"Should I try Veozah or start hormone replacement therapy?"
Your hot flashes are making you miserable, you're desperate for relief, but you're stuck between two very different treatment paths—and your doctor may not have time to explain the nuances.
Here's what makes this decision so challenging: Both Veozah and HRT can dramatically reduce hot flashes. But they work completely differently, have different risk profiles, different costs, and work better for different women.
This isn't a simple "one is better" situation. The right choice depends on your specific health history, risk factors, age, symptom severity, and personal preferences.
In this comprehensive guide, we're breaking down everything you need to know to make an informed decision:
- How each treatment actually works (in plain English)
- Real-world effectiveness: what the studies show vs. what women report
- Safety profiles and side effects: the good, bad, and unexpected
- Cost comparison: from insurance copays to out-of-pocket expenses
- Who's the ideal candidate for each treatment
- Can you switch between them? Can you use both?
- Expert opinions and what doctors are recommending in 2025
By the end, you'll have the clarity to have a productive conversation with your doctor about which option makes sense for you.
The Quick Comparison Table
Here's the high-level overview, then we'll dive deep into each aspect:
| Factor | Veozah | HRT (Estrogen) |
|---|---|---|
| How it works | Blocks temperature regulation signals in brain | Replaces declining estrogen |
| Hormones? | No (non-hormonal) | Yes (hormonal) |
| Hot flash reduction | 50-60% | 70-90% |
| Other symptoms helped | Hot flashes, night sweats only | Nearly all menopause symptoms |
| Who can use it | Most women, including cancer survivors | Women without estrogen-sensitive cancers or clotting disorders |
| Cost with insurance | $0-150/month ($0 with co-pay card) | $10-100/month |
| Cost without insurance | $550-650/month | $30-200/month |
| Side effects | Stomach upset, insomnia, liver monitoring required | Breast tenderness, bloating, headaches (usually temporary) |
| Long-term benefits | Hot flash relief only | Bone protection, heart health, skin/hair health, brain health |
| Start working | 4-8 weeks | 2-4 weeks |
| FDA approved since | 2023 | 1940s-2000s (various formulations) |
How They Work: The Science Made Simple
How Veozah Works
The technical explanation:
Veozah (fezolinetant) is a neurokinin-3 (NK3) receptor antagonist. It blocks signals in the hypothalamus—your brain's temperature control center—that trigger hot flashes.
The simple explanation:
Think of hot flashes like a faulty thermostat. During menopause, certain brain signals go haywire, making your body think it's overheating when it's not. Veozah essentially tells those faulty signals to quiet down.
What Veozah does NOT do:
- Replace hormones
- Affect your ovaries
- Change your estrogen levels
- Treat any other menopause symptoms beyond hot flashes
The key advantage: You get hot flash relief without hormones, which matters if you can't or don't want to take estrogen.
How HRT Works
The technical explanation:
HRT replaces the estrogen (and sometimes progesterone) your ovaries stop producing during menopause. Estrogen regulates temperature control, so replacing it stops hot flashes at their source.
The simple explanation:
Menopause symptoms happen because your estrogen drops. HRT gives your body back the estrogen it's missing, which turns off the hot flash switch—along with improving 30+ other symptoms.
What HRT DOES do:
- Replace declining hormones
- Treat hot flashes AND night sweats, mood changes, vaginal dryness, brain fog, sleep issues, joint pain, and more
- Protect bones (prevents osteoporosis)
- Support heart health (when started at the right time)
- Maintain skin elasticity and collagen
- Support cognitive function
The key advantage: Comprehensive symptom relief plus long-term health benefits—not just hot flash management.
Effectiveness: What the Numbers Show
Veozah Effectiveness Data
Clinical trial results:
- Reduces hot flashes by 50-60% on average
- Women went from ~10 hot flashes daily to ~4-5 daily
- Reduces severity of hot flashes by about 50%
- Works within 4 weeks, maximum benefit by 8-12 weeks
What real women report:
- Some women: "Life-changing, reduced hot flashes by 80%"
- Many women: "Noticeable improvement, down from severe to moderate"
- Some women: "Helped but didn't eliminate them completely"
- A few women: "Didn't work well for me"
Success rate: About 70-80% of women experience meaningful improvement
Important note: Veozah ONLY treats hot flashes and night sweats. If you have other menopause symptoms (brain fog, mood changes, joint pain, etc.), they won't improve with Veozah.
