The questions answered in this podcast are listed below.
They were compiled by GPs and health professionals around Australia.

1. Is fezolinetant safe for use in older populations, particularly those over 70?
2. Is fezolinetant listed on the PBS? If not, what is its cost?
3. Can fezolinetant be taken alongside other medications, such as thyroxine?
4. How long is it safe for a woman to continue using fezolinetant?
5. Is fezolinetant suitable for use during the perimenopausal stage?
6. Can fezolinetant be used in combination with an estrogen patch or gel for women who still experience vasomotor symptoms?
7. Is fezolinetant safe to use alongside other medications, such as Oxybutynin or SSRIs? Do we have any data on interactions?
8. Is fezolinetant safe for young women with aggressive breast cancer who are undergoing hormone therapy?
9. How should a woman transition from menopausal hormone therapy (MHT) to fezolinetant? Can low-dose MHT be used alongside fezolinetant?
10. For women who have undergone chemotherapy for breast cancer and have abnormal liver function tests post-treatment, should fezolinetant only be started once liver function returns to normal?
11. Should fezolinetant be discontinued if liver function tests become abnormal during treatment?
12. Is there any evidence that fezolinetant helps with memory and concentration issues in menopausal women?
13. Why does fezolinetant cause endometrial hyperplasia?
14. Could you confirm whether the endometrial hyperplasia observed in clinical trials was benign?
15. Is fezolinetant suitable for women with a personal or family history of breast cancer?
16. Is there any data on the effects of fezolinetant beyond 52 weeks? Were women from diverse ethnic backgrounds, beyond America and Europe, included in the trials?
17. What are the recommendations regarding the effect of fezolinetant on liver function? How should liver function be monitored, and when should testing be repeated or the medication stopped?
18. Can GPs prescribe fezolinetant, or is it restricted to specialists?
19. Is fezolinetant appropriate for men experiencing hot flushes due to hormone blockers for prostate cancer (off-label use)?
20. Patient Case: I have a patient currently on fezolinetant, Pristiq, and Tamoxifen. What would you recommend in this case?
21. Patient Case: I have a mid-40s patient suffering from frequent hot flushes every 10-15 minutes, despite being on the maximum dose of MHT. Can fezolinetant be used in combination with MHT to target these hot flushes? Also, what are your thoughts on testosterone? Some of my patients use compounded testosterone to manage their symptoms. Would this be helpful for this patient, and can testosterone be used alongside fezolinetant?
22. Patient Case: A patient started fezolinetant nearly a month ago to address almost hourly sweats and flushes. Initially, she saw a significant improvement for the first 5 days, but now the frequency and severity of symptoms have gradually returned. Is this tachyphylaxis, or should the dosage of fezolinetant be increased? Should it be used intermittently? How should I advise this patient?

Expert: Prof Rod Baber, Obstetrician and Gynaecologist

Host: Dr Terri Foran, GP and Medical Educator

Total time: 29 mins

Recommended resources:

• Australasian Menopause Society
• Jean Hailes for Women’s Health
• Non-hormonal options for hot flushes: Part 1 – Your questions answered | Healthed