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New Drug To Stop Hot Flushes

A new menopause drug has been approved in the US since May (2023) and it is thought that it could be approved in the UK by the end of the year.

It is non-hormonal medication, made by Astellas Pharma called fezolinetant (brand name Veozah) and it is for those women who can’t take HRT because of a risk of breast cancer or clots.

The medication works directly on the brain to switch off hot flushes by blocking a protein the brain’s hypothalamus called neurokinin-3 which helps to regulate body temperature.

In one clinical trial, after 12 weeks, the fezolinetant reduced the frequency of hot flushes by about 60%.  But those taking the placebo also saw a reduction in hot flushes by 40%. The medication also helped improve quality of sleep.

According to the FDA in America, the most common side effects include abdominal pain, diarrhoea, insomnia, back pain, hot flush and elevated hepatic transaminases.   I have highlighted hot flush as this is one of the key side effects that this newly approved medication is designed to help eliminate!

And from the FDA, the prescribing information for Veozah includes a warning for elevated hepatic transaminase, or liver injury. Before using Veozah, patients are told they should have blood work done to test for liver damage. And that the healthcare provider should also repeat this blood test at month 3, month 6, and month 9 after you start taking Veozah.

The list of ingredients for this medication include the following:

Active ingredient: fezolinetant
Inactive ingredients: ferric oxide, hydroxypropyl cellulose, hypromellose, low-substituted hydroxypropyl cellulose, magnesium stearate, mannitol, microcrystalline cellulose, polyethylene glycol, talc, and titanium dioxide

If you are looking for a more natural way to help you through this stage in your life, rather than taking medication which can carry side effects, then see my book ‘Natural Solutions to Menopause’ available from  https://www.naturalhealthpractice.com/natural-solutions-to-menopause.html

Menopause Is Not An Illness It Is A Natural Event!

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Menopause is not an illness. If you subscribe to the standpoint currently held by the conventional medical profession, you’d be forgiven for thinking it was.

What is menopause?

In conventional terms menopause and its symptoms are viewed as a disorder caused by falling hormone levels. So, by giving menopausal women hormones in the form of hormone replacement therapy (HRT), the deficiency can be corrected and we have a ‘cure’. This argument is supported by the supposed similarity between the menopause and diabetes. When insulin levels are insufficient to maintain normal blood glucose levels, then insulin is supplied from outside and the balance is corrected.

But diabetes is different from the menopause in one important respect: diabetes is not a natural event. It is not expected that everyone will get diabetes; but all women will pass through the menopause. It is a natural stage in our lives and there is a wealth of scientific evidence that there are alternatives to HRT.

Women in many other cultures do not experience the menopause as a crisis demanding medical intervention. Many of them simply do not suffer the physical and emotional symptoms that women in the West are programmed to accept as inevitable. In our society the focus of the menopause is one of loss. Women are programmed to dwell on loss – the loss of periods, the loss of the ability to create life, the loss of hormones, the problems of the ’empty-nest’ syndrome. In other societies, this time in a woman’s life is seen as one of gain, a time of great wisdom. A time when the emphasis shifts away from doing the chores, working in the fields, to the role of lawmaker and counsellor to younger couples, where maturity and experience make a significant and valuable contribution to the family and society.

My approach is to take the menopause as a natural event. HRT is always there as the last resort, and it should only be used as such. Try the natural approaches first, and then assess whether you really do need HRT. The odds are that you won’t.

Dietary changes

A well-balanced diet is essential during the menopause as it enables the body to adjust automatically to the hormone changes.  Eating a good amount of fresh fruit and vegetables and also including phytoestrogens in the form of chickpeas, lentils, soya, kidney beans etc. is important.  Caffeine in tea and coffee etc. can bring on a hot flush for many women.  The same can apply to spicy foods and alcohol.

Phytoestrogens

Why is menopause experienced so differently around the world? Up to 85% of Western women will experience hot flushes compared to only 14% in some Asian countries.  As a result, scientists have been studying the benefits of phytoestrogens which occur naturally in certain foods such as soya, chickpeas, lentils. etc.

Almost all fruit, vegetables and grains contain phytoestrogens in varying strengths but it is the isoflavones (one of the classes of phytoestrogens) that are the most beneficial kind.  They are found in legumes such as soya, lentils, chickpeas etc.

