The Dangers of Non-Hormonal Menopause Drugs

The Dangers of Non-Hormonal Menopause Drugs by Jeffrey Dach MD

Mary is a 55 year old breast cancer survivor. Her breast cancer was diagnosed at age 47 and treated with lumpectomy alone with no recurrence after 8 years of follow up. Recently, Mary has been experiencing menopausal symptoms of night sweats and hot flashes, so she asked her primary care doctor about hormone replacement. Since she has a history of breast cancer, her primary care doctor suggested Mary take a new non-hormonal drug called Veozah for relief of the night sweats and hot flashes. Mary started the drug and thankfully, the night sweats and hot flashes resolved. Header image: Dr. Felice Gersh, courtesy of Felice Gersh MD and Karen Martel.

Brisdell, SSRI Antidepressant Called Paxil

The first FDA approved non-hormonal treatment for nigh sweats and hot flashes was Brisdelle, an old drug FDA approved 10 years ago in 2013. Brisdelle is an SSRI antidepressant called Paxil. All SSRI antidepressants are medically ineffective for menopausal symptoms of hot flashes. That is why Paxil never caught on for treatment of hot flashes. This was discussed in my previous 2013 newsletter entitled, FDA Approval for Paxil for Hot Flashes A Cruel Joke ?.

Adverse effects of Paxil and all SSRI antidepressants include sexual dysfunction, emotional blunting, and increased risk for suicide, homicide and violent behavior. SSRI drugs are addictive and discontinuation carries side effects, so they must be tapered gradually under supervision. Needless to say, this is not good, and this was all discussed in my previous article: The SSRI Antidepressant Hoax.

The New Drug is Veozah

The new non-hormonal drug is called Veozah (fezolinetant), FDA approved a year ago in May 2023 for the treatment of menopausal night sweats and hot flashes. Unlike the failed Brisdelle SSRI antidepressant drug, Veozah actually DOES WORK ! The drug successfully reduces hot flash symptoms by blocking the Neurokinin3 receptors (NK3r) in the brain. The NK3 receptors are the neuron receptors in the hypothalamus that radiate to the autonomic centers controlling thermoregulation. A 12 week study showed Veozah efficacy for reduction of Hot Flashes is about the same as estrogen hormone replacement. This study was funded by Astella Pharaceuticals and was extended for a 40 week blinded observation period, so the entire study lasted one year. (1-2)

Gastrointestinal Adverse Effects

Neurokinin 3 receptors are also found in the gastrointestinal tract, expressed in efferent fibers of the vagus nerve which innervate parasympathetic nervous system of the GI tract, thus accounting for the gastrointestinal side effects of abdominal pain and diarrhea reported in the clinical trials for Veozah.(1-2)

In 2002, Dr. C. Blondeau writes:

neurokinin-1 and neurokinin-3 receptors are involved in the parasympathetic control of digestive functions.(3)

Neurokinin 3 receptors have also been implicated in various auto-immune diseases. Whether or not Veozah will increase auto-immune disease remains unknown.  Our knowledge of neurokinin receptors is still in its infancy, and it may take years of research to uncover the adverse effects of blocking NK3 receptors in the brain and gastrointestinal tract. (3-7)

Why Are These Drugs Dangerous?

Veozah was FDA approved in menopausal women with contra-indications to estrogen hormone replacement such as history of breast cancer, endometrial cancer, or venous thromboembolic disease. However, as Felice Gersh MD comments in the video below, the drug market segment for breast and uterine cancer patients is too small to generate enough profit to recoup drug development costs. However, there exists a much larger and more lucrative market. This larger market includes all the “hormone averse” women who fear hormones. A critical analysis of advertising for Veozah reveals targeting of  hormone averse post menopausal women, meaning women who have been brainwashed by the drug industry to fear estrogen. This is a much larger market. Dr. Felice Gersh says in the below video, “this breaks my heart”. We will explain this below. (8 )

Drug Marketing to the Hormone Averse Woman

The Veozah drug marketed off-label to “hormone averse” women will create a windfall for the drug industry and a catastrophe for the patient. Menopause is an estrogen deficiency disease, and requires estrogen, not a NK3 receptor blocker that addresses only thermoregulation while ignoring the rest of the body.  Night sweats and Hot Flashes are only one of the many symptoms of menopausal estrogen deficiency described in my previous newsletter: Health Benefits of Menopausal Hormone Replacement.

An Even Larger Secondary Drug Market

Post menopausal estrogen deficiency creates numerous degenerative diseases which then each require their own drug treatment. These estrogen deficiency diseases are: osteoarthritis, osteoporosis, depression, coronary artery disease, dementia, vaginal atrophy, genito-urinary symptoms to name a few, all treated with their own category of pharmaceutical drugs as seen with this list (below). Call me a conspiracy theorist, but this looks like a plan to create another drug windfall using pharmaceuticals to treat the estrogen deficiency diseases of menopause.

