Perimenopause & Menopause.
Perimenopause is the 4 to 10 year transition before menopause, during which hormones fluctuate and symptoms begin. Menopause is confirmed after 12 consecutive months without a period. Hot flashes and night sweats are the hallmark complaints. Genitourinary changes, mood disruption, and insomnia are common and frequently undertreated.
PREVALENCE
Universal in women with ovaries
VASOMOTOR SYMPTOMS
70 to 80% experience hot flashes
SYMPTOM DURATION
Median 7 to 10 years
| Total signals indexed | 37 |
| Strong-tier | 6 |
| Moderate-tier | 13 |
| Emerging-tier | 15 |
| Exploratory-tier | 3 |
FIGURE A · TIER DISTRIBUTION
Signals per confidence tier
The largest single group is the Emerging tier (15); 6 of the 37 indexed signals reach Strong, the tier reserved for the most robust, replicated evidence.
FIGURE B · ARM COMPOSITION
Where each signal originates
Direct contributes the most signals (24); Community the fewest (2). Each evidence arm applies its own inclusion threshold.
BIOLOGY
Biological context
Hot flashes are driven by loss of estrogen's suppression of neurokinin B signaling in the hypothalamus. Rising neurokinin B activity disrupts the thermoregulatory set point, triggering vasodilation and sweating. This pathway is the target of fezolinetant, the newest approved treatment. Serotonin and norepinephrine pathways are also involved, explaining why SSRIs and clonidine help.
RESEARCH & FUNDING
Research landscape
The 2002 WHI study was widely misinterpreted, causing a decade of hormone therapy under-prescribing that left millions of women undertreated. Risk-benefit data has since been substantially rehabilitated. Fewer than 20% of ob-gyn residents feel adequately trained in menopause management.
REPURPOSING SIGNALS
37 signals indexed.
The breakdown above shows how those 37 signals grade out by confidence tier and where each one originates. The candidates themselves, the specific approved drugs with their verbatim-verified evidence across the direct, pathway, and community arms for perimenopause & menopause, sit behind access while Whel is in research preview.
Explore the candidates.
Each candidate carries its full evidence trail: scored across five dimensions, graded from strong to exploratory, with every source and date attached so it can be checked. Every candidate is open to read in full.
ALSO TRACKED
Tracked, but not graded as single-agent candidates.
These are recorded for perimenopause & menopause but kept out of the graded repurposing index: multi-agent combination regimens (legitimate clinical regimens, not single-agent repurposing candidates) and supplements or herbals (reported as complementary context). Neither is scored on the five-dimension rubric.