New NHS Treatment for Menopausal Symptoms: Understanding Fezolinetant

A new treatment option for menopausal symptoms has recently become available on prescription through the NHS in the United Kingdom. The medication, fezolinetant, marketed under the brand name Veoza, has been recommended by the National Institute for Health and Care Excellence (NICE) as a treatment for moderate to severe vasomotor symptoms, more commonly known as hot flushes and night sweats.

For many women whose symptoms significantly affect their quality of life, the availability of a non-hormonal prescription treatment on the NHS represents an important development.

What Is Fezolinetant?

Fezolinetant is a once-daily tablet (45 mg) developed specifically to reduce hot flushes and night sweats associated with menopause. Unlike hormone replacement therapy (HRT), the medication does not contain oestrogen or progesterone.

How It Works

Instead, it works by targeting the temperature regulation system in the brain.

During menopause, declining oestrogen levels affect a group of neurons in the hypothalamus known as KNDy neurons, which play a role in controlling the body’s internal temperature. When these neurons become overactive, the brain can misinterpret normal temperature changes as overheating, triggering the sudden waves of heat experienced as hot flushes.

Fezolinetant works by blocking the neurokinin-3 (NK3) receptor, helping to stabilise the brain’s temperature control system and reduce the frequency and severity of these symptoms.

Because of this mechanism, the medication is classified as a neurokinin-3 receptor antagonist, representing a different therapeutic approach compared with hormone therapy.

Who Might Benefit?

Fezolinetant may be suitable for women experiencing moderate to severe menopausal vasomotor symptoms, particularly those who:

• Cannot take hormone replacement therapy due to medical reasons
• Prefer to avoid hormonal treatments
• Have not responded well to other non-hormonal approaches
• Are seeking alternatives to medications sometimes prescribed off-label for hot flushes

According to experts within the Menopause Experts Group, the introduction of targeted non-hormonal therapies such as fezolinetant represents an important expansion in menopause care, particularly for women who cannot safely use HRT.

The MEG expert panel includes clinicians such as Vikram Talaulikar, MBBS, MD, FRCOG, PhD, Honorary Associate Professor in Women’s Health at University College London and a British Menopause Society Certified Menopause Specialist.

Evidence From Clinical Trials

Clinical trials involving thousands of women have shown that fezolinetant can significantly reduce the frequency and severity of hot flushes.

Participants taking the medication reported:

• Fewer daily hot flush episodes
• Reduced intensity of symptoms
• Improvements in sleep disrupted by night sweats

For many women, improvements were seen within several weeks of starting treatment.

As with all new medications, monitoring continues as the treatment becomes more widely used in routine clinical practice.

NHS Availability

Following evaluation, the National Institute for Health and Care Excellence recommended fezolinetant for NHS use in England for women who meet specific criteria.

Typically this includes women who:

• Experience moderate to severe vasomotor symptoms
• Are unable to take HRT or for whom HRT is not considered appropriate

Prescriptions will generally follow consultation with a GP or menopause specialist, although availability may initially vary between NHS regions depending on local prescribing pathways.

Safety and Monitoring

Although fezolinetant is not a hormonal medication, it is still a prescription medicine that requires medical supervision.

Clinical guidance recommends monitoring liver function during treatment, as some clinical trial participants experienced changes in liver enzyme levels. Doctors may therefore arrange blood tests before starting treatment and periodically during use.

Reported side effects in studies have generally been mild and may include:

• Headache
• Abdominal discomfort
• Sleep disturbance
• Temporary changes in liver enzyme levels

Healthcare professionals will assess each patient individually to determine whether the medication is appropriate.

A Broader Shift in Menopause Care

The introduction of fezolinetant into NHS prescribing pathways reflects a growing recognition that menopause care should offer a wider range of evidence-based treatment options.

Hormone replacement therapy remains the most effective treatment for many menopausal symptoms, but it is not suitable or desirable for everyone. The availability of a targeted non-hormonal therapy provides clinicians with another option when supporting women whose symptoms significantly affect their daily lives.

As scientific understanding of menopause continues to evolve, treatments such as fezolinetant highlight increasing research into the neurological mechanisms behind hot flushes, opening the door to new approaches in menopause management.

A Comment from the Founder

Dee Murray, Founder of Menopause Experts Group, says the arrival of a non-hormonal treatment on the NHS will be welcomed by many women.

“While hormone replacement therapy remains the most effective treatment for menopausal symptoms for many women, there has always been a group who simply cannot take HRT due to medical reasons, or who choose not to use it.

For those women, the menopause conversation can sometimes feel as though it has moved forward without them. The availability of fezolinetant on the NHS brings some light relief and offers another option for women who have previously been left out of the hormone replacement discussion.

What matters most is that women have informed choice, and the more credible, evidence-based options available to clinicians and patients, the better menopause care becomes for everyone.”