Nonhormonal treatments for vasomotor symptoms.

Purpose of the review: Vasomotor symptoms or hot flashes are reported by 80% of women and have a median duration of 7 years. About 25-30% of women have severe enough symptoms that activities of daily living and workplace productivity are compromised. Although hormone therapy is the 'gold standard' for hot flash treatment, many women are unable or unwilling to use it.

Recent findings: A number of nonhormone treatments for hot flashes are supported by medical evidence, but only two (paroxetine mesylate and fezolinetant) are currently Food and Drug Administration approved. Selective serotonin reuptake inhibitors and selective serotonin reuptake inhibitor-norepinephrine reuptake inhibitors, gabapentin, oxybutynin, clonidine, and fezolinetant are described. The new class of neurokinin-3 receptor antagonists includes both fezolinetant and elinzanetant and acts directly on the hypothalamic neurons that control body temperature regulation. These latter agents have an efficacy profile that approaches that of hormone therapy and lack the off-target side effects seen with other nonhormonal treatments.

Summary: Women who cannot use or wish to avoid hormones have a number of nonhormonal options to choose from to treat hot flashes. New science elucidating the biology of hot flashes holds great promise for highly effective treatments that do not have off-target effects.