Each year The Menopause Society, previously known as the North American Menopause Society (NAMS), holds an annual meeting to discuss the latest in clinical care guidelines and recommendations, innovation, research and science surrounding the menopause transition
Here are a few of my top takeaways from this year’s session.
Highlighting Perimenopause
Perimenopause, or the years of hormonal volatility prior to menopause onset, was front and center at this year's meeting. Lectures focused on similar themes to those noted in Bonafide’s 2025 State of Menopause Survey. Mentions of common complaints such as “women feeling unprepared for symptoms,” “not feeling like themselves” and “feeling dismissed by their healthcare providers,” were common themes.
The fact that there is no specific diagnostic test for perimenopause was emphasized. Early initiation of hormone replacement therapy during perimenopause was discussed as both an option to manage symptoms and as an area of research to assess preventive benefits for both cardiovascular and cognitive health.
A New Prescription: Elinzanetant (Lynkuet)
The FDA approval of elinzanetant, a dual NKB1,3 antagonist indicated for managing moderate to severe hot flashes and night sweats without using hormones, was met with great excitement and anticipation. Availability of this drug is expected in mid-November. The 120mg dose (2x 60mg tabs) is advised daily at bedtime. The most frequently reported side effect seen in clinical studies was headache. Liver enzyme blood testing is recommended at baseline and after 3 months of use.
A recent NEJM article suggests elinzanetant is safe to use in the breast cancer population. The CNS (central nervous system) side effects reported alongside the use of this prescription include fatigue and somnolence, dizziness and potentially vertigo. Elinzanetant requires a prescription from a healthcare provider.
Menopause and perimenopause are top of mind these days. Having multiple options to manage not only vasomotor symptoms (VMS) (hot flashes and night sweats), but also downstream effects, such as sleep disruption, is beneficial.
Elinzanetant is the second of two NKB antagonist drugs to be approved by the FDA for the treatment of vasomotor symptoms associated with menopause. The NKB blocking mechanism of action in these drugs is non-hormonal, which is a welcome option for those who cannot, or prefer not to take hormone therapy.
Cardiovascular Disease is Top of Mind
White coat hypertension, also known as high blood pressure, experienced in the doctor’s office, is real hypertension and warrants evaluation and management. Endothelial damage, or damage found in the inside lining of blood vessels, occurs before menopause; research on hormone use during perimenopause was discussed for risk reduction for this damage and ideal timing of hormone therapy initiation, before age 60 and within 10 years of menopause onset, was emphasized.
It's important to remember that these guidelines are just that, guidelines. Consideration of hormone therapy should be individualized, as timing, route of administration, dosage and duration are not one size fits all.
Innovation in Sleep Support
Vasomotor symptoms, sleep disruption and mood changes all occur together during the menopause transition. At present, there are no approved medications for sleep disruption specifically resulting from hormones, or for midlife women.
Progesterone alone was discussed as a potential option during this year’s meeting. While there are prescription medications targeting sleep, many have unwanted side effects. DORAs (dual orexin receptor agonists – which work on receptors in the brain) were discussed as good pharmacologic options for sleep, but they do require a prescription and don’t work through hormonal pathways.
An important caveat mentioned many times during the meeting this year is that estrogen therapy is not effective for sleep disruption in the absence of VMS. This allows for an exciting opportunity for a sleep aid which specifically addresses women facing sleep disruption due to hormonal changes during the menopause transition.
Nocturnal awakenings with extended wakefulness after sleep onset (WASO) have been noted as the most common disruptive sleep complaints during perimenopause and menopause.
Sexual Health, The Vulva and Genital Dermatology
There were several incredible lectures given by dermatologists who focused on the vulva, or the external genital structures including the labia, clitoris, perineum and surrounding skin. They surprised the audience by stating that the #1 vulvar irritant in many lubricants is chlorhexidine. The resulting dermatitis (irritation and inflammation of the skin) can take as long as two weeks to resolve. As an alternative, experts advocated for silicone lubricants and moisturizers containing hyaluronic acid (HLA) instead.
Waterwipes were mentioned as the only dermatologist recommended brand for wipes; all others contain (or could potentially contain) allergens that could cause dermatitis.
In addition to supporting vulvar health, there was also a focus on improving sexual function. One company at the exhibition hall, Dare, plans to launch an over-the-counter topical sildenafil (Viagra), called Dare to Play, which is designed to enhance female arousal and orgasm. This will be available through a specialty pharmacy, without a prescription. Dare will also be partnering with ROSY, an online sexual health community founded by an OBGYN, and friend of Bonafide.
Prioritizing Bone Health
Low bone mass (osteopenia) and osteoporosis are not uncommon during menopause in part, due to the drop in estrogen. DEXA scan (bone density testing) guidelines for screening are currently recommended starting at age 65 or 60 with risk factors, but experts suggested we may be missing the boat; they suggest screening earlier at age 50 to maximize prevention efforts. Insurance coverage, however, might prove challenging.
One expert suggested that calcium and vitamin D, in the absence of deficiency or dietary voids, are not necessarily helpful for bone loss. This information was received with surprise and disbelief by the audience. And while estrogen is helpful for mitigating risk, measuring estrogen levels in the blood is of no help in determining bone-related therapy decisions. The protective effect of estrogen diminishes with discontinuation.
Final Thoughts
The 2025 Menopause Society meeting attendance was at an all-time high, with multiple medical disciplines represented. In fact, the number of practitioners in The Menopause Society has increased by 200%! Two hefty donations for $10 million will focus on a next generation digital presence and “leading the conversation” video series focused on menopausal health. Equity in healthcare access and cost, specifically for midlife women’s health, were overarching themes and welcomed with enthusiasm.
It’s exciting to see how the menopause space continues to evolve! We’re noticing more innovation, new interest and greater attention paid to a historically underserved area.
