Menopause, a natural phase in a woman’s life, is often accompanied by distressing symptoms such as hot flashes, night sweats, and sleep disruption. For decades, hormone therapy has been the cornerstone of treatment. But women suffered without treatment due to the fear of hormone therapy. Now, a newer, non-hormonal option is offering women an effective alternative—reshaping how clinicians approach care.
The medication fezolinetant (marketed as Veozah) has been recommended by the NICE (National Institute of Clinical Excellence) in the UK. Unlike traditional treatments, it does not replace hormones. Instead, it targets specific brain pathways—blocking neurokinin-3 receptors involved in temperature regulation—to reduce the frequency and severity of hot flashes.
Taken as a once-daily tablet, fezolinetant typically begins to show improvement within one to two weeks, with full benefits seen over four to eight weeks. Clinical studies have demonstrated a meaningful reduction in both the number and intensity of hot flashes, making it a practical option for women seeking non-hormonal relief.
From a safety standpoint, the drug is generally well-tolerated. The most commonly reported side effects include mild headache, nausea, fatigue, and occasional gastrointestinal discomfort. These are usually transient and do not require discontinuation in most patients.
However, an important aspect of its use is liver safety monitoring. A small proportion of patients may develop elevations in liver enzymes, which is why blood tests are recommended before starting treatment and periodically thereafter. Women with known liver disease or significantly abnormal liver function tests are typically advised against its use. Additionally, potential drug interactions need to be reviewed, as certain medications may affect how fezolinetant is metabolised.
This approach is particularly valuable for women who cannot take hormones—such as those with a history of breast cancer—or for those who prefer to avoid hormonal therapy altogether.
In contrast, hormone therapy—estrogen, with or without progesterone—remains the most effective treatment for menopausal symptoms. It not only provides rapid and robust relief from hot flashes but also improves sleep, addresses vaginal dryness, and helps protect bone health. For many women without significant risk factors, it continues to be the first-line option.
That said, hormone therapy is not suitable for everyone. It may carry small but important risks in certain individuals, including those with a history of blood clots, stroke, or hormone-sensitive cancers. Careful patient selection is therefore essential.
The evolving landscape of menopause management underscores a broader shift in modern medicine: moving away from a one-size-fits-all approach toward more individualised care. Women today have more choices than ever before—ranging from highly effective hormonal therapies to targeted non-hormonal options.
The decision ultimately rests on a balance of effectiveness, safety, and personal preference. With informed discussion and guided care, women can now navigate menopause with greater comfort, confidence, and control than ever before.
Dr Vaishnavi V L. MD MRCOG DFSRH CCT
Senior Consultant OBGYN and Urogynaecology,
Kauvery Hospital, Chennai
