You finally get an FDA-approved, estrogen-free flash fighter…and immediately worry it’ll stealth-add five pounds like your old SSRI. Data says relax. Researchers pooled every SKYLIGHT trial—2852 women followed for 52 weeks—and found weight change on fezolinetant was practically a rounding error: +0.23 kg (30 mg) and +0.15 kg (45 mg) vs +0.47 kg on placebo. BMI mirrored the stall, but the surprise win was at the waist: drug groups shaved almost 1 cm off their circumference while placebo didn’t budge. 

Why? When night sweats stop stealing REM, cortisol settles, insulin behaves, and 6 a.m. workouts stop feeling like medieval torture. Nanette Santoro, MD, who presented the data, called the waist drop “metabolically interesting.” We call it a two-fer: cool flashes and a quieter tape measure.

THRĒ’s Quick-Fire Take

1. Who we offer it to: anyone who can’t or won’t use estrogen—think clot risk, active breast-cancer surveillance, or just personal vibe.

2. How we monitor: baseline liver panel (there’s a boxed warning), repeat at 3 months, then yearly.

3. What patients report: flashes down in < 1 week, sleep quality up, zero chatter about tight jeans.

4. Wallet reality: list price is steep; we fight insurers with the same energy we fight vasomotor hell.

Bottom Line

Menopause already feels like a metabolic prank. Fezolinetant cools the furnace without padding the hips—a true unicorn in the non-hormonal world.