PeriWise
In short
- Two non-hormonal drugs for hot flashes arrived: fezolinetant (FDA 2023) and elinzanetant (FDA October 2025), which cut hot-flash frequency by over 73% at 12 weeks in its phase-3 trial.
- NICE's 2024 update added menopause-specific CBT as a recommended option.
- In October 2025 the European Society of Endocrinology published a perimenopause/menopause clinical practice guideline endorsed by major societies.
- 2025 research spotlighted overlooked areas: digestive symptoms, cognition in perimenopause, and cardiometabolic risk after early menopause.
For decades, menopause research moved slowly. The last three years have been different. Here is what actually changed — with sources, because this area is full of headlines that outrun the data.
A new drug class for hot flashes
Hot flashes originate in the brain's thermoregulatory center, where a group of neurons (KNDy neurons) becomes hyperactive as estrogen falls. Two medicines now target that mechanism directly, without hormones. Fezolinetant, an NK3-receptor antagonist, was approved by the FDA in May 2023. Elinzanetant (brand name Lynkuet), a dual NK1/NK3 antagonist, received FDA approval on 24 October 2025 after UK approval earlier that year; in its OASIS-3 trial it reduced moderate-to-severe hot-flash frequency by more than 73% at twelve weeks versus 47% for placebo, with participants also reporting better sleep. For women who cannot take hormones — for example after certain cancers — this is the first genuinely new option in a generation.
CBT enters the guidelines
The UK's NICE guideline update (November 2024) recommends menopause-specific cognitive behavioural therapy as an option for hot flashes, sleep difficulties and depressive symptoms — alongside hormone therapy or as an alternative. The strongest measured effect was on how much symptoms bother and disrupt, which for daily life is often the point.
Perimenopause gets its own guideline — finally
In October 2025 the European Society of Endocrinology published a Clinical Practice Guideline for the evaluation and management of menopause and perimenopause, endorsed by the Endocrine Society, the European Menopause and Andropause Society and the British Menopause Society. In parallel, international cohort analyses argued that current diagnostic criteria miss many women who are biologically in the transition — expect the definition of perimenopause itself to keep evolving.
2025's overlooked-symptom research
Work presented around The Menopause Society's 2025 annual meeting widened the lens beyond hot flashes: in one survey 94% of respondents reported digestive symptoms (bloating 77%, constipation 54%); perimenopausal women scored measurably lower on memory and attention tasks than premenopausal peers; and early menopause was linked to a 27% higher risk of metabolic syndrome, strengthening the case for early cardiometabolic prevention.
Why this matters for tracking
Every one of these developments rewards women who can describe their own pattern precisely: which symptoms, how often, how severe, what changed. New options only help if your clinician can see what they are treating.
Frequently asked questions
What is elinzanetant and how is it different from HRT?
Elinzanetant is a non-hormonal medicine — a dual neurokinin-1/neurokinin-3 receptor antagonist — approved by the FDA in October 2025 for moderate to severe hot flashes. It calms the overactive temperature-control circuit in the brain directly, rather than replacing hormones.
Is CBT really a treatment for hot flashes?
NICE's 2024 update recommends menopause-specific CBT as an option. Evidence shows reduced bother and frequency of vasomotor symptoms and improved sleep — it does not change hormones, but it measurably changes impact.
Where can I read the new perimenopause guideline?
The European Society of Endocrinology's Clinical Practice Guideline was published in the European Journal of Endocrinology in October 2025 and is publicly accessible.
See your own pattern
PeriWise is a private iOS app for tracking perimenopause symptoms — logging is free, your data never leaves your iPhone, and doctor-ready PDF reports are always included. Get the app or browse Things That Helped.
Sources
Everything above is our own writing. The facts come from these sources — always read the originals:
- FDA approves elinzanetant (Lynkuet) — Bayer, October 2025 — https://www.bayer.com/en/us/news-stories/lynkuet
- Contemporary OB/GYN — FDA approves elinzanetant for vasomotor menopausal symptoms — https://www.contemporaryobgyn.net/view/fda-approves-elinzanetant-lynkuet-for-vasomotor-menopausal-symptoms
- NICE Guideline NG23 — Menopause: identification and management (updated November 2024) — https://www.nice.org.uk/guidance/ng23
- European Society of Endocrinology Clinical Practice Guideline, European Journal of Endocrinology, October 2025 — https://academic.oup.com/ejendo
- AJMC — Study findings at The Menopause Society 2025 — https://www.ajmc.com/view/3-new-study-findings-to-look-out-for-at-menopause-society-2025