October 26, 2026

The American College of Obstetricians & Gynecologists (ACOG) has updated its hormone replacement (HRT) guidelines

Last week, the American College of Obstetricians & Gynecologists (ACOG) published expanded clinical guidance on hormone replacement therapy (HRT) for the management of symptomatic menopause. This is the first update in over a decade, and marks a major shift in favor of selective hormone replacement for women experiencing perimenopause and menopause symptoms, including hot-flashes (vasomotor symptoms or VMS), which often persist for years.

The news is a preview of forthcoming clinical guidance on the management of the genitourinary syndrome of menopause expected in 2027.

What is Menopause?

Menopause commonly occurs around age 50. It can come sooner or later, and symptoms often last for years due to decreasing hormones and the cessation of monthly periods. It can also occur abruptly due to medical treatment like surgery, chemotherapy or radiation, often used to save lives from intractable bleeding or cancer.

According to ACOG’s guidance, 50–92% of women report menopause symptoms, 16–66% of women in the United States report sleep disruption, and more than one-third of perimenopausal and postmenopausal women worldwide report experiencing depressive symptoms. These symptoms interfere with daily life, and treatment to reduce them can be positively life altering.

Concerns With Hormone Therapy

When people have low thyroid, we supplement with thyroid hormones. So, if menopause symptoms are caused by decreasing levels of hormones, why not just supplement them? Every medical treatment has its pros and cons. There are measurable risks of HRT which include:

Blood Clots and Stroke – Oral estrogen increases the risk of deep vein thrombosis and stroke, although transdermal forms have lower risks.
Cancer Risk – Estrogen alone in women with a uterus increases the risk of uterine cancer. To reduce the risk, progesterone is added. The combination of estrogen and progesterone, however, increases the risk of breast cancer if taken for more than five years.
Side Effects – such as headaches, nausea, bloating and breast tenderness are common.
Contraindications – Women with a history of hormone sensitive cancers like breast cancer, active liver disease, prior history of blood clots and other specific medical history are not good candidates for hormone replacement.

The Benefits of Hormone Replacement Therapy

In the past, the concerns listed above made doctors hesitant to recommend HRT. The ACOG update provides specific recommendation to reduce the risks with allowing the benefits such as:

Symptom Relief: Eases hot flashes, night sweats, sleep disturbances, brain fog, and mood changes.
Bone Health: Prevents bone loss and reduces the risk of fractures or osteoporosis.
Vaginal and Urinary Health: Improves vaginal dryness, itching, pain during intercourse, and urinary urgency or infections via local or systemic estrogen.
Metabolic Support: Enhances insulin sensitivity, helps redistribute abdominal fat, and supports lipid profiles.
Timing Benefits: Starting HRT before age 60 or within 10 years of menopause maximizes protection for the heart and brain.

Skin Tone – HRT can counteract the loss in collagen, elastin and hyaluronic acid seen with aging. It can smooth the skin’s contour and increase hydration and plumpness. HRT can soften fine lines and reduce skin dryness. HRT can also change pigmentation, most the time it evens out pigmentation, but it can also cause darker spots or freckles.

Hormone Replacement Consultations

As a Board Certified Plastic Surgeon, specializing in Cosmetic Plastic Surgery, I care for many women on HRT. I need to have a working knowledge of the subject, but it is not something I prescribe. For the latest advice on HRT, be sure to consult your Gynecologist or primary care physician for the latest recommendations. Menopause symptoms can be debilitating, and appropriate treatment can significantly improve your quality of your life. It is important to discuss both the risks and benefits before starting treatment. Moreover, if you are on HRT and considering Elective Surgery, be certain to let your surgeon know.