Hot flushes and night sweats – collectively called vasomotor symptoms – are among the most common and disruptive symptoms of menopause. They affect almost 40% of women in the lead up to menopause, known as perimenopause.Until 2024, treatment options were largely limited to hormone replacement therapy (HRT). HRT is very effective for many women. But some can’t take it because they experience significant side effects or have certain health conditions. Veoza (fezolinetant) is a drug approved specifically for menopausal vasomotor symptoms. Unlike HRT, it doesn’t replace naturally declining hormones. Instead, it blocks signals in the bran’s temperature-control system, which becomes overactive during menopause.How does it work?Estrogen is involved in temperature regulation, generally acting to lower body temperature. During perimenopause, declining estrogen levels triggers the activation of a group of brain cells in the hypothalamus known as KNDy (pronounced candy) cells.When activated, these cells release a signalling molecule called neurokinin B. This over-stimulates the brain’s temperature regulation system, triggering hot flushes and night sweats.Veoza blocks the neurokinin 3 receptor (NK3) which means neurokinin B cannot bind to it. This prevents neurokinin B from delivering its signal and quietens the overactive temperature-control pathway.How is it used in Australia?Veoza was approved for use in Australia in March 2024 as a 45mg tablet daily.It’s not subsidised through the Pharmaceutical Benefits Scheme (PBS), meaning women pay A$75–80 per month for prescriptions. There is currently no maximum treatment duration.What can and can’t it do?Hot flushes and night sweats don’t just impact temperature – they can affect sleep, mood and daytime function. So while Veoza specifically treats vasomotor symptoms, there may be benefits for other symptoms.But menopause is much more than just hot flushes and night sweats. Because Veoza doesn’t replace hormones such as estrogen, it doesn’t treat most mood symptoms, vaginal dryness, reduced bone density or other consequences of estrogen deficiency. HRT remains the preferred treatment when women have these broader symptoms. HRT replaces the estrogen (and typically progesterone) lost during menopause, improving a wide range of menopausal symptoms, while also helping to maintain bone health. Whether Veoza can be used in combination with HRT may depend on the individual and should be discussed with your doctor. Most clinical evidence today has evaluated Veoza as an alternative to, rather than in combination with HRT. Read more: What are the most common symptoms of menopause? And which can hormone therapy treat? Why choose a non-hormonal option?Veoza takes a non-hormonal approach, offering a valuable alternative for women who are unable to take HRT due to side effects or have certain hormone-sensitive cancers. A large survey conducted across Europe, UK, US and Japan found that, of the women who had vasomotor symptoms, one in ten couldn’t take HRT, highlighting the need for alternative treatments. Veoza may also be an attractive option for women whose main concern is vasomotor symptoms.How effective is Veoza?Veoza is effective for many women but it doesn’t stop symptoms completely. The safety and efficacy of Veoza has been tested in three studies involving more than 3,000 women experiencing moderate to severe vasomotor symptoms. In two large clinical trials, three months of treatment reduced symptoms from about 10–12 moderate-to-severe hot flushes or night sweats each day to about 4–5 in women taking Veoza. This compared with 6–7 in women taking placebo (an inactive pill). Another trial found Veoza also reduced sleep disturbances and improved quality of life in women considered not suitable for HRT. However, one trial conducted in East Asia found the lower 30mg dose was safe and well tolerated, but no more effective than placebo. Overall, Veoza appears to provide meaningful, though not complete, relief.What are the side effects and other risks?The most commonly reported side effects include headache, nausea, abdominal pain and insomnia. Rare cases of liver injury have also been reported. Australian and international regulators now recommend liver function testing before treatment and regular monitoring during the first nine months of therapy. Veoza may also interact with other medications, which may either affect how those medications work, or how Veoza works. This includes the antidepressant fluvoxamine. Veoza doesn’t prevent pregnancy, so women who are still fertile may still require contraception. Read more: Perimenopause usually begins in your 40s. How do you know if it has started? What’s next for these medications?Clinical trials have now demonstrated Veoza effectively reduces hot flushes out to one year. But researchers are continuing to monitor how well the drug works in real-world scenarios, including effectiveness beyond one year, long-term safety, rare side effects and effectiveness in women with complex medical conditions who are often excluded from clinical trials.Newer, safer drugs are also emerging, including Lynkuet (elinzanetant). This targets both NK1 and NK3 and was approved in September 2025 to treat vasomotor symptoms associated with menopause. Clinical trials in more than 1,500 women showed Lynkuet reduced vasomotor symptoms, sleep and quality of life, including in women who couldn’t take HRT. Lynkuet also seems to have a better liver safety profile compared to Veoza. It may also be used in future in other populations, where medications are needed to target the neurokinin system. Up to 80% of men undergoing androgen deprivation therapy for prostate cancer report hot flashes. Clinical trials are underway to assess the benefit of Veoza for hot flashes associated with prostate cancer.Robyn Brown receives funding from the National Health and Medical Research Council (NHMRC). Leigh Walker receives funding from the National Health and Medical Research Council (NHMRC), Australian Research Council (ARC), CASS Foundation and Brain Behaviour Research Foundation (BBRF).