American College of Physicians Endorses Hormone Therapy as Primary Treatment for Menopausal Hot Flashes and Night Sweats
New clinical guidance from the American College of Physicians designates menopausal hormone therapy as the first-line treatment for vasomotor symptoms such as hot flashes and night sweats, based on strong evidence. Women with a uterus should receive combined estrogen and progestogen, while those without a uterus can receive estrogen alone. Alternative second- and third-line options include SNRIs, SSRIs, gabapentin, and newer neurokinin receptor antagonists for patients who cannot tolerate or have contraindications to hormone therapy.
The American College of Physicians' endorsement represents a significant shift in menopause treatment approaches. The guidance comes after the FDA removed previous warnings about cardiovascular risks and breast cancer associated with hormone therapy, and following new analyses of the landmark Women's Health Initiative study that suggested more favorable outcomes than originally reported. These developments have prompted major medical organizations to reassess the safety profile of hormone therapy for appropriate patient populations.
The clinical pathway established in the guidance acknowledges that hormone therapy remains the most effective option for managing vasomotor symptoms, while recognizing that some patients cannot use this approach. The tiered recommendation system directs clinicians toward alternative medications—including two classes of antidepressants, an anticonvulsant, and newer specialized drugs—when hormone therapy is contraindicated or poorly tolerated.
This guidance could influence treatment decisions for millions of women experiencing menopausal symptoms, potentially expanding access to hormonal options that had fallen out of favor over the past two decades. The recommendation may reduce undertreatment of vasomotor symptoms, which significantly impact quality of life for many women. Additionally, the emphasis on proactive clinical conversations about menopause could improve overall care coordination and patient education, though implementation may vary depending on healthcare access, insurance coverage, and individual clinician adoption of these recommendations.