Fezolinetant for treating vasomotor symptoms associated with the menopause [ID5071]

The menopause occurs when menstruation stops and the end of natural reproductive life is reached. Usually it is defined as having occurred when there has been no naturally occurring period for 12 consecutive months. It is a natural part of ageing. Changes associated with menopause occur when the ovaries stop maturing eggs and secreting oestrogen and progesterone.

The experience of symptoms varies (length and severity) but most people will have some vasomotor symptoms associated with the decrease in oestrogen.

Vasomotor symptoms include hot flushes and night sweats caused by constriction and dilatation of blood vessels in the skin that can lead to a sudden increase in blood flow to allow heat loss.

Vasomotor symptoms can have a significant impact on a person’s life and have been linked to problems with sleep quality of life and low moods and anxiety that occur with menopause. Perimenopause starts when symptoms of menopause appear and continues until 1-year after the last period. Menopause usually occurs between age 45 and 55 with an average age of 51-years.

The prevalence of problematic vasomotor symptoms that need treatment is estimated to be 25%(1) and the prevalence decreases with age to 15% at age 55 to 59 6% at age 60-69 and only 3% at over 70(2).

However medical intervention is often not sought so the true prevalence of vasomotor symptoms may be much higher with studies showing that up to 80% may experience vasomotor symptoms as part of the menopause(3).Hormone replacement therapy (HRT) is the main treatment option for vasomotor symptoms in menopause.

NICE recommends oestrogen and progestogen for those with a uterus; or oestrogen alone for those without a uterus (NG23).NG101 notes that HRT should be stopped if breast cancer is diagnosed and should not be offered routinely when there is a history of breast cancer unless in exceptional circumstances.

HRT may be considered unsuitable for other people such as those who have other hormone-dependent cancers who have had significant side effects from HRT or who prefer not to have hormonal treatment.When HRT is not suitable some treatments used in clinical practice for VMS include selective serotonin reuptake inhibitors (SSRIs) serotonin and norepinephrine reuptake inhibitors (SNRIs) clonidine and anti-convulsants such as gabapentin and pregabalin.

Many of these treatments are used outside of the terms of their marketing authorisation. Cognitive behavioural therapy (CBT) is sometimes used alone or in combination with pharmacological treatments for VMS.

NICE recommends SSRI antidepressants for those with breast cancer but not for those taking tamoxifen(NG101).References:1. Hickey M. Szabo R.A. and Hunter M.S. (2017) Non-hormonal treatments for menopausal symptoms. British Medical Journal 359.2. BMJ Best Practice. Menopause. Accessed 23 May 2024.3.

Woods N.F. and Mitchell E.S. (2005) Symptoms during the menopause: prevalence severity trajectory and significance in womens lives. American Journal of Medicine 118(S12B) 14-24.