Also pay attention to these points in your diet:

  • Stabilise blood sugar levels by reducing the amount of sugar and refined foods in the diet and eating little which helps to stop the mood swings etc
  • Reduce or eliminate caffeinated drinks such as tea and coffee which contribute to the blood sugar problem
  • Ensure a good intake of essential fatty acids from oily fish, nuts and seeds which help lubricate the joints, skin and vagina
  • Avoid soft fizzy drinks which contain high levels of phosphorus and increase the risk of osteoporosis by increasing calcium loss
  • Include a good intake of phytoestrogens in the diet from many sources and not just soya

Vitamins and Minerals

As well as eating a healthy diet, supplementation is beneficial during the menopause not only to ensure adequate nutrients for maintaining healthy bones but many can also help with the menopausal symptoms.

A good quality multivitamin and mineral, designed for the menopause, should form the foundation of the supplement programme.  This multi should contain good levels of antioxidants and also calcium, magnesium, vitamin D and boron.  (The one I use in the clinic is called MenoSupport FROM www.naturalhealthpractice.com.) And then particular emphasis should be put on the following nutrients:

Vitamin E

This is an important vitamin to consider at the menopause. Research has shown its effect on reducing hot flushes and night sweats.  Vitamin E is also helpful for vaginal dryness.

Vitamin C

Not only is Vitamin C important for preventing illness but it also has specific benefits at the menopause. It can help with hot flushes and also helps to build up collagen which gives skin its elasticity and it is therefore helpful in the prevention and treatment of vaginal dryness.  It can also help retain the elasticity in the urinary tract and so prevent leakage or stress incontinence, which is common at the menopause. Collagen is also important for your bones.

B Vitamins

These are called the ‘stress’ vitamins because they are enormously beneficial when you are under a great deal of pressure. Symptoms of B-vitamin deficiency include anxiety, tension, irritability, lack of energy and poor concentration which are often symptoms associated with the menopause.

Omega 3 fatty acids

Signs of an Omega 3 deficiency are dry skin, lifeless hair, cracked nails, fatigue, depression, dry eyes, lack of motivation, aching joint, difficulty in losing weight, forgetfulness, breast pain – all symptoms that could be ‘blamed’ on the menopause. They need to be supplemented around the menopause because they can help with many of the symptoms. Furthermore, because they help to ‘lubricate’ the body in general, they can help with vaginal dryness.

Herbs

There are a number of herbs that have traditionally been used at the menopause.

Black cohosh

From all the published research, the herb that has the most dramatic effect on hot flushes and night sweats is black cohosh.  It was originally used by Native North Americans and is very effective in helping with hormonal imbalances.  It has a generally calming effect on the nervous system and as well as the hot flushes and night sweats and can be helpful with other symptoms include anxiety, tension and depression.

Other useful herbs at the menopause include agnus castus, dong quai, sage and milk thistle.  It is better to get organic herbs where possible.  (I use a combination called Black Cohosh Support in the clinic see www.naturalhealthpractice.com.)

Women can now live 30 to 50 years past the menopause stage and you want to live those years in good health and free from symptoms.  By eating well, taking appropriate supplements and exercising, your health will improve, which enhances the quality of your life.  Good nutrition together with the right supplements, enables the body to adjust to the changes at the menopause automatically and keeps the skin and hair soft, minimises aching joints and stiffness, slows the ageing process, controls weight naturally without dieting, maintains libido and helps to prevent osteoporosis, heart disease and cancer.

Contact the Glenville Nutrition Clinic team to arrange a consultation with one of the Nutritionists.

Top Tips On How To Treat, Prevent And Reverse Osteoporosis

My top tips for preventing osteoporosis:

Your diet is important.  Calcium is stored in your skeleton and is used as a buffer to neutralise acid. This means that the more acidic your diet becomes the more calcium can be leeched from your bones and the higher the risk of fractures.  The most acid producing foods are animal proteins including meat and cheese.  Milk and yogurt are more alkaline.  Higher intakes of animal protein are associated with lower bone density.  For more information on diet and supplements for osteoporosis see my book ‘Osteoporosis – how to treat, prevent and reverse it’.

Vitamins and minerals are important for bone health.  The first nutrient that comes to mind is calcium. But many other nutrients are equally important.

Calcium –it not only improves bone density but also reduces the risk of fractures.  Choose supplements that contain calcium citrate rather than calcium carbonate for maximum absorption.

Magnesium – helps to metabolise calcium and converts vitamin D to the active form necessary to ensure that calcium is efficiently absorbed. 

