Treating Menopause Without Delay: A Primary Care Approach to VMS, With Jill Liss, MD

Vasomotor symptoms (VMS) of menopause remain one of the most common reasons midlife women seek care, yet many clinicians may still approach menopausal hormone therapy with caution shaped by early interpretations of the Women’s Health Initiative (WHI). At the American College of Obstetricians and Gynecologists (ACOG) 2026 Annual Clinical and Scientific Meeting, Jill Liss, MD, an associate clinical professor of obstetrics and gynecology at the University of Colorado School of Medicine, spoke with Patient Care Online about how the evidence and treatment landscape have evolved and why hormone therapy should again be viewed as a highly effective, appropriate first-line therapy for many patients She also emphasized that newer neurokinin receptor antagonists offer an important nonhormonal option for those with contraindications or strong preference to avoid estrogen. Liss also underscored the importance of primary care as a critical access point for menopause management. Details in the interview below.

Q: Can you give a broad overview of where things stand right now in the vasomotor symptoms (VMS) treatment landscape?

Jill Liss, MD: This is an exciting time in the VMS landscape. Hormone therapy is back in favor—in the sense that it should never have fallen out of favor. Subsequent analyses and renewed interest have really given us more confidence, and we’re seeing increased uptake among patients. We’re overcoming fears following the Women’s Health Initiative, and hormone therapy remains our first-line, highly effective treatment.

At the same time, we’re seeing innovation—something we don’t often get in women’s health. The newer neurokinin receptor antagonists are becoming more accessible. While access remains a challenge, it is improving. These therapies are highly effective and represent the first truly effective alternative to hormone therapy.

Q: With so many options now available, how should a primary care physician who isn’t a menopause specialist start thinking about which treatment to use first?

Liss: I would start by reassuring clinicians. Many of us trained in an era where we were taught to fear hormones. But the risks are truly low—fewer than 10 per 10 000 in most cases for adverse events.

Most candidates—particularly those younger than 60 years without major comorbidities such as myocardial infarction, stroke, history of thrombosis, or estrogen-positive cancer—are appropriate candidates for hormone therapy. Clinicians can feel confident using these therapies safely in average-risk patients.

It’s also important to recognize that the risks of not treating are significant. There are major access issues and disparities in care. Untreated hot flashes are not just nuisance symptoms—they are associated with worse cardiovascular outcomes, increased dementia risk, and poorer bone health. Whether they are causal or a biomarker, they should be taken seriously.

Primary care is an ideal setting to initiate treatment for menopause symptoms in average-risk individuals.

Q: Time and access are often barriers in primary care. How should clinicians approach these conversations?

Liss: Time and access are real limitations. These conversations don’t always need to happen in a single visit. One approach is to begin the discussion, listen carefully, and schedule a follow-up.

There are also excellent resources available through ACOG and The Menopause Society. For example, ACOG has published What Your OB-GYN Wants You to Know About Menopause. Providing patients with educational materials allows them to return better informed and ready to discuss treatment options.

Primary care clinicians can also begin treatment while patients are waiting to see a specialist. In many areas, that wait can be 6 to 12 months. Initiating therapy can help reduce suffering in the interim.

Q: Where do you see newer therapies such as neurokinin receptor antagonists fitting into treatment?

Liss: I see neurokinin receptor antagonists as an important option for patients who have contraindications to hormone therapy. Patient preference also plays a role—some individuals may be candidates for hormone therapy but prefer not to use it.

In those cases, I think it’s important to explore the reasons behind that preference, as it may reflect a misunderstanding. But if a patient prefers to avoid hormones or has a contraindication, these therapies are an appropriate first-line option.

They are particularly valuable in populations such as patients with breast cancer, who typically should not use estrogen and often experience more severe vasomotor symptoms.