Disease Entity                  Drug
Osteoporosis:          Fosamax, Bisphosphonates
Osteoarthritis:          Celebrex, NSAIDS
Depresssion:            Prozac, Wellbutrin, SSRI antidepressants
Coronary Artery Disease: Statin Drugs
Dementia:                 Donepezil (Aricept)
Weight Gain : Phentermine, Ozempic
Cognitive Dysfunction: Ritalin and Adderal
Chronic Fatigue:          Amphetamines
Vaginal Atrophy:           Prasterone
Recurrent Urinary Tract Infections: Antibiotics

How to Make Your Patient Hormone Averse

Imagine if every primary care and OB/GYNE doctor started handing out this Veozah drug off-label to every”hormone averse”  post menopausal patient. Maybe the patient didn’t start that way, but they sure became “hormone averse” after a short conversation with their primary care doctor explaining the “evils” of estrogen. All of these post-menopausal women should be taking estrogen. They have no history of breast or uterine cancer and therefore have no contraindications to estradiol, which is a far superior treatment compared to Veozah.

Everything Seems OK

Once starting Veozah drug, the night sweats and hot flashes resolve, and the patient is happy, thinking everything is going OK. However, after a few years, after it is too late, the patient will realize that their osteoarthritis, osteoporosis, cognitive dysfunction, genitourinary symptoms, vaginal atrophy, depression and chronic fatigue are due to estrogen deficiency. They will realize they have been misguided and lied to. They should have been taking estradiol all along. They may then seek out a different physician who is willing to give them real estrogen hormone replacement.

Withdrawal Effects of Blocking Neurotransmitter Receptors

What happens when women stop the Veozah drug? The night sweats and hot flashes return with a vengeance. This is a drug withdrawal effect commonly observed for all neurotransmitter receptor blocking drugs. The neurons compensate for the Veozah drug by making more receptors which are upregulated. This is the same mechanism for drug addiction with other neurotransmitter blocker drugs such as Amphetamines, Ritalin, Adderal, Methamphetamine etc. When the patient stops taking the drug, the withdrawal effects of debilitating night sweats and hot flashes force the patient to go back on the drug. This is the definition of an addictive drug. It is impossible to get off. The patient discovers she must be on Veozah for life or suffer the withdrawal effects of even worse debilitating night sweats and hot flashes.

No Long Term Studies – Drug Discontinuation Effects?

The Veozah hot flash study lasted 12 weeks, with another 40 weeks of blinded observation.  Astella Pharmaceuticals, the drug manufacturer funding the studies, did not report on what happens when the drug is discontinued. The FDA approved the drug without considering long term effects of drug discontinuation, or any long term effects of blocking Neurokinin receptors of neurons of the hypothalamus of the brain. Neurokinin receptors are present throughout the body in various organ systems, mainly the gastrointestial tract. What happens when these are blocked? We do not know.

Felice Gersh MD  Veozah: The new nonhormonal drug for hot flashes
In this 17 minute video by Dr. Felice Gersh, an integrative OB/Gyne doctor, Dr. Gersh expresses many of the same concerns mentioned above. The drug company advertising targets all “hormone averse” post menopausal women. potentially leading to a catastrophe for the menopausal patient not receiving estrogen, the correct treatment.  The transcript can be found in the reference below. (8)

Veozah Advertisement –  Notice no mention thisVeozah  drug should be limited to women with active Breast Cancer and Uterine Cancer…

Conclusion: The danger of Veozah is that non-hormonal menopausal drugs are not a treatment for menopause, defined as an estrogen deficiency state. The elimination of Hot Flashes and Night sweats creating a false sense of security. The reality is non-hormonal menopause drugs do not address the chronic degenerative diseases of estrogen deficiency.

Articles with Related Interest

Errors in Modern Medicine: Fear of Estrogen

Health Benefits of Menopausal Hormone Replacement.

All Bioidentical Hormone Replacement Articles.

FDA Approval for Paxil for Hot Flashes A Cruel Joke ?

The SSRI Antidepressant Hoax.

Jeffrey Dach MD
7450 Griffin Road, Suite 190
Davie, Fl 33314

Links and References

1) Lederman, Samuel, et al. “Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1): a phase 3 randomised controlled study.” The lancet 401.10382 (2023): 1091-1102.
The study was placebo-controlled for 12 weeks followed by a 40-week blinded extension to assess the maintenance of effect.Funded by Astellas Pharma.

