On October 15, 2026, the journal Obstetrics & Gynecology published new recommendations from the American College of Obstetricians and Gynecologists (ACOG) on treating menopause symptoms. According to Contemporary OB/GYN, Practice Bulletin No. 13 replaces the 2014 recommendations and covers hot flashes, related sleep disturbances, and mood symptoms.
Systemic hormone therapy is strongly recommended for treating hot flashes and night sweats in patients without contraindications. This means offering treatment for bothersome symptoms—not prescribing hormones to everyone after a certain age.
Menopausal hormone therapy (MHT), also called hormone replacement therapy (HRT), is treatment with estrogen, sometimes combined with a progestogen. It can significantly improve how you feel, but that doesn’t make it a universal “fountain of youth” therapy.
The wording is decisive. However, the strength of a recommendation and the quality of evidence are different things: ACOG rated the quality of evidence for hormone therapy to treat hot flashes as moderate. A strong recommendation means the method should be offered to eligible patients, taking expected benefits and risks into account. Contraindications still apply.
The effectiveness of hormones was recognized well before this update. The 2022 position statement from The North American Menopause Society already described hormone therapy as the most effective treatment for hot flashes and night sweats. ACOG’s 2026 recommendations organize the evidence gathered to date and broaden the range of options, including nonhormonal treatments.
The conclusion is different when it comes to preventing aging. A review of the results of the Women’s Health Initiative (WHI), published in JAMA on May 1, 2024, does not support using the hormone regimens studied to prevent cardiovascular disease, dementia, and other chronic conditions. WHI studied specific medications; it would also be inaccurate to apply all of its findings to every modern regimen.
Details of the new guidance presented here are based on publicly available materials from Contemporary OB/GYN and Patient Care Online.
Doctors call hot flashes and night sweats vasomotor symptoms. A wave of heat may come over you during a meeting, on public transport, or in the middle of the night. There is no required number of episodes before you can seek help. It’s more useful to look at how your life is affected:
I wake up feeling hot and can’t get back to sleep for a long time.
I have to change my damp clothes or bedding during the night.
I have to stop working or talking when a hot flash comes on.
I avoid meetings, trips, or presentations because I’m worried about sweating.
After waking up during the night, I find it hard to focus on everyday tasks.
This is not a diagnostic test or a requirement for getting a prescription. The list can help you describe the severity of your symptoms to your doctor. Even one item may be enough reason to discuss getting help—you don’t have to wait until you’re completely exhausted.
ACOG recommends starting the chosen hormone therapy before age 60 or within 10 years of natural menopause for patients without contraindications. These are guidelines for starting treatment, not a guarantee of safety. Being in the recommended age range does not, by itself, settle the question.
The 2022 position statement from The North American Menopause Society lists unexplained vaginal bleeding, liver disease, a history of estrogen-sensitive cancer, coronary heart disease, heart attack, stroke, venous thromboembolism, and a high inherited risk of thromboembolic disease among the contraindications to systemic therapy.
Tell your doctor about these diagnoses, even if they happened a long time ago. Bring your medical records and a list of medications: saying “I had some blood vessel problems once” leaves too many questions unanswered.
Starting treatment and continuing a therapy that has already been prescribed are separate decisions. The age guideline does not mean that a medication should automatically be stopped on your 60th birthday.
Saying “I take hormones” doesn’t tell you much about the treatment. The medication, dose, route of administration, and symptoms you want to relieve all matter.
Form | What it’s used for | What to discuss |
|---|---|---|
Systemic estrogen pills | Hot flashes and night sweats | Individual risks, dose, and endometrial protection |
Systemic estrogen through the skin: patch, gel, or spray | Hot flashes and night sweats | Risks, ease of use, and endometrial protection |
Low-dose vaginal estrogen | Local vaginal and vulvar symptoms | Local symptoms and specific prescribing considerations |
If you still have your uterus, a progestogen is usually added to systemic estrogen to protect the endometrium from hyperplasia and cancer. Don’t leave this component out on your own.
Patches are sometimes seen as an automatically safer alternative to pills. The 2022 position statement from the menopause society does note encouraging observational findings on the risk of venous blood clots with transdermal estrogen. However, there is not enough direct evidence from randomized comparisons of safety. A patch does not remove contraindications to systemic treatment.
If you have only local symptoms, the position statement recommends low-dose vaginal estrogen in preference to systemic therapy. Restrictions for systemic medications should not automatically be applied to this treatment.
Choosing not to take hormones doesn’t mean you’re left with nothing but putting up with symptoms. ACOG’s new recommendations strongly recommend some antidepressants from the SSRI and SNRI groups, as well as neurokinin receptor antagonists, for vasomotor symptoms. Being prescribed an antidepressant in this situation does not, by itself, mean you have been diagnosed with depression.
There’s also a nuance to using hormones for night sweats and insomnia. A separate strong ACOG recommendation addresses sleep disturbances associated with vasomotor symptoms. If you lie awake but don’t have hot flashes, this recommendation alone does not mean HRT should automatically be prescribed.
ACOG considers the evidence for hormone therapy to treat depression symptoms associated with menopause insufficient. If depression or major depressive disorder is the main concern, separate treatment based on depression guidelines is needed.
This evening, you can briefly note when hot flashes occur, what wakes you at night, and which activities you have to cancel. Then prepare some questions:
What exactly are we treating: hot flashes, waking up because of heat, insomnia on its own, or local discomfort?
How do my age and the time since my last period affect the decision to start treatment?
Which diagnoses, bleeding, and medications affect my risks?
Why are you recommending this form of medication, and do I need endometrial protection?
What improvement should I expect, and what would be a reason to review the treatment?
Hormone therapy should have a specific goal—for example, being able to sleep through the night without waking up from a hot flash.
According to ACOG’s new recommendations, the effectiveness and tolerability of treatment should be assessed 3 months after starting, and then every 12 months. If new concerns arise, you can seek advice sooner. When and how to stop therapy is decided individually, taking the risks and the possibility of symptoms returning into account.
If your hot flashes go away but insomnia remains, that’s a reason to address your sleep separately rather than automatically increasing your hormone dose.
No, MHT is not contraception. If pregnancy is still possible, discuss a separate method of birth control with your doctor.
Don’t order a large “hormone panel” on your own: your doctor will choose any necessary tests based on your age, symptoms, and medical history. It’s more useful to bring previous test results, medical records, and a list of medications to your first appointment.
Tell the doctor who prescribed the treatment: the significance of bleeding depends on the regimen and how long you’ve been on treatment, so it should not automatically be considered normal. Heavy bleeding, severe weakness, or feeling faint calls for urgent medical attention.
Yes, the risk may increase with some treatment regimens and durations. The 2022 position statement from the menopause society considers this risk in light of the type of therapy and individual medical history; not all medications can be treated as the same.
You shouldn’t change the form of your medication on your own: doses of different forms are not directly interchangeable. A doctor should approve the new regimen, including a progestogen if one is needed.
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