New Menopause Guidelines Give Women More Options for Hot Flashes, Sleep Problems and Mood Changes

If you're in your 50s and waking up drenched in sweat, struggling to get a good night's sleep, or dealing with hot flashes that seem to come out of nowhere, you may have been told it's just part of getting older. You don't necessarily have to live with it. New guidelines from the American College of Obstetricians and Gynecologists (ACOG) reinforce the effectiveness of hormone therapy for many women while giving greater attention to medications and other treatments that don't involve hormones.

Published online in October, 2026, ACOG Clinical Practice Guideline No. 13 appears in the November 2026 issue of Obstetrics & Gynecology. It replaces guidance issued in January 2014. The recommendations address hot flashes and night sweats, sleep disturbances, and mood symptoms that can interfere with everyday life.

Dr. Camille Clare, president of the American College of Obstetricians and Gynecologists, said in announcing the guidelines that these symptoms can interfere with women’s health, their ability to care for their families, and their careers.

Peri-menopause and menopause symptoms can be debilitating, interfering with women’s overall health, their ability to care for their families, and their work and career. Menopause is a normal and natural stage of life, but that doesn’t mean that women must suffer through the symptoms without help. Ob-gyns are the leaders in menopause care, and as training and research continue to evolve, this guidance is important not only for them but also for our colleagues in other specialties who need to be aware of the evidence-based treatment options available. It is critically important that women have access to and coverage for evidence-based care, especially as menopause misinformation continues to flourish." — Dr. Camille A. Clare.

The update comes as doctors and patients reconsider hormone therapy following years of concern about its safety. Research has helped clarify how a woman's age, medical history, and timing of treatment affect the balance of benefits and risks. For women approaching menopause or still experiencing symptoms years afterward, the guidance offers more ways to find relief.

What Are the Most Common Symptoms of Menopause?

Menopause is reached after 12 consecutive months without a menstrual period, assuming there is no other medical cause. According to the National Institute on Aging, menopause typically occurs between ages 45 and 55.

The years leading up to menopause are known as peri-menopause. During that time, fluctuating levels of estrogen and progesterone can affect temperature regulation, sleep, and mood. According to ACOG's October 2026 clinical guideline, between 50 percent and 92 percent of women experience vasomotor symptoms, the medical term for hot flashes and night sweats.

The organization also reports that between 16 percent and 66 percent of U.S. women experience menopause-related sleep disturbances. More than one-third of perimenopausal and postmenopausal women worldwide report depressive symptoms. For some women, symptoms are mild and temporary. Others experience years of interrupted sleep, fatigue, and discomfort. Night sweats may repeatedly wake a woman, leaving her exhausted the next morning. Hot flashes can strike without warning, making work, social activities, and ordinary routines uncomfortable.

Symptoms may continue well beyond the final menstrual period, which makes the new recommendations relevant to women in their 60s and beyond.

Is Hormone Therapy Safe for Women Over 50?

For many healthy women younger than 60 or within 10 years of menopause, hormone therapy is an effective treatment whose benefits often outweigh the risks when there are no medical reasons to avoid it. ACOG strongly recommends systemic menopausal hormone therapy for eligible women experiencing bothersome hot flashes and night sweats.

Systemic treatment delivers hormones throughout the body and is available as pills, patches, gels, and sprays. Women who have a uterus generally need estrogen combined with a progestogen to protect the uterine lining. Women who have undergone a hysterectomy may be able to use estrogen alone. Hormone therapy can also improve sleep when night sweats and hot flashes are causing repeated awakenings.

Timing matters. ACOG recommends starting treatment before age 60 or within 10 years of the beginning of menopause when medically appropriate. That does not mean women older than 60 are automatically excluded. For women starting treatment later, the decision should be individualized because the underlying risks of blood clots, stroke, and coronary heart disease generally increase with age.

A woman's medical history, breast cancer risk, cardiovascular health and personal treatment goals all influence the decision.

Why Are Doctors Reconsidering Hormone Therapy?

Much of the concern about hormone therapy dates to 2002, when findings from the Women's Health Initiative raised alarms about increased risks of breast cancer, blood clots, stroke, and other serious health problems among women taking a particular combination of oral hormones. The findings changed prescribing practices, and many women stopped treatment or avoided it altogether.

One important limitation has received greater attention in subsequent years: Nearly two-thirds of the women enrolled in the Women's Health Initiative hormone therapy trials were age 60 or older. That makes it difficult to apply all of those findings directly to younger women beginning treatment around menopause.

Later research has helped doctors better understand how treatment risks differ according to age, the type of hormones prescribed, and when therapy begins. Federal regulators have also reassessed menopause hormone product warnings.

Dr. Bruce Pier, a co-author of the ACOG guidelines, said misconceptions about hormone therapy’s risks have shaped both prescribing and patient decisions.

Hormone therapy is a really important tool we have to help with menopause symptom management. Unfortunately, misconceptions about the risks of hormone therapy have affected some clinicians’ willingness to prescribe it and some patients’ interest in using it. This new guidance importantly includes a comprehensive review of the evidence on menopausal hormone therapy to guide individualized patient counseling and shared-decision-making conversations about treatment options.” —Bruce Pier, MD, FACOG.