HRT Effectiveness Data
Clinical trial results:
- Reduces hot flashes by 70-90% on average
- Many women become completely or nearly hot-flash-free
- Works within 2-4 weeks
- Most effective menopause treatment available
What real women report:
- Majority of women: "Hot flashes are gone or rare"
- Many women: "I feel like myself again—not just hot flashes but everything improved"
- Some women: "Took a few tries to find the right dose/type"
- Very few women: "Didn't help" (usually dose was too low)
Success rate: 85-95% of women experience significant to complete hot flash relief
Additional benefits HRT provides:
- Eliminates or reduces vaginal dryness: 90% improvement
- Improves sleep quality: 70-80% report better sleep
- Reduces mood swings and depression: 60-70% improvement
- Helps brain fog and memory: 50-60% notice improvement
- Reduces joint pain and stiffness: 40-50% improvement
- Prevents bone loss: 50% reduction in fracture risk
- May protect cognitive function long-term
The reality: HRT is more effective for hot flashes than Veozah, AND it treats multiple other symptoms.
Safety & Side Effects: The Complete Picture
Veozah Safety Profile
Common side effects (affect 10-25% of women):
- Stomach upset, abdominal discomfort
- Diarrhea
- Insomnia or sleep disturbances (ironic, considering it's for hot flashes)
- Back pain
- Hot flashes temporarily worsening before improving (first 1-2 weeks)
Serious concern: Liver effects
- Can elevate liver enzymes in some women
- Requires blood tests: Every 3 months for first 9 months, then annually
- About 1.2% of women develop elevated liver enzymes requiring discontinuation
- Not recommended if you already have liver disease
Who should NOT take Veozah:
- Women with liver disease or elevated liver enzymes
- Women taking certain medications that affect liver enzymes (check with doctor)
- Pregnant women (though if you're having hot flashes, you're likely menopausal)
Who CAN take Veozah:
- Women with breast cancer history
- Women with blood clot history
- Women with heart disease
- Women who can't or won't take hormones
Long-term safety: Unknown—it's only been FDA-approved since 2023. Long-term studies are ongoing.
The verdict: Generally well-tolerated, but liver monitoring is required and some women can't tolerate GI side effects.
HRT Safety Profile
Common side effects (affect 10-30%, usually temporary):
- Breast tenderness (first 1-3 months, usually resolves)
- Bloating (often improves with formulation changes)
- Headaches (if switching from nothing to hormones, usually temporary)
- Nausea (more common with pills, less with patches)
- Mood changes while finding the right dose
Most of these improve after 2-3 months or with dose/type adjustments.
Serious risks to know about:
1. Breast cancer risk:
- Small increased risk with long-term use (5-10+ years)
- Risk is lower with estrogen-only vs. combination therapy
- Risk is lowest with bioidentical hormones
- About 1-4 additional cases per 1,000 women using HRT for 5 years
- For perspective: Obesity and alcohol increase breast cancer risk more than HRT
2. Blood clot risk:
- Slightly increased with oral estrogen
- Much lower risk with transdermal (patch/gel)
- Higher risk if you have clotting disorders or are very overweight
- About 2-3 additional cases per 1,000 women per year
3. Stroke risk:
- Very small increased risk, mainly with oral estrogen
- Lowest risk with patches/gels
- Age matters: higher risk if starting HRT after age 60
Important context on risks:
- When started early (within 10 years of menopause): HRT may actually REDUCE heart disease risk
- Patch/gel formulations: Lower clot and stroke risk than pills
- Estrogen-only (no uterus): Lower risks than combination therapy (with synthetic progestins)
- Lowest dose that works: Minimizes risks
- Individual risk assessment matters
Who should NOT take HRT:
- Women with history of estrogen-receptor-positive breast cancer
- Women with history of blood clots or stroke
- Women with active liver disease
- Women with unexplained vaginal bleeding
Who CAN take HRT:
- Most healthy women under 60 or within 10 years of menopause
- Women who've had a hysterectomy (estrogen-only, even lower risk)
- Women with family history of breast cancer (but no personal history)
- Women with well-controlled diabetes, high blood pressure, etc.
