What is the new drug instead of HRT? Veozah and Other Non-Hormonal Menopause Treatments

October 6, 2025 •

5 min read

Up to 80% of postmenopausal women experience moderate to severe hot flashes and night sweats, impacting their quality of life significantly. For those who cannot or choose not to use Hormone Replacement Therapy (HRT), the need for new, effective, non-hormonal solutions is pressing, leading many to ask: what is the new drug instead of HRT?.

Quick Summary

Fezolinetant (Veozah) is a new non-hormonal drug approved to treat menopausal hot flashes by targeting brain thermoregulation. Other pharmacological and lifestyle-based alternatives are also available for women seeking options other than HRT.

Key Points

Veozah (fezolinetant) is a new non-hormonal drug for hot flashes: Approved in 2023, it blocks a specific brain pathway (NK3) to regulate body temperature without using hormones.
Veozah requires liver monitoring: Patients taking Veozah must undergo blood tests before and during treatment to check for potential liver injury.
Other pharmacological alternatives exist: Established medications like SSRIs/SNRIs (antidepressants), gabapentin, and clonidine can also help manage hot flashes and other symptoms, often used off-label.
Elinzanetant is a potential future option: This investigational drug targets both NK3 and NK1 receptors, potentially addressing hot flashes, mood, and sleep issues.
Lifestyle changes are effective complements: Regular exercise, stress management techniques like CBT, and dietary modifications can significantly help reduce menopausal symptoms.
Not all women can take HRT: Health risks such as certain cancers or cardiovascular issues may make traditional hormone therapy unsuitable, highlighting the importance of these new alternatives.

For decades, Hormone Replacement Therapy (HRT) has been a primary treatment for menopausal symptoms like hot flashes and night sweats. However, HRT is not suitable for all women, particularly those with a history of certain cancers, blood clots, or cardiovascular disease, leading to a need for alternative options. In response, medical science has made significant strides in developing new, targeted, non-hormonal medications to address these debilitating symptoms.

The Rise of Targeted, Non-Hormonal Alternatives

Advances in understanding the neurobiology of menopause have paved the way for a new class of non-hormonal drugs. Rather than replacing lost hormones, these novel treatments target the specific brain pathways that regulate body temperature and cause hot flashes. This offers a promising solution for women who cannot use HRT due to medical reasons or personal preference.

Fezolinetant (Veozah): A Breakthrough Treatment

The most prominent and recent answer to the question, "what is the new drug instead of HRT?" is fezolinetant, sold under the brand name Veozah. Approved by the FDA in May 2023, it represents a significant milestone in women's health.

How Veozah Works

Unlike hormonal therapies, Veozah is a neurokinin 3 (NK3) receptor antagonist. During menopause, the decline in estrogen can lead to an overactivation of the NK3 pathway in the brain's thermoregulatory center, triggering hot flashes and night sweats. Veozah works by blocking this specific pathway, helping to restore normal body temperature regulation. This targeted mechanism provides a direct and effective approach to managing these symptoms without using hormones.

Important Safety Information

While effective, Veozah requires careful consideration of its side effects, including a potential risk of elevated liver transaminase, which can indicate liver injury.

Liver Monitoring: Patients are required to undergo blood tests to check for liver damage before starting Veozah and periodically thereafter.
Other Side Effects: Common side effects include abdominal pain, diarrhea, and insomnia.
Contraindications: It should not be used by patients with cirrhosis, severe renal damage, or end-stage renal disease.

Other Pharmacological Options for Menopause Symptoms

For many years, various other prescription medications have been used off-label (not specifically approved for menopause) to manage symptoms. These include:

Antidepressants (SSRIs/SNRIs): Certain low-dose antidepressants, such as paroxetine (Brisdelle, the only FDA-approved SSRI for hot flashes), venlafaxine (Effexor XR), and escitalopram, have been shown to reduce the frequency and severity of hot flashes. They can also help with mood changes often associated with menopause.
Gabapentin (Neurontin): Primarily used for nerve pain and seizures, gabapentin can also be effective in reducing hot flashes, especially in women who experience significant sleep disturbances.
Clonidine (Catapres): This blood pressure medication can help reduce hot flashes and night sweats by acting on the central nervous system. However, it can have side effects like dry mouth, drowsiness, and dizziness.
Oxybutynin (Ditropan): A drug for overactive bladder, oxybutynin has also been found to be useful in managing hot flashes, though higher doses may increase the risk of side effects like dry mouth.

The Horizon of New Therapies: Elinzanetant

Beyond Veozah, other novel non-hormonal medications are on the horizon. Elinzanetant, currently under review by the FDA, is another NK3 antagonist, but it also targets the NK1 receptor, which is involved in regulating mood and sleep. Early clinical trials suggest it may reduce hot flashes and improve sleep quality, offering another potential tool in the menopause treatment toolkit.

Lifestyle and Complementary Approaches

For women seeking non-pharmaceutical options, many lifestyle and complementary therapies can help manage symptoms.

