Hormonal therapy recommended as a first-line treatment for menopausal vasomotor symptoms

by American College of Physicians

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The American College of Physicians (ACP) recommends estrogen in combination with progestogen (for females with a uterus) or estrogen monotherapy (for females without a uterus) as first-line treatment for perimenopausal and postmenopausal females experiencing menopausal vasomotor symptoms (VMS), which consist of hot flashes and night sweats. ACP's new clinical guideline is published in Annals of Internal Medicine.

VMS are the most common symptoms associated with menopause and affect up to 80% of females. Beginning in perimenopause, declining and fluctuating reproductive hormone levels can lead to VMS and other symptoms, including sleep disturbance, weight fluctuations, anxiety, depression and genitourinary symptoms. VMS can persist into postmenopausal years, and their frequency and severity can disrupt daily activities and affect quality of life.

For females seeking treatment for VMS, ACP concluded that estrogen in combination with progestogen and estrogen monotherapy had the most favorable benefits compared with harms. For females who have contraindications to or do not tolerate estrogen therapy, ACP suggests physicians use an SNRI (desvenlafaxine or venlafaxine) as second-line treatment, or an SSRI (escitalopram or paroxetine), gabapentin, or an NKra (elinzanetant or fezolinetant) as third-line treatment. ACP encourages physicians to ask their patients about their experience with menopausal VMS, as many females may not initiate these discussions on their own.

ACP emphasizes that when selecting a treatment for VMS, clinicians should use an informed decision-making approach and discuss benefits, harms, contraindications, comorbid conditions, values and preferences, financial burden, and access to and availability of treatments.

Publication details

Pharmacologic Treatments for Females With Menopausal Vasomotor Symptoms: A Clinical Guideline From the American College of Physicians, Annals of Internal Medicine (2026). DOI: 10.7326/ANNALS-26-01205

Journal information: Annals of Internal Medicine

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Obstetrics & gynecologyWomen's healthClinical pharmacology Provided by American College of Physicians Who's behind this story?

Gaby Clark

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