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Yesterday
Can neurokinin-3 receptor antagonism transform management of menopausal vasomotor symptoms?

Menopausal vasomotor symptoms (VMS), including hot flashes and night sweats, significantly impact quality of life, sleep, and daily functioning. While hormone therapy has long been the standard, safety concerns and contraindications have created a need for effective non-hormonal pharmacologic alternatives.

Emerging evidence suggests that neurokinin-3 receptor (NK3R) antagonism may offer a novel, targeted approach to managing VMS. By modulating hypothalamic thermoregulatory pathways implicated in VMS, this mechanism targets neurobiological processes associated with hot flashes. Clinical trials have demonstrated reductions in the frequency and severity of VMS, with improvements reported as early as the first week in some studies and sustained over time.

Patient-reported outcomes also suggest potential benefits in sleep, daily functioning, and overall quality of life. NK3R antagonists have been generally well tolerated in clinical trials, with headache and fatigue among the most commonly reported adverse events. Transient elevations in liver enzymes have been observed, and monitoring may be warranted in some patients.

How do you approach treatment selection for patients who are not candidates for hormone therapy? What role could targeted thermoregulatory pathways play in future menopause management?

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  • Yesterday
    HRT has made resurgence in the management of VMS in terms of the safety and its efficacy has always been there but there is still legacy of it not being safe lingers on which am sure will get better due course of time but in the interim NK3R antagonist have come up which target the very pathogenesis of VMS and are a great choice barring the one with the liver disease in pts not want to go on HRT and have primarily symptoms of Hot flashes and if monitored well with LFTS are excellent choice but have to keep in mind that menopause is a syndrome with multiple other symptoms and may have to be used in other meds like SSRI etc for comprehesive management
  • 1w
    well anyone with an underlying liver condition prob would not be a candidate for this treatment but so many other people could benefit from non- hormonal therapies. one of the reasons women are so skeptical about being treated for their bothersome menopause is because of the side effects of the hormone therapies and so in the past a lot of natural products have been used but this is another weapon in the arsenal to help combat this very bothersome and unpredictable disorder. and headache and fatigue are not that concerning of side effects because a lot of women in menopause or peri-menopause have these symptoms anyway
  • 1w
    i am all for any non hormonal options hope it proves effective
  • 1w
    So for non-hormone options I give the choice between gabapentin, SSRI ov Veozah. give the pro's and Con's ad let them decide The idea of a targeted solution is certainly Show More
  • 1w
    So for non-hormone options I give the choice between gabapentin, SSRI ov Veozah. give the pro's and Con's ad let them decide
    The idea of a targeted solution is certainly a distinct positive, and will make it more appealing going forward both for effect and avoiding side effects
  • 1w
    So for non-hormone options I give the choice between gabapentin, SSRI ov Veozah. give the pro's and Con's ad let them decide
    The idea of a targeted solution is certainly a distinct positive, and will make it more appealing going forward both for effect and avoiding side effects
  • 1w
    Veozah would definitely benefit women who cannot do hormone treatment and have failed SSRi treatment
  • 2w
    For patients with Menopausal Vasomotor Symptoms who can’t or prefer not to use hormone therapy, NK3R antagonists are increasingly a front-line non-hormonal choice, rather than a fallback after SSRIs/SNRIs or gabapentin.
  • 2w
    This seems to be a great option for VMS who are not candidates for hormone therapy.
  • 3w
    Fezolinetant (Veozah) for patients with normal liver function and contraindications to estrogen and/or progestin therapy (breast CA - hormone positive patients, or patients with CAD), has been a game changer
  • 3w
    NK3R has been emerging and a great alternative due to potential side effects and long term safety from HRT. Veozah has been heavily promoted by drug reps and I usually do q3 month liver function monitoring for clinical safety. I have seen significant control in VMS symptoms with Veozah and expect this to be a new gold standard in controlling VMS in the future.

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