A 'vital' new drug for hot flushes is now available: what does this mean for UK women?

The National Institute for Health and Care Excellence (NICE) greenlit the use of Veoza for women in the UK via the NHS this week.

Now authorised, it's thought that half a million women could benefit from the drug, also known as fezolinetant, where hormone replacement therapy (HRT) is not an option due to contraindication or preference. The 45mg tablet is taken once a day.

Unlike HRT, this drug is a non-hormonal option, and it exclusively eases vasomotor symptoms, which include night sweats and hot flushes. These symptoms are caused by changes to the brain's thermoregulatory zone as oestrogen declines. The drug works by blocking nerve pathways to this area.

It's thought that vasomotor symptoms are among the most common, affecting up to 70% of women, making Veoza a "game-changing" option, as HRT is not suitable for everyone. Those with a history of breast cancer, ovarian cancer, blood clots, or untreated high blood pressure are not eligible, for example.

However, NICE have said that fezolinetant is also not suitable for those with a history of oestrogen-dependent cancers or liver disease, as these groups were not included in the drug trials. Those who have had breast cancer and finished their treatment may be able to have it, but it will be down to individual assessment.

"We know that menopause hot flushes and night sweats can have a profound impact on quality of life and significantly affect overall wellbeing," says Helen Knight, director of medicines at NICE.

"For those who are unable to take HRT for varying reasons, options have historically been limited, and we have heard clearly from patients how difficult that can be," she says. "The evidence shows fezolinetant can meaningfully reduce symptoms, and was found to be cost-effective, offering value for the taxpayer. This decision will give much-needed relief to those for whom HRT is unsuitable.”

Dr Sue Mann, national clinical director in women’s health for NHS England, called it a "vital treatment option which could help hundreds of thousands of women experiencing menopause to better manage their symptoms and feel more in control of their health.”

Can I get Veoza on the NHS?

Yes, Veoza is available on the NHS via prescription when HRT is unsuitable. It has been recommended for the treatment of moderate to severe hot flushes and night sweats.

This decision by NICE is only applicable in England. Northern Ireland and Wales typically follow the same guidance, however. Scotland has the Scottish Medicines Consortium (SMC), which is separate, and this body has not recommended the drug for use on the NHS.

You can also buy Veoza with a private prescription.

Veoza vs HRT

For those eligible for both HRT and Veoza, discuss your options with your doctor, as they will be able to offer personalised advice.

This new drug is a suitable option for managing hot flushes and night sweats, giving those unable or not wanting hormone therapy another option. After decades of limited safe and effective alternative treatment options, despite the number of women affected, this is a win.

However, it's important to look at the options carefully. "The drug has not been directly compared in studies to HRT - the gold standard for treating menopausal hot flushes - nor has it been compared with other non-hormonal treatments either. Currently, there's a lack of evidence on the long-term (more than one year) efficacy and safety, and this drug has not been tested on all ages of menopausal women," says Dr Louise Newson, a menopause specialist.

"Crucially, fezolinetant also won't address the health risks associated with menopause. For example, it won't improve your bone density, reduce inflammation and protect our brains and cardiovascular system from the effects of low hormones. Only by correcting the hormone deficiency with natural, body-identical hormones will this be done," she says.

Much like when you take HRT or other HRT alternatives, the drug must be combined with other lifestyle interventions, such as changes to diet and exercise habits.