Hot flashes in menopause, not just hormone replacement therapy. There is an innovative solution that comes from Research: the expert explains it to us

Annoying, uncontrollable, often conditioning. Disorders related to menopause can severely compromise the quality of life of women over 50.

The main symptom, common to three out of four women, are hot flashes which last from a few seconds to several minutes, and which can begin to appear even a few years before entering menopause and persist for a long time afterwards. What triggers them is the hyperactivation of a group of neurons found in the hypothalamus – area of ​​the brain which also has the function of regulating body temperature – and which due to the drop in estrogen increases in number and size, intensifying their action and causing vasodilation with related vasomotor disorders, such as a strong and widespread redness of the facesensation of intense heat on the face, around the neck And to the chest, chills, profuse sweating even at night, often rapid heartbeatstate of mental confusion (the so-called «brain fog»), anxiety And emotional instability.

«Studies confirm that approximately 80 percent of menopausal women suffer from vasomotor disorders and which in 40 percent of cases have a moderate to very severe intensity, interfering with daily activities, work and quality of life”, explains Rossella Nappipresident of the International Menopause Society, full professor of Obstetrics and Gynecology atUniversity of Pavia and Head of SSD Obstetrics and Gynecology 2 – Medically Assisted Procreation of the San Matteo Foundation of Pavia.

Night sweats particularly affect sleepa fundamental factor of our well-being. «Waking up repeatedly at night, very sweaty, leads to high psycho-physical and mental wear over time», underlines the expert. «It has been calculated that sleep disorders have repercussions on mood, daytime wakefulness, psycho-physical efficiency and lead to a generalized sense of tiredness. Furthermore, sleep is the eighth pillar that prevents cardiovascular risk. AND women with hot flashes produce more stress hormones, accumulating a greater risk to the cerebral microcirculation and central nervous system, as well as to the heart».

To counteract these symptoms, the most commonly adopted solution is hormone replacement therapy. «It has always been thought that menopause and the associated vasomotor symptoms were the result of the decrease in estrogen alone», specifies Nappi. “However, research has identified the role of specific neuronal pathways located in the hypothalamus in causing hot flashes,” he adds.

Discoveries that have fueled the study of targeted alternative treatments, leading to the development of a new non-hormonal molecule, fezolinetant – recently on the market – which is able to act directly on the brain mechanism that activates hot flashes. «We do not retire hormone therapiesobviously, but it must be said that they are not suitable for all women and not all are available to take them» explains the specialist. «Often, menopause is perceived as an event that should not be manipulated because it is natural. So that’s it this alternative therapeutic option to hormones offers the new possibility of treating the symptom by acting directly on neurokinin Bthe molecules that regulate body temperature at the brain level.”

Progenitor of a new class of drugs, il fezolinetant It therefore broadens the perspective in the management of disorders related to menopause, allowing the therapy to be personalized based on the type and severity of the symptoms. «Up until now, estrogen has mainly been administered to eliminate hot flashes, because hormone therapy can also be good for women’s overall health in a general sense. But while estrogen offers various benefits, including treating vaginal dryness and osteoporosis, on the other it can cause menstruation to return and raise the risk of breast cancer in the long term. Not all women feel comfortable taking them and this is the reason why women continue to buy supplements in a futile attempt to control symptoms in other ways, or to take psychotropic drugs which are sometimes prescribed, but which have many effects. collaterals, are not registered with these specific indications and, obviously, are not so effective. Ultimately, the arrival of this new class of drugs represents additional help.”

Research on this front is only just beginning. At the University of Pavia and at the San Matteo Polyclinic a molecule that represents a further evolution is already being tested. «While fezolinetant acts on the neurokinin 3 receptor, theelinzanetant currently being studied in Pavia, it has an action on both neurokinin 3 and neurokinin 1 and it seems that the dual intervention on the two receptors is even more effective in sleep disorders”, specifies Nappi. «With the same action, compared to the molecule already on the market, the new elinzanetant is also faster: it reduces hot flashes by 50 percent within a week and by 75 percent within 4/12 weeks». Let us therefore expect further steps forward for the protection of female well-being in menopause: it may be available within a couple of years.

The manual to find out more

In the new essay Living well in menopause (Fabbri Editori, 176 pages, €14.50), Rossella Nappi explains what to do when you enter this phase or are approaching it, and offers advice for living it with awareness and positivity. «We have a long life even afterwards, we prepare ourselves for an existence full of new possibilities», highlights Nappi, one of the leading Italian experts on the topic.
«Menopause represents an autobiographical event from a psychosocial and physiological point of view. However, every woman experiences it in her own way: some peacefully and only need prevention, others with symptoms that lower the quality of life. It is not menopause that we need to cure, because it is part of us. However, we must and can treat the symptoms as best we can.”