Fezolinetant (Veozah): A Non-Hormonal Option
SaveFezolinetant (Veozah) is a non-hormonal pill for moderate-to-severe menopausal hot flashes, approved by the FDA in 2023. It blocks a neurokinin-3 brain receptor that helps regulate body temperature and, in two phase 3 trials, cut hot-flash frequency and severity more than placebo. It requires periodic liver-enzyme monitoring.
Last updated: July 2026
What is fezolinetant and how does it work?
Fezolinetant is a non-hormonal medicine that targets the brain circuit behind hot flashes rather than replacing estrogen. As estrogen falls in menopause, certain hypothalamus neurons become overactive and disrupt the body's temperature set point, producing flashes. Fezolinetant blocks the neurokinin-3 receptor on those neurons, helping restore temperature control 3Ref 3The North American Menopause Society (Menopause Society) (2023).The 2023 nonhormone therapy position statement of The North American Menopause Society.Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.. The North American Menopause Society describes it as the first drug in this class approved specifically for vasomotor symptoms, offering an option for women who cannot or prefer not to use hormones 3Ref 3The North American Menopause Society (Menopause Society) (2023).The 2023 nonhormone therapy position statement of The North American Menopause Society.Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.. Sold as Veozah, it is a once-daily oral tablet approved by the FDA in 2023 3Ref 3The North American Menopause Society (Menopause Society) (2023).The 2023 nonhormone therapy position statement of The North American Menopause Society.Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.. Because it contains no estrogen or progestogen, it does not carry the hormone-related considerations that shape decisions about menopausal hormone therapy.
How well does fezolinetant work?
Two large phase 3 trials, SKYLIGHT 1 and SKYLIGHT 2, tested fezolinetant against placebo in women with moderate-to-severe hot flashes. Both found that it significantly reduced the frequency and severity of vasomotor symptoms compared with placebo, with improvement measurable by week 4 and maintained through 12 weeks 1Ref 1Lederman S, Ottery FD, Cano A, et al. (2023).Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study.In the SKYLIGHT 1 phase 3 trial in postmenopausal women, fezolinetant reduced the frequency and severity of moderate-to-severe hot flashes versus placebo, with improvement by week 4, and reversible liver-enzyme elevations informing monitoring.2Ref 2Johnson KA, Martin N, Nappi RE, et al. (2023).Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause: a phase 3 RCT.The SKYLIGHT 2 phase 3 randomized trial confirmed that fezolinetant reduced vasomotor symptom frequency and severity compared with placebo through 12 weeks in postmenopausal women.. The trials enrolled postmenopausal women, so its role earlier in the perimenopausal transition is less studied, and it is not used in adolescence 1Ref 1Lederman S, Ottery FD, Cano A, et al. (2023).Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study.In the SKYLIGHT 1 phase 3 trial in postmenopausal women, fezolinetant reduced the frequency and severity of moderate-to-severe hot flashes versus placebo, with improvement by week 4, and reversible liver-enzyme elevations informing monitoring.2Ref 2Johnson KA, Martin N, Nappi RE, et al. (2023).Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause: a phase 3 RCT.The SKYLIGHT 2 phase 3 randomized trial confirmed that fezolinetant reduced vasomotor symptom frequency and severity compared with placebo through 12 weeks in postmenopausal women.. For perspective, hormone therapy remains the most effective single treatment for hot flashes, cutting frequency by roughly 75% for many women, so fezolinetant is often framed as a strong non-hormonal alternative rather than a replacement for hormones 4Ref 4The North American Menopause Society (Menopause Society) (2022).The 2022 Hormone Therapy Position Statement of The North American Menopause Society.Hormone therapy remains the most effective treatment for vasomotor symptoms, reducing frequency by roughly 75% for many women, which frames fezolinetant as a non-hormonal alternative.. Comparing it with other ways to stop hot flashes helps set expectations.
What are the side effects and liver monitoring?
Fezolinetant is generally well tolerated, but it carries a specific liver-safety requirement. In the phase 3 trials, some participants had reversible increases in liver enzymes, which is why liver blood tests are checked before starting and periodically during treatment 1Ref 1Lederman S, Ottery FD, Cano A, et al. (2023).Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study.In the SKYLIGHT 1 phase 3 trial in postmenopausal women, fezolinetant reduced the frequency and severity of moderate-to-severe hot flashes versus placebo, with improvement by week 4, and reversible liver-enzyme elevations informing monitoring.2Ref 2Johnson KA, Martin N, Nappi RE, et al. (2023).Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause: a phase 3 RCT.The SKYLIGHT 2 phase 3 randomized trial confirmed that fezolinetant reduced vasomotor symptom frequency and severity compared with placebo through 12 weeks in postmenopausal women.. Common side effects reported in studies included headache, abdominal pain, diarrhea, and trouble sleeping, and most were mild 1Ref 1Lederman S, Ottery FD, Cano A, et al. (2023).Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study.In the SKYLIGHT 1 phase 3 trial in postmenopausal women, fezolinetant reduced the frequency and severity of moderate-to-severe hot flashes versus placebo, with improvement by week 4, and reversible liver-enzyme elevations informing monitoring.. It is not used in people with known cirrhosis or significant kidney impairment, and a clinician reviews other medicines for interactions. Because monitoring and eligibility matter, fezolinetant is a shared decision rather than an over-the-counter fix. Understanding menopause symptoms and your overall health history helps frame whether it is a sensible fit.
