What’s the best nonhormonal therapy for hot flashes? Experts release new menopause therapy guidelines

Middle-aged woman holding a towel, possibly having hot flashes

New guidelines around the use of nonhormonal therapy for hot flashes — or vasomotor symptoms— due to menopause have been released by the North American Menopause Society.

Dr. Juliana Kling, a women’s health specialist at Mayo Clinic and one of the authors of the new guidelines, says, “The new guidelines include a review of the newest (Food and Drug Administration) FDA-approved medications as well as other medications and other treatments, like clinical hypnosis, cognitive behavioral therapy, discussion of supplements, and over-the-counter treatments that are either helpful or not helpful for treating hot flashes and night sweats.”

Hormone therapy remains the most effective treatment to help with the discomfort of hot flashes. However, not all women are good candidates for hormone therapy and may seek other alternatives, such as integrative medicine.

“This position statement looks at that data and demonstrates that cognitive behavioral therapy and clinical hypnosis can help treat hot flashes and night sweats,” says Dr. Kling.

However, there was no strong evidence that lifestyle changes, like cooling techniques and avoiding triggers, relieve hot flashes.

Other key points include little or poor evidence that yoga, exercise and diet can improve symptoms. Weight loss, however, may be considered for improving symptoms associated with hot flashes.

Watch: Dr. Juliana Kling talks about non-hormone menopause treatments for hot flashes

Dr. Juliana Kling discusses nonhormonal menopause treatment for hot flashes

Journalists: Broadcast-quality soundbites are available in the downloads at the bottom of the posts. Please courtesy: “Juliana Kling, M.D./Women’s Health/Mayo Clinic.”

The new nonhormonal oral medication to help with severe hot flashes caused by menopause recently approved by the FDA is the first of its kind.

“It’s a novel medication, meaning we don’t have anything like it available for prescribing to patients,” says Dr. Kling. “It’s called fezolinetant, a neurokinin 3 receptor antagonist. It works in the brain to treat hot flashes and night sweats.”

Fezolinetant is the generic name of the medication. Dr. Kling says it offers patients a choice.

“For people who can’t take hormone therapy or choose not to, it’s a good option for them, potentially, to treat their hot flashes and night sweats,” she says.

“What’s important about this medication is that it’s only our second FDA-approved nonhormonal medication available for people having hot flashes and night sweats that impact their quality of life,” says Dr. Kling.

Until now, the antidepressant paroxetine (Brisdelle) was the only FDA-approved medication to help with hot flashes due to menopause. The selective serotonin reuptake inhibitor (SSRI) is available as menopause medication in lower doses.

Menopause is a natural process for all women, beginning on average at age 52. Symptoms include periods of sweating, flushing, rapid heartbeat, and chills lasting for several minutes that can disrupt sleep and quality of life. Hot flashes happen in about 80% of menopausal women and on average, last for more than seven years. Though some women continue to experience them longer than 10 years.

Dr. Kling says that treating hot flashes and having another option to help women during these years creates a ripple effect.

“We recently published a study here at Mayo Clinic that found that women that had more menopause symptoms had a higher risk of adverse work outcomes, meaning they’re missing work, or perhaps they’re leaving their job altogether. This goes beyond just quality of life-impacting symptoms but has big ramifications.”

The study found an estimated $1.8 billion is lost in work time per year and $26.6 billion annually when medical expenses are added in the U.S. alone.

Dr. Kling says what’s novel about the drug is that it “targets the root of where hot flashes and night sweats likely come from in the brain.”

“We have this area in the hypothalamus that’s the thermoregulatory zone. It’s like the thermostat in our brain,” says Dr. Kling. “And after menopause, because of lack of estrogen feeding back to that area, you start to get hot flashes and night sweats. This medication will go and block part of that pathway to help prevent or treat those hot flashes and night sweats.”

“For those that have breast cancer — or have had a heart attack, or a stroke or a blood clot — and are having hot flashes and night sweats and can’t use hormone therapy, this is another option that they can consider to treat their quality of life-impacting hot flashes and night sweats,” says Dr. Kling.

Menopausal hormone therapy is the most effective tool for treating hot flashes and night sweats associated with menopause. It also can help to prevent osteoporosis.

“This new medication shouldn’t replace hormone therapy,” says Dr. Kling. “Hormone therapy remains the most effective treatment for hot flashes and night sweats. For many women, the benefits will outweigh the risk if they’re under 60 or within 10 years from their last menstrual cycle. I want to ensure that women get the appropriate care and don’t think this is a substitute for perhaps an evidence-based and safe treatment, like hormone therapy, for them.”

Estrogen is a form of hormone replacement therapy health care professionals prescribe in various forms, such as pills, patches and creams.

Menopause typically begins 12 months after a woman’s last menstrual cycle. During this time, hormone levels start to fluctuate, and the onset of menopause symptoms begins.

Symptoms of menopause can include:

• Sleep disturbances
• Hot flashes
• Night sweats
• Fatigue
• Weight gain
• Thinning hair
• Dry skin
• Urinary changes
• Fatigue or decreased energy levels
• Vaginal dryness
• Changes in libido

Not everyone will experience menopause the same way, and that’s why having more than one therapeutic option for treatment is also essential. Along with medication choices, eating a healthy diet, exercising and refraining from smoking are choices encouraged for overall good health.

Dr. Kling says women no longer need to suffer alone or silently. Talk with your health care team to find the best therapy for your symptoms.

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