A quick note first: I'm not a doctor. This guide is to help you and your mother understand her options and prepare for her GP visit. 1. WHY THIS UPDATE MATTERS In 2002, a large US study (the Women's Health Initiative) linked hormone therapy to breast cancer and heart risks, and many women stopped or never started it. Later analysis showed those risks were mostly in older women who started treatment many years after menopause. Today most medical bodies say that for healthy women under 60, or within about 10 years of their last period, the benefits of hormone therapy for symptoms usually outweigh the risks. The American College of Obstetricians and Gynecologists has now updated its guidance for the first time since 2014, covering hot flashes, night sweats and sleep problems. The overall message is that menopause symptoms are worth treating, and there are good options beyond "put up with it". 2. TREATMENT OPTIONS | Option | Helps with | Usually not suitable for | Main side effects | |---|---|---|---| | Hormone therapy (oestrogen, plus progestogen if she has a womb) | Hot flashes, night sweats, sleep, mood, bone strength | History of breast cancer, blood clots, stroke or active liver disease | Breast tenderness, bloating, spotting; small rise in clot risk with tablets (less with patches or gels) | | Vaginal oestrogen | Dryness, pain during sex, urinary symptoms | Usually suitable for most; check after breast cancer | Mild local irritation | | Non-hormonal tablets (e.g. some antidepressants, gabapentin, newer medicines such as fezolinetant) | Hot flashes; some help sleep or mood | Depends on the medicine and other conditions | Nausea, dizziness, drowsiness; liver checks for some | | Cognitive behavioural therapy (CBT) | Coping with hot flashes, sleep, low mood | Suitable for almost everyone | None significant | | Lifestyle: cooler bedroom, layers, regular exercise, less alcohol and caffeine | Hot flashes, sleep, bone and heart health | Suitable for everyone | None | 3. 8 QUESTIONS FOR THE GP 1. Are my symptoms likely to be menopause, and do I need any tests? 2. Is hormone therapy safe for me, given my personal and family history? 3. Would a patch or gel be better for me than tablets? 4. If I can't or don't want hormones, what non-hormonal options suit me? 5. How long would I take treatment, and how do we review it? 6. What can I do about sleep right now? 7. Should I have a bone density check? 8. What changes should make me come back sooner? 4. HOW IRISH GUIDANCE COMPARES In Ireland, GPs generally follow guidance similar to the UK's NICE menopause guideline, which also supports hormone therapy for most women with symptoms after an individual risk discussion. Ireland also made many HRT products free under a State scheme in 2024 (VERIFY on hse.ie). I'm not certain how closely the new ACOG update matches Irish practice, so ask the GP. 5. A GENTLE SCRIPT "Mam, I've been reading about how menopause treatment has changed a lot in the last few years. It sounds like there are safer options now than when you last looked into it. Would you like me to come with you to the GP, or help write down your questions?" SELF-CHECK I don't have reliable details of the 2026 ACOG update itself. Confirm on acog.org: exactly what changed, any new age or timing advice, and any new medicines it recommends.