New and Emerging Tools for Managing Menopausal Sleep Disturbance, With Fiona Baker, PhD

Recognition of menopausal sleep disturbance as a clinically significant and treatable condition represents a meaningful shift from prior decades, when many women were told sleep disruption would resolve on its own after menopause. At SLEEP 2026, Fiona Baker, PhD, a senior program director at SRI International, outlined how evolving science and an expanding treatment toolkit are changing what clinicians can offer this population.

Sleep disturbance is one of the most common and debilitating symptoms of the menopause transition, yet there are currently no therapies specifically approved for sleep disturbance associated with menopause. Baker noted many women with clinically distressing sleep disturbances went unmanaged under the assumption the problem was transient and self-resolving. Growing recognition of the hormonal and vasomotor contributors to sleep disruption has prompted development of both behavioral and pharmacological approaches targeted to this population.

Behavioral and Pharmacological Options for Menopausal Sleep Disturbance

Cognitive behavioral therapy for insomnia remains the most durable behavioral intervention for insomnia complaints, with evidence supporting sustained improvements in sleep beyond the treatment period.

For women whose sleep disruption is driven primarily by vasomotor symptoms, hormone therapy is an established and guideline-endorsed option. The International Menopause Society identifies hormone therapy as the most effective intervention for vasomotor symptoms and sleep disturbances in women where those symptoms are contributing to disrupted sleep.

Neurokinin-Targeted Therapies and the Non-Hormonal Pipeline

Newer non-hormonal therapies targeting hot flash mechanisms, specifically the neurokinin-targeted agents, have added to the menu of options for women who cannot or prefer not to use hormone therapy. Fezolinetant is a nonhormonal, selective NK3 receptor antagonist that blocks neurokinin B binding on KNDy neurons in the hypothalamus, moderating thermoregulatory activity and reducing vasomotor symptom frequency and severity. Real-world data from the OPTION-VMS study, presented at The Menopause Society's 2025 Annual Meeting, showed fezolinetant produced statistically significant reductions in wakefulness after sleep onset and improved sleep efficiency at weeks 4, 8, and 12 on actigraphy.

The North American Menopause Society's 2023 nonhormone therapy position statement designated fezolinetant as a Level I recommended treatment for vasomotor symptoms, alongside CBT, clinical hypnosis, SSRIs/SNRIs, and gabapentin.

Baker emphasized the practical significance of this expanded landscape: when multiple treatment pathways exist, clinicians are better positioned to individualize care based on the specific pattern of contributors driving each patient's sleep disturbance.

Editors’ note: Baker reports relevant disclosures with Bayer.

References

1. Baker FC. Sleep across the menopausal transition. Presented at: SLEEP 2026; June 2026. Baltimore, Maryland.

2. Moon HJ, Yu SN, Hur MH. Effects of cognitive behavioral therapy on sleep quality and insomnia severity index in women with menopausal insomnia: a systematic review and meta-analysis. Women's Health Nursing. 2025. doi:10.4069/whn.2025.09.07

3. Shufelt CL, et al. The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. 2023;30(6):573-590. doi:10.1097/GME.0000000000002200

4. Lederman S, et al. Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study. Lancet. 2023;401(10382):1091-1102.