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A non-hormonal HRT alternative for hot flushes

byDr. Lucy Wilkinson

While hormone replacement therapy (HRT) is the most effective way to tackle many menopause symptoms, it isn’t suitable for everyone. Some people can’t take HRT for medical reasons while others prefer not to. There are other options. Fezolinetant, sold under the brand name Veoza, is a non-hormonal menopause treatment for hot flushes and night sweats that has recently been approved for the UK market. Read on to find out if it could help you and the evidence behind this new treatment.

What is this new non-hormonal treatment?

Fezolinetant is currently sold under the brand name Veoza in the UK. It belongs to a group of medicines called NK3R antagonists. These can be used to treat menopause symptoms, especially menopausal hot flushes.

Menopause symptoms are caused by reduced levels of oestrogen during and after menopause. We use HRT to treat these symptoms by supplying the body with the oestrogen it no longer produces. 

This is a simple and effective approach, but new studies have revealed that it isn’t the only way to treat menopause symptoms.

Over recent years, more attention has been paid to the way menopause affects part of the brain called the hypothalamus.

The hypothalamus acts like the body’s ‘thermostat’, and changing hormone levels at menopause can cause it to malfunction. This is why hot flushes and night sweats are annoyingly common at this time.”

But it seems that it isn’t just oestrogen that plays a part – other chemicals are at least partly responsible too. Neurokinin B is one example. It’s thought to act on the hypothalamus in response to falling oestrogen levels. This causes issues with temperature control, which can lead to hot flushes and night sweats. 

NK3R antagonists prevent neurokinin B from binding to its receptors, which blocks some of its actions and puts a stop to those infuriating hot flushes.

Why are people excited about this new non-hormonal treatment?

We know that HRT is a highly effective treatment for menopause symptoms, but it comes with certain benefits and risks. These depend on your medical history and health, but can include an increased risk of breast cancer and blood clots. This is why HRT is not suitable for everyone.

Fezolinetant – also known as Veoza – is hormone-free. This makes it an exciting new product for the treatment of menopause symptoms. It gives an alternative option if you need effective treatment but can’t take hormones.

What is the evidence?

Evidence is still emerging about the safety and effectiveness of NK3R antagonists like Fezolinetant, but there is enough evidence that the UK’s drugs regulator, the MHRA, has approved it for use. Research so far includes:

  • One small randomised controlled trial published in 2017 that included 28 women. The study found that hot flushes reduced by 45% in women who took the medication compared with those who did not
  • A 2021 review of early trials found that NK3R antagonists are more effective at treating menopause symptoms than a group of non-hormonal medications known as serotonin-norepinephrine reuptake inhibitors (SNRIs). These SNRIs are used for conditions including anxiety, depression and certain types of chronic pain
  • A 2022 Phase 3 trial of over 500 women also found promising results in treating hot flushes

Studies seem to show that Fezolinetant works very quickly, with some studies finding a beneficial effect on both hot flushes and night sweats within just one to two days.

There is still not much information about the long-term effects of Fezolinetant.

How do I get Fezolinetant (Veoza)?

Fezolinetant, sold under the brand name Veoza in the UK, was made available on private prescription in the UK from the 5th January 2024. The price has not yet been approved, but the British Menopause Society anticipates that it will be around £45-50 per month, plus any dispensing fees applied by the pharmacy. It is not yet available on the NHS, but this may happen in the near future subject to regulatory processes.

You may unfortunately need to wait if you are over 65. Due to a lack of evidence, the MHRA has not yet made a recommendation on using Fezolinetant in this age group.

Fezolinetant isn’t suitable for everyone. It is not recommended for people with some types of liver disease or severe kidney disease. It will also not address menopause symptoms other than hot flushes, so you may find that you still struggle with other issues.

Learn more about the different types of HRT.

How do I take Fezolinetant (Veoza)?

Fezolinetant, sold as Veoza in the UK, comes as a 45mg tablet. The dose is usually one tablet per day.

What other non-hormonal treatment options are available for menopause symptoms?

While there is a lot of talk about Fezolinetant, other non-hormonal options are already widely used for treating menopause symptoms. Although HRT is generally more effective, non-hormonal treatments could be a good option if you’re unable to take hormones or just aren’t keen on the idea.

  • Certain types of antidepressants are sometimes used to improve menopause symptoms, including hot flushes. These include common medications like sertraline, fluoxetine and citalopram. If you already take one of these medicines, your doctor might even recommend simply increasing your dose before trying anything else.
  • Tibolone is a non-hormonal treatment that can be used to treat menopause symptoms – it’s only suitable for those whose last period was at least one year ago.
  • Clonidine is another non-hormonal medication used to treat menopause symptoms and it’s been found to help reduce hot flushes and night sweats.

Finally, lifestyle changes can be effective too. Caffeine, alcohol, smoking, stress and lack of exercise can all have an impact on symptoms including hot flushes and night sweats. 

Find out more about alcohol and menopause.

Final word

Fezolinetant is a promising new treatment for menopause symptoms and may be a good option for you, especially if you are unable to take hormonal treatments. However, it is only thought to work for hot flushes and night sweats, so you might still struggle with other menopause symptoms.

Find out more about menopause on our blog or in our symptoms library.