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The National Institute for Health and Care Excellence (NICE) has recommended a non-hormonal treatment for moderate-to-severe vasomotor symptoms caused by menopause for use on the NHS in England.
In final draft guidance published on 11 March 2026, NICE approved fezolinetant (Veoza; Astellas Pharma), a 45mg tablet taken once a day, which blocks the nerve pathways in the brain that trigger hot flushes and night sweats.
Fezolinetant is approved for use in patients for whom HRT is not suitable or who do not wish to take HRT — for example, HRT may be medically contraindicated in cases of deep vein thrombosis or pulmonary embolism.
NICE added that the drug may also be chosen following a clinical risk assessment in some cases of diabetes or heart disease.
According to the draft guidance, the treatment is not recommended for those with current breast cancer, other oestrogen-dependent cancers or liver disease.
NICE said that patients who have previously had breast cancer or oestrogen-dependent cancers and have completed treatment should undergo an individual risk assessment before being considered for fezolinetant, as clinical trial data in this group are not yet available.
Liver function monitoring is required before starting treatment and regularly thereafter, NICE added.
Helen Knight, director of medicines evaluation at NICE, said: “We know that menopausal hot flushes and night sweats can have a profound impact on quality of life and significantly affect overall wellbeing.
“For those who are unable to take HRT for varying reasons, options have historically been limited, and we have heard clearly from patients how difficult that can be.
“The evidence shows fezolinetant can meaningfully reduce symptoms, and was found to be cost effective, offering value for the taxpayer. This decision will give much-needed relief to those for whom HRT is unsuitable.”
Commenting on the decision, Christina Nurmahi, lead pharmacist for women and newborn at University Hospital Southampton, said the announcement was “excellent news and very much welcomed”.
“Management of vasomotor symptoms in those women unable to have HRT can be challenging; having another non-hormonal option available to us will prove to be very helpful for many women in this situation,” she said.
Nuttan Tanna, pharmacist consultant in women’s health and osteoporosis/bone health at London North West University Healthcare NHS Trust, said patients unable or unwilling to use HRT might otherwise be prescribed antidepressants such as selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, gabapentin or clonidine.
“We know from clinical practice that there is a real need for a more effective treatment for vasomotor symptom control,” she added.
However, Tanna noted that HRT offers a wider range of benefits, such as bone protection, in addition to vasomotor symptom control.
Paul Simpson, chair elect of the British Menopause Society, said: “Whilst hormonal treatment is appropriate for many women, it is not suitable for all — having NHS-funded access to a new class of non-hormonal medication will offer the opportunity for symptom relief in these circumstances.
“The positive impact this class of drug can have on menopause care has been on the horizon for some time, with many women patiently awaiting this approval.
“The next steps are to integrate this medication into primary and secondary care settings through our local formularies and care pathways.”
