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Pharmacologic treatment options for vasomotor symptoms

A presentation at the North American Menopause Society Annual Meeting outlined the approval status and effectiveness of various pharmacologic treatments of vasomotor symptoms.

An estimated 25% of women will seek pharmacologic therapies for vasomotor symptoms (VMS) such as hot flashes, according to a poster presented at the North American Menopause Society (NAMS) Annual Meeting held in Atlanta, Georgia, from October 12-15, 2022.

There is a wide range of options for women seeking treatment for menopause-related symptoms—hormonal and nonhormonal—including pills, patches, mists, and gels. New nonhormone therapy options are currently waiting for approval from the US Food and Drug Administration (FDA).

"Because hot flashes are one of the most common and bothersome symptoms of menopause, it makes sense that so much research has focused on ways to effectively treat them,” said Stephanie Faubion, MD, MBA, NAMS medical director.

She concluded, “Menopausal women today have more treatment options than ever before, with hormone therapy remaining the most effective. Because some women are unable or unwilling to take hormones, however, we need to continue researching alternatives.”

According to the poster presentation, their approval is based on the idea that VMS physiology is controlled by the kisspeptin-neurokinin B-dynorphin neuron complex in the hypothalamus of the brain located directly adjacent to the thermoregulatory center.

There are 2 promising drugs in development—fezolinetant and elinzanetant—which are both neurokinin B antagonists. Pavinetant, however, is no longer being pursued as VMS treatment or pursuing FDA approval because of its concerning effects on the liver. Larger studies will be conducted soon to confirm the benefits of these new drugs.

"This is an exciting time,” said Susan Reed, MD, MPH, MS, professor emeritus, vice chair of research, and adjunct professor of epidemiology in the department of Obstetrics & Gynecology at the University of Washington, as well as the poster’s primary presenter.

Reed concluded, “There have been relatively few novel hormone therapies developed for VMS in the past decade, and there is only one FDA-approved nonhormone therapy for VMS that was ever approved, and that was in 2013. Within the next several years, however, we hope to see some major breakthroughs and multiple new options for menopausal hot flash management, including a new estrogen and two new nonhormone therapies.”

Reference:

S Reed. What’s New and What Works in the Treatment of Hot Flashes?Presented at: North American Menopause Society Annual Meeting. October 12-15, Atlanta, Georgia.