Hot flushes and night sweats are among the most recognised symptoms of perimenopause and menopause, but their impact is often underestimated. Frequent vasomotor symptoms can interrupt sleep, affect concentration, disrupt work and place pressure on relationships and emotional wellbeing.
Hormone replacement therapy, also called menopausal hormone therapy or HRT, remains the most effective treatment for troublesome hot flushes and night sweats for many women. However, HRT is not suitable or acceptable for everyone.
Recent UK developments have expanded the range of non-hormonal menopause treatments available. In March 2026, NICE recommended Fezolinetant for NHS use in England when HRT is unsuitable [1]. In July 2026, the MHRA extended the UK licence for Elinzanetant to include women experiencing vasomotor symptoms while receiving adjuvant endocrine therapy for breast cancer [2].
These are important developments, but the medicines have different indications, availability and monitoring requirements.
What Are Vasomotor Symptoms?
Vasomotor symptoms are caused by changes in the brain’s temperature regulation system during the menopause transition.
They may include:
- Sudden feelings of intense heat
- Sweating
- Flushing of the face, neck or chest
- Night sweats
- Chills after a flush
- A racing heartbeat
- Anxiety during or immediately after an episode
Some women experience occasional mild flushes. Others may have repeated episodes throughout the day and night.
Night sweats can be particularly disruptive because they fragment sleep. This may contribute to fatigue, irritability, reduced concentration, headaches and difficulty coping with daily demands.
Why Do Hot Flushes Happen?
As oestrogen levels fluctuate and decline, a group of nerve cells involved in temperature control becomes more active. This narrows the body’s thermoneutral zone, which is the temperature range within which the body does not need to sweat or shiver.
Small changes in body temperature may therefore trigger a disproportionately strong cooling response, producing a hot flush or night sweat.
Traditional HRT helps by replacing declining oestrogen. Newer non-hormonal medicines take a different approach by targeting the nerve pathways responsible for the flush response.
What Is Fezolinetant?
Fezolinetant, sold under the brand name Veoza, is a non-hormonal treatment for moderate to severe vasomotor symptoms.
It is a neurokinin-3 receptor antagonist. It blocks part of the signalling pathway in the brain that becomes overactive when oestrogen levels fall.
In March 2026, NICE recommended Fezolinetant as an NHS treatment in England for moderate to severe menopause-related vasomotor symptoms when HRT is unsuitable [1].
This may include women who have a medical reason why systemic HRT is not appropriate, or those for whom a clinical assessment concludes that HRT should not be used.
NICE’s recommendation does not position Fezolinetant as a direct replacement for HRT in every woman. HRT remains the usual first-line treatment for suitable patients because it can address a wider range of menopause symptoms and may also support bone health.
Fezolinetant is specifically intended to reduce hot flushes and night sweats.
Does Fezolinetant Require Monitoring?
Fezolinetant has been associated with liver injury, so liver function testing is required before treatment begins and periodically during treatment [3].
It may not be suitable for women with liver disease, and any symptoms that could indicate a liver problem should be assessed promptly.
These may include:
- Unexplained tiredness
- Loss of appetite
- Nausea or vomiting
- Dark urine
- Pale stools
- Yellowing of the skin or eyes
- Pain in the upper abdomen
Treatment suitability should always be assessed by an appropriately qualified prescriber who can review medical history, current medication and relevant blood results.
What Is Elinzanetant?
Elinzanetant, sold under the brand name Lynkuet, is another non-hormonal medicine for moderate to severe vasomotor symptoms.
It acts on both neurokinin-1 and neurokinin-3 receptors. Clinical trials found that it reduced the frequency and intensity of hot flushes and night sweats, and it may also support sleep in some women [4].
The MHRA first approved Elinzanetant for menopause-related vasomotor symptoms in July 2025.
In July 2026, its UK licence was extended to include women receiving adjuvant endocrine therapy for breast cancer who experience moderate to severe vasomotor symptoms [2].
This is significant because medicines used to reduce the risk of breast cancer recurrence, including some forms of endocrine therapy, can cause severe hot flushes and night sweats. Systemic hormonal treatment may be unsuitable for these women.
Elinzanetant is the first medicine specifically licensed in the UK for this indication.
Is Elinzanetant Available on the NHS?
