Real hope or pipe dream?

On June 1st, 2024, a new non-hormonal oral medication for the treatment of menopausal symptoms arrived in Belgium. Fezolinetant, brand name Veoza, has been described as a safe and effective alternative to hormone therapy for women with hot flashes and night sweats. Does this represent real hope or is this another pipe dream?

Menopause is universal

Menopause symptom treatment has come a long way since Oprah threw her support behind the dubious compounded hormone treatment. However, misunderstanding persists. Menopause is universal. All women if they live long enough will go through menopause but individual experiences may vary. 70% of menopausal women will have hot flashes and night sweats. Other menopausal symptoms are insomnia, mood swings, brain fog, weight gain, vaginal dryness, reduced sex drive, and morning joint stiffness. 

Menopausal hormone therapy is effective 

The heterogeneity in our sensitivity to hormonal fluxes during perimenopause and beyond is the reason why symptoms are variable. In general, estradiol increases during early perimenopause declines during late perimenopause, and is virtually absent in post-menopause. Hormone therapy stabilizes estrogen in the perimenopause and provides estrogen in the menopause. Hormone substitution therapy is an effective treatment for bodily and mental symptoms of (peri)menopause. 

Non-hormonal menopausal therapy is less effective than hormone therapy

A woman with a history of breast cancer or a personal preference for non-hormones has very few effective treatment options. Plant supplements are not very effective. Low-dose daily oral antidepressants reduce menopausal symptoms by about 10-20%. Other treatment options like clonidine and gabapentin have the same efficacy as the antidepressant but their side effects make them unsuitable for everyone.

Fezolinetant shows great promise

Fezolinetant is a new oral non-hormone with great promise and few side effects. It blocks the brain’s hypoestrogenic-mediated perception of heat. The result is 6 fewer hot flashes per day after 4 weeks of daily treatment. Unlike hormones, negative effects on breast cancer, strokes, or blood clots would not be expected. 

Fezolinetant is expensive and still being studied for other indications

Unfortunately, fezolinetant is expensive and is not yet reimbursed.  At this time, the safety of fezolinetant for women with breast cancer has not been studied and may not be used in women with certain types of liver and renal disease Finally, it is too soon to tell if fezolinetant will reduce menopausal symptoms other than hot flashes and night sweats.  

For more info, join the movement at www.menostrong.be