2) Shaukat, Ayesha, et al. “Veozah (Fezolinetant): A Promising Non‐Hormonal Treatment for Vasomotor Symptoms in Menopause.” Health Science Reports 6.10 (2023): e1610.
The primary manifestation of the drug’s side effects consisted of various undesirable symptoms such as abdominal pain, diarrhea, insomnia, backache, hot flushes, and increased hepatic transaminases.

3) Blondeau, C., N. Clerc, and A. Baude. “Neurokinin-1 and neurokinin-3 receptors are expressed in vagal efferent neurons that innervate different parts of the gastro-intestinal tract.” Neuroscience 110.2 (2002): 339-349.

neurokinin-1 and neurokinin-3 receptors are involved in the parasympathetic control of digestive functions.

4) Sanger, Gareth J. “Neurokinin NK1 and NK3 receptors as targets for drugs to treat gastrointestinal motility disorders and pain.” British journal of pharmacology 141.8 (2004): 1303-1312.

5) Sanger, Gareth J., et al. “Defensive and pathological functions of the gastrointestinal NK3 receptor.” Vascular pharmacology 45.4 (2006): 215-220.

6) Poole, Daniel Philip, et al. “Stimulation of the neurokinin 3 receptor activates protein kinase Cε and protein kinase D in enteric neurons.” American Journal of Physiology-Gastrointestinal and Liver Physiology 294.5 (2008): G1245-G1256.

Tachykinins, acting through NK(3) receptors (NK(3)R), contribute to excitatory transmission to intrinsic primary afferent neurons (IPANs) of the small intestine. Although this transmission is dependent on protein kinase C (PKC),

7) Mishra, Amrita, and Girdhari Lal. “Neurokinin receptors and their implications in various autoimmune diseases.” Current Research in Immunology 2 (2021): 66-78.

Neurokinin receptors are ubiquitously expressed on the nervous and immune systems and control various physiological functions and are associated with multiple immunopathological conditions. Several immune cells including B cells, T cells, DCs, and macrophages express NK1Rs and modulate immune response (Mathers et al., 2007; Morelli et al., 2020).

Neurokinin receptors are widely expressed in the various systems including the nervous, cardiovascular, genitourinary, immune, digestive system. They are also expressed in different tissues and glands including the salivary gland, skin, and muscles (Costa et al., 2006; Eglezos et al., 1991; Evangelista, 2001; Green et al., 2006; Renzi et al., 2000; Satheeshkumar and Mohan, 2014). Distributions of neurokinin receptors are very uneven among the various organs. NK1R and NK3R receptors are present in the central nervous system and peripheral tissues.

8)  Veozah: The new nonhormonal drug for hot flashes | Felice Gersh, MD 17 minute video

Transcript: Many women are living in fear of what should be a beloved hormone of the body, ovarian produced estradiol. At menopause, we lose our ovarian production of estradiol.

So, because there are so many women who are fearful of hormones like estrogen for no good reason other than as an offshoot of that unfortunate study (WHI 2002). The women’s health initiative from over 20 years ago, which just created an avalanche of negativity, which we are going to talk about that again much more so that you understand the DATA that all of this negativity was based on, which is bad data, but nevertheless the legacy has persisted. I am trying to get rid of it, change the whole paradigm of thinking about hormones from one of negativity to love and positivity. But because the negativity is so prevalent , drug manufacturers, and their researchers have been trying to find alternatives to estrogen to treat night sweats and hot flashes.

Estrogen is involved with regulating temperature. So when we go through menopause and have estrogen deficiency, Hot flashes and Nights sweats are triggered by this particular peptide neurokinin3 (NK3). This peptide is made in the hypothalamus of the brain where the thermoregulatory centers reside. So the drug industry created a drug to block the receptor for NK3. How brilliant is that ? This drug blocks the receptor and is pretty effective at blocking night sweats and hot flashes. And I am totally for it for women who cant take estradiol. It is a small segment of the female population, but it does exist. What kind of a patient would that be? A woman who has an ongoing estrogen positive cancer, like breast cancer and endometrial cancer. Estrogen can cause these cancer to proliferate and grow more. And that is the reality. As a general statement, women with estrogen positive cancers will not be prescribed estrogen. So, this new drug, Veozah, gives them a good option.

Hooray and applause for this new pharmaceutical.
That is not a large enough audience to target this drug to.
So Now they are talking about not just marketing it of course to women who really shouldn’t be on estrogen, but to women who should be, who are now, in their words, “hormone averse”. They are growing that market by making women think it is good to be “hormone averse”, and to think it is better to use something that is non-hormonal. So, that is how they are promoting this. Like it is a great thing. Wow! A non-hormonal treatment for night sweats and hot flashes that may be as effective for that one thing as estrogen ! They are not saying it is better. They can not say it is better. They maybe can say it is as good. That remains to be seen.

