For women who cannot or choose not to take hormone replacement therapy (HRT), a new once-daily tablet offers a non-hormonal alternative by regulating the body's 'thermostat'. However, experts warn that many who could benefit from this drug are missing out.
How Fezolinetant Works
HRT, used by millions of women in the UK, eases hot flushes and night sweats by topping up oestrogen and progesterone levels. In contrast, fezolinetant (brand name Veozah) blocks nerve pathways in the brain that trigger these symptoms. In a landmark trial involving around 400 women aged 40 to 65 who could not take HRT, those taking fezolinetant experienced significant reductions in symptoms, often within a week, according to a 2024 report in The BMJ. The drug was well tolerated with few side-effects.
Professor Waljit Dhillo, an endocrinologist at Hammersmith Hospital in London who led early trials, described fezolinetant as 'completely game-changing'. He told Good Health: 'It’s like turning on a switch. Within a day or two, the flushes go away.'
Who Can Benefit?
About 500,000 women could benefit from this first non-hormonal treatment for hot flushes and night sweats approved on the NHS in England. This includes women for whom HRT is unsuitable, such as those at higher risk of blood clots or with heart disease. Women who avoid HRT due to side-effects like breast tenderness, headaches, or bloating are also eligible. However, breast cancer patients undergoing medically induced menopause are excluded from NHS access because fezolinetant is still being tested in this group. A Canadian trial involving over 500 women with breast cancer is due to complete in mid-2027, which could extend the licence. Privately, the drug costs about £45 for a month's supply.
Alternative: Elinzanetant
Another drug, elinzanetant (brand name Lynkuet), blocks the same receptors as fezolinetant but also targets receptors in the brain's cortex that affect sleep quality. It has already been tested on women with cancer-induced menopause, showing reduced hot flushes and improved sleep. The National Institute for Health and Care Excellence (NICE) is deciding whether to approve it for NHS use.
Side-Effects and Limitations
Fezolinetant's side-effects include abdominal pain, diarrhoea, insomnia, back pain, and rare serious liver damage. Elinzanetant may cause headaches, fatigue, diarrhoea, and abdominal pain. Professor Dhillo notes that these drugs only address hot flushes and night sweats, not wider symptoms like muscle weakness or mood swings. Unlike HRT, they do not protect against osteoporosis or cardiovascular disease. Concerns also exist about unintended consequences from binding to neurokinin receptors in other systems.
Alternatives to Drug Therapy
Non-hormonal drugs like clonidine, gabapentin, and SSRIs are sometimes used, but Professor Dhillo says there is little evidence they work beyond a placebo effect. Lifestyle changes, such as avoiding triggers like spicy foods, caffeine, and alcohol, and using cognitive behavioural therapy, have good data supporting their use.
