Nanette Santoro, MD: Vasomotor symptoms, treatment, and potential of elinzanetant

Vasomotor symptoms, such as hot flashes, are among the most common and distressing symptoms of menopause, affecting the vast majority of women. Nanette Santoro, MD, professor and E Stewart Taylor Chair of Obstetrics and Gynecology at the University of Colorado School of Medicine, recently highlighted the challenges and advancements in the treatment of menopausal symptoms while at The Menopause Society annual meeting in Chicago, Illinois. The meeting is taking place through September 14, 2024.

"A vast majority of women will struggle with [hot flashes]," Dr. Santoro said. "A smaller proportion are severely affected. And it's the driver, the key driver, that brings about two-thirds of menopausal women to the doctor's office asking questions." Hot flashes, which can last for an average of 7 years, are a common reason women seek medical advice about menopause.

"For most of history, we've only had hormones. Hormones work great for hot flashes," Santoro said. "Hormones are not bad news, they're good news. There's a lot of ways to give them, and most women can safely take them." Hormone therapy remains an effective option, especially for women experiencing hot flashes along with other menopausal symptoms.

However, for women unable or unwilling to take hormones, there are alternatives. "SSRIs, women that took them who had breast cancer couldn't take hormones but had hot flashes, would notice they got better. Gabapentin... led to the approval of paroxetine mesylate as a non-hormonal treatment."

Now, a new class of medications, the neurokinin-3 (NK3) receptor antagonists, offers a promising alternative. "Fezolinetant, is the first to come to approval," Dr. Santoro said. This class of drugs acts on the brain's neurokinin receptors, providing nearly the same effectiveness as estrogen without the associated risks or side effects of other medications.

"This now becomes really another first-line treatment that does not have off-target effects," Santoro added. Unlike SSRIs or gabapentin, which can cause undesirable effects like sleepiness or mood changes, the NK3 receptor antagonists specifically target hot flashes. This new class of drugs represents a significant advancement in the treatment of menopausal symptoms, offering hope for women seeking effective and safer alternatives to traditional hormone therapy.

Click here for more coverage from The Menopause Society Meeting.