By the way, they haven’t tested Veozah against estrogen. They don’t want to , I am sure. What did they test it against.? Placebo!. Okay. So guess what? It (Veozah) is better than nothing. That is for sure. Well a lot of things are better than nothing. Deep breathing is better than nothing. A fan is better than nothing. etc.
Veozah may really be as effective as estrogen because it is working on the pathway t activated when you don’t have estrogen, which activates the neurokinin receptor pathway. Maybe it is. That remains to be seen. Remember, the study was for 12 weeks. OK so definitely over 12 weeks, the drug is very good for reducing and potentially eliminating night sweats and hot flashes, and definitely better than nothing.

But what they are doing in their advertising breaks my heart. And I want you to know, please don’t listen to them unless you have breast or uterine cancer. Because otherwise, you are a candidate, in almost every case, for going on real estrogen, estradiol. Why would you take a drug (Veozah) that is only, and by the way they do emphasize this, they are being honest about it, the drug only treats the hot flashes and night sweats. It is not treating every other organ system that is benefited by estrogen. Let us name a few:

The cardiovascular system
The musculoskeletal system.
The neurologial system.
The gastro intestinal system.
The skin system.
The genitourinary system
every system!!

It is not benefiting any of them except by facilitating better sleep. I am giving them a thumbs up for: You will have better sleep, which is good for everything.

Estradiol has a direct benefit on all those organ systems.

So if you have a choice and there is no contraindication to take real estradiol, that is what should take.

But like a said, they dont have a big enough market for Veozah drugs to just market with women who have breast or uterine cancer. So, they want to market to all women. What a market that is! So, they are talking about the best non-hormonal, with this real implication, whoah! How great is that, NO-Hormones. Like Hormones are evil.

It would be WOW! we can make you feel great and never give you any nutrition. Oh well, that is processed foods. That didn’t work out too well either.

So here is the thing. Please know there is a role for this new drug. Know that it does have a benefit for reducing night sweats and hot flashes. For women with absolute contraindications to estrogen this could be fantastic. But know that if you can take estradiol, that is the way you should go.

Don’t be listening to this, WOW, women who are averse to hormones, now you have some great tool.

What the real thing should be, why are you averse to hormones? Who brainwashed you into thinking something that is essential for health is bad for you?

Hormones are there because they do everything. Losing them is natural. That doesn’t mean its naturally good. Aging is natural. Let me emphasize that. Natural as can be.  That doesn’t mean aging is good for you. Your body is not getting better and better as you go through each decade from 50-60, 60-70, 70-80 to 90. But I want it to stay really fabulously healthy.

To help every organ system in your body, you will not take this drug instead of real estrogen. The generic name is fezolinetant, and the brand name is Veozah.

Well, that is not all. What is the price of this amazing new drug? The retail price is about 660 dollars per month. That is a lot of money not covered by insurance yet, but you can be sure they are hard at work trying to get it covered for some other crazy high price that somebody is going to pay through their health insurance premium, or it could be you just paying for it outright.

I am not saying hormone replacement drugs are cheap, but generally, those prices are nowhere near this price.

It (Veozah) will not help your brain. It will not help your heart, your arteries, your bones, your muscles, your bladder, your vagina, your skin, your eyes, your hair, . Its not going to help any of them. Estradiol will help all of these things.

Yes, it is modern medicine at its best to give more options. that are need for certain small but critically important segments of the population. Women dealing with breast and uterine cancer. It is a good thing to have this drug. I am happy it is here. But what do we know about its long term effects? NOTHING !

Does a peptide only work in one place in the body for only one function? NO!

If you give high doses, usual dosage is 45 milligrams, If you gie 90 mg. the side effects on the gastrointestinl tract are huge. This peptide also acts on the gut. Nothing does one thing. When you block a receptor for a peptide, guaranteed there are going to be side effects, both short term and long term.

If you can take real estradiol, make that your first choice.
I welcome this new drug, but not for women who can take the real hormone they need to reverse the side effects of night sweats and hot flashes and all the other effects in the body of an estrogen deficient human female.


9) Brisdelle (Paroxetine) for Hot Flashes? Not a Great Idea
Diana Zuckerman, PhD, National Center for Health Research

10) Menopausal Hormone Replacement Health Benefits
December 29 2023

11) Hassan, Fatima, et al. “Neurokinin 1/3 receptor antagonists for menopausal women: A current systematic review and insights into the investigational non-hormonal therapy.” Medicine 102.23 (2023).

In our review, we find that without the disruption of the estrogen levels among menopausal and post-menopausal women, hot flush symptoms could be controlled. However, common modalities of treatment of symptomatology comprise hormone replacement therapy with either progestogen and estrogen together or estrogen alone. While hormone replacement is efficacious and considered generally safe for women in the short term