Understanding the Shift in Postmenopausal Treatment
Historically, hormone replacement therapy (HRT) was a primary treatment for menopausal symptoms like hot flashes and night sweats. Concerns regarding the safety risks of HRT, such as the potential for breast cancer and blood clots, have led to increased interest in non-hormonal alternatives, especially for certain individuals. This has driven the development of targeted new medications.
Veozah (Fezolinetant): A Breakthrough Non-Hormonal Drug
Veozah (fezolinetant) received U.S. Food and Drug Administration (FDA) approval in May 2023, representing a notable advancement in women's health.
How Veozah Works
Veozah is a neurokinin 3 (NK3) receptor antagonist. It functions by blocking the NK3 receptor in the brain's temperature regulation center, helping to normalize this function which can be disrupted by declining estrogen levels during menopause. This action helps reduce the frequency and intensity of hot flashes and night sweats.
Important Safety Considerations
Veozah has important safety information to consider. The FDA issued a boxed warning in December 2024 concerning a rare risk of serious liver injury, requiring regular liver function monitoring before and during treatment. Common side effects may include abdominal pain, diarrhea, insomnia, and back pain.
Elinzanetant: A Promising Candidate on the Horizon
Elinzanetant is another non-hormonal treatment under development. It acts as a neurokinin-1 and 3 receptor antagonist, potentially addressing multiple pathways associated with menopausal symptoms.
Trial Results and Future Outlook
Clinical trials for elinzanetant have shown significant reductions in the frequency and intensity of hot flashes, with some studies indicating improvements in sleep and quality of life. Results published in September 2025 indicated a 73% reduction in hot flashes by week 12 for those receiving the treatment. The manufacturer, Bayer, has submitted data to the FDA, with a potential approval and launch anticipated in 2025. This could offer another non-hormonal option, potentially beneficial for those experiencing sleep issues alongside hot flashes.
Other Non-Hormonal Treatments for Menopausal Symptoms
Besides the newer NK3 antagonists, several other non-hormonal options are available:
- Antidepressants (SSRIs/SNRIs): Low doses of certain antidepressants, such as paroxetine, can be effective in reducing hot flashes and are an option for women who cannot use HRT or who also have mood changes.
- Gabapentin: This medication, also used for epilepsy, can help decrease hot flashes, particularly night sweats.
- Oxybutynin: Primarily used for bladder issues, oxybutynin has also been found to be effective for hot flashes.
Comparing Treatment Options for Postmenopausal Hot Flashes
| Feature | Veozah (Fezolinetant) | Elinzanetant | Hormone Replacement Therapy (HRT) |
|---|---|---|---|
| Hormonal? | No | No | Yes (Estrogen ± Progestin) |
| Mechanism | NK3 receptor antagonist; blocks brain pathway | NK1 and NK3 receptor antagonist; dual-action blocking of brain pathways | Replenishes lost hormones |
| Approval Status | FDA-approved (May 2023) | Pending (filed with FDA) | Long-approved, widely available |
| Primary Symptom Target | Moderate to severe hot flashes and night sweats | Moderate to severe hot flashes, night sweats, and sleep disturbances | Wide range of menopausal symptoms, including VMS, vaginal dryness, and bone health |
| Common Side Effects | Abdominal pain, diarrhea, insomnia, back pain, liver enzyme elevation | Headache, fatigue | Bloating, breast tenderness, headaches, nausea, increased risk of blood clots, and certain cancers |
Considering Your Treatment Plan
Choosing the right treatment requires discussion with your healthcare provider. Key steps include consulting with a doctor or menopause specialist, reviewing your medical history to identify safe options, defining your primary symptom concerns, and discussing the potential risks and benefits of each treatment.
Incorporating Lifestyle and Behavioral Modifications
Lifestyle and behavioral changes can complement medical treatment. Regular exercise can help with weight, mood, and sleep. Dietary adjustments, such as avoiding triggers like spicy foods or caffeine, and ensuring adequate calcium and vitamin D intake are also beneficial. Stress management techniques like meditation or yoga, and cognitive behavioral therapy (CBT) can help address stress, anxiety, and sleep problems linked to menopause.
Conclusion: A New Era for Managing Postmenopause
The options for managing postmenopausal symptoms are increasing, providing more targeted and potentially safer alternatives to traditional HRT. The introduction of Veozah offers effective non-hormonal relief for hot flashes and night sweats. With emerging treatments like elinzanetant and other non-hormonal choices, individuals have more ways to address their symptoms and enhance their quality of life. For further information on Veozah and other non-hormonal options, you can consult resources such as the Mayo Clinic Press. A personalized approach involving medical guidance, lifestyle changes, and collaboration with your healthcare provider is key to finding the best path forward.
