Between 45 and 97% of menopausal women suffer vasomotor symptoms (hot flushes/flashes and night-sweats) which can significantly impact their quality of life and 10–20% find them almost intolerable.

Conventional treatment is hormone replacement therapy (HRT) but some women cannot or prefer not to take HRT. However, current non-hormonal options have suboptimal efficacy and tolerability.

Neurokinin B, predominantly acting via the neurokinin 3 receptor (NK3R), has been implicated in the generation of menopausal hot flushes/flashes.

We undertook a systematic qualitative review to compare outcomes of placebo-controlled randomised clinical trials using neurokinin 3 receptor antagonists (NK3Ras) with those using Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) for the non-hormonal treatment of menopausal hot flushes/flashes.

NK3Ra trials reported numerically superior efficacy and better safety/tolerability compared with SNRIs trials. Provided that phase 3 NK3Ra trials are supportive, NK3Ras appear a promising therapy for this challenging area.