In 1941, women with menopause finally were able to get relief from hot flashes with the release of Premarin. The estrogen-based hormonal drug works to restore some of the body’s estrogen, evening out the flashes and other menopause symptoms. And since 1941, no new classes of drug have been available for the same purpose.
That may change next year. Earlier this month, National Geographic’s Meryl Davids Landau reported that a new non-hormonal drug specifically for hot flashes could be released in 2023. The medication, fezolinetant, is currently under review by the Food and Drug Administration.
Hot flashes affect about 80 percent of women during menopause, with some people experiencing more than seven episodes a day. The flashes last from a few seconds to several minutes. On average, women going through menopause will experience regular hot flashes for about four years—but a very unlucky third of women have to deal with them for about a decade. And for Black and Indigenous American women, it’s even worse. Their flashes start earlier, last longer, and occur more frequently.
Until recently, scientists weren’t exactly sure what caused hot flashes to occur. They knew that it was related to a malfunctioning hypothalamus, but didn’t know exactly where the problem came from. A 2018 study in the journal Neuroendocrinology, though, shows that scientists were finally able to trace it back to specific neurons in the hypothalamus, called KNDy (pronounced candy) neurons. KNDy neurons regulate temperature, and the new drug blocks those neurons when they start to improperly react, which causes a hot flash.
“When estrogen falls, it causes this KNDy neuron complex to just basically go bonkers,” Dr. Susan Reed said during a keynote speech at the 2020 Annual North American Menopause Society Conference, as reported by UW Medicine. “It’s like turning on a gazillion fire hydrants, which spill over into the adjacent thermoregulatory center and cause thermoregulatory dysregulation, resulting in hot flashes. The thermoregulator center sends signals to the rest of the body to cool us when we are too hot (via hot flashes) and to warm us when we are too cool (shiver).”
Phase three clinical trials already have preliminary results that show fezolinetant eliminates two to four hot flashes every day. Another drug, elinzanetant, which acts in a similar way is also in phase three trials. With two-thirds of working women (in the UK alone) noting that menopause symptoms negatively impact their workday, these medications could become a hot commodity.