What You Should Know
- Non‑hormonal medications like Veozah and Lynkuet offer a new option for women who can’t or prefer not to take estrogen, targeting the brain’s neurokinin B pathway to reduce hot flashes and night sweats by 50–70% according to the peer-reviewed International Journal of Women’s Health.
- These treatments are especially meaningful for women with estrogen‑dependent cancers, with Lynkuet even proven safe and effective in breast cancer patients, though liver‑function monitoring is required.
- “For women with estrogen‑dependent cancers like breast or uterine cancer, these drugs offer the first opportunity for truly effective treatment,” says Dr. Sara L. Stockman, Department of Obstetrics, Gynecology and Reproductive Sciences at UPMC Magee‑Womens Hospital.
- Hormone therapy remains the most comprehensive option for eligible women, improving a wider range of symptoms and offering additional benefits.
For decades, hormone replacement therapy (HRT) was the primary tool doctors relied on to treat the most disruptive symptoms of menopause. However, as Dr. Sara L. Stockman, Department of Obstetrics, Gynecology and Reproductive Sciences at UPMC Magee‑Women’s Hospital, explains, that approach never worked for everyone.
“A lot of women have mistrust of hormones, and there’s a subset of women for whom hormone therapy isn’t safe — particularly women who’ve had estrogen‑dependent cancers.”
Why Hot Flashes Happen: It’s Not Just About Estrogen
“We used to think hot flashes were just the lack of estrogen,” Dr. Stockman explains. “What became more apparent is that it’s not just the lack of estrogen but rather it’s what’s happening upstream in the brain.”The key player is neurokinin B, a hypothalamic neuropeptide that helps regulate body temperature. Under normal circumstances, estrogen keeps neurokinin B levels in check. But during menopause, when estrogen drops, neurokinin B surges, which makes women hypersensitive to even small temperature changes.
“That’s really what we think is causing hot flashes,” she says.
How Veozah and Lynkuet Work Without Hormones
This new understanding led to the development of neurokinin‑3 receptor antagonists, including Veozah (fezolinetant) and Lynkuet (elinzanetant), which directly block the neurokinin B pathway.
“These drugs block that neuropeptide,” Dr. Stockman says. “It’s a way to effectively target hot flashes and night sweats without giving hormonal therapy…and they’re definitely pretty effective.”
While estrogen therapy typically reduces vasomotor symptoms – hot flashes and night sweats – by 70–90% according to the peer-reviewed International Journal of Women’s Health, these new medications achieve a 50–70% reduction, not quite as strong as estrogen, but far better than older non‑hormonal options like SSRIs or gabapentin.
For women who cannot take estrogen, the impact is enormous.
“For women with estrogen‑dependent cancers like breast or uterine cancer, these drugs offer the first opportunity for truly effective treatment,” she says. “Lynkuet was even tested in women with breast cancer and proven safe and effective.”
Safety, Side Effects, and Monitoring
While SSRIs can cause mood‑related or sexual side effects, the main concern with these new medications is liver function.
“With fezolinetant, you check liver labs every month for three months, then again at six and nine months,” Dr. Stockman explains. “It’s just to make sure there aren’t any abnormalities.”
Since these drugs don’t replace estrogen, they don’t provide bone‑protective or cardiovascular benefits, which are areas Dr. Stockman says future research should focus on.
Where Hormone Therapy Still Fits In
Despite the excitement around non‑hormonal options, Dr. Stockman says that hormone therapy remains the most effective and comprehensive treatment for women who are good candidates.
“If women are comfortable with hormones and they’re eligible, it’s still my preference,” she says. “It gives a broader set of benefits than just symptom relief.”
She also notes a shift in terminology:
- For women experiencing early menopause, estrogen truly replaces what the body should still be producing, so the term hormone replacement therapy remains accurate.
- For women past the typical age of menopause, doctors increasingly use menopausal hormone therapy, since estrogen levels are naturally low at that stage.
Hormone therapy is FDA‑approved for:
- Moderate to severe hot flashes and night sweats
- Genitourinary syndrome of menopause (vaginal dryness, discomfort)
- Bone loss prevention in select women
While data is still coming in, many women report improvements in brain fog, mood symptoms, and overall well‑being.
Empowering Women With Accurate Information
With so much confusion and misinformation surrounding menopause, Dr. Stockman, recognized for her research work while a Senior Fellow at Massachusetts General Hospital, says her mission is to help women feel informed and confident about it.
“I love doing women’s health research to provide accurate information so women feel empowered to make important decisions about their health.”
As new treatments like Veozah and Lynkuet expand the options available, women now have more pathways than ever to find relief, whether through hormones, non‑hormonal therapies, or a combination tailored to their needs.
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