Annals of internal medicine · 2026
Pharmacologic Treatments for Females With Menopausal Vasomotor Symptoms: A Clinical Guideline From the American College of Physicians.
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Qaseem Amir, Mackey Katherine, Yost Jennifer, Shekelle Paul G, Shamliyan Tatyana A, Cross J Thomas, Clinical Guidelines Committee of the American College of Physicians
Аннотация
DESCRIPTION: The American College of Physicians (ACP) developed this clinical guideline on pharmacologic treatments for internal medicine physicians and other clinicians caring in outpatient settings for females with menopausal vasomotor symptoms.
METHODS: The ACP Clinical Guidelines Committee developed this guideline based on systematic reviews on effectiveness, comparative effectiveness, harms, public and patient values and preferences, and economic evidence of pharmacologic treatments for females with menopausal vasomotor symptoms using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
RECOMMENDATION: In females who are seeking treatment of vasomotor symptoms.
UNLABELLED: First-line treatments.
UNLABELLED: ACP recommends that clinicians initiate one of the following (strong recommendation): estrogen in combination with progestogen in females with a uterus (high-certainty evidence) or estrogen monotherapy in females without a uterus (high-certainty evidence).
UNLABELLED: Second-line treatments.
UNLABELLED: ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line treatment (conditional recommendation): serotonin-norepinephrine reuptake inhibitors, either desvenlafaxine or venlafaxine (moderate-certainty evidence).
UNLABELLED: Third-line treatments.
UNLABELLED: ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line or second-line treatment (conditional recommendation): selective serotonin reuptake inhibitors, either escitalopram or paroxetine (low-certainty evidence); the gabapentinoid gabapentin (low-certainty evidence); or neurokinin receptor antagonists, either elinzanetant or fezolinetant (moderate-certainty evidence).
UNLABELLED: When selecting a treatment of vasomotor symptoms, 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.
METHODS: The ACP Clinical Guidelines Committee developed this guideline based on systematic reviews on effectiveness, comparative effectiveness, harms, public and patient values and preferences, and economic evidence of pharmacologic treatments for females with menopausal vasomotor symptoms using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
RECOMMENDATION: In females who are seeking treatment of vasomotor symptoms.
UNLABELLED: First-line treatments.
UNLABELLED: ACP recommends that clinicians initiate one of the following (strong recommendation): estrogen in combination with progestogen in females with a uterus (high-certainty evidence) or estrogen monotherapy in females without a uterus (high-certainty evidence).
UNLABELLED: Second-line treatments.
UNLABELLED: ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line treatment (conditional recommendation): serotonin-norepinephrine reuptake inhibitors, either desvenlafaxine or venlafaxine (moderate-certainty evidence).
UNLABELLED: Third-line treatments.
UNLABELLED: ACP suggests that clinicians use one of the following in females who have contraindications to or do not tolerate first-line or second-line treatment (conditional recommendation): selective serotonin reuptake inhibitors, either escitalopram or paroxetine (low-certainty evidence); the gabapentinoid gabapentin (low-certainty evidence); or neurokinin receptor antagonists, either elinzanetant or fezolinetant (moderate-certainty evidence).
UNLABELLED: When selecting a treatment of vasomotor symptoms, 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.