Chapter 33: New medication for Hot Flashes- Elinzanetant
A new drug shows promise for hot flashes due to menopause
Hot flashes are one of the most common symptoms of menopause, affecting approximately 60-80% of women during the menopausal transition. Lower rates have been observed in Asian women for reasons that remain unclear.
Hot flashes typically begin during the perimenopausal phase and reach their peak frequency and severity within the first two years after menopause. About 50% of women continue to experience hot flashes five years post-menopause, and 10-15% may have them for 15 years or longer. Women undergoing surgical menopause (for example, oophorectomy) or those with conditions like premature ovarian insufficiency often experience more severe and earlier-onset hot flashes. The frequency and intensity of hot flashes can vary widely, ranging from mild episodes occurring a few times a month to severe, daily episodes that can significantly impair quality of life.
Physiologically, hot flashes are sudden, intense feelings of warmth, usually concentrated in the upper body, face, and neck. They are often accompanied by sweating, flushing, and a rapid heartbeat. These episodes occur due to thermoregulatory dysfunction triggered by fluctuating estrogen levels, particularly during menopause. The hypothalamus, which regulates body temperature, becomes overly sensitive to small changes in core temperature. This sensitivity is thought to be mediated by decreased estrogen levels, leading to dysregulation of neurotransmitters such as serotonin and norepinephrine, which are involved in the body's heat control mechanisms. As a result, the body may inappropriately activate vasodilation and sweating to cool itself, even when such actions are unnecessary.
Treatments…
Hormone Replacement Therapy: Estrogen therapy, with or without progestin, is the most effective treatment for menopausal hot flashes. However, it is contraindicated for women with a history of breast cancer, clotting disorders, or cardiovascular issues.
Non-Hormonal Therapies: SSRIs, SNRIs, are effective can cause weight gain and gabapentin are effective options for managing hot flashes, particularly those that occur at night. Clonidine can reduce the frequency of hot flashes but may cause side effects like dizziness.
Lifestyle Changes: To alleviate symptoms, avoid triggers such as spicy foods, caffeine, alcohol, and stress. Dressing in layers and maintaining a cool environment can also help.
Complementary Therapies: Phytoestrogens, found in soy and flaxseed, may help with mild symptoms. Black cohosh is an herbal supplement that has mixed evidence regarding its efficacy.
Cognitive Behavioral Therapy (CBT): This therapy can improve coping mechanisms for hot flashes and enhance overall quality of life.
Acupuncture: Acupuncture may provide symptom relief for some women, although the evidence regarding its effectiveness is variable.
Two phase 3 clinical trials compared the drug elinzanetant with a placebo at two timepoints. The drug subdued hot flashes quickly: By the fourth week, a majority of those taking the drug reported at least a 50 percent reduction in frequency.
By week 12, more than 70 percent taking elinzanetant, compared with more than 40 percent on placebo, experienced that drop in hot flash frequency, researchers reported August 22 in the Journal of the American Medical Association. Participants on elinzanetant also reported significantly improved sleep compared with those on placebo at the 12-week mark.
Elinzanetant is a new non-hormonal medication that has shown significant efficacy in managing hot flash symptoms associated with menopause. In phase 3 trials, over 70% of participants experienced at least a 50% reduction in symptoms within 12 weeks of treatment. This innovative drug targets receptors involved in temperature regulation and insomnia, demonstrating sustained effectiveness over 26 weeks with minimal side effects, such as headaches and fatigue. Elinzanetant provides an important alternative for women who cannot use hormone therapy or other medications due to health concerns and side effects, addressing the critical need for safer treatments to enhance the quality of life during menopause.
Suman Manchireddy MD
Reliant MD Group LLC, Leesburg, VA 20176
References :
JAMA- Elinzanetant Clinical trial