ACP Guideline: Hormones First-Line for Hot Flashes and Night Sweats (Oct 2026)

Tier 1: Established: peer-reviewed research or government health authority
Publisher: American College of Physicians (Annals of Internal Medicine) · Published: October 5, 2026 · Accessed: October 9, 2026

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• ACP (clinical guideline, Annals of Internal Medicine, published Oct 5 2026) strongly 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 vasomotor symptoms (hot flashes and night sweats).
• For females with contraindications to or who do not tolerate estrogen, ACP suggests an SNRI (desvenlafaxine or venlafaxine) as second-line treatment.
• For females with contraindications to or who do not tolerate first- or second-line treatment, ACP recommends an SSRI (escitalopram or paroxetine), gabapentin, or an NKra (elinzanetant or fezolinetant) as third-line treatment.
• ACP urges clinicians to ask female patients about their experience of menopausal VMS, because many may not initiate the discussion on their own.
• ACP emphasizes informed shared decision-making that considers benefits, harms, contraindications, comorbid conditions, values and preferences, financial burden, and access to and availability of treatments.
• Vasomotor symptoms are the most common symptom of menopause and affect up to 80% of females, beginning in perimenopause and often persisting into the postmenopausal years.