Recapping TMS 2025: Evolving Insights and Future Directions in Menopause Care

This content was independently produced by Pharmacy Times in partnership with Bayer Healthcare.

The Menopause Society (TMS) 2025 Annual Meeting covered a variety of topics within the menopause space, from menopausal hormone therapy (MHT) and its potential impacts on Alzheimer disease-related biomarkers, the link of earlier menopause onset and reduced cardiac function to brain health, the need for standardized menopause education among all health care professionals, and the positive shifts in hormone therapy use.^1-4

Estradiol-Containing MHT and Potential Links to Alzheimer Disease–Related Biomarkers

Research presented at TMS 2025 suggests that when initiated in early postmenopause, estradiol-containing MHT may influence Alzheimer disease–related biomarkers, particularly amyloid-β (Aβ) levels. Using data from the ELITE trial cohort, investigators analyzed plasma samples from postmenopausal women to evaluate the effects of oral 17β-estradiol on Alzheimer-related biomarker trajectories.¹

The findings indicated that MHT significantly accelerated the decline in Aβ40 compared with placebo, though effects on other biomarkers—such as Aβ42, GFAP, NfL, and ptau181—were not statistically significant. In early postmenopausal women, MHT appeared to produce greater but nonsignificant declines in Aβ42 and improvements in the Aβ42/Aβ40 ratio, with similar trends observed among ApoE4 carriers. No significant biomarker changes were seen in women who were in late postmenopause. Overall, these results provide partial support for the hypothesis that MHT may offer neuroprotective effects when initiated soon after menopause.¹

Earlier Age at Menopause Onset, Reduced Cardiac Function, and Brain Health

Earlier menopause onset and reduced cardiac function may jointly contribute to poorer brain health in women, according to new data. Researchers found that women who experienced menopause at a younger age demonstrated stronger associations between lower left ventricular ejection fraction—a measure of heart function—and markers of brain aging, including reduced gray matter volume and increased white matter hyperintensity burden. Using data from the Canadian Alliance for Healthy Hearts and Minds Study and the Ontario Health Study, investigators analyzed brain and heart MRI scans along with cognitive test scores from over 700 postmenopausal women.²

The results suggest that diminished cardiac function and earlier menopause onset may compound each other’s negative effects on brain structure, though no significant associations were found with cognitive test performance. These findings emphasize the links between cardiovascular and neurological health and highlight the need to include sex-specific factors such as age at menopause when assessing dementia risk.²

Provider Type and Specialty Influenced Menopause-Related Care

Provider type and specialty were observed to significantly influence whether women seeking menopause-related care received prescription treatments. Using data from over 5400 women treated between 2016 and 2023, investigators discovered that only 17% received medication for menopausal symptoms, highlighting considerable variability in prescribing practices across specialties.³

Women were most likely to receive systemic estrogen from obstetrician/gynecologists and least likely to receive it from internal medicine, family medicine, or endocrinology providers. Conversely, selective serotonin reuptake inhibitors (SSRIs) were more often prescribed by internal and family medicine clinicians. The study also found that midwives and nurse practitioners were more likely than physicians to prescribe systemic estrogen, and SSRIs were more commonly prescribed by physician assistants, nurse practitioners, and residents.³

These findings underscore major gaps in menopause management training across medical specialties, emphasizing an urgent need for standardized, evidence-based education to ensure all health care professionals can effectively treat patients and menopause-related symptoms.

Overall Perception, Understanding, and Use of Hormone Therapy Positively Shifted

Perceptions, understanding, and use of hormone therapy have improved significantly over the past 5 years, reflecting a gradual recovery from the early misinterpretations of the Women’s Health Initiative findings, which discouraged hormone therapy use due to perceived risks of heart disease and breast cancer. Despite evidence clarifying that hormone therapy is safe and effective for many women—particularly those under the age of 60 years or within 10 years of menopause onset—overall use remains relatively low.⁴

In the Attitudes and Usage study of nearly 6800 US women aged 25 to 65 years, awareness and acceptance of hormone therapy notably increased. The proportion of women who said they knew “something” or “a lot” about hormone therapy rose from approximately 28% in 2021 to 36% in 2025, with those believing the benefits outweigh the risks increasing from 38% to 49%. Willingness to use hormone therapy also grew from 40% to 53% and actual usage among women aged 40 to 60 years rose from 8% to 13%, with the largest gains seen among Black, Hispanic, and other underrepresented groups. Topical hormone therapy vehicles, such as creams and gels, also saw the most growth in use.⁴

