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August 20, 2024
Non-Hormonal Treatment Options for Moderate to Severe Vasomotor Symptoms

Vasomotor symptoms, such as hot flushes, affect a significant proportion of women during and after menopause. These symptoms result from hormonal changes that alter the hypothalamic thermoneutral zone, making women more sensitive to temperature fluctuations. Neurokinin 3 (NK3) receptor antagonists represent a novel class of non-hormonal treatments designed to target specific pathways involved in regulating body temperature.

Scientific Insights:

  1. Mechanism of Action: NK3 receptor antagonists act on the neurokinin 3 receptors within the central KNDy (kisspeptin, neurokinin B, and dynorphin) neuronal network in the hypothalamus. This network is critical for maintaining body temperature and is disrupted in menopausal women, leading to VMS.
  2. Clinical Efficacy: Recent phase 3 trials have demonstrated that NK3 receptor antagonists significantly reduce the frequency and severity of hot flushes compared to placebo. Studies have reported reductions in hot flush frequency by approximately 56% to 61% with NK3 receptor antagonists, while improvements in VMS severity have been sustained throughout the treatment period.
  3. Comparison with Traditional Non-Hormonal Treatments: Traditional non-hormonal treatments for VMS, such as SSRIs and SNRIs, offer variable efficacy and are associated with side effects like nausea and insomnia. NK3 receptor antagonists provide a targeted approach with efficacy comparable to or better than SSRIs/SNRIs and potentially fewer side effects.
  4. Future Research Directions: Ongoing research is needed to explore the long-term safety and efficacy of NK3 receptor antagonists, especially in populations with contraindications to hormone therapy. Additionally, studies will need to evaluate the impact of these drugs on other health outcomes, such as bone health and cardiovascular events.

How do emerging neurokinin 3 (NK3) receptor antagonists compare to traditional non-hormonal treatments for managing moderate to severe vasomotor symptoms (VMS) associated with menopause?

  • August 20, 2024
    It’s great to see new therapies develop for such a difficult problem to treat. I have not prescribed the NK3 antagonists yet. Unfortunately, I suspect it will be cost prohibitive for many patients.
  • August 19, 2024
    I consider this first NK3 receptor antagonist as a game changer. For those women for whom estrogen based hormonal therapy is contraindicated or if they just decline the option of such treatment, I now have an alternative nonhormonal and efficacious pharmocologic therapy to offer as a worthwhile option. As with any new medication, 3rd party payers are very reluctant to cover the higher costs, which selects out only those who can afford the out of pocket expense, but I am hopeful that this situation will improve over time.
  • August 12, 2024
    The bottom line is that NK3 receptor antagonists have a specific indication to treat VMS symptoms while many of the other non-traditional non hormonal options are being used off label and do not specifically target the cause of VMS.
  • August 12, 2024
    The use of these agents, such as fezolinetant, have definite advantages in terms of less side effects and better tolerability. Unfortunately, the cost profile for most insured patients means that they have to fail other forms of treatment (SSRIs, etc) before you can get approval for their use.
  • August 12, 2024
    Different non-hormonal moa, provides significant reduction in the frequency and severity of moderate to severe vms symptoms but need frequent lft monitoring .
  • August 11, 2024
    this nonhormonal approach working well for post menopausal side to resolved hot flahes and cold sweats

  • August 11, 2024
    A non hormonal medication for VMS by blocking Neurokinins at receptor sites Veozah appears to be helping my pre and menopausal patients who do not or can not take hormones for their symptoms. I have been following liver and renal functions as per recommendations and thus far have not needed to discontinue the medication. Issues are of course coverage which appears to be minimal, the other of course no positive effect on osseous system but then little worry regarding cancer issues and shows response within 10 day period in majority of patients.
  • August 11, 2024
    Veozah / NK3 recetor antagnosit is a revolutionary treatment for VMS and for the first time have a medicine targetting the VMS at the grass root level, there was big void before in managing VMS and there is still prevailing relucatnce unfortuantely to HRT among the pts . Menopausal syndrome is a constellation of symptoms one needs to have a broad based approach in managing but hot flashes and night sweats by and large remain the most bothersome symptoms and to treat them has more broad based indirect treatments but now with NK3 have a very targetted approach and can be used alone or in combination with the others , Have been using it with good success and with a good feed back , how ever Liver fucntion need to be monitored and pt needs to be screened well for chronic liver disease before starting it ! All in all great breakthrough in treating VMS and am sure more meds on the same lines will emerge !!
  • August 11, 2024
    they provide another option for non-hormonal treatment.
  • August 11, 2024
    I have prescribed the only FDA approved NK3 inhibitor Fezolinetant --Veozah to my patients for the last few months, since it became FDA approved. Despite the black box warning about liver function tests required at commencement of therapy and regularly thereafter, my patients had no hesitation in accepting the treatment which is completely non hormonal.
    All my patients who were able to get access (preauthorization is required and is a significant barrier to access at present) reported quick onset ---within 1 week to 10 days significant relief and have continued to maintain good therapeutic response and are very happy.
    I am happy because my patients who could not or would not take hormone therapy now have an excellent therapeutic completely non-hormonal option.
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August 19, 2024
Insights into the vulvar component of the genitourinary syndrome of menopause (GSM)

Insights into the vulvar component of the genitourinary syndrome of menopause (GSM)

Source : https://pubmed.ncbi.nlm.nih.gov/38704313/

Genitourinary syndrome of menopause is a comprehensive term that groups genital, urinary and sexual signs and symptoms mainly due sex hormone deficiency and aging, with a crucial impact on quality...

Understanding vulvar health in genitourinary syndrome of menopause is vital for targeted treatment, as it influences symptom severity and quality of life, necessitating further research into effective management options.

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August 19, 2024
Menopause depression: Under recognised and poorly treated

Menopause depression: Under recognised and poorly treated

Source : https://pubmed.ncbi.nlm.nih.gov/38761367/

Menopause is a biological process experienced by all people assigned female at birth. A significant number of women experience mental ill health related to the major brain gonadal hormone shifts...

Innovative approaches, centered on women's lived experiences, are essential for effectively addressing menopausal mental ill health, improving quality of life, and supporting continued workforce participation and relationships.

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August 12, 2024
Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition

Systematic review and meta-analysis of the effects of menopause hormone therapy on cognition

Source : https://pubmed.ncbi.nlm.nih.gov/38501109/

These findings suggest time-dependent effects of MHT on certain aspects of cognition, with variations based on formulation and timing of initiation, underscoring the need for further research with larger samples...

Estrogen-only menopausal hormone therapy (MHT) improves global cognition and verbal memory when started near menopause. In contrast, estrogen-progestogen MHT can impair cognitive function, particularly with longer duration.

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August 12, 2024
Efficacy and safety of traditional Chinese medicine in the treatment of menopause-like syndrome for breast cancer survivors: a systematic review and meta-analysis

Efficacy and safety of traditional Chinese medicine in the treatment of menopause-like syndrome for breast cancer survivors: a systematic review and meta-analysis

Source : https://pubmed.ncbi.nlm.nih.gov/38191442/

The meta-analysis stated that TCM could better improve the MLS of patients, alleviate related symptoms, and did not increase adverse drug reactions in BC survivors. This review brings more attention...

Traditional Chinese Medicine (TCM) significantly alleviates menopause-like syndrome symptoms in breast cancer patients, improving quality of life without increasing adverse effects, showing promise as an adjunct therapy.

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