Long-term safety: Studied extensively for 60+ years. There is a lot of data.
The verdict: When appropriately prescribed, benefits typically outweigh risks for most women under 60. Risks are lower than commonly feared, especially with patches/gels and individualized dosing.
Cost Comparison: What You'll Actually Pay
Veozah Costs
Retail price: $550-650/month (yes, really)
With commercial insurance:
- Typical copay: $50-150/month
- With manufacturer copay card: Most patients pay $0
- Maximum savings: Up to $1,000 per prescription
- Requirements: Commercial insurance must cover Veozah (may require prior authorization)
Additional costs:
- Liver function tests: Every 3 months for 9 months
- Each test: $30-75 depending on insurance
- First year additional cost: $120-300 in blood work
For Medicare patients:
- Cannot use manufacturer copay card (federal law)
- Typical Medicare copay: $80-150/month (Tier 3 or 4)
- Patient assistance programs may help if you qualify
For uninsured:
- Retail $550-650/month
- Patient assistance program available (income-based)
Annual cost examples:
- Best case (commercial insurance + card): $0-180/year ($0-15/month avg)
- Medicare: $960-1,800/year ($80-150/month)
- Uninsured: $6,600-7,800/year ($550-650/month)
Check current Veozah pricing options
HRT Costs
Estrogen-only options:
Pills (generic estradiol):
- With insurance: $10-30/month
- Without insurance (with discount card): $20-50/month
Patches (generic estradiol):
- With insurance: $25-60/month
- Without insurance (with discount card): $80-150/month
- Brand names (Vivelle-Dot): May have copay assistance
Creams/gels:
- With insurance: $40-100/month
- Without insurance: $150-300/month
Combination HRT (estrogen + progesterone):
- Generic pills: $15-40/month with insurance
- Patches: $50-120/month with insurance
- Separate prescriptions: Add $10-30/month for progesterone
Additional costs:
- Annual doctor visit: $20-75 copay
- Annual labs (if required): $20-100 copay
- Mammogram (usually covered annually)
Annual cost examples:
- Generic pills: $120-360/year ($10-30/month)
- Generic patches: $300-720/year ($25-60/month)
- Brand name options: $600-1,440/year ($50-120/month)
Cost Winner: HRT (Usually)
For most women with insurance: HRT is significantly cheaper
- HRT: $10-60/month
- Veozah: $0-25/month with copay card (but $50-150 without it)
For Medicare patients: HRT is much cheaper
- HRT: $5-30/month
- Veozah: $80-150/month (no copay card allowed)
For uninsured: HRT is dramatically cheaper
- HRT: $20-100/month with discount cards
- Veozah: $550-650/month
Find out the real costs of medications for treating menopause symptoms.
Learn how to save money on your menopause prescriptions in our article: 10 Ways to Save Money on Menopause Treatment
When Veozah costs less: If you have commercial insurance and qualify for the manufacturer copay card (paying $0), Veozah can be cheaper than brand-name HRT—but not cheaper than generic HRT.
Who Should Choose Veozah?
Ideal Veozah Candidates
You're a great candidate for Veozah if:
✅ You have a history of estrogen-receptor-positive breast cancer
This is the #1 reason many women choose Veozah. If you've had breast cancer that was estrogen-sensitive, HRT is typically off the table. Veozah offers hot flash relief without hormones.
✅ You have a personal history of blood clots
Deep vein thrombosis (DVT) or pulmonary embolism in your history makes estrogen risky. Veozah doesn't increase clot risk.
✅ You're strongly opposed to taking hormones
Some women simply don't want to take hormones for personal, philosophical, or medical reasons. That's valid.
