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A non-hormonal HRT alternative for hot flushes – latest news

byDr. Lucy Wilkinson

While hormone replacement therapy (HRT) is an effective way to tackle menopause symptoms, it isn’t suitable for everyone. Some people can’t take HRT for medical reasons while others prefer to take a non-hormonal menopause treatment. Neurokinin 3 receptor (NK3R) antagonists may be the answer one day. They are an emerging non-hormonal treatment for menopause symptoms, particularly hot flushes.

What is this new non-hormonal treatment?

NK3R antagonists are a group of medications which, it is hoped, will one day be used to treat menopause symptoms – especially menopausal hot flushes.

Menopause symptoms are caused by reduced levels of oestrogen during and after menopause. HRT works by supplying the body with the oestrogen it no longer produces. 

Our understanding of menopause is deepening all the time. Over recent years, more attention has been paid to the way menopause and changing oestrogen levels affect part of the brain called the hypothalamus. 

The hypothalamus acts like the body’s ‘thermostat’, and changing hormone levels at menopause can cause it to malfunction. This is why hot flushes and night sweats are annoyingly common at this time.”

But it seems that it isn’t just oestrogen that plays a part – other chemicals are at least partly responsible too. Neurokinin B is one example. It’s thought to act on the hypothalamus in response to falling oestrogen levels. This in turn causes issues with temperature control, which can lead to hot flushes and night sweats. 

NK3R antagonists prevent this chemical from binding to its receptors, which blocks some of its actions and puts a stop to those infuriating hot flushes.

Why are people excited about this new non-hormonal treatment?

We know that HRT is a highly effective treatment for menopause symptoms – but it comes with certain benefits and risks. These depend on your medical history and health, but can include an increased risk of breast cancer and blood clots. This is why HRT is not suitable for everyone.

NK3R antagonists are hormone-free and would be an exciting new development in the treatment of menopause symptoms. It provides an alternative option if you need effective treatment but can’t take hormones.

What is the evidence?

Evidence is still emerging about the safety and effectiveness of NK3R antagonists:

One small randomised controlled trial published in 2017 included 28 women. The study found that hot flushes reduced by 45% in women who took the medication compared with those who did not

A 2021 review of early trials found that NK3R antagonists are more effective at treating menopause symptoms than a group of non-hormonal medications known as serotonin-norepinephrine reuptake inhibitors (SNRIs). These SNRIs are used for conditions including anxiety, depression and certain types of chronic pain

A 2022 Phase 3 trial of over 500 women also found promising results in treating hot flushes

Studies seem to show that NK3R antagonists work very quickly, with some studies finding a beneficial effect on both hot flushes and night sweats within just one to two days.

Although this all sounds promising, don’t give up your cooling spray just yet. More evidence is needed, along with approval by your country’s prescribing authority, before NK3R antagonists are made available to treat menopause symptoms.

When will it be available?

NK3R antagonists aren’t currently available for general use in the UK. This means that your doctor won’t be able to prescribe them, even privately. 

In May 2023, the Food and Drug Administration (FDA) in the United States approved fezolinetant, a NK3R antagonist, to treat moderate to severe vasomotor symptoms – hot flushes and night sweats.

The good news is that research is ongoing and this treatment could become available in the UK in the near future. 

In the meantime, speak to your doctor if you need help with your menopause symptoms.

Learn more about the different types of HRT.

What other non-hormonal treatment options are available for menopause symptoms?

While there is a lot of talk about HRT, non-hormonal options are also widely used for treating menopause symptoms. Although HRT is generally more effective, non-hormonal treatments could be a good option if you’re unable to take hormones or just aren’t keen on the idea. 

Certain types of antidepressants are sometimes used to improve menopause symptoms, including hot flushes. These include common medications like sertraline, fluoxetine and citalopram. If you already take one of these medicines, your doctor might even recommend simply increasing your dose before trying anything else.

Tibolone is a non-hormonal treatment which can be used to treat menopause symptoms – it’s only suitable for those whose last period was at least one year ago.

Clonidine is another non-hormonal medication used to treat menopause symptoms and it’s been found to help reduce hot flushes and night sweats.

Finally, lifestyle changes can be effective too. Caffeine, alcohol, smoking, stress and lack of exercise can all have an impact on symptoms including hot flushes and night sweats. 

Find out more about alcohol and menopause.

Final word

NK3R antagonists are a promising new treatment for menopause symptoms. However, they are not yet available for general use.

If you are struggling with menopause symptoms but HRT isn’t the right option for you, speak to your doctor to find out about your options.

Find out more about menopause on our blog or in our symptoms library

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