At the time of writing in August 2026, Elinzanetant has not yet been assessed by NICE and is not routinely available through the NHS [2].
A UK medicine licence confirms that a treatment has met regulatory standards for quality, safety and effectiveness. It does not automatically mean that the medicine will be funded by the NHS.
Availability may therefore differ between private and NHS care, and the position may change after future NICE assessment.
How Do These Treatments Differ From HRT?
HRT and non-hormonal neurokinin medicines work in different ways.
HRT replaces hormones that have declined during perimenopause and menopause. Depending on the treatment plan, it may help with:
- Hot flushes
- Night sweats
- Sleep disturbance
- Mood changes
- Vaginal and urinary symptoms
- Menopause-related loss of bone density
Fezolinetant and Elinzanetant do not replace oestrogen. They target specific pathways in the brain involved in vasomotor symptoms.
They may therefore be valuable for women who cannot take HRT, do not wish to use it or need an additional treatment discussion. However, they should not be assumed to provide all the wider effects associated with HRT.
Who Might Benefit From a Non-Hormonal Treatment?
A non-hormonal prescription may be considered when:
- Hot flushes or night sweats are moderate to severe
- Symptoms substantially affect sleep, work or quality of life
- HRT is medically unsuitable e.g after hormone sensitive cancer
- A woman does not wish to use hormonal treatment
- Previous treatments have not provided adequate relief
- Vasomotor symptoms are associated with breast cancer endocrine therapy
The right option depends on personal medical history, existing medication, liver health, cancer history and individual treatment goals.
What Other Non-Hormonal Options Are Available?
Fezolinetant and Elinzanetant are not the only non-hormonal approaches to menopause symptoms.
Depending on the individual, treatment may include:
- Cognitive behavioural therapy
- Certain antidepressant medicines
- Sleep support
- Lifestyle changes
- Reducing alcohol or other personal triggers
- Maintaining a cool sleep environment
- Layered clothing and breathable bedding
- Weight and metabolic health support where appropriate
No single strategy works for everyone. A personalised plan may combine medical treatment with practical symptom-management techniques.
Questions to Ask During your Menopause Consultation
Useful questions may include:
- Is HRT suitable for me?
- Could a non-hormonal treatment be appropriate?
- What monitoring will I need?
- Could the treatment interact with my current medicines?
- What symptoms or side effects should I be aware of?
- Will the treatment help symptoms other than hot flushes?
- When should the treatment be reviewed?
Personalised Menopause Care
The arrival of new non-hormonal medicines is a positive development because women need more than one treatment pathway.
However, newer does not automatically mean better for every patient. HRT remains the first-line option for many women, while non-hormonal treatments can meet an important need for others.
At The Menopause Medic, treatment decisions are made following a detailed medical assessment. Consultations are available in Berkhamsted and St Albans, with secure online appointments for women across Hertfordshire and the UK.
Women travelling from Hemel Hempstead, Tring, Watford, Harpenden, Welwyn Garden City, Kings Langley, Rickmansworth, Amersham, Chesham and surrounding areas can access in person bespoke menopause care based on their symptoms, medical history and preferences.
References
[1] NICE. Fezolinetant for treating moderate to severe vasomotor symptoms associated with menopause, TA1143.
https://www.nice.org.uk/guidance/ta1143
[2] British Menopause Society. MHRA has added to the licence for elinzanetant.
https://thebms.org.uk/2026/07/mhra-has-added-to-the-license-for-elinzanetant/
[3] British Menopause Society. NICE supports NHS prescribing of fezolinetant.
https://thebms.org.uk/2026/03/nice-supports-nhs-prescribing-of-fezolinetant/
[4] Medicines and Healthcare products Regulatory Agency. MHRA approves elinzanetant to treat moderate to severe vasomotor symptoms caused by menopause.
https://www.gov.uk/government/news/mhra-approves-elinzanetant-to-treat-moderate-to-severe-vasomotor-symptoms-hot-flushes-caused-by-menopause
[5] NICE. Menopause: identification and management, NG23.
https://www.nice.org.uk/guidance/ng23
Medical Disclaimer This article is for general information and education only. It does not provide individual medical advice, diagnosis or treatment. Medicine availability, prescribing guidance and NHS funding may change. Always consult an appropriately qualified healthcare professional before starting, stopping or changing menopause treatment.