New ACOG Menopause Guidelines Expand Hormone Therapy and Symptom Treatment Recommendations

New menopause treatment guidelines from the American College of Obstetricians & Gynecologists (ACOG) give clinicians a broader framework for treating common perimenopause and menopause symptoms, including hot flashes, night sweats, sleep disruption and mood changes. The organization calls the recommendations its most comprehensive menopause management guidance to date.

Released Oct. 15 ahead of World Menopause Day on Oct. 18, the guidelines address menopausal hormone therapy alongside nonhormonal medications and nonpharmacologic treatments. The central theme is individualized care: Treatment decisions should reflect a patient’s symptoms, medical history, risk factors, goals and preferences.

ACOG reports that 50% to 92% of women in menopause experience vasomotor symptoms, such as hot flashes and night sweats, while 16% to 66% of U.S. women report menopause-related sleep disruption. More than one-third of perimenopausal and postmenopausal women worldwide report depressive symptoms.

What does ACOG recommend for menopause hormone therapy?

Hormone therapy remains an important option for treating menopause symptoms, according to ACOG, but treatment should not follow a one-size-fits-all formula. The organization recommends shared decision-making that takes into account a patient’s symptoms, age, medical history, treatment goals and baseline risks for cardiovascular disease, breast cancer and venous thromboembolism.

For patients without contraindications who choose hormone therapy, ACOG recommends initiating treatment before age 60 or within 10 years of the start of spontaneous menopause.

There is no single stopping point recommended for every patient. Decisions about when and how to discontinue hormone therapy should be individualized through ongoing risk assessment and conversations about the benefits and risks of continued treatment.

Those recommendations follow another significant hormone-therapy development this year. In February 2026, the FDA approved labeling changes for six menopausal hormone therapy products that removed risk statements concerning cardiovascular disease, breast cancer and probable dementia from their boxed warnings. The changes applied to products representing systemic combination therapy, systemic estrogen, systemic progestogen and topical vaginal estrogen.

What nonhormonal treatments does ACOG recommend for menopause symptoms?

Hormone therapy is not right for every patient, and the new guidelines give more attention to alternatives.

ACOG includes neurokinin receptor antagonists as nonhormonal treatment options for vasomotor symptoms. The guidance also discusses SSRIs and SNRIs for patients experiencing vasomotor symptoms, depression or both.

The recommendations address non-drug approaches as well, including cognitive behavioral therapy, mindfulness-based interventions, exercise, clinical hypnosis and acupuncture for vasomotor, sleep and mood symptoms. ACOG says these may be used alone but are generally recommended as options alongside hormonal or other medications.

ACOG takes a different position on phytoestrogens and herbal supplements. The organization says evidence does not support their safety or efficacy for vasomotor or other menopause symptoms and notes that these supplements are not FDA-regulated and have not been tested for safety, efficacy or purity.

How does menopause affect the skin?

Menopause is also receiving more attention in aesthetic medicine as researchers examine how hormonal changes affect the skin. A 2026 Journal of Cosmetic Dermatology review describes declining estrogen during perimenopause and menopause as affecting collagen production and the skin’s extracellular matrix. The review reports that women lose approximately 30% of their skin collagen during the first five years of menopause, followed by about 2% per year thereafter.

The Journal of Cosmetic Dermatology review also discussed topical retinoids, cosmeceuticals, dermal injectables, biostimulators and energy-based treatments among approaches used or evaluated for menopause-related skin changes. The article notes that topical estrogen for skin aging is not FDA-approved and cites ACOG guidance that compounded bioidentical menopausal hormone therapy should not routinely be prescribed when FDA-approved formulations exist.

Industry research points to a substantial information gap around skin changes during menopause. A Galderma survey presented at IMCAS 2026 included more than 4,300 peri- and postmenopausal women ages 45 to 60 across nine countries who had undergone or would be open to aesthetic treatments. More than half learned about menopause’s effects on their skin by experiencing the changes themselves, and more than 30% said they would have preferred to learn about them in their 30s.

The most commonly reported changes in that survey included facial lines and wrinkles, loss of firmness and elasticity, increased dryness and duller skin tone. Galderma also announced that it would include menopausal status in its injectable aesthetics clinical trials going forward.

Menopause care is extending beyond hot flashes

The World Health Organization is also drawing attention to gaps in the evidence around early menopause. In an Oct. 16 feature, physician and scientist Priya Satalkar-Götz described experiencing her first menopause symptoms in her 20s. The article notes that menopause can affect temperature regulation, sleep, skin, the eyes and other mucous membranes, as well as mood, memory and cognitive function, but symptoms and their severity vary from person to person. WHO emphasized the need for high-quality, long-term research to better understand the safety and effectiveness of different interventions, including which approaches work for different populations and what their long-term effects may be.

According to WHO, evidence-based guidelines can help clinicians assess the quality of available research, make more consistent treatment decisions and identify areas where evidence remains limited. Better research could also improve earlier recognition of menopause, inform treatment and long-term monitoring, and give patients clearer information as they consider their options.

ACOG’s current guideline does not address every menopause-related condition. The organization is developing separate clinical guidance on genitourinary syndrome of menopause, which it says will be published in 2027.

Together, the recent developments put a greater emphasis on evidence-based, individualized menopause care at a time when hormone therapy, women’s wellness and menopause-related aesthetic concerns are increasingly part of the same patient conversation.