In November 2025, the U.S. Food and Drug Administration announced plans to remove broad boxed warnings concerning cardiovascular disease, breast cancer and probable dementia from menopause hormone products. The FDA approved the first labeling changes for six products in February 2026. On Oct. 30, 2026, the agency approved updated labeling for three additional estradiol transdermal patch products.

The changes do not mean hormone therapy is free of risks. Important safety information remains in product labeling, and treatment is not appropriate for every woman. The renewed interest in hormone therapy has also raised questions about availability. According to media reports, some women have encountered difficulty obtaining estrogen patches. FDA officials said they were unaware of an imminent nationwide shortage and reported that manufacturers had doubled production over the previous year.

What Are the Best Nonhormonal Treatments for Hot Flashes?

Women who cannot use hormones, or prefer not to, have several evidence-based alternatives. ACOG strongly recommends certain antidepressants and neurokinin receptor antagonists as treatment options for hot flashes and night sweats. Selected antidepressants are also recommended for menopause-related depressive symptoms.

A strong recommendation means the medical evidence supports offering the treatment to eligible patients. It does not mean every treatment works equally well.

• Antidepressants

Many women cannot or prefer not to take hormone therapy for hot flashes, but they are often unsure of what non-hormone options work and what doesn’t.” — Chrisandra Shufelt, M.D., a women’s health specialist at the Mayo Clinic.

Dr. Shufelt says that healthcare professionals can confidently guide women to effective non-hormone therapies and steer them away from inappropriate or ineffective therapies.

Certain selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) can reduce hot flashes. Some also treat depressive symptoms. Low-dose paroxetine is the only antidepressant specifically approved by the FDA for menopause-related hot flashes.

However, fluoxetine and paroxetine generally should be avoided in women taking tamoxifen for breast cancer because they can interfere with the body's ability to activate the cancer medication.

That distinction is particularly important for breast cancer survivors who may be unable to use systemic hormone therapy.

• Neurokinin Receptor Antagonists

These newer medications act on pathways in the brain that help regulate body temperature.

Two FDA-approved options are:

• Fezolinetant (Veozah): Targets neurokinin-3 receptors and can reduce hot flashes and night sweats. The medication carries an FDA boxed warning about rare but serious liver injury. Liver function testing is required before treatment and at specified intervals afterward.
• Elinzanetant (Lynkuet): Targets both neurokinin-1 and neurokinin-3 receptors. It is approved to treat moderate to severe hot flashes and has also shown benefits for sleep disturbances. Its prescribing information recommends liver function testing before treatment and again at three months.

ACOG also conditionally recommends gabapentin when other recommended nonhormonal medications are ineffective or poorly tolerated.

These treatments offer alternatives, but their effectiveness, side effects, and possible drug interactions differ. A doctor can help determine which is appropriate.

Can Exercise, Therapy and Other Approaches Relieve Menopause Symptoms?

Medication is not the only option. ACOG conditionally recommends several nonmedication approaches, including cognitive behavioral therapy, mindfulness-based interventions, exercise, clinical hypnosis and acupuncture.

A conditional recommendation means the treatment may be useful, but the evidence is less certain or the benefits vary among patients. Cognitive behavioral therapy can help women manage hot flashes, sleep disturbances and mood symptoms. Exercise may improve sleep and emotional well-being while supporting heart health, strength, and mobility as women age. Clinical hypnosis and acupuncture may also provide relief for some women, although the evidence supporting these approaches is less robust.

These methods can complement medical treatment, and some women may choose to use them without medication. Women should be cautious about supplements marketed as natural menopause cures. The guidelines found insufficient evidence to support the effectiveness and safety of herbal supplements and phytoestrogens for treating menopause symptoms.

Some products may also interact with prescription medications or contain ingredients that have not been adequately studied.

Can Menopause Affect Sleep, Mood and Memory?

Yes. Hormonal changes during peri-menopause and menopause can contribute to sleep disturbances, irritability, anxiety, and depressive symptoms. Hot flashes and night sweats can interrupt sleep, leaving women tired and less able to concentrate the following day.

Professor Martha Hickey, University of Melbourne and Royal Women’s Hospital, says the best available research shows that many women experience some degree of cognitive symptoms, such as brain fog, during the menopause transition.

But there’s a lack of long-term data, which means that there’s a gap in our knowledge about how the brain fog symptom develops and changes from peri-menopause to after menopause ends. It’s a real gap in our understanding.” — Professor Martha Hickey.

Hormone therapy may improve sleep when those interruptions are related to vasomotor symptoms. However, ACOG found insufficient evidence to recommend for or against menopausal hormone therapy specifically for treating menopause-related depressive symptoms.

Women experiencing major depression should receive appropriate treatment for that condition rather than relying on hormone therapy. Memory complaints and difficulty concentrating can also occur during the menopausal transition, particularly when sleep is disrupted.

