Veozah for Menopause: A Comprehensive Guide for Women Navigating Perimenopause and Menopause

What Is Veozah?

Veozah (fezolinetant) is a prescription, non-hormonal medication used to treat moderate to severe vasomotor symptoms (VMS) associated with menopause. Vasomotor symptoms include hot flashes and night sweats, which can interfere with sleep, work, and everyday life.

Veozah is different from hormone therapy (HRT) because it does not contain estrogen or another hormone. Instead, it belongs to a class of medications called neurokinin 3 (NK3) receptor antagonists. It works on a signaling pathway in the brain involved in regulating body temperature.

How Does Veozah Work?

During the menopause transition, changes in estrogen levels affect the brain's temperature-regulation system. A group of neurons in the hypothalamus called KNDy neurons plays an important role in this process. These neurons release neurokinin B (NKB), which acts on neurokinin 3 (NK3) receptors.

When this signaling pathway becomes overactive, the body's temperature-control system can become more sensitive to small changes in temperature. This is thought to contribute to hot flashes and night sweats.

Veozah blocks NK3 receptors, reducing the effects of neurokinin B signaling. By targeting this pathway, Veozah can reduce the frequency and severity of moderate to severe vasomotor symptoms. Learn more about estradiol, progesterone, and how HRT works.

Unlike HRT, Veozah does not replace estrogen. It targets a different biological pathway involved in vasomotor symptoms.

Does Veozah Work?

Yes. Randomized clinical trials have found that fezolinetant significantly reduces the frequency and severity of moderate to severe vasomotor symptoms compared with placebo.

In the phase 3 SKYLIGHT 1 trial, women taking fezolinetant 45 mg experienced significantly greater reductions in the frequency and severity of vasomotor symptoms than women taking placebo at both 4 and 12 weeks. Improvements were observed as early as the first week and were maintained during the longer-term study period.

Pooled results from the SKYLIGHT 1 and SKYLIGHT 2 trials also found that fezolinetant reduced vasomotor symptoms across a range of participant characteristics, including age, race, smoking status, and alcohol use.

The clinical trials also found improvements in menopause-related quality of life among women treated with fezolinetant.

Individual results vary. Clinical trial results describe what happened across groups of participants and cannot predict exactly how much symptom relief one person will experience.

How Quickly Does Veozah Work?

Some women may notice improvement within the first week of treatment. In clinical trials, statistically significant reductions in vasomotor symptom frequency and severity were demonstrated by week 4 and continued through week 12.

That does not mean everyone will experience noticeable relief within the same timeframe. Your response can depend on your symptoms, overall health, and other factors.

Starting Veozah? Track your symptoms while you're starting treatment. Keeping a record of your hot flashes and night sweats can help you see whether their frequency, severity, or timing changes after starting Veozah. Use the MenoHello Hot Flash Diary to track your symptoms over time.

What Symptoms Does Veozah Treat?

Veozah is FDA-approved to treat moderate to severe vasomotor symptoms due to menopause. This includes hot flashes and night sweats.

Reducing hot flashes and night sweats may also improve sleep and quality of life when those symptoms are disrupting rest. Clinical trials of fezolinetant have reported improvements in menopause-related quality of life.

However, Veozah is not a general treatment for every symptom associated with menopause. If you are dealing with vaginal or urinary symptoms, bone loss, or other menopause-related concerns, you may need a different treatment or an additional approach.

Veozah Is a Non-Hormonal Treatment

Veozah does not contain estrogen and does not work by replacing declining hormone levels. That makes it a different type of treatment from systemic hormone therapy.

A non-hormonal option may be particularly relevant for someone who cannot use hormone therapy, does not want to use hormones, or is considering alternatives to HRT. However, whether Veozah is appropriate depends on your individual medical history and the medications you take.

Having a history of a condition that may affect whether hormone therapy is appropriate does not automatically mean Veozah is the right choice. Your healthcare provider can help you compare treatment options based on your specific situation.

