New therapies offer hope for management of menopausal hot flashes

Hot flashes are one of the most common symptoms of menopause, affecting roughly 75% of women. They can adversely affect a woman’s quality of life by disrupting sleep and mood and can lead to more serious health consequences. A presentation at The North American Menopause Society (NAMS) Annual Meeting in Washington, DC, September 22-25, 2021, will review several nonhormone therapies currently under investigation for hot flash management.

Recent studies have shown that vasomotor symptoms (the clinical term for hot flashes) can last, on average, 7-10 years, and can sometimes last even longer in women whose symptoms began in perimenopause. While some women only have mild hot flashes, others can have more bothersome symptoms which can lead to problems with lower bone density and subclinical cardiovascular disease.

The good news is that several therapies are currently under investigation for vasomotor symptom management. Dr. Stephanie Faubion, NAMS medical director, will highlight some of the more promising therapies which are already approved for other indications and others that represent novel compounds that are not yet government approved. Newer options include:

• Oxybutynin, an antimuscarinic, anticholinergic agent used for management of overactive bladder symptoms and hyperhidrosis has also been found to reduce vasomotor symptom frequency and severity. Although there are concerns regarding dementia risk with its long-term use, short-term use may provide symptom relief for women with significant or bothersome vasomotor symptoms.
• Neurokinin 3 receptor antagonists which are in phase 3 clinical trials for treatment of vasomotor symptoms represent a promising nonhormone therapy. They appear to rapidly reduce hot flash frequency and severity, although their effects on weight, as well as cardiovascular, bone, brain, and sexual health are unknown. In addition, their long-term safety and efficacy have yet to be established.
• Estetrol (E4) is a naturally occurring estrogen that has been shown in initial studies to reduce vasomotor frequency and severity, as well as improve the vaginal maturation index. E4 was recently approved in the US and Canada for use as a contraceptive and is under investigation currently for vasomotor symptom management.

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