The groundbreaking new drugs that relieve hot flashes and night sweats – without the side effects of HRT

For women who do not want or cannot use hormone replacement therapy (HRT), there is another option: a tablet that regulates the body’s ‘thermostat’ once a day without hormones.

Yet many who could benefit from the drug are missing out, experts warn.

HRT is used by millions of women in Britain to relieve hot flashes and night sweats – two of the most common symptoms of menopause. It works by replenishing the levels of estrogen and progesterone, which drop during menopause.

The new drug, fezolinetant (brand name Veozah), has a different mechanism: it blocks nerve pathways in the brain that cause hot flashes and night sweats.

In a groundbreaking study, around 400 women aged 40 to 65 who suffered from moderate to severe hot flashes and night sweats and were unable to use HRT were given fezolinetant or a placebo once a day for six months.

Those taking the active drug experienced a significant reduction in symptoms – in many cases, the benefits were felt after just a week of taking it, The BMJ reported in 2024. It was also well tolerated with few side effects.

Waljit Dhillo, professor of endocrinology and metabolism based at Hammersmith Hospital in London, who led early studies into this class of drugs, said fezolinetant would be “completely game-changing” for many women.

HRT is used by millions of women in the UK to reduce hot flashes and night sweats – two of the most common symptoms of menopause (photo by model)

As he told Good Health, “It’s like turning on a switch. Within a day or two the hot flashes disappear.’

Around 500,000 women could benefit from the new pill, the first non-hormonal treatment for hot flashes and night sweats to be approved by the NHS in England.

This also applies to those for whom HRT is not suitable.

Traditional estrogen-based therapies may increase the risk of potentially fatal blood clots. Therefore, they are not recommended for women at higher risk of deep vein thrombosis and pulmonary embolism (blood clots in the lungs).

Some women with heart disease may also be prescribed fezolinetant.

Those who do not use HRT because they are concerned about its side effects are also eligible.

HRT can cause breast tenderness, headaches and bloating. It may also slightly increase the risk of breast cancer; if 1,000 women use combined HRT for five years, there will be around five more cases of the disease than normal.

However, controversially, breast cancer patients who often go through a medically induced menopause as a result of their treatment will not be given the new drug on the NHS. This is despite the fact that their symptoms can often be worse than those of other women.

‘Treatments for breast cancer, including chemotherapy, surgery and hormone therapies including tamoxifen and aromatase inhibitors, can cause a rapid drop in estrogen levels, resulting in sudden menopause, which is often more severe than natural menopause,’ says Dr Haitham Hamoda, a consultant gynecologist at King’s College Hospital in London.

The problem for NHS patients is that fezolinetant is still being tested on this group of women. They must wait for the results of studies, including a clinical trial involving more than 500 women in Canada with breast cancer, due to be completed by mid-2027.

The new drug, fezolinetant (brand name Veozah), has a different mechanism: it blocks nerve pathways in the brain that cause hot flashes and night sweats

In this trial, half will take fezolinetant for a year, while half will take a placebo. If the results are positive, the license can be extended to women with breast cancer. In the meantime, they may be able to get the drug privately, if they can convince their doctor that it will benefit them and can pay around £45 for a month’s supply.

There is also another – and possibly better – alternative that may be more readily available on the NHS.

Fezolinetant works by preventing a chemical called neurokinin B from binding to receptors on cells in the hypothalamus of the brain. This is thought to prevent blood vessels from widening, increasing blood flow and raising temperatures.

Elinzanetant (brand name Lynkuet) also blocks these receptors. But it also binds to another type of receptor found on cells in the cerebral cortex that are essential for sleep quality. (Disturbed sleep is common during menopause.)

Unlike fezolinetant, elinzanetant has already been tested in women whose menopause was caused by cancer treatment. Large studies have shown that it reduces the frequency and severity of hot flashes and improves sleep.

The National Institute for Health and Care Excellence (NICE) is now deciding whether it will be made available through the NHS.

Like all medicines, elinzanetant may cause side effects. These include headache, fatigue, diarrhea and abdominal pain.

The possible side effects of fezolinetant include abdominal pain, diarrhea, insomnia and back pain, as well as, in rare cases, serious or life-threatening liver damage.

And as Professor Dhillo acknowledges, these new drugs address just two symptoms of menopause.

‘The drug will not address broader symptoms, including muscle weakness and mood swings.’

Another major disadvantage is that, unlike HRT, the drug does not help protect against the increased risk of osteoporosis and cardiovascular disease associated with menopause.

There are concerns that if the drugs bind to neurokinin receptors in the digestive system, cardiovascular system and immune system, it could have unintended consequences.

Some non-hormonal medications are already used to treat hot flashes, for example clonidine (usually prescribed for high blood pressure), gabapentin (for nerve pain) and SSRI antidepressants.

But ‘there isn’t much scientific evidence to say that they actually work beyond a placebo effect and that they should really only be used as a last resort,’ says Professor Dhillo.

Lifestyle changes such as avoiding triggers such as spicy foods containing nerve-stimulating capsaicin, as well as caffeine and alcohol, and the use of cognitive behavioral therapy – a talking therapy that changes the way women perceive and respond to hot flashes – “have good data to support their use,” says Professor Dhillo.