Not every change in mood, sleep, or memory is caused by menopause. Sleep apnea, thyroid disorders, depression, and medication effects can produce similar symptoms. Persistent confusion, worsening memory problems, or difficulty completing familiar tasks warrant medical evaluation.

The new guidelines focus on symptom relief. They do not address using hormone therapy to prevent dementia or heart disease. For broader information about maintaining cognitive health with age, the National Institute on Aging provides guidance on brain health and cognitive aging.

How Does Menopause Affect Bone Health?

Hot flashes and sleepless nights get most of the attention. Yet one of the most important changes during menopause is one you can’t feel. Estrogen helps protect your bones, and when estrogen levels fall, bone loss speeds up.

According to the Bone Health and Osteoporosis Foundation (BHOF), women can lose as much as 20 percent of their bone density during the first five to seven years after menopause. The foundation also estimates that roughly half of women age 50 and older will suffer a broken bone caused by osteoporosis.

Osteoporosis is often called a silent disease. Bones weaken without pain or warning, and for many women the first sign is a broken wrist, spine, or hip. In addition, it is a leading cause of a woman needing long-term care at some point in her lifetime.

Learn More: What is Long-Term Care?

Who Should Get a Bone Density Test?

Endocrinologist Marcella Donovan Walker, MD, professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, says that in older age, a very high percentage of people, more women than men, have osteoporosis or low bone mass.

One in three women over the age of 50 will experience a fracture related to osteoporosis in their lifetime.” — Marcella Donovan Walker, M.D.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for all women 65 and older, as well as postmenopausal women younger than 65 who are at increased risk. Screening typically uses dual-energy X-ray absorptiometry (DXA) to measure bone mineral density, sometimes paired with a fracture risk assessment.

However, some doctors favor an earlier baseline scan. Screening guidelines are built around when fractures rise, around 65, while the fastest bone loss happens around menopause, in the early 50s. A scan in your 50s shows where you’re starting from while there’s still time to slow the loss. It can also help with the hormone therapy decision, which works best within 10 years of menopause.

“There is a growing conversation to address bone prevention much earlier than 65,” said Dr. Soma Mandal, medical director of Women’s Health at Hackensack Meridian Jersey Shore University Medical Center. A baseline scan can also inform the decision about hormone therapy, which is most effective and carries the fewest risks when started within 10 years of menopause. Not every expert agrees that average-risk women need a scan before 65, so talk with your doctor about your personal risk factors and whether earlier testing makes sense for you.

Risk factors for younger women include low body weight, smoking, and a parent who broke a hip. If you went through menopause early or have other risk factors, ask your doctor whether you should be tested before 65.

Why Menopause Treatment Matters for Women in Midlife

For many women, menopause arrives during an already demanding stage of life. Careers, family responsibilities, and the needs of aging parents often compete for attention. Some women are caring for a spouse or parent while managing changes in their own health.

Repeated sleepless nights, fatigue, and mood disturbances can make those responsibilities harder to manage. Treating disruptive menopause symptoms may improve daily functioning and quality of life, helping women stay more comfortable and engaged in their usual activities.

The years surrounding menopause are also an important time to consider health and financial needs later in life. Women generally live longer than men and are more likely to need extended care as they age.

According to the 2022 U.S. Department of Health and Human Services report, Long-Term Services and Supports for Older Americans: Risks and Financing, women face a greater lifetime likelihood of needing help with everyday activities as they age than men. Because of these risks, Long-Term Care Insurance is often added to a comprehensive retirement plan to address not just the risk, but the rising cost of long-term care. Health insurance and Medicare will not pay for long-term care, as they only pay for short-term skilled care. The result is a physical, emotional, and financial burden placed on families and finances.

That care may involve assistance with bathing, dressing, mobility, or other daily needs because of chronic illness, disability, or cognitive decline. LTC News research shows that most people apply for Long-Term Care Insurance between the ages of 47 and 67.

For families already helping an older parent, the LTC News Caregiver Directory offers a way to search for home care providers, assisted living communities, memory care, and other long-term care services.

Managing menopause symptoms does not prevent future long-term care needs. However, addressing current health concerns and preparing for the financial and practical consequences of aging are both important parts of planning for later life.

What Should Women Ask Their Doctors About Menopause Treatment?

Women experiencing frequent hot flashes, night sweats or persistent sleep problems should discuss their symptoms with a gynecologist or another doctor experienced in menopause care.

Questions worth asking include:

• Are my symptoms caused by menopause, or could another condition be involved?
• Am I a candidate for hormone therapy based on my age and medical history?
• Would an estrogen patch, pill, or another form of treatment be most appropriate?
• What nonhormonal medications might work for me?
• Could my current medications affect which menopause treatments are safe?
• How should we monitor my symptoms and treatment risks?

Women already receiving treatment may also benefit from reviewing their options as they age or their health changes.

The American College of Obstetricians and Gynecologists offers additional patient information about menopause and treatment options. The new recommendations make one point clear: Menopause is a normal stage of life, but significant symptoms don't have to be ignored. For women who ruled out hormone therapy years ago, or who never realized other treatments were available, the updated guidance provides a reason to revisit the conversation.