✅ Hot flashes are your ONLY bothersome symptom
If you're not dealing with vaginal dryness, mood changes, sleep issues, or other symptoms—just hot flashes—Veozah's targeted approach might be perfect.
✅ You have commercial insurance and qualify for the copay card
This makes Veozah financially accessible ($0-25/month vs. $550 retail).
✅ You're willing to do quarterly blood tests
The liver monitoring requirement isn't a deal-breaker for you.
When Veozah Might NOT Be Right
❌ You have multiple menopause symptoms
Brain fog, mood swings, vaginal dryness, joint pain, sleep issues beyond night sweats—Veozah won't help these. HRT will.
❌ You have liver disease or elevated liver enzymes
Veozah requires healthy liver function.
❌ You're on Medicare
Without the copay card, Veozah costs $80-150/month vs. $5-30/month for generic HRT. Unless you absolutely can't take estrogen, HRT makes more financial sense.
❌ You want long-term health benefits
Veozah treats hot flashes. HRT protects bones, may support heart and brain health, and treats multiple symptoms.
❌ You had GI issues with medications in the past
Stomach upset is a common Veozah side effect.
Who Should Choose HRT?
Ideal HRT Candidates
You're a great candidate for HRT if:
✅ You're experiencing multiple menopause symptoms
Hot flashes PLUS mood changes, brain fog, vaginal dryness, sleep problems, joint pain—HRT addresses all of them.
✅ You're under 60 or within 10 years of menopause
This is the "window of opportunity" when HRT is safest and most beneficial.
✅ You want bone protection
HRT reduces fracture risk by about 50%. If you're concerned about osteoporosis (family history, small frame, etc.), this matters.
✅ You don't have contraindications
No history of estrogen-positive breast cancer, blood clots, stroke, or active liver disease.
✅ You want the most effective hot flash treatment
HRT reduces hot flashes by 70-90% vs. Veozah's 50-60%.
✅ Cost matters
Generic HRT is $10-50/month for most women, making it very affordable.
✅ You've had a hysterectomy
Estrogen-only HRT (no progesterone needed) has even lower risks and is very well-tolerated.
When HRT Might NOT Be Right
❌ You have a history of estrogen-receptor-positive breast cancer
This is typically a contraindication (though some doctors are reconsidering in specific cases).
❌ You have a personal history of blood clots
DVT, PE, or clotting disorders make estrogen risky. Veozah would be safer.
❌ You're over 60 and never tried HRT
The risk-benefit ratio changes after 60, especially if you're 10+ years past menopause. Not impossible, but needs careful consideration.
❌ You have unexplained vaginal bleeding
Needs investigation before starting HRT.
❌ You have active liver disease
Both oral estrogen and Veozah require liver function.
❌ You're philosophically opposed to hormones
If this is a core value for you, Veozah or other non-hormonal options make sense.
Can You Switch Between Them?
Switching From HRT to Veozah
Why women switch:
- Develop a contraindication to estrogen (breast cancer diagnosis)
- Persistent breakthrough bleeding
- New risk factors develop
- Personal preference changes
How to switch:
- Stop HRT (taper if on high dose)
- Start Veozah
- Hot flashes may return temporarily during transition
- Takes 4-8 weeks for Veozah to reach full effect
What to expect:
- Veozah won't treat your other symptoms (vaginal dryness, mood, etc.)
- You may need additional treatments for those
- Hot flash control may not be as complete as with HRT
Switching From Veozah to HRT
Why women switch:
- Veozah not effective enough (still having 5-10 hot flashes daily)
- Want to treat other symptoms beyond hot flashes
- Cost (especially Medicare patients)
- GI side effects from Veozah
- Want long-term health benefits (bone protection)
How to switch:
- Can stop Veozah abruptly (no taper needed)
- Start HRT
- Most women notice improvement within 2-4 weeks
What to expect:
- Better hot flash control (usually)
- Improvement in other menopause symptoms
- May need to find the right HRT type/dose
- Lower cost (usually)
Good news: You're not locked in. You can try one, switch to the other, or even—in some cases—use both.
