On 15 October 2026 the American College of Obstetricians and Gynecologists (ACOG) published new clinical guidance on managing menopause symptoms. ACOG describes it as the most comprehensive menopause guidance it has issued, covering treatment options for vasomotor symptoms (hot flashes and night sweats) along with menopause-related sleep and mood changes. This is our summary of what was announced and why it matters in practice. The full guideline and ACOG's press release are linked at the end.

Why ACOG says it was needed

The figures cited in the guidance show how common these symptoms are. Between 50% and 92% of women in menopause report vasomotor symptoms, 16% to 66% of women in the United States report menopause-related sleep disruption, and more than a third of perimenopausal and postmenopausal women worldwide report depressive symptoms.

Natural menopause occurs at an average age of 50 in the US, but symptoms can begin years earlier in perimenopause and continue for years afterwards. Induced menopause, after surgery, chemotherapy or radiation, can bring the same symptoms at a younger age.

ACOG President Dr. Camille A. Clare said the guidance is meant for clinicians in other specialties as well as ob-gyns, and stressed the need for access to evidence-based care “especially as menopause misinformation continues to flourish.”

Hormone therapy: more detail, and a clear window for starting

The updated guidance goes further into the different hormone therapy options for vasomotor symptoms and the sleep disturbance that comes with them. It also gives more direction on timing. When hormone therapy is chosen and there are no contraindications, ACOG recommends starting it before age 60 or within 10 years of the onset of natural menopause.

The decision to start is framed as shared decision-making. It should weigh the patient's symptoms and goals against the benefits and risks for that individual, taking into account age, medical history and baseline risk of cardiovascular disease, breast cancer and venous thromboembolism. Decisions about when and how to stop are also individualised, based on ongoing risk assessment and discussion with the patient.

Coauthor Dr. Bruce Pier noted that misconceptions about the risks of hormone therapy have made some clinicians reluctant to prescribe it and some patients reluctant to use it. The guidance includes a comprehensive review of the evidence to support individual counselling.

Nonhormonal options get a fuller place

For patients who cannot take hormone therapy or prefer not to, the guidance reviews evidence-based nonhormonal treatments. These include the neurokinin receptor antagonists fezolinetant and elinzanetant, a newer class of drugs that targets vasomotor symptoms directly. It also discusses SSRIs and SNRIs, which can help with both vasomotor symptoms and depression, and makes recommendations on nonpharmacologic approaches.

Coauthor Dr. Robert P. Kauffman described hormone therapy as often the best option but not the right one for everyone, which is why the guidance covers hormonal, nonhormonal and nonpharmacologic treatment side by side.

Earlier education for patients

Dr. Catherine D. Cansino, the guideline's author, highlighted gaps in menopause care. The guidance calls for earlier and more complete patient education, so that patients recognise their symptoms and seek treatment sooner.

What else ACOG is publishing

  • A November 2026 special issue of Obstetrics & Gynecology dedicated to menopause, with articles on sleep disruption, hormonal options in perimenopause, cardiometabolic effects, estrogen therapy and breast cancer risk, and social determinants of health.
  • Separate guidance on the genitourinary syndrome of menopause, which ACOG expects to publish in 2027.
  • A patient book released earlier this year, Menopause: What Your Ob-Gyn Wants You to Know.

What this means for clinicians

For anyone managing perimenopausal and menopausal patients, Clinical Practice Guideline 13 is now ACOG's reference point. In practice: ask about vasomotor, sleep and mood symptoms early, and discuss hormone therapy candidly, including the window for starting it. Have nonhormonal and nonpharmacologic options ready for patients who need them. Document the shared decision, and revisit it as the patient's risk profile changes. Read the full guideline before applying it to individual patients.

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