Need help finding someone who specializes in menopause? See our guide to finding a menopause specialist.

How Do You Take Veozah?

The FDA-approved dose of Veozah is 45 mg once daily. It can be taken with or without food, preferably at about the same time each day. The tablet should be swallowed whole rather than cut, crushed, or chewed.

If you miss a dose, the FDA patient information says to take it as soon as possible on the same day as long as there are at least 12 hours before the next scheduled dose. Otherwise, skip the missed dose and return to your normal schedule the following day.

Veozah and Liver Safety

Veozah has an FDA boxed warning for the risk of rare but serious liver injury. This is the most important safety issue to understand before starting treatment. The FDA added the boxed warning in December 2024 after postmarketing reports of serious liver injury.

Liver Testing Before and During Treatment

Your healthcare provider should perform liver blood tests before you start Veozah. The current prescribing information then calls for follow-up liver testing:

• Monthly during the first 3 months
• Again at month 6
• Again at month 9

Additional liver testing may be needed if you develop symptoms that could indicate liver injury.

Your healthcare provider may decide not to start Veozah if your baseline liver tests are too high. The FDA labeling specifically says not to start treatment if either aminotransferase is at least twice the upper limit of normal or if total bilirubin is at least twice the upper limit of normal for the testing laboratory.

Signs of Possible Liver Injury

Stop taking Veozah and contact your healthcare provider immediately if you develop symptoms that could indicate liver injury, including:

• Unusual or new fatigue
• Loss of appetite
• Nausea or vomiting
• Itching
• Yellowing of the skin or eyes (jaundice)
• Pale-colored stools
• Dark urine
• Abdominal pain, particularly pain in the upper right abdomen

The FDA recommends prompt evaluation, including liver blood tests, when these symptoms occur.

What Are the Side Effects of Veozah?

Like any prescription medication, Veozah can cause side effects. The most common adverse reactions reported in clinical trials included:

• Abdominal pain
• Diarrhea
• Insomnia
• Back pain
• Hot flushes
• Elevated liver enzymes

Not everyone experiences these side effects, and this is not a complete list of possible adverse reactions. Talk with your healthcare provider if you develop a side effect that concerns you or does not go away.

Veozah Drug Interactions

Veozah should not be taken with medications that are CYP1A2 inhibitors. These medications can increase the amount of fezolinetant in the body and may increase the risk of adverse effects.

Tell your healthcare provider and pharmacist about every medication, vitamin, supplement, and herbal product you take so they can check for potential interactions.

Who Should Not Take Veozah?

The FDA labeling lists three specific contraindications. Veozah should not be used by people who:

• Have cirrhosis
• Have severe renal impairment or end-stage renal disease
• Are taking a CYP1A2 inhibitor

You should also tell your healthcare provider if you have liver disease, other liver problems, or kidney problems. Your provider can determine whether Veozah is appropriate based on your medical history and current medications.

What About Breast Cancer or Other Conditions That May Make HRT Complicated?

Because Veozah is not a hormone, it may be considered as a non-hormonal treatment option for someone who cannot or does not want to use hormone therapy. This can include some people for whom hormone therapy is not appropriate because of their medical history.

However, having a particular medical condition does not automatically make Veozah appropriate or eliminate the need for medical guidance. If you have a history of breast cancer, cardiovascular disease, blood clots, liver disease, or another significant medical condition, discuss your treatment options with the healthcare professional managing your care.

How Long Can You Take Veozah?

Clinical studies have evaluated fezolinetant for up to 52 weeks and found that reductions in vasomotor symptoms were maintained during longer-term treatment.

How long you should continue treatment is an individual decision. Your healthcare provider can help you weigh your symptom relief, side effects, liver-test results, other health considerations, and available treatment alternatives.

What If Veozah Doesn't Work Well Enough?

Not every treatment works equally well for every person. If your hot flashes or night sweats remain bothersome while taking Veozah, talk with your healthcare provider rather than changing the dose or stopping treatment on your own.