Regular Exercise: Can help manage weight, improve mood, and potentially reduce hot flashes.
Stress Management: Techniques like mindfulness, meditation, and Cognitive Behavioral Therapy (CBT) have shown effectiveness in reducing menopausal anxiety, mood swings, and hot flash severity.
Dietary Adjustments: Reducing caffeine, alcohol, and spicy foods may help minimize hot flash triggers. A diet rich in fruits, vegetables, and whole grains can support overall health.
Acupuncture: Some studies suggest that acupuncture may reduce the frequency and severity of hot flashes, though evidence is mixed.
Vaginal Lubricants/Moisturizers: Over-the-counter products can effectively manage vaginal dryness, a common menopausal symptom.

Comparison of Key Menopause Treatments


Treatment	Mechanism of Action	Key Benefits	Side Effects	Key Considerations
Veozah (Fezolinetant)	Non-hormonal NK3 receptor antagonist; blocks brain pathway that regulates body temperature.	Reduces frequency and severity of hot flashes.	Abdominal pain, diarrhea, insomnia, potential liver enzyme elevation.	Requires liver monitoring; first-in-class non-hormonal option.
SSRIs/SNRIs	Non-hormonal modulation of serotonin and norepinephrine levels in the brain.	Reduces hot flashes and improves mood.	Nausea, headache, sexual dysfunction.	Often used off-label; Brisdelle is FDA-approved specifically for hot flashes.
Transdermal HRT (e.g., Patches)	Delivers estrogen through the skin, replenishing hormones.	Most effective treatment for hot flashes; avoids "first-pass" liver effect.	Slightly increased risk of blood clots with oral versions; patches lower this risk.	Gold standard for effectiveness; suitable for many but not all women.
Gabapentin	Non-hormonal anticonvulsant that modulates calcium channels.	Reduces hot flashes and helps with sleep.	Dizziness, drowsiness.	Used off-label; good for women with sleep issues or nerve pain.

Finding the Right Path

With new and existing options available, women have more choices than ever for managing menopausal symptoms. The decision on the best treatment should always be made in consultation with a healthcare provider, considering individual health history, symptom severity, and preferences. The emergence of targeted, non-hormonal drugs like Veozah provides a significant and promising new tool, especially for those unable to use HRT. This allows for a more personalized and holistic approach to women's health during the menopausal transition.

For more information on Veozah and other new hormone-free treatments, you can consult reputable sources like BreastCancer.org, which discusses its relevance for those who cannot use HRT after certain treatments.

Note: While new treatments are exciting, they are not without potential side effects or costs. It is crucial to have an open and honest conversation with your doctor about all available options to determine the safest and most effective approach for you.

Conclusion

The landscape of menopausal symptom management is evolving, moving beyond HRT to include a new generation of targeted, non-hormonal medications. Fezolinetant (Veozah) is a notable example, offering a specific mechanism to address hot flashes. This, along with other established non-hormonal pharmacological options, lifestyle changes, and promising new drugs like elinzanetant, gives women more personalized and safer alternatives. This diversification of treatments ensures that every woman can find an effective strategy to manage menopause, improving her quality of life and overall well-being.

Frequently Asked Questions

Veozah, the brand name for fezolinetant, is a non-hormonal, once-daily pill approved by the FDA to treat moderate to severe hot flashes caused by menopause. It works by blocking the neurokinin 3 (NK3) receptor in the brain, which helps regulate body temperature, thus reducing the frequency and severity of hot flashes.

Veozah is an important alternative for women who cannot or choose not to take HRT. This includes women with a history of hormone-sensitive cancers (like breast cancer), blood clots, or certain cardiovascular conditions.

The most commonly reported side effects of Veozah include abdominal pain, diarrhea, insomnia, and back pain. Patients should also be aware of the risk of elevated liver enzymes and will need regular blood work to monitor liver function.

Certain antidepressants, like SSRIs and SNRIs, can help manage hot flashes by affecting levels of serotonin and norepinephrine in the brain, which are involved in thermoregulation. This can be beneficial for women who need treatment for mood changes alongside hot flashes.

While some women find relief with complementary therapies like acupuncture or certain herbs (e.g., black cohosh, soy isoflavones), the FDA has not approved most herbal remedies for menopausal symptoms. Evidence of effectiveness is mixed, and potential side effects or interactions with other medications should be discussed with a healthcare provider.

Elinzanetant is a non-hormonal drug currently under investigation for menopausal symptoms. Like Veozah, it blocks the NK3 receptor. However, it also targets the NK1 receptor, which may help improve mood and sleep, offering a potentially broader range of benefits.

Many lifestyle adjustments can help. Regular exercise can reduce hot flashes and improve mood, while stress management techniques like Cognitive Behavioral Therapy (CBT) can address anxiety and sleep issues. Avoiding triggers like caffeine, alcohol, and spicy foods can also be beneficial.

Veozah has been shown to reduce hot flashes over the long term, with studies showing continued benefits for at least six months and up to a year. However, long-term safety is still being evaluated, and ongoing discussion with a doctor is necessary.