Veozah (Fezolinetant): A Nonhormonal Option for Hot Flashes

Veozah is the brand name for fezolinetant, a once-daily pill approved by the FDA in 2023 to treat moderate to severe vasomotor symptoms (the medical term for hot flashes and night sweats) caused by menopause. Unlike hormone therapy, it contains no estrogen or progesterone, which is why it is called a nonhormonal treatment.

It works on the brain's thermostat. During menopause, falling estrogen disrupts a group of neurons in the hypothalamus called KNDy neurons, which help regulate body temperature. These neurons use a signaling chemical called neurokinin B that acts on the NK3 receptor. Fezolinetant blocks that receptor, calming the overactive neurons and reducing how often the body triggers a hot flash.

Because it targets the temperature pathway directly rather than replacing hormones, Veozah is often considered by women who cannot take estrogen, such as some breast cancer survivors, or who simply prefer to avoid hormones. It is one of several nonhormonal choices; our guide to [SSRIs and SNRIs for hot flashes](/blog/ssris-snris-for-hot-flashes-nonhormonal-menopause-guide) covers other options in the same category.

In the SKYLIGHT trial program (SKYLIGHT 1, 2, and the SKYLIGHT 4 long-term safety study), fezolinetant 45 mg daily reduced hot flash frequency by about 60% and severity by about 40% at 12 weeks compared with placebo. Many women noticed improvement within the first week, and the benefit continued through the 52-week study period.

Those numbers describe meaningful, everyday relief: fewer flashes during the day and fewer sweats interrupting sleep at night. Better sleep alone can ripple into mood, focus, and energy, which is why treating hot flashes often helps with symptoms that seem unrelated. Still, results vary from person to person, and Veozah reduces symptoms rather than eliminating them entirely.

It is worth knowing what Veozah does not do. It is approved specifically for hot flashes and night sweats, not for other menopause concerns like bone loss or vaginal dryness, which are handled differently. If night sweats are your main problem, our article on [menopause night sweats](/blog/menopause-night-sweats-causes-and-how-to-stop-them) pairs well with this one for practical, sleep-focused strategies.

This is the most important safety point. In December 2024, the FDA added a boxed warning, its most prominent type of warning, about the risk of rare but serious liver injury with Veozah (FDA Drug Safety Communication, 2024). After the drug reached the market, cases of drug-induced liver injury were reported, including some serious enough to involve liver transplantation.

Because of this, the label now requires liver blood testing before you start Veozah and periodically while you take it. In the SKYLIGHT 4 safety study, roughly 1 to 2% of participants had elevated liver enzymes, which is why monitoring matters. You should stop the medication and contact your provider right away if you develop signs of liver problems such as yellowing of the skin or eyes (jaundice), dark urine, pale stools, nausea, unusual fatigue, or pain in the upper right belly.

This warning does not mean the drug is unsafe for everyone; it means it must be used with proper monitoring and honest conversation about your liver health. Your provider will review your history, order the required blood tests, and decide whether Veozah is a good fit. As with any menopause treatment, weighing benefits against risks is personal, the same balanced approach we describe in [when to start HRT](/blog/when-to-start-hrt-the-timing-hypothesis-explained).

Veozah is often considered for women with moderate to severe hot flashes who cannot or prefer not to use hormone therapy. That includes some breast cancer survivors, women with a history of blood clots, and those who simply want a nonhormonal path. It may also appeal to women who tried an SSRI or SNRI for hot flashes and did not get enough relief.

It is not for everyone. Because of the liver warning, it is generally avoided in people with known liver problems, and it is not used together with certain medications that interact with it (some drugs that affect liver enzymes). It is also not intended for women who are still able to become pregnant without appropriate discussion, and it does not treat mood, bone, or genital symptoms of menopause.

The honest takeaway is that Veozah fills a real gap for women who need nonhormonal relief, but it requires blood-test monitoring and a candid look at your health history. Comparing it against hormonal and other nonhormonal options with your provider is the right way to decide, and our overview of [acupuncture for menopause](/blog/acupuncture-for-menopause-does-it-help-hot-flashes) rounds out the nondrug side of the conversation.

Hormone therapy (HRT) replaces estrogen and is still the most effective treatment for hot flashes, and it also protects bone and helps genital symptoms. Veozah does not replace hormones and treats only the hot flashes and night sweats, but it is an option when estrogen is off the table or unwanted. In short, they solve overlapping but not identical problems.

Safety profiles differ too. HRT carries its own considerations around timing, clot risk, and personal history, while Veozah's headline concern is liver monitoring. Neither is universally "safer"; the better choice depends on your symptoms, medical history, and preferences. Many women find the decision clearer after seeing the trade-offs side by side with a provider.

If hormone therapy is something you are still weighing, our guides on [when to start HRT](/blog/when-to-start-hrt-the-timing-hypothesis-explained) and everyday [hot flash strategies](/blog/menopause-hot-flashes-causes-and-how-to-stop-them) can help you prepare questions. There is no single right answer, only the one that fits your body and your priorities.