How is elinzanetant impacting sleep in postmenopausal women?

In recent years, and as early as fall 2025, neurokinin receptor antagonists have arrived on the market as non-hormonal options for the treatment of vasomotor symptoms associated with menopause. Fezolinetant (Veozah; Astellas Pharma) was approved by the FDA in May of 2023, and elinzanetant (Lynkuet; Bayer) in October 2025.^1,2

“There is a little bit of a difference between the two,” said Stephanie S. Faubion, MD, MBA, FACP, MSCP, IF, director, Mayo Clinic Center for Women’s Health; professor and chair, Department of Medicine, Mayo Clinic, Jacksonville, Florida; and medical director, The Menopause Society.

“Fezolinetant is an NK3 receptor antagonist, and elinzanetant is an NK1 and NK3 receptor antagonist, and the difference, we believe, is that NK3 is mostly vasomotor symptom management, and NK1 probably has a little bit of an effect on vasodilation, so it can have an effect on hot flashes as well, but also has an effect on sleep through substance P, and so we think that elinzanetant may be a little more targeted to sleep specifically, in addition to vasomotor symptoms.”

Emerging interest and research is now exploring how these NK receptor antagonists are playing a role in a large impact area of vasomotor symptoms; sleep.

“When we consider menopausal sleep disturbances, the primary complaint that women report is waking up after they have first fallen asleep, waking up and then having trouble going back to sleep, so they are spending some time in the night waking, and then spending that time awake instead of sleeping,” added Fiona Baker, PhD, director, Human Sleep Research Program, SRI International. Baker was also an author of a post-hoc analysis of the phase 2 NIRVANA trial (NCT06112756) presented at the SLEEP 2026 Annual Meeting in Baltimore, Maryland.³

The trial randomized 110 postmenopausal women with PSG-confirmed WASO of at least 30 minutes and at least 20 moderate-to-severe vasomotor symptoms (VMS) per week to elinzanetant 120 mg (n = 55) or placebo (n = 55) once daily for 12 weeks. PSG assessments were conducted at baseline, week 4, and week 12 (2 consecutive nights per timepoint). The Sleepiz One+, a contactless home-monitoring device, was used in a subset of participants (elinzanetant: n = 33, placebo: n = 33), whereas sleep diary data were collected nightly across all participants.

“There were previous studies, the OASIS trials, that showed very strong evidence that elinzanetant is very effective at improving sleep disturbances associated with menopause,” said Baker. “In NIRVANA, the goal there was to look at multi-modal measures of sleep disturbance associated with menopause in women who had moderate to severe vasomotor symptoms to better understand how elinzanetant is working. What NIRVANA shows is that across all 3 measures, whether it was looking at self-reports or looking at the polysomnography, the gold standard sleep measures, or even that device placed next to the bed, elinzanetant, across the 12-week period, reduced wakefulness after sleep onset. I think those results really confirm and extend what was known from the OASIS trials, that elinzanetant is effective at improving sleep disturbance.”

With all the positive data emerging on these NK receptor antagonists, the patient’s comfort level still plays a crucial role in determining treatment options for VMS, as well as sleep disruption considerations.

“There are many patients who feel strongly that they do not want to use hormone therapy for one reason or another. There are others that feel strongly that they do not want to use an antidepressant. So sometimes it is what they do not want to use. Sometimes it is what seems most appealing in terms of ease,” said Faubion, who added even non-medication options should be front of mind as well.

“There are plenty of those, including cognitive behavioral therapy, for example, which has been proven useful for both vasomotor symptoms and for insomnia, so some women may prefer a non-medication option.”

For a more detailed explanation of the NIRVANA phase 2 trial data, click here for a full interview with Fiona Baker, PhD.

Image credit:

Astellas Pharma, Bayer, Adobe Stock.

References:

1. Ebert M. FDA approves fezolinetant for vasomotor symptoms. Contemporary OB/GYN. Published May 12, 2023. Accessed June 25, 2026. https://www.contemporaryobgyn.net/view/fda-approves-fezolinetant-for-vasomotor-symptoms
2. Krewson C. FDA approves elinzanetant (Lynkuet) for vasomotor menopausal symptoms. Contemporary OB/GYN. Published October 24, 2025. Accessed June 25, 2026. https://www.contemporaryobgyn.net/view/fda-approves-elinzanetant-lynkuet-for-vasomotor-menopausal-symptoms
3. Fitch J. Fiona Baker, PhD, details elinzanetant's effectiveness on wakefulness after sleep onset in postmenopausal women. Contemporary OB/GYN. Published June 16, 2026. Accessed June 25, 2026. https://www.contemporaryobgyn.net/view/fiona-baker-phd-details-elinzanetant-effectivenes-wakefulness-sleep-onset-postmenopausal