The end of hot flashes is in sight: A revolution for women in menopause is coming

As predicted by leading experts, a new drug that acts directly on the brain and prevents the occurrence of hot flashes, will introduce a real revolution in eliminating the side effects of menopause.

Since the first non-hormonal drug for the problems of menopause, produced by the company “Astelas Farma”, has already been approved in the United States, experts believe that this drug will completely transform the lives of hundreds of thousands of women.

The drug, fezolinetant, was approved in the US on May 12, and could soon be approved for use in Europe and the UK by the end of the year.

“This drug will be a real blockbuster,” believes Professor Valjit Dilo, an endocrinologist at King’s College London who led the pioneering trial in 2017 that paved the way for the drug’s development. “It works like a switch. Within a day or two the hot flashes disappear. It’s amazing how well these drugs work. It will completely change the lives of women.”

Effective and fast acting

The drug, which is also being tested by the European Medicines Agency (EMA), works by blocking a brain protein called neurokinin-3 which plays a unique role in regulating body temperature in menopausal women.

A large clinical trial of fesolinent published in March found that, after 12 weeks of use, it reduced the frequency of hot flashes by about 60 percent in women with moderate to severe symptoms, compared with a 45 percent reduction in those taking a placebo. The women also said that the drug reduced the severity of hot flashes and improved the quality of their sleep.

“What’s really amazing about these drugs is how quickly they work and how much of an effect they have,” emphasizes Professor Richard Anderson, one of the directors of the Center for Reproductive Health at the University of Edinburgh. “Usually, estrogen takes a few weeks to have an effect. With this, women feel improvement even after the first pill.”

The advantage of this drug is that it is not a hormone therapy.

Hot flashes affect daily life and sleep

About 70 percent of women who go through menopause experience hot flashes, and 10 to 20 percent describe them as “almost unbearable” and state that they seriously affect daily life and sleep, and this is the symptom that usually leads women to seek medical help. Some women experience dizziness and rapid heartbeat in addition to hot flashes.

Because the new drug acts directly on the temperature-control pathway, it does not replace estrogen, which declines sharply at menopause, and therefore will not affect the wider range of symptoms some women experience, including fatigue, muscle and bone weakness, vaginal atrophy and mood swings.

The progress in this field comes after decades of painstaking research by the American neuropathologist, Professor Naomi Rance, who identified a specific group of neurons that increase in the brain of menopausal women. She further discovered, by measuring small temperature variations in the tails of laboratory mice, that these neurons release a protein neurokinin-Bwhich can cause hot flashes.

“I realized that understanding the brain circuits that control heat waves could be useful in finding new drugs, but I never thought it would happen in my lifetime,” says Professor Rance. “I was delighted to learn that the Medicines Agency had approved the drug, in part because it shows how basic science research leads to clinical applications.”