Can You Use Both Together?
Short answer: Sometimes, yes!
Scenarios where combination makes sense:
1. Incomplete hot flash control on HRT
- You're on HRT and most symptoms improved
- But hot flashes are still bothersome
- Adding Veozah may provide additional relief
- Some doctors are prescribing this combination
2. Need HRT for other symptoms but can't take enough estrogen
- You need estrogen for vaginal dryness, bone health
- But can't tolerate high enough dose for hot flash control
- Adding Veozah targets hot flashes separately
3. Transitioning off HRT
- You need to stop HRT (age, new risk factors)
- Start Veozah before stopping HRT
- Continue Veozah after stopping HRT
- Prevents hot flash rebound
The research: This is newer territory. Some studies are exploring combination therapy. Talk to your doctor if you're interested in this approach.
Cost consideration: Using both means two copays, though with Veozah copay card, cost might be reasonable.
What Doctors Are Saying in 2025
Dr. JoAnn Pinkerton, Executive Director, North American Menopause Society:
“For women suffering from frequent moderate to severe hot flashes, fezolinetant (Veozah) is an exciting breakthrough in women’s health as it is a highly effective nonhormonal treatment that reduces hot flashes and improves quality of life.”
Dr. Janet Maynard, Director, Office of Rare Diseases, Pediatrics, Urologic and Reproductive Medicine at FDA:
“Hot flashes as a result of menopause can be a serious physical burden on women and impact their quality of life, the introduction of a new molecule to treat moderate to severe menopausal hot flashes will provide an additional safe and effective treatment option for women.”
Dr. Risa Kagan, a board-certified OBGYN, and The Menopause Society-certified practitioner:
“Women have long endured hot flashes and night sweats due to menopause with few treatment options available, so the approval of VEOZAH in 2023 has been an important addition to available treatments. As a physician, I see firsthand the impact that these symptoms can have on a woman's life – both personally and professionally – and it's rewarding to have this nonhormonal, first-of-its-kind option available that may help appropriate patients.”
Emerging trend: More doctors are open to combination therapy (HRT + Veozah) for women with severe symptoms who aren't fully controlled on HRT alone.
The Decision Framework
Still unsure which to choose? Work through these questions:
Question 1: Can you safely take estrogen?
NO → Veozah or other non-hormonal options
- Breast cancer history (estrogen-receptor-positive)
- Blood clot history
- Stroke history
- Active liver disease
YES → Continue to Question 2
Question 2: What symptoms are you experiencing?
Hot flashes ONLY → Either option works; consider cost and preferences
Multiple symptoms (hot flashes + mood/sleep/vaginal/joint issues) → HRT is better choice
Question 3: How old are you / when did menopause start?
Under 60 and/or within 10 years of menopause → HRT is safest and most beneficial
Over 60 and more than 10 years past menopause → Requires careful discussion with doctor; Veozah might be lower-risk option
Question 4: What's your insurance situation?
Commercial insurance → Check if Veozah copay card makes it $0; compare to HRT costs
Medicare → HRT is dramatically cheaper; choose Veozah only if you can't take estrogen
No insurance → HRT with discount coupons is much cheaper ($20-100/month vs. $550+/month)
Question 5: Do you want long-term health benefits beyond hot flash relief?
YES (bone protection, potential heart/brain benefits) → HRT
NO (just want hot flashes to stop) → Either works; consider cost
Question 6: How severe are your hot flashes?
Severe (15+ daily, disrupting life) → HRT is more effective (70-90% reduction vs. 50-60%)
Moderate (5-10 daily) → Both can provide good relief
Question 7: Are you comfortable with liver monitoring?
NO → HRT might be better fit
YES → Either option works
Action Steps: Making Your Decision
This Week:
1. Assess your eligibility for HRT
- Review your medical history
- Do you have contraindications to estrogen?
- Are you within 10 years of menopause?
2. List ALL your symptoms
- Just hot flashes? Or multiple symptoms?
- How severe is each symptom?