Who might consider fezolinetant?
Fezolinetant is aimed at women with moderate-to-severe menopausal hot flashes who want a non-hormonal option. That includes people who cannot use hormone therapy — for example, some breast cancer survivors or those with a history of blood clots — and those who simply prefer to avoid hormones 3Ref 3The North American Menopause Society (Menopause Society) (2023).The 2023 nonhormone therapy position statement of The North American Menopause Society.Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.4Ref 4The North American Menopause Society (Menopause Society) (2022).The 2022 Hormone Therapy Position Statement of The North American Menopause Society.Hormone therapy remains the most effective treatment for vasomotor symptoms, reducing frequency by roughly 75% for many women, which frames fezolinetant as a non-hormonal alternative.. It is one of several evidence-based non-hormonal choices; certain antidepressants for hot flashes and cognitive behavioral therapy are others, and the best pick depends on your health profile, other symptoms, and cost or coverage 3Ref 3The North American Menopause Society (Menopause Society) (2023).The 2023 nonhormone therapy position statement of The North American Menopause Society.Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.. Because hot flashes can last a median of more than 7 years, having a durable option matters 5Ref 5Avis NE, Crawford SL, Greendale G, et al. / Study of Women's Health Across the Nation (SWAN) (2015).Duration of menopausal vasomotor symptoms over the menopause transition.Frequent vasomotor symptoms lasted a median of 7.4 years in the SWAN cohort, underscoring why a durable treatment option matters.. A clinician weighs benefits, the liver-monitoring commitment, and alternatives with you.
When fezolinetant questions need a menopause clinician
A gynecologist or menopause-focused clinician can determine whether fezolinetant is appropriate and arrange the required liver testing. That conversation is worthwhile when hot flashes are moderate-to-severe, when hormones are unsuitable or unwanted, and when you want to compare non-hormonal options side by side. It helps to review how long menopause symptoms last so you can plan for treatment duration and follow-up. Bring your full medication list, any liver or kidney history, and a record of how often flashes occur. Gale can help you prepare for that conversation.
Common questions
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Using fezolinetant safely
- —Yellowing of the skin or eyes, dark urine, or right-upper-abdomen pain is a reason to seek prompt clinician review for possible liver injury
- —Nausea, unusual fatigue, or loss of appetite during treatment is a reason to seek clinician review and liver testing
- —Missing scheduled liver blood tests is a reason to contact your prescriber before continuing
- —Hot flashes that stay severe despite treatment are a reason to seek clinician review of alternatives
This article is general health education, not medical advice. Whether fezolinetant is appropriate, and how it should be monitored, is a decision for a prescribing clinician such as a gynecologist or menopause specialist.
References
- 1.Lederman S, Ottery FD, Cano A, et al. (2023). Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study. Lancet. doi:10.1016/S0140-6736(23)00085-5 ✓In the SKYLIGHT 1 phase 3 trial in postmenopausal women, fezolinetant reduced the frequency and severity of moderate-to-severe hot flashes versus placebo, with improvement by week 4, and reversible liver-enzyme elevations informing monitoring.
- 2.Johnson KA, Martin N, Nappi RE, et al. (2023). Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause: a phase 3 RCT. Journal of Clinical Endocrinology & Metabolism. doi:10.1210/clinem/dgad058 ✓The SKYLIGHT 2 phase 3 randomized trial confirmed that fezolinetant reduced vasomotor symptom frequency and severity compared with placebo through 12 weeks in postmenopausal women.
- 3.The North American Menopause Society (Menopause Society) (2023). The 2023 nonhormone therapy position statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000002200 ✓Fezolinetant is a neurokinin-3 receptor antagonist and an evidence-based non-hormonal option for vasomotor symptoms, alongside cognitive behavioral therapy and certain antidepressants.
- 4.The North American Menopause Society (Menopause Society) (2022). The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. doi:10.1097/GME.0000000000002028 ✓Hormone therapy remains the most effective treatment for vasomotor symptoms, reducing frequency by roughly 75% for many women, which frames fezolinetant as a non-hormonal alternative.
- 5.Avis NE, Crawford SL, Greendale G, et al. / Study of Women's Health Across the Nation (SWAN) (2015). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Internal Medicine. doi:10.1001/jamainternmed.2014.8063 ✓Frequent vasomotor symptoms lasted a median of 7.4 years in the SWAN cohort, underscoring why a durable treatment option matters.
5 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy