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A meta-analysis of seven placebo-controlled trials found that neurokinin-receptor antagonists were associated with improved patient-reported sleep disturbance in menopausal women with moderate-to-severe vasomotor symptoms. Improvement was reported at four, 12 and 24 weeks, but the findings do not establish that sleep benefits occur independently of reduced hot flashes.
A meta-analysis of seven placebo-controlled trials found that nonhormonal neurokinin-receptor antagonists were associated with reduced patient-reported sleep disturbance among menopausal women with moderate-to-severe vasomotor symptoms, with improvement reported as early as four weeks. The findings, presented at the Menopause Society annual meeting and reported by MedPage Today on October 22, 2026, add evidence about sleep outcomes for women considering alternatives to hormone therapy.
Across the included trials, the researchers reported better sleep-disturbance scores for participants taking the drugs than for those receiving placebo at four weeks (standardized mean difference, or SMD, -3.94; 95% confidence interval -5.71 to -2.16), 12 weeks (SMD -3.11; 95% CI -4.60 to -1.61) and 24 weeks (SMD -2.04; 95% CI -3.93 to -0.15). The researchers said the direction of benefit continued at each measured point. These are pooled standardized effects, not a direct estimate of how many hours of sleep participants gained.
The analysis included data from 3,184 women: 949 took fezolinetant, 864 took elinzanetant and 1,371 received placebo. Five trials used the same validated PROMIS Sleep Disturbance Short Form questionnaire and could be pooled for the primary analysis; two trials using other questionnaires were considered separately. Lower scores on the PROMIS measure indicate less reported difficulty with sleep quality, restfulness, and falling or staying asleep over the previous seven days.
In subgroup analyses, both drugs were associated with statistically significant sleep improvement through 12 weeks. The reported effect was larger for elinzanetant than fezolinetant at four weeks (SMD -5.24 versus -1.98) and 12 weeks (SMD -4.52 versus -1.44). The authors cautioned that these were comparisons across trial subgroups, not evidence from a direct head-to-head trial establishing which drug works better.
Sleep Outcomes Beyond Hot Flashes
Sleep disruption can be a major concern for people experiencing menopause-related hot flashes and night sweats. The analysis addresses a gap in evidence because, as lead author Maria Julia Lemos told MedPage Today, earlier large trials had generally measured sleep as a secondary outcome rather than making it the focus of a pooled analysis.
The findings may help clinicians and patients discuss nonhormonal treatment options when hormone therapy is unsuitable or not wanted. They do not show that these medicines should be used as sleep drugs on their own, nor do they establish that the sleep-score changes are clinically meaningful for every patient. The study assessed sleep disturbance in people with vasomotor symptoms, and the benefit could be connected to relief from those symptoms.
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Seven Trials, Two Medicines
The research team searched PubMed, Embase and the Cochrane database for studies published through May 2026. The seven placebo-controlled trials included OASIS I, II and III; SWITCH-1; DAYLIGHT; pooled data from SKYLIGHT I and II; and a 2019 study by Depypere and colleagues. The researchers reported that all included trials had a low risk of bias, while also noting differences among participants, treatment regimens and follow-up periods.
Fezolinetant (brand name Veozah) blocks the NK3 receptor, while elinzanetant (Lynkuet) acts on NK1 and NK3 receptors. Both target pathways involved in the brain’s regulation of body temperature. Their use for vasomotor symptoms is nonhormonal; the meta-analysis examined whether trial data also supported an effect on reported sleep disturbance.
“They may help women sleep better, not just have fewer hot flashes.”
— Maria Julia Lemos, MD, lead author, speaking to MedPage Today
Limits of the Sleep Findings
The results are based on patient-reported questionnaires, not objective sleep measurements, and the authors said the analysis included a relatively small number of trials with substantial variation in patients, treatment regimens and follow-up. Although the pooled scores favored treatment at the reported intervals, the supplied report does not establish how large a change patients would experience in everyday sleep or whether it would be meaningful for each individual.
It is also not possible to separate sleep improvement from relief of hot flashes and other vasomotor symptoms in this analysis. The larger effects reported for elinzanetant do not prove superiority over fezolinetant because the drugs were not compared in a head-to-head trial. The available account does not provide a new safety comparison or a recommendation to use either medicine specifically for insomnia.
Direct Comparisons Still Needed
The next evidence needed, according to Lemos, is a head-to-head trial comparing fezolinetant and elinzanetant. Such research could test differences between the medicines directly rather than infer them from separate placebo-controlled trial groups. Further studies could also clarify how much sleep improvement is independent of reduced vasomotor symptoms and whether changes in questionnaire scores correspond to meaningful improvements for patients.
For now, the meta-analysis adds pooled evidence to discussions of treatment for menopause-related vasomotor symptoms, but it does not settle which option is preferable or who is most likely to benefit. People considering treatment should discuss the available options and their individual circumstances with a health professional.
Key Questions
Which medicines were assessed in the analysis?
The analysis included trials of fezolinetant and elinzanetant, nonhormonal neurokinin-receptor antagonists studied for menopause-related vasomotor symptoms.
When did the analysis find sleep improvement?
The pooled results favored treatment over placebo at four, 12 and 24 weeks. The earliest reported improvement was at four weeks; the study does not say that every patient experienced better sleep by then.
Does the study show these medicines treat insomnia directly?
No. It measured reported sleep disturbance in women with moderate-to-severe vasomotor symptoms. The researchers said they could not separate sleep benefits from relief of hot flashes and related symptoms.
Does the analysis show one drug is better?
No direct comparison was conducted. Subgroup results showed a larger reported effect for elinzanetant at four and 12 weeks, but the authors said head-to-head trials are still needed to compare the medicines.
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