These findings suggest a growing cultural and clinical shift toward more informed, positive attitudes about menopause care. Although hormone therapy adoption remains modest, the data point to increasing openness and sustained satisfaction among users, with over 85% reporting positive experiences. Investigators emphasized the ongoing need for clinician education, expanded access to menopause-trained health care professionals, and continued efforts to provide women with accurate, evidence-based information about hormone therapy’s benefits and risks.⁴

Elinzanetant’s FDA Approval

A standout among the new clinical data has been the use of elinzanetant (Lynkuet; Bayer Healthcare) in moderate to severe hot flashes due to menopause. It received approval from the FDA on the heels of the TMS 2025 Meeting and is the first dual neurokinin 1 and neurokinin 3 receptor antagonist to achieve approval status.⁵

Elinzanetant is a hormone-free treatment to reduce menopause-related vasomotor symptoms (VMS) among differing female populations in 4 phase 3 clinical trials: OASIS-1 (NCT05042362), OASIS-2 (NCT05099159), and OASIS-3 (NCT05030584), which included naturally or surgically induced postmenopausal women between 40 and 65 years of age experiencing moderate to severe VMS associated with menopause; and OASIS-4 (NCT05587296), which enrolled women aged 18 to 70 years receiving endocrine therapy for hormone receptor–positive breast cancer experiencing 35 or more moderate to severe VMS per week.^5,6

Future Directions and the Pharmacist’s Role

Now that elinzanetant is FDA approved to treat VMS related to menopause, experts, including JoAnn Pinkerton, MD, a professor of obstetrics and gynecology at the University of Virginia, emphasized the importance of the pharmacist’s role when supporting patients who are prescribed elinzanetant.⁷

“Pharmacists need to understand these neurokinin-targeted therapies and the potential insurance challenges that may arise,” she explained in an interview with Pharmacy Times. “This is especially important because, with fezolinetant [Veozah; Astellas Pharma US], many insurance plans required patients to try 2 other therapies before they could move on to fezolinetant—creating a significant barrier.”⁷

Outside of elinzanetant, pharmacists remain vital within the treatment of menopause and related symptoms. These data presented at TMS 2025 demonstrate the need for larger trials to clarify relationships between menopause, MHT, and cardiovascular and brain health, and highlight the importance of pharmacist-led counseling to help peri- and postmenopausal women make informed decisions.

Pharmacists and other health care professionals can play a key role in identifying cardiovascular and cognitive risks, supporting preventive strategies, and guiding women of all ages in maintaining long-term brain and heart health. Pharmacists can support this goal by promoting safe, evidence-informed therapy choices and counseling patients on hormone therapy and nonhormonal options to enhance the quality and consistency of menopause care.^1-4

REFERENCES

1. McGovern G. Estradiol-containing MHT may impact Alzheimer disease-related biomarkers in postmenopausal women. Pharmacy Times. October 21, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/estradiol-containing-mht-may-impact-alzheimer-disease-related-biomarkers-in-postmenopausal-women

2. McGovern G. Earlier menopause, reduced cardiac function potentially linked with negative impacts on brain health. Pharmacy Times. October 25, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/earlier-menopause-reduced-cardiac-function-potentially-linked-with-negative-impacts-on-brain-health

3. McGovern G. Menopause care varies by provider, highlighting need for standardized education. Pharmacy Times. October 25, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/menopause-care-varies-by-provider-highlighting-need-for-standardized-education

4. McGovern G. Hormone therapy use, understanding, and perceptions have positively shifted from 2021 to 2025. Pharmacy Times. October 24, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/hormone-therapy-use-understanding-and-perceptions-have-positively-shifted-from-2021-to-2025

5. Valletti D. FDA approves elinzanetant as first nonhormonal therapy for menopause vasomotor symptoms. Pharmacy Times. October 24, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/fda-approves-elinzanetant-as-first-nonhormonal-therapy-for-menopause-vasomotor-symptoms

6. McGovern G. Elinzanetant reduces frequency, severity of VMS in differing female populations. Pharmacy Times. October 21, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/elinzanetant-reduces-frequency-severity-of-vms-in-differing-female-populations

7. Pinkerton J, Valletti D. Lynkuet access program aims to help women save on neurokinin-targeted therapy. Pharmacy Times. October 24, 2025. Accessed October 27, 2025. https://www.pharmacytimes.com/view/lynkuet-access-program-aims-to-help-women-save-on-neurokinin-targeted-therapy