- Which impacts your life most?
3. Check your insurance coverage
- What's the copay for generic estradiol?
- Does your plan cover Veozah? (May need prior authorization)
- Do you qualify for Veozah copay card? (Commercial insurance only)
4. Review your risk factors
- Family history of breast cancer?
- Personal history of blood clots?
- Cardiovascular disease?
- Osteoporosis risk factors?
Before Your Appointment:
5. Write down your questions
- "Am I a good candidate for HRT?"
- "What type and dose of HRT would you recommend?"
- "Do you think Veozah would work for me?"
- "What are MY specific risks with HRT?"
- "Can we try HRT first and switch if needed?"
Get prepared before your visit with our downloadable list of helpful questions to ask your doctor.
6. Know your priorities
- What matters most: cost, effectiveness, safety, treating multiple symptoms?
- Are you comfortable with hormones or strongly prefer non-hormonal?
During Your Appointment:
7. Have an honest conversation
- Share your concerns
- Ask about your specific situation
- Don't let fear of one option or the other override evidence
- Ask about trying the most effective option first
8. Discuss trial periods
- "Can we try HRT for 3 months and reassess?"
- "If Veozah doesn't work well enough, can we switch?"
9. Get prescriptions and pricing info
- Ask for generic options
- Ask about manufacturer savings programs
- Check actual costs before filling your prescription
Bottom Line
Veozah is a game-changer for women who can't take estrogen. It's the most effective non-hormonal option we have, and for breast cancer survivors or women with clotting disorders, it offers real relief that wasn't available before 2023.
But HRT is still the gold standard for most women. It's more effective for hot flashes, treats multiple symptoms, provides long-term health benefits, and costs less. If you CAN safely take HRT, it's usually the better choice.
The good news: You don't have to choose perfectly the first time. You can try one, switch to the other, or even use both. The goal is finding what works for YOUR body, YOUR symptoms, and YOUR life.
Don't suffer needlessly. Whether you choose Veozah, HRT, or another option, treatment is available, effective, and affordable.
You deserve relief. You deserve to feel like yourself again. And you have options.
Frequently Asked Questions
Is Veozah safer than HRT?
It depends on your individual risk factors. Veozah doesn't carry the small breast cancer or blood clot risks that estrogen does, making it safer for women with those specific risk factors. However, HRT has 60+ years of safety data, while Veozah is new (2023). For most healthy women under 60, HRT's risks are very low.
Can I take Veozah if I've had a hysterectomy?
Yes, but it may not be necessary. Women who've had a hysterectomy can take estrogen-only HRT (no progesterone needed), which has even lower risks than combination HRT. Veozah would still work, but estrogen-only is usually more effective, treats more symptoms, and costs less.
Which works faster, Veozah or HRT?
HRT typically works faster (2-4 weeks for noticeable improvement) compared to Veozah (4-8 weeks for full effect). However, some women notice Veozah helping within 2-3 weeks.
Will I gain weight on Veozah or HRT?
Weight gain is not a common side effect of either treatment. In fact, HRT may help prevent the metabolic changes that lead to menopause weight gain. Weight changes are more related to aging and lifestyle than to these medications.
Can I drink alcohol while taking Veozah or HRT?
Moderate alcohol consumption is generally fine with both. However, since Veozah requires liver monitoring, excessive alcohol use could complicate that. With HRT, moderate drinking (1 drink per day or less) is usually acceptable.
How long can I stay on Veozah or HRT?
Veozah: Long-term safety data is still being collected. Current recommendation is to reassess periodically. HRT: Many women safely use it for 5-10+ years. The "5-year limit" myth is outdated. Work with your doctor to determine what makes sense for you.
What if neither Veozah nor HRT works for me?
Other options include: low-dose SSRIs (Paxil/paroxetine), gabapentin, clonidine, acupuncture, cognitive behavioral therapy for hot flashes, and lifestyle modifications. A combination approach often works when single treatments don't.
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’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.\
Related Reading:
Last updated: November 25, 2025
This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider before starting, stopping, or changing any medication.