Medical group updates guidance on managing menopause symptoms

The updated guidelines highlight hormone therapies, which have seen renewed interest following the lifting of previous safety warnings. Federal officials confirmed on Friday that the Food and Drug Administration is working to ensure an adequate supply of these treatments.

“We would love our patients to go to their OB-GYNs regarding questions about menopause and really advocate for getting the treatment that they need,” said ACOG President Dr. Camille Clare.

Menopause is defined as 12 consecutive months without a menstrual period, typically occurring around age 50 in the United States. The preceding stage, perimenopause, is characterized by fluctuating hormone levels.

According to ACOG, more than half of menopausal women experience vasomotor symptoms like hot flashes and night sweats, while up to two-thirds report sleep disruption. Over a third of women worldwide experiencing perimenopause and menopause also experience depressive symptoms.

For many women, hormone therapy is recommended as a first-line treatment for bothersome menopausal symptoms. However, concerns arose in 2002 following a study linking a combination of estrogen and progestin to health risks. While subsequent research has demonstrated the benefits outweighing the risks for many, the government warning discouraged use for over two decades.

The FDA recently removed the boxed warning from numerous hormone-based treatments, leading to increased demand. Despite reports of difficulty obtaining certain formulations, the FDA stated Friday that it is unaware of an imminent nationwide shortage, noting that manufacturers have doubled production.

Dr. JoAnn Manson, a professor of medicine at Harvard Medical School, emphasized the importance of women discussing their symptoms with healthcare providers. “These symptoms should be treated,” she said.

Beyond hormone therapy, alternative treatments like fezolinetant and elinzanetant, which target brain regions involved in temperature regulation, and certain antidepressants are also recommended. Non-drug approaches, including cognitive behavioral therapy, mindfulness, exercise, clinical hypnosis, and acupuncture, can also be beneficial.

Dr. Stephanie Faubion, medical director at The Menopause Society, welcomed the ACOG guidelines. “It’s undisputed that hormone therapy is the first line and most effective therapy for hot flashes,” she said. ACOG encourages shared decision-making between doctors and patients regarding treatment options, considering individual health history and age.