Resources / Neurokinin receptor antagonists – a new non-hormonal treatment for menopause-related hot flushes and sweats

Neurokinin receptor antagonists – a new non-hormonal treatment for menopause-related hot flushes and sweats

Menopause may be associated with debilitating, and often long-lasting, vasomotor symptoms (hot flushes and sweats), which affect around 80% of women. These symptoms pose a significant physical and psychosocial burden on many women who are trying to manage their day-to-day lives.

Guidelines currently recommend hormone replacement therapy (HRT) as a first-line treatment for menopause-associated vasomotor symptoms. Some women, however, are unwilling to take HRT or are unable to do so because of side effects or for medical reasons. Various other treatments, including antidepressants,  may be prescribed for women unable to take HRT, but these are usually less effective and may cause unacceptable side effects.

A new class of medicines, NK3 receptor antagonists, that act directly on the part of the brain responsible for vasomotor symptoms (the hypothalamus) has been shown to significantly reduce hot flushes and sweats. One of these, fezolinetant, has recently been approved by the UK Medicines & Healthcare products Regulatory Agency (MHRA).

How do NK3 receptor antagonists work?

The ovaries and a part of the brain called the hypothalamus are very important in the body’s temperature control, and a delicate balance exists between oestrogen, produced by the ovaries, and a chemical called neurokinin produced by the hypothalamus that maintains body temperature within a very narrow range. Before the menopause transition, oestrogen suppresses the activity of the nerve cells in the hypothalamus that produce neurokinin, but as oestrogen levels fall, this suppression starts to be lost and the nerve cells become increasingly active and produce more neurokinin leading to loss of temperature control, resulting in flushing and sweating.

NK3 receptor antagonists like fezolinetant block the production of neurokinin, reducing this abnormal nerve cell activity, thereby also reducing episodes of flushes and sweats.

Although these medicines are new, so far they don’t seem to be associated with significant side effects, but as time goes on, and as more people start to take them, we’ll get to know more.

It’s important to know that fezolinetant has not been shown to provide any of the other benefits of oestrogen such as protection against osteoporosis or cardiovascular disease, but its potential beneficial impact on quality of life by reducing hot flushes and sweats is likely to be significant. Further research will hopefully tell us more about whether there are any other benefits.

Fezolinetant is only available on private prescription, and not on the NHS at the moment, but it’s currently being evaluated by the National Institute of Health and Care Excellence (NICE), so we hope it will be available on the NHS in the not-too-distant future.

Click on the link to hear Dr Susan Reed talk about this new treatment.

Ref: article

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You are not alone. As a local example, in Manchester over 46% of council employees are female and over 40 years old. In a CIPD survey (2019) over 30% of women said they were unable to work because of menopausal symptoms.

Only 25% said they could tell their manager the real reason for their absence. The Council account for nearly 7% of all employment in Manchester. They implemented a new Menopause policy in March 2022. CIPD survey | Manchester Council Menopause Policy | CIPD Manchester

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