“A 55-year-old woman was referred to the clinic with persistent breakthrough bleeding on HRT for menopause and progestogen sensitivity symptoms. 

She had tried various preparations for HRT including transdermal oestrogen (patches and gel) combined with micronised progesterone and medroxyprogesterone acetate (both cyclically and continuous) but had suffered from constant breakthrough bleeding. She did not want to have an intrauterine progestogen coil. She had also experienced side effects from progestogens such as low mood, bloating and fluid retention. 


She had multiple pelvic ultrasound scans over two years and two hysteroscopy procedures which did not reveal any pathology.

Her medical history included past history of premenstrual symptoms and hypothyroidism (for which she took levothyroxine 75 mcg daily orally). 


She had reached a point in her treatment journey where the side effects of HRT were adversely impacting her life, and she wanted non-hormonal treatments. She discussed fezolinetant and started with 45 mg daily dose. She noticed a rapid improvement in her hot flushes within the first two weeks and continued to have good suppression of hot flushes at follow up. She is also using vaginal oestrogen for genitourinary symptoms alongside fezolinetant. 


The reduction in hot flushes and improved sleep has improved her overall functioning and quality of life.”