Your provider may review how you are taking the medication, check for other causes of your symptoms, review other medications you take, or discuss alternative or additional treatment options.

How Much Does Veozah Cost?

The cost of Veozah can vary substantially depending on your insurance coverage, pharmacy, and eligibility for manufacturer savings programs. Because prices and savings programs can change, we've separated current pricing information from this medical guide. See current Veozah pricing, insurance coverage, and savings options.

Depending on your plan and the specific expense, some menopause-related healthcare and medications may be eligible for FSA or HSA funds. See our FSA/HSA guide for menopause medications and products.

Looking for more ways to reduce prescription costs? See our 10 ways to save money on menopause treatment, including insurance, discount programs and other cost-saving strategies.

Questions to Ask Your Healthcare Provider About Veozah

1. Is Veozah appropriate for my medical history?
2. Do I need any liver or kidney testing before starting it?
3. What liver tests will I need, and when will they be repeated?
4. Could any of my medications, vitamins, or supplements interact with Veozah?
5. What symptoms should prompt me to stop taking Veozah and contact you?
6. How will we determine whether Veozah is working for me?
7. What should I do if I miss a dose?
8. What other treatment options are available if Veozah does not provide enough relief?
9. How long should I continue treatment?

Need help finding someone who specializes in menopause? See our guide to finding a menopause specialist.

The Bottom Line

Veozah is a non-hormonal prescription medication specifically approved for moderate to severe vasomotor symptoms associated with menopause. It works by blocking NK3 receptors involved in the brain's temperature-regulation pathway rather than replacing estrogen.

Clinical trials have shown that fezolinetant can significantly reduce the frequency and severity of hot flashes and night sweats, with improvements seen as early as the first week in clinical studies.

Veozah also has an important safety consideration: the FDA requires liver testing before treatment and at specific intervals during the first nine months because of the risk of rare but serious liver injury.

Whether Veozah is right for you depends on your symptoms, medical history, medications, treatment preferences, and how you respond to the medication. It is one option among several evidence-based approaches to managing menopausal vasomotor symptoms.

This article is for informational purposes only and does not constitute medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Individual results may vary.

Symptom Relief

Managing menopause symptoms can feel overwhelming, especially when effective solutions seem hard to find. From unexpected skin changes to frustrating hot flashes, these shifts can impact daily life and overall well-being. Explore our Symptom Relief page to discover products that other women have found helpful in managing their symptoms of perimenopause and menopause.

If you're tracking more than hot flashes, explore the MenoHello Symptom Tracking Toolkit for additional ways to document symptoms and patterns.

If you’ve found a product that has made a difference for you, let us know through our contact form—we’d love to share it with others!

Explore More

Want to dive deeper into menopause and its symptoms? Visit our Resources page, where you’ll find a collection of studies, articles, and books from trusted experts. Whether you're looking for the latest research or practical insights, these resources can help you better understand your body and make informed decisions about your menopause journey.

Dive Deeper Into Menopause

References

1. U.S. Food and Drug Administration. (2024). VEOZAH (fezolinetant) Prescribing Information.
2. U.S. Food and Drug Administration. (2024). FDA Adds Warning About Rare Occurrence of Serious Liver Injury with Use of Veozah (Fezolinetant) for Hot Flashes Due to Menopause.
3. 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. The Lancet, 401(10382), 1091–1102.
4. U.S. Food and Drug Administration. (2023). FDA Approves Novel Drug to Treat Moderate to Severe Hot Flashes Caused by Menopause.
5. U.S. Food and Drug Administration. (2023). Drug Trials Snapshots: VEOZAH (fezolinetant).
6. St. Onge E. (2023). Fezolinetant: A New Nonhormonal Treatment for Vasomotor Symptoms.
7. Australian Prescriber. (2024). Fezolinetant for moderate to severe vasomotor symptoms associated with menopause.

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