The American College of Obstetricians and Gynecologists published its most comprehensive menopause guidance this week, covering hot flashes, night sweats, sleep and mood.
Zoom in: When hormone therapy is selected, ACOG recommends starting it before age 60 or within 10 years of the start of spontaneous menopause, in patients who have no contraindications to hormone use.
By the numbers: Between 50% and 92% of women in menopause report hot flashes or night sweats, 16% to 66% of US women report menopause-related sleep disruption, and more than a third report depressive symptoms.
- Natural menopause arrives at an average age of 50 in the United States, though symptoms can run for years on either side of it.
The other side: For patients with contraindications or a preference to avoid hormones, the guidance reviews neurokinin receptor antagonists such as fezolinetant and elinzanetant, along with SSRIs and SNRIs.
- It also backs cognitive behavioural therapy, mindfulness, exercise, clinical hypnosis and acupuncture, generally in combination with medication.
Yes, but: Evidence fails to support phytoestrogens or herbal supplements for these symptoms, ACOG says, warning that such products are heavily marketed while escaping FDA testing for safety, efficacy and purity.
What they're saying: Misconceptions about the risks of hormone therapy have affected some clinicians willingness to prescribe it and some patients interest in using it, said Bruce Pier, a coauthor of the guidance.
Why it matters: Roughly half the population passes through menopause, and this gives patients a document to cite when a clinician waves the symptoms away or a supplement aisle promises relief.
