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Advances in vasomotor symptom treatments

Transcript: Current and emerging therapies

Last updated:10th Jul 2024
Published:10th Jul 2024

Dr Sheryl Kingsberg

All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.


So currently, the gold standard for treating peri- and post-menopausal symptoms, particularly vasomotor symptoms, are going to be hormone therapy. And that if you have a uterus, it's going to be an oestrogen with a progestogen. And if you don't have a uterus, it can be oestrogen alone. And again, that's the gold standard. But not every woman will be willing to take a hormone therapy or is a candidate for hormone therapy for a variety of reasons for their contraindication.

In addition to the hormone therapy, what we have currently would include cognitive behaviour therapy. I am a cognitive behavioural psychologist, so I support that, and it is evidence-based. We have good data that cognitive behaviour therapy for menopause, and you really need to find a clinician who is a psychologist that specialises in menopause treatment, is very effective. For example, the impact on vasomotor symptoms, while the data aren't clear about whether CBT, as we call it, can reduce the frequency of hot flashes, I do think they can, in terms of helping women become aware of the triggers for a hot flash, whether they're lifestyle or behavioural, drinking red wine or being in a difficult situation, the way CBT also can help is in reducing the impact of a hot flash. So, learning to shift the way you think about managing those thoughts that go along with the hot flash, for example, the what if, what if I have a hot flash in the middle of a major presentation? And helping women learn to address those sort of catastrophic fears and managing what they would do in that situation anyway. So, CBT is very helpful.

We also have some antidepressants. Paroxetine in a low dose, in seven milligrammes, has been approved for vasomotor symptoms, and we know that we use off-label other antidepressants, SSRIs, SNRIs, to treat not just the the mood-related symptoms, but vasomotor symptoms. Gabapentin and oxybutynin are used to address vasomotor symptoms in women who can't or won't take hormone therapy. And now we have the emerging therapies which include the NK1, NK3 receptor agonists. We have fezolinetant, and we have elinzanetant that has not yet gone for approval in the United States, but fezolinetant has been approved and is very effective in reducing vasomotor symptoms. And some data would support its use in sleep disturbance. And elinzanetant shows promise in those areas as well and may impact mood as well.

So, we have emerging therapies that are non-hormonal, that work directly on brain chemistry that is related to what causes those symptoms, particularly vasomotor symptoms. And I think there is tremendous promise for their use for women who are suffering terribly with many symptoms of menopause that are currently going unaddressed and untreated.

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