Stephanie Faubion, MD, on the first menopause therapy discussion

Menopause management should begin with a clear understanding of a patient’s treatment goals, which then guide the choice between hormonal and nonhormonal therapy, according to Stephanie S. Faubion, MD, MBA, FACP, MSCP, IF, medical director of The Menopause Society; professor and chair of the department of medicine; and the Penny and Bill George Director of the Mayo Clinic Center for Women’s Health at Mayo Clinic in Jacksonville, Florida.

“When I’m talking to patients about menopause management, I think the first question is, ‘What are their treatment goals? What are we trying to treat?’” Faubion said. If a patient’s main concerns are hot flashes and sleep disturbances, she opens a discussion about hormonal versus nonhormonal therapy and any contraindications to hormone therapy.

Choosing a nonhormonal option

For patients who prefer a nonhormonal approach, Faubion discusses options including fezolinetant and elinzanetant, both neurokinin 3 (NK3) receptor antagonists.

“NK3 receptor antagonists are an amazing new class of medications that have emerged in the last three years and have really opened up more options for women,” Faubion said.

“Both medications may help women with sleep disturbances, but elinzanetant’s additional NK1 receptor antagonism may be particularly helpful for sleep as well,” she said.¹

Monitoring, follow-up, and open questions

Faubion advised checking liver function tests before initiating either drug. With elinzanetant, she rechecks liver function at 3 months; with fezolinetant, she follows a schedule of baseline and months 1, 2, 3, 6, and 9, citing real-world reports of liver test abnormalities.

“For any menopause treatment, I typically follow up with patients around the two-month mark to see how they’re doing and whether they’ve responded to therapy,” Faubion said, adding that she invites patients to message her through the patient portal if problems arise sooner.

Experience with these agents in perimenopause remains limited, Faubion noted, and while there is some experience with elinzanetant in breast cancer survivors, fezolinetant data in that population are forthcoming.

“I think the more experience we gain, the more we’ll learn about their effects in these areas,” Faubion said, referring to breast, bone, and cardiovascular health.

Reference

1. Simon JA, Pinkerton JV, Seitz C, et al. Improvements in sleep disturbance with elinzanetant: analysis of PROMIS SD SF 8b domains from the OASIS-1 and -2 clinical trials. Presented at: The Menopause Society Annual Meeting. October 20-24, 2026. San Diego, California.