Menopause Hot Flashes and Low Mood: What the New ACOG Guidance Says About Hormone Therapy and Exercise

Hot flashes at 2 a.m., sleepless nights, and a mood that swings for no reason. If you or someone you love is going through menopause, you have probably gotten several tips telling you what to do about it. However, this month brought real evidence that is worth more than any viral tip.

First, a major US doctors’ group updated its menopause guideline and now strongly recommends hormone therapy for some symptoms. Then, a separate review found that walking, Zumba and yoga may help with low mood. So, let’s look at what each one actually says, and what it does not.

What Did ACOG Actually Change?

The American College of Obstetricians and Gynecologists (ACOG) published Clinical Practice Guideline No. 13 in Obstetrics & Gynecology on October 15, 2026. It replaces a 2014 bulletin. Healthline reported on it on October 20.

Importantly, the headline recommendation is narrower than many posts suggest. ACOG strongly recommends menopausal hormone therapy (MHT) for hot flashes and for sleep problems caused by hot flashes, in people who have no medical reason to avoid it.

Who Should Think Twice

Hormone therapy is not for everyone. Reasons to avoid it include unexplained vaginal bleeding, a history of breast or other estrogen-sensitive cancer, past blood clots, stroke or heart attack, and active liver disease. Therefore, the decision should be made with a doctor, who weighs your age, history and risks.

Timing Matters

ACOG recommends starting hormone therapy before age 60 or within 10 years of the start of natural menopause. After that window, the decision should be individualised. Moreover, you should review how well it is working after three months, and then once a year.

What About Mood?

This is the part many people miss. ACOG says the evidence is insufficient to recommend for or against hormone therapy for menopause-related depressive symptoms. In other words, the guideline does not say hormones fix low mood.

Instead, ACOG strongly recommends SSRIs or SNRIs for hot flashes and depression. It also says that if you meet the criteria for major depression, you should be treated under standard depression guidelines. According to Healthline, more than a third of women in perimenopause and after menopause report depressive symptoms.

Options If Hormones Are Not for You

• Strongly recommended nonhormonal medicines: SSRIs, SNRIs and neurokinin receptor antagonists for hot flashes.

• Conditionally recommended: gabapentin, plus cognitive behavioural therapy, mindfulness, clinical hypnosis, acupuncture and regular exercise, usually alongside medication.

• Not supported: soy isoflavones and herbal supplements. Healthline says the evidence is insufficient for them.

That last point matters if you are tempted by herbal “menopause cures.” You should know that a traditional remedy and a proven treatment are not the same thing.

Can Walking, Yoga or Zumba Really Help Your Mood?

Possibly, and this is where the second study comes in. University College London reported a review and meta-analysis of 12 randomised trials with more than 1,000 women in perimenopause and early post-menopause. It was published in the Menopause journal on October 13, 2026.

What Worked Best

• Aerobic activity: walking, Zumba, dance and Taekwondo had the strongest effect on depressive symptoms and overall quality of life.

• Mind-body activity: yoga, tai chi, Pilates and stretching gave strong gains in psychological quality of life.

• Examples used in trials: walking three times a week for 30 minutes, or three one-hour Zumba classes a week.

Also, most of the programmes were group-based, and the researchers think the social connection may have helped. In addition, aerobic programmes generally needed fewer sessions, which may suit you if time and energy are limited.

The Honest Limits

However, the researchers say the evidence base is limited, the studies varied a lot, and many were at high risk of bias. So, exercise is a helpful extra, not a replacement for treatment. As lead researcher Simone Saidel noted, many women cannot or choose not to take hormone therapy, which is why accessible options matter.

Why Was There So Much Confusion About Hormone Therapy?

For years, many women and some doctors avoided hormone therapy because of worries about its risks. Guideline co-author Bruce Pier, MD, told Healthline that “misconceptions about the risks of hormone therapy have been widespread,” and said the hope is that the new guidance clears them up and expands access to treatment.

Most participants in the large Women’s Health Initiative study were 60 or older, which limits how well its findings apply to younger women. That is one reason timing now features so strongly in the advice. Even so, risks such as blood clots still exist, so a personal conversation with your doctor remains essential.

How to Prepare for the Doctor’s Visit

Many women wait years before mentioning symptoms. Pier’s advice, quoted by Healthline, is to talk to your clinician, because you do not have to suffer through them. So, before you go, write down how often you wake up sweating, how well you sleep, and how your mood has changed. Also note your family history of cancer, clots or heart disease, because your doctor will ask.

What This Means for You

• Talk to a clinician about hot flashes, sleep or mood, even if you think they are “just part of getting older.”

• Ask about your own risks before starting hormone therapy, because contraindications and timing apply.

• Do not self-treat mood changes. If low mood is heavy or lasts, get it assessed.

• Move regularly. Start with a short walk or a dance class you enjoy, as an addition to medical care.

• Be careful with unproven supplements, and avoid buying hormones from unregulated sellers.

For more, browse our health and fitness desk and lifestyle section.

Quick FAQs

1. Does ACOG say every woman should take hormone therapy?

No. It strongly recommends it for hot flashes and related sleep problems in people without medical reasons to avoid it, after a personal risk discussion.

2. Does hormone therapy treat depression in menopause?

ACOG says the evidence is insufficient to recommend for or against it for menopause-related depressive symptoms.

3. Which exercise helped mood most in the review?

Aerobic activities such as walking and Zumba had the strongest effect on depressive symptoms, according to UCL.

4. Is this medical advice?

No. This article summarises published guidance. Please speak to your doctor about your own situation.