For 80 years, the only real answer for hot flashes was “Estrogen.” If you couldn’t take estrogen, you were offered leftovers (antidepressants, nerve pills). In 2023, that changed. The FDA approved Veozah (Fezolinetant). This is not an antidepressant. It is not a hormone. It is an entirely new class of drug designed specifically for the biology of the hot flash.
The Science: The KNDy Neuron
To understand Veozah, you have to meet the KNDy Neurons (pronounced “Candy”). These are neurons in your hypothalamus (thermostat). Think of KNDy neurons as the “Heater Switch.”
- Estrogen is the finger that holds the switch OFF.
- Neurokinin B (NKB) is the chemical that flips the switch ON.
In a pre-menopausal woman, high estrogen keeps the switch held down. The heater stays off. In menopause, the estrogen finger disappears. Without that pressure, the Neurokinin B runs wild, flipping the switch ON constantly. Boom: Hot Flash.
How Veozah Works
Veozah is a Neurokinin 3 (NK3) Receptor Antagonist. It doesn’t replace the estrogen finger. Instead, it blocks the Neurokinin B. It puts a cap over the switch so it cannot be flipped on, even though there is no estrogen there. It creates a “cool blockage” in the brain.
The Results: In clinical trials, Veozah was impressive. It reduced moderate-to-severe hot flashes by over 60%, which is close to the efficacy of estrogen and far better than antidepressants. Crucially, it works fast. Many women feel relief within week one.
Who Is It For?
This is the “Holy Grail” for:
- Breast Cancer Survivors: It has zero hormonal activity. It does not touch estrogen receptors. It is theoretically safe for ER+ cancer patients (though long-term data is still being gathered, oncologists are largely optimistic).
- Stroke/Clot Survivors: No clot risk.
- Women who just don’t want hormones.
The Catch (There’s Always a Catch)
- The Liver: In rare cases, Veozah can stress the liver. You are required to have blood work (liver enzymes) done before starting, and then every 3 months for the first 9 months. If your liver markers spike, you have to stop.
- The Cost: As a brand-new patent drug, it is expensive (often $500+/month without insurance). Insurance coverage is improving, but it often requires a “Prior Authorization” proving that you tried and failed other options first.
- It’s a “One-Trick Pony”:
- Estrogen treats flashes, bones, brain, heart, and vagina.
- Veozah only treats flashes. It will not protect your bones. It will not fix vaginal dryness. You are paying a premium for a very specific fix.
But for a woman who is drenching her sheets five times a night and cannot take hormones, this pony is a prize winner.