Fezolinetant - a potential alternative to hormone replacement therapy for menopausal women

Dear Editor, Menopause is a significant milestone in a woman's life, marking the end of the reproductive cycle due to the depletion of all the ovarian follicles. During the transition period leading up to the Final Menstrual Period, women may experience some symptoms, including vasomotor symptoms (VMS), mood changes, sleep disturbances, and bone-related symptoms.(1) Hot flushes, the most common VMS, that  can persist for several minutes to up to 10 years.(1) Currently, Hormonal Replacement Therapy (HRT) is the standard treatment for VMS; however, recent studies have shown an increased risk of hormone-dependent cancers, such as breast cancer, in the UK associated with the duration and type of HRT used.(2) A new alternative treatment that has emerged is Fezolinetant, an NK3R antagonist, which has shown the potential to be more effective than HRT for menopausal women. VMS is caused by the loss of thermoregulatory control triggered by menopause events.(3) Fezolinetant has been tested for VMS in a randomized controlled trial (RCT) and has shown a significantly reduced  symptoms.(3) A previous four-week study on menopausal women experiencing hot flushes seven times per 24 hours showed a 73% reduction in VMS in those receiving the NK3R antagonist, compared to a 45% reduction in those receiving a placebo.(4) The treatment was well-tolerated, and the compliance was high. Furthermore, the study showed only minor side effects, unrelated to the drug. (4) Although HRT remains the mainstay of treatment for VMS, some women cannot use this therapy due to contraindications. NK3R antagonists, such as Fezolinetant, have shown great potential in alleviating these symptoms and require further studies for proper implementation. Physicians and institutes need to explore the opportunity of this potential treatment in Pakistan through extensive randomized controlled trials so that this treatment can lead to a significant difference in the lives of women experiencing VMS symptoms during menopause.