ACP recommends hormonal therapy as a first-line treatment for menopausal vasomotor symptoms

PHILADELPHIA, October 5, 2026-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 who are seeking treatment for menopausal vasomotor symptoms (VMS), which consist of hot flashes and night sweats. ACP's new clinical guideline, "Pharmacologic Treatments for Females with Menopausal Vasomotor Symptoms: A Clinical Guideline from the American College of Physicians," is published in Annals of Internal Medicine.

VMS symptoms 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 life activities and impact 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 female patients about their experience with menopausal VMS, as they may not initiate these discussions on their own.

"Too many females silently suffer from disruptive hot flashes and night sweats without ever receiving effective treatment," said Jan K. Carney, MD, MPH, MACP, FRCP, president of ACP. "This guideline gives physicians and other clinicians practical, evidence-based recommendations on when to use hormone therapy and what alternatives to consider, helping ensure that patients have access to treatments that might meaningfully reduce VMS frequency and severity and improve their quality of life."

ACP emphasizes that when selecting a treatment of 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.

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About the American College of Physicians 

The American College of Physicians is the largest medical specialty organization in the United States with members in more than 172 countries worldwide. ACP membership includes 163,000 internal medicine physicians, related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on X, Facebook, Instagram, Threads, and LinkedIn, and subscribe to our RSS feed.

Contact: Lori Bookbinder, 215-351-2431, [email protected]