For women who are unable or choose not to opt for hormone replacement therapy (HRT), a new alternative has emerged: a daily pill that manages the body’s temperature control without the use of hormones.
Despite its potential benefits, experts caution that many eligible individuals are not taking advantage of this medication.
HRT is a popular choice among millions of women in the UK to alleviate hot flashes and night sweats, two prevalent symptoms associated with menopause. By supplementing the body’s decreasing levels of estrogen and progesterone, it offers relief during this transitional phase.
The innovative drug, known as fezolinetant (marketed as Veozah), operates differently. It works by inhibiting the nerve pathways in the brain responsible for initiating hot flashes and night sweats.
In a pivotal study, approximately 400 women between the ages of 40 and 65, who experienced moderate to severe menopausal symptoms and were unable to undergo HRT, were administered either fezolinetant or a placebo daily for a span of six months.
Participants receiving the active medication reported substantial symptom improvement, with many noticing a positive change within just a week, according to a 2024 report by The BMJ. Furthermore, the drug was well-received with minimal side effects.
Waljit Dhillo, a professor of endocrinology and metabolism, based at Hammersmith Hospital in London, who led early trials into this class of drug, said fezolinetant would be ‘completely game-changing’ for many women.
HRT is used by millions of women in the UK to ease hot flushes and night sweats – two of the most common symptoms of the menopause (picture posed by model)
As he told Good Health: ‘It’s like turning on a switch. Within a day or two, the flushes go away.’
About 500,000 women could benefit from the new pill, the first non-hormonal treatment for hot flushes and night sweats to be approved on the NHS in England.
This includes those for whom HRT is unsuitable.
Traditional oestrogen-based therapies can increase the risk of potentially fatal blood clots so they are not recommended for women at higher risk of deep vein thrombosis and pulmonary embolisms (blood clots on the lungs).
Some women with heart disease can also be prescribed fezolinetant.
Those who don’t take HRT because they are worried about its side-effects are eligible for it, too.
HRT can cause breast tenderness, headaches and bloating. It can also slightly increase the risk of breast cancer; if 1,000 women take combined HRT for five years, there will be about five more cases of the disease than usual.
Controversially, however, breast cancer patients who often go through medically induced menopause as a result of their treatment, won’t get 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, as well as hormone therapies including tamoxifen and aromatase inhibitors, can cause a rapid drop in levels of oestrogen, resulting in a sudden menopause, which is often more severe than natural menopause,’ says Dr Haitham Hamoda, a consultant gynaecologist 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 have to wait for the results of studies, including a clinical trial involving more than 500 women in Canada with breast cancer which is due to complete in mid-2027.
The new drug, fezolinetant (brand name Veozah), has a different mechanism, blocking nerve pathways in the brain that trigger hot flushes 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 licence could be extended to cover women with breast cancer. In the meantime, they may be able to get the drug privately, if they can persuade their doctor they would benefit and can afford to pay about £45 for a month’s supply.
There is also another – and potentially better – alternative that may be available on the NHS sooner.
Fezolinetant works by stopping a chemical called neurokinin B from binding to receptors on cells in the brain’s hypothalamus. It is thought that this prevents blood vessels from widening, blood flow from increasing and temperature from spiking.
Elinzanetant (brand name Lynkuet) blocks these receptors, too. But it also binds to another type of receptor found on cells in the brain’s cortex that are key to sleep quality. (Disturbed sleep is common during the menopause.)
Unlike fezolinetant, elinzanetant has already been tested on women whose menopause was induced by cancer treatment, with large trials showing that it reduces the frequency and severity of hot flushes and improves sleep.
The National Institute for Health and Care Excellence (NICE) is now deciding whether to make it available on the NHS.
Like all drugs, elinzanetant can potentially cause side-effects. These include headaches, fatigue, diarrhoea and abdominal pain.
Fezolinetant’s potential side- effects include abdominal pain, diarrhoea, insomnia and back pain, as well as, in rare cases, serious or life-threatening liver damage.
And, as Professor Dhillo acknowledges, these new drugs tackle only two symptoms of the menopause.
‘The drug will not address wider symptoms, including muscle weakness and mood swings.’
Another major disadvantage is that, unlike HRT, the drug doesn’t help to protect against the raised risk of osteoporosis and cardiovascular disease linked to the menopause.
There are concerns that if the drugs bind to neurokinin receptors in the digestive, cardiovascular and immune systems, it could have unintended consequences.
Some non-hormonal drugs are already used to treat hot flushes, for example, clonidine (which is usually prescribed for hypertension), gabapentin (for nerve pain) and SSRI antidepressants.
However, ‘there’s not much scientific evidence to say that they actually work beyond a placebo effect and they should really only be used as a last resort’, says Professor Dhillo.
In contrast, lifestyle changes, such as avoiding triggers including spicy foods which contain nerve-triggering capsaicin, as well as caffeine and alcohol, and using cognitive behavioural therapy – a talking therapy that changes the way women perceive and react to hot flushes – ‘have good data to support their use’, says Professor Dhillo.
