Advances in Pharmacotherapy for Menopausal Vasomotor Symptoms

Vasomotor symptoms (VMS) are considered the cardinal symptoms of menopause, affecting up to 80% of American women at some point during the menopausal transition. VMS, particularly if they are moderate to severe, frequent, or cause sleep disturbances, can have a negative impact on a woman's quality of life, physical and mental health, and professional life. Furthermore, VMS have been associated with negative health outcomes, including an increased risk of coronary heart disease and cognitive impairment. Menopausal hormonal therapy (MHT) is supported by level 1 evidence and can address many of the negative impacts associated with menopause, including VMS. However, not all women can take MHT (owing to having contraindications to their use) or choose not to take MHT. In addition to MHT, non-hormonal therapy options, which include neurokinin (NK)-targeted therapies, are also available. Fezolinetant (NK3 receptor antagonist) and the newly approved elinzanetant (NK1 and NK3 receptor antagonist) are non-hormonal treatment options approved for the treatment of VMS associated with menopause. These approvals expand the treatment options for women. A number of investigational agents are currently in phase 2 trials for potential future use for VMS; these include Q-122, PhytoSERM, NOE-115, GS1-144, and HS-10384. In this review, we highlight the recent advancements in our understanding of the pathophysiology of VMS and consider the current, new, and investigational treatment options for the treatment of VMS.