. Anyone can read the public summaries, but your own treatment decisions should be made with your healthcare provider.
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
- War.gov. (2026). New Clinical Guideline Helps Keep Women ‘Optimized for the Fight’.
- Defense Health Agency. (2026). New menopause clinical practice guideline helps keep women ‘optimized for the fight’.
- Epocrates. (2026). Beyond hot flashes: What VA/DoD’s first menopause guideline means for prescribing.
- U.S. Government Accountability Office. (2026). Women Veterans: VA Should Improve Menopause Care Monitoring and Patient Education (GAO-26-107853).
- U.S. Department of Veterans Affairs. (2026). VA/DOD Clinical Practice Guidelines.