Non-hormonal treatments for vasomotor symptoms

In this interview, News Medical he talks to me Dr. Katie BarberClinical Director, GP, and Registered BMS Menopause Specialist at Oxford Menopause Ltd., re menopauseits impact vasomotor symptomsand his role non-hormonal therapies such as Fezolinetic in improving patient care.

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Hot flashes and night sweats are often dismissed as a routine part of menopause. What do people misunderstand about these symptoms and how can effective treatment change patients’ daily lives?

One of the biggest misconceptions is that hot flashes (vasomotor symptoms) and night sweats are just “inconvenient” and don’t significantly affect daily life. In fact, for approximately 25-30% of women, these vasomotor symptoms can be severe and debilitating. Up to 75-80% of women experience them at some point during menopause.

The impact extends far beyond the symptoms themselves. They can disrupt sleep, affect relationships, reduce motivation to exercise, and affect food choices. When these symptoms are effectively treated, patients often experience better sleep quality, reduced anxiety and brain fog, and an overall improvement in well-being.

Why is NICE’s recommendation of a non-hormonal option like fezolinetant an important step for people experiencing moderate to severe symptoms?

NICE’s recommendation represents an important step forward because it widens the treatment options available to women. Many patients have historically been told that there are no alternatives when hormone replacement therapy is not suitable for them.

This decision reinforces the importance of personalized care. It gives clinicians and patients more flexibility to make informed decisions based on individual needs, preferences and clinical circumstances, which is essential in the management of menopause.

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Clinically, who is most likely to benefit from this treatment?

Fezolinetant is particularly beneficial for women who cannot receive hormone replacement therapy, either due to medical contraindications or personal choice. These individuals have historically had limited licensed treatment options available to them.

From a clinical perspective, the treatment landscape in the UK also includes off-label prescribing. However, NICE Clinical Knowledge Summary guidance is clear that selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs) or clonidine should not be routinely offered as first-line treatment for vasomotor symptoms alone.

Using fezolinetant as an option allows clinicians to better tailor menopause care. It advocates a more personalized approach, ensuring that treatment decisions are aligned with each patient’s specific needs and circumstances.

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Fezolinetant works differently from hormone treatments. How would you explain its mechanism in simple words?

Fezolinetant works by targeting the system in the brain that regulates temperature, rather than replacing hormones. During menopause, hormonal changes such as estrogen can overstimulate certain signals in the brain that cause hot flashes and night sweats.

This treatment blocks one of these key signals, known as neurokinin B, helping the body regulate temperature more effectively. For patients who cannot or prefer not to use hormones, this offers a completely different and targeted approach.

What were the most important findings from the SKYLIGHT clinical trials?

The SKYLIGHT Phase 3 program involved large, global, randomized, placebo-controlled trials involving thousands of participants. This broad data set increases confidence that the findings are applicable to real-world clinical practice.

The trials showed that fezolinetant significantly reduced both the frequency and severity of vasomotor symptoms compared to placebo. Improvements were seen as early as the first week and were maintained for 52 weeks.

The studies also provided reassuring safety data, showing that the treatment was generally well tolerated, while underscoring the importance of monitoring liver function as a precaution.

Fezolinetant requires monitoring of liver function. How should this be communicated to patients?

It is important to reassure patients that monitoring is a routine precaution and not an indication that problems are expected. Many drugs require similar checks.

Patients should understand that liver function tests (taken as a blood test) will be performed before starting treatment, monthly for the first three months, and then as clinically appropriate. This allows clinicians to detect and manage any potential changes early.

For patients who have struggled with other treatments, how quickly can they see improvements?

Treatment success is highly individualized because of the wide variation in frequency and severity of hot flashes and other menopausal symptoms. Clinical trial data show that many women begin to notice improvements as early as the first week of treatment. By the fourth week, reductions in both frequency and severity of symptoms are typically evident.

By week 12, further improvements are often seen, with many patients experiencing continued reductions in both the number and intensity of symptoms, suggesting that benefits can accrue during the first few months of treatment.

Ultimately, treatment success is individual, but generally means that symptoms become manageable enough to allow women to function in daily life. This may include helping someone improve their relationships, continue working, regain motivation to exercise, or make healthier food choices.

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What needs to happen at system level to ensure equal access to menopause care across the NHS?

We have made real progress in menopause care across the UK, but access remains too inconsistent and often depends on where someone lives or what people want within local services. This is not acceptable for something that affects such a large percentage of the population. We need clear, nationally consistent clinical pathways, alongside better training and practice guidance, so that all health professionals can provide high-quality, evidence-based care.

In fezolinetant, the ability to prescribe in primary care is essential. This reflects the way menopause treatments, including HRT, are already treated in the NHS. Limiting access to specialist settings risks widening inequalities and delaying treatment. More broadly, we need to be bolder and use this as a catalyst for wider change, shifting menopause care into community settings where many patients can be effectively managed.

In my own experience in Oxfordshire, a primary care menopause service led by British Menopause Society specialists significantly reduced referrals to secondary care and cut waiting times from up to nine months to just four to eight weeks. This kind of model shows what is possible. We must now move from pockets of excellence to consistent, high-quality menopause care for every woman, wherever she lives.

What is the key message you would like patients to take from this NICE recommendation?

The NICE recommendation recognizes that these symptoms are real, bothersome, debilitating and deserve effective treatment options. It reflects the growing recognition of the impact of menopause on quality of life and validates the experiences of those who have felt underserved.

My message is that menopause care is moving toward greater choice and personalization, which all women deserve.

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Where can readers find more information?

About Dr Katie Barber

Dr Katie Barber is a GP providing clinical care and teaching in Oxfordshire since 2006. She is also a published academic and experienced educator, supporting both healthcare professionals and the public across the UK.

Dr. Barber was motivated to work in women’s health after training in gynecology. She gained her advanced certificate in menopause care from the Faculty of Sexual and Reproductive Healthcare and British Menopause Society in 2019 and is a registered menopause specialist with the British Menopause Society.

From 2019 to 2021, Dr Barber was Clinical Lead for the NHS Menopause Service at John Radcliffe in Oxfordshire. She then became Clinical Lead for the NHS Community Gynecology Service in Oxfordshire, where she continues to work as a women’s health doctor specializing in menopause.

Dr. Barber also has a personal motivation to work in menopause care, having seen her mother’s experience of induced menopause due to breast cancer. She describes seeing her mother suddenly plunge into painful symptoms:

She was a dedicated professional, always proud of her role and impeccably dressed every morning. However, before she could get out the door, the hot flashes would hit and send her back to the shower two minutes later. It was a frustrating cycle, and one in which she felt completely lost. There was so little discussion about menopause in the 1990s and early 2000s.