Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before starting any new supplement regimen.
The Newest Non-Hormonal Approach: Veozah (Fezolinetant)
In May 2023, the U.S. Food and Drug Administration (FDA) approved a groundbreaking, non-hormonal prescription medication called Veozah, with the generic name fezolinetant, to treat moderate to severe hot flashes from menopause. Unlike hormone replacement therapy (HRT), which replaces lost estrogen, Veozah targets a specific neural pathway in the brain's thermoregulatory center.
How Veozah Works
During menopause, declining estrogen levels disrupt the brain's temperature control center within the hypothalamus. This disruption increases the activity of a specific neuropeptide called neurokinin B (NKB), leading to the body's heat-dissipation mechanisms triggering hot flashes. Veozah works by blocking the neurokinin 3 (NK3) receptor, effectively modulating this neuronal activity and preventing hot flashes from occurring.
Considerations and Side Effects of Veozah
In December 2024, the FDA issued a boxed warning for Veozah regarding the rare but serious risk of liver injury. Patients must undergo baseline liver function tests before starting the medication and then regularly for the first nine months of treatment. Common side effects include abdominal pain, diarrhea, insomnia, and back pain. Veozah is not suitable for everyone and is contraindicated in individuals with cirrhosis, severe kidney problems, or those taking certain other medications.
Hormone Replacement Therapy (HRT)
For decades, hormone replacement therapy has been considered the most effective treatment for hot flashes and other menopausal symptoms. HRT works by supplementing the body with estrogen, with or without progestin, to counteract the hormonal decline of menopause.
Types and Risks of HRT
- Estrogen-only therapy: For women who have had a hysterectomy.
- Combination therapy (estrogen and progestin): For women with a uterus, progestin is added to protect against endometrial cancer.
While highly effective, HRT carries potential risks of blood clots, stroke, and breast cancer, though risks are lower for younger women near menopause. Current guidelines suggest using the lowest effective dose for the shortest duration necessary, especially for women aged 60 or older or more than 10 years past menopause onset.
Other Non-Hormonal Prescription Options
For women who cannot take HRT or prefer alternative options, several other medications have been used, often "off-label".
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Low doses of certain antidepressants can significantly reduce hot flash frequency and severity. Paroxetine (Brisdelle) is an FDA-approved non-hormonal drug for hot flashes. Other SSRIs and SNRIs used include venlafaxine and escitalopram. Common side effects can include nausea, headache, and sleep disturbances.
Gabapentin and Pregabalin
These anti-seizure medications can help alleviate hot flashes, particularly nighttime symptoms. Side effects can include drowsiness, dizziness, and weight gain. Gabapentin may be a good option for women who also have a history of neuropathic pain.
Clonidine
Primarily a blood pressure medication, clonidine can offer modest relief from hot flashes. Its use is limited by potential side effects such as drowsiness and dry mouth.
Oxybutynin
This medication, typically used for overactive bladder, has also been found to reduce hot flashes. Its anticholinergic properties can lead to side effects like dry mouth and dizziness.
Comparing Treatment Options for Menopausal Hot Flashes
| Feature | Veozah (Non-Hormonal) | Hormone Replacement Therapy (HRT) | Other Non-Hormonal Drugs |
|---|---|---|---|
| Mechanism | Blocks NK3 receptors in the brain's thermoregulatory center. | Replaces declining estrogen levels. | Modulates neurotransmitters, nerve signals, or addresses associated symptoms. |
| Efficacy | Clinically proven for moderate to severe symptoms; effective within weeks. | Highly effective, often considered the gold standard for relief. | Efficacy varies by medication, ranging from mild to moderate relief. |
| Key Risks | Rare but serious liver injury; regular monitoring required. | Potential for blood clots, stroke, and breast cancer, especially in older women or with long-term use. | Side effects vary, including drowsiness (Gabapentin) and potential cognitive effects (Oxybutynin). |
| Best For | Women with moderate to severe hot flashes who cannot or prefer not to use HRT. | Symptomatic women under 60 and within 10 years of menopause onset without contraindications. | Women with co-existing conditions (e.g., depression, pain) where the drug can treat multiple symptoms. |
Conclusion: Choosing Your Path to Relief
Choosing the right hot flush treatment is a personal decision that requires a thorough discussion with a healthcare provider. Factors such as symptom severity, medical history, contraindications, and individual preferences all play a crucial role. For many women, newer non-hormonal options like Veozah offer a highly effective alternative to traditional HRT, especially for those with breast cancer history or other risk factors. For others, HRT remains the most powerful tool. Beyond prescription drugs, lifestyle adjustments can also provide valuable support in managing mild to moderate symptoms. By understanding the diverse range of available treatments—both hormonal and non-hormonal—menopausal women can make an informed choice to effectively manage their symptoms and improve their quality of life. For further information on FDA-approved medications, see the FDA drug safety and availability website.
