Evolving Approaches to Vasomotor Symptoms in Menopause: Novel Pathways and Emerging Therapies

Pauline Maki, MD, welcomes the expert panel and introduces the focus on novel mechanisms and emerging therapies for vasomotor symptoms in menopause.

Panelists describe how hypothalamic KNDy neuron dysregulation drives hot flashes and night sweats following estrogen decline.

Discussion centers on the daily and long-term consequences of untreated VMS, including sleep disruption, fatigue, and cognitive decline.

Experts contrast traditional hormone therapy with newer nonhormonal agents, outlining patient suitability and limitations.

The panel reviews the role of NK1 and NK3 receptors in thermoregulation and symptom genesis, setting the stage for targeted therapy.

Discussion highlights fezolinetant’s rapid-onset efficacy, favorable tolerability, and safety findings as the first NK3 antagonist approved for VMS.

The experts examine the dual NK3/NK1 mechanism of elinzanetant and its broader potential to address mood and sleep disturbances.

Review of OASIS-1 through OASIS-4 trial results demonstrating consistent improvements in VMS frequency, severity, and sleep quality.

The panel underscores how quick onset of benefit improves adherence and patient satisfaction in clinical practice.

Discussion covers hepatic enzyme monitoring, oncologic safety considerations, and real-world precautions for NK antagonist use.