Managing Menopause-Associated Vasomotor Symptoms Via New Nonhormonal Therapy
Hormone replacement therapy is widely accepted as the most effective treatment for vasomotor symptoms associated with menopause; however, it is not an option for some patients. If hormonal therapy is contraindicated, such as in certain individuals with a history of breast cancer, heart disease, stroke, or blood clots, or if the patient does not desire hormone treatment, then prescribers could recommend other nonhormonal medications. A new alternative to hormone replacement therapy has recently received FDA approval, adding another option for treating vasomotor symptoms that negatively affect the quality of life of women experiencing menopause.
Well over 50 million women in the US are estimated to be in menopause. According to studies, approximately 80% of those individuals experience vasomotor symptoms of hot flashes and night sweats. Vasomotor symptoms are generally classified as either mild, with the feeling of heat but no sweating occurs; moderate, with the feeling of heat and sweating occurs, but activity can be continued; or severe, with the feeling of heat, sweating occurs, and activity cannot be continued. Significant sweating, flushed skin, disrupted sleep, anxiety, mood disturbance, and increased risk for cardiovascular disease can all be associated with hot flashes. The health impact extends well beyond general discomfort. Considerable reduction in the quality of life is a concern and burden for affected women.
When the usual levels of estrogen and progesterone begin to fluctuate, the body is entering perimenopause. Menopause is defined as when menstrual cycles have ceased for 12 months for a patient. As estrogen levels decrease as perimenopause/menopause occurs, the hormone's involvement in temperature regulation in the hypothalamus is impacted, allowing neurokinin 3 (NK3) receptors to become hyperactive. NK3 receptors are responsible for controlling kisspeptin/neurokinin/dynorphin neurons. When these neurons are unregulated, they continue to fire and cause hot flashes in the body. A new first-of-its-kind therapy that acts as an NK3 receptor antagonist has recently been approved. By blocking NK3, temperature control is regained, and vasomotor symptoms are reduced. The drug is known asVeozah (fezolinetant)and is indicated for treatment of moderate-to-severe vasomotor symptoms due to menopause. Veozah is a 45mg tablet taken once a day. The prescribing information includes a warning related to hepatic transaminase elevation, so prescribers must evaluate and monitor patients for hepatic function and injury.
As nonhormonal treatments like Veozah are continuing to be researched and developed, the North American Menopause Society (NAMS) has published a newly revisedNonhormone Therapy Position Statementfor 2023 that addresses related prescribing strategies. Published in the June 2023 edition of the journalMenopause, the piece reinforces the value of hormone therapy as the most effective treatment for vasomotor symptoms. Still, it encourages the importance of healthcare providers being aware and highly informed regarding evidence-backed nonhormone treatment options. It is vital to be able to consult on the best therapy approach for patients who are unable to use hormonal therapy.
Theannual meeting for NAMSwill take place September 27-30, 2023, and will focus on "Midlife Women's Health in the Era of Precision Medicine." The meeting provides an opportunity to earn continuing education credits or pharmacotherapeutic credits. The guidance provided by authoritative resources such as NAMS can be helpful for healthcare providers. You can also stay informed about emergent drug information, including treatment options for symptoms of menopause, byupdating or registering your profileto receive email alerts and other critical drug information updates from PDR. You can also stay current by using the official PDR app,mobilePDR, available for free from your favorite app stores.
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