ACOG Clinical Practice Guideline: Management of Menopause-Related Vasomotor, Sleep, and Mood Symptoms

PURPOSE: To provide evidence-based recommendations for the management of vasomotor, sleep, and mood symptoms related to spontaneous menopause and induced menopause (at or beyond age 40 years). TARGET POPULATION: Perimenopausal and postmenopausal individuals assigned female sex at birth (ie, women, transgender men, and gender-diverse individuals) with vasomotor, sleep, and mood symptoms related to spontaneous or induced menopause. METHODS: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of a subspecialist in reproductive endocrinology and infertility, a Menopause Society Certified Practitioner and subspecialist in reproductive endocrinology and infertility, and a specialist in obstetrics and gynecology. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS: This Clinical Practice Guideline includes recommendations on pharmacologic and nonpharmacologic interventions for the management of menopause-related vasomotor, sleep, and mood symptoms. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide clinical guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.