Vitamin D3 – important for the absorption of calcium (it must be D3 rather than D2). D3 is 87% more effective in raising and maintaining vitamin D levels than D2. We have a wide spread deficiency problem in the UK, my recommendation is to do a simple home finger prick test for vitamin D available at Glenville Nutrition Clinic to check whether you are deficient and then you can be sure of how much vitamin D you need to take each day.

Vitamin C – important in the manufacture of collagen, the ‘cement’ that holds the bone matrix together.   Choose vitamin C as ascorbate rather than the acidic form – ascorbic acid.

Boron – an important mineral in relation to osteoporosis as it plays a crucial part in the conversion of vitamin D into its active form, which, in turn, is necessary for calcium absorption.

Exercise – It is better to have a combination of weight-bearing exercises like walking and dancing and weight resistance like bicep curls and lunges to create mechanical stress which helps put calcium into your bones.

Have a bone density scan to check the condition your bones are in now.   You may have to organise this scan privately as it is not easy to get one on the NHS but it will be worth it (my clinic team can also arrange a referral for you).

Why Is Vitamin D Crucial For Brain Health?

We have known for many years that Vitamin D is important for bone health and in the prevention of osteoporosis. However, it is only in recent years that we have realised how important this nutrient is for general health and, particularly, for brain health. Here are just some of the main benefits of vitamin D:


• It plays a major role in breast and bowel cancer prevention
• It is important for your immune function, particularly when you need to fight off colds and flus
• It helps protect your body against conditions as diverse as type 2 diabetes, heart disease, joint pain, dementia, infertility, autism, and allergies
• It reduces the risk of SAD (Seasonal Affective Disorder)

Vitamin D also balances your immune function (if you have an autoimmune problem, it’s especially important to have your vitamin D levels tested), helps control inflammation, has antioxidant properties, and helps to control beta-amyloid plaque build-up. All these benefits are important for your brain health, so getting your levels exactly right is crucial if you are to benefit from them.

Vitamin D Deficiency

Vitamin D deficiencies have also been implicated in autoimmune diseases such as rheumatoid arthritis, lupus, and inflammatory bowel disease. We get most of our vitamin D quota from sunlight because natural food sources are few. Those most at risk of vitamin D deficiency are those who:

• Don’t go out much in the daytime
• Don’t expose their skin to sunlight
• Constantly wear make-up or cosmetics with built-in sun protection factors

The tone of your skin affects vitamin D production, so the darker your skin, the less your body produces vitamin D. Covering up large area of skin for religious reasons also reduces vitamin D production. It is estimated that we need about 30 minutes exposure to the sun every day to produce enough vitamin D to keep us healthy.

If you are moderately deficient in vitamin D, you have a 53% increased risk of dementia, and your risk of increases by 125% if you are severely deficient. With Alzheimer’s, one study found that those who were moderately deficient had a 69% increased risk, and the risk increased to 122% in those who were severely deficient.

This research showed evidence that these seem to be a threshold level in the blood below which the risk of developing dementia and Alzheimer’s increases. Levels above 50 nmol/L are the most strongly associated with good brain health. However, I think a level between 80 – 100 nmol/L gives the best overall effect on general health, and this is the level I get my patients to aim for in my clinic.

How To Know If You’re Vitamin D Deficient

A question lots of people ask me when I give talks, is how much vitamin D should I take? The answer, of course, is that it depends on the level of your deficiency. For this reason, I now recommend that everyone gets their vitamin D levels checked, given this nutrient’s far-reaching health benefits, and then supplement to get the level back to normal. We have had instances in the clinics where the lab has even phoned to say there was no vitamin D detected at all.

There is, though, such a thing as too much vitamin D. A vitamin D level that is too low (less then 10nmol/L) increases the risk of all-cause mortality (dying of any cause) – but the same is true if your vitamin D levels are too high (more than 140 nmol/L). That’s why it’s important to get tested regularly, at the clinic we use this test that can be done via the post.

What Vitamin D To Choose?

Choose vitamin D in the form of D3, also called cholecalciferol. There is a cheaper form, called D2 (ergocalciferol), but research suggests that vitamin D3 is 87% more effective at raising and maintaining your vitamin D levels than vitamin D2. Researchers have said that ‘the assumption that vitamins D2 and D3 have equal nutritional value is probably wrong and should be reconsidered.’ Most people (especially older people) do not convert vitamin D2 to the active form that their bodies can use efficiently so it is best to speak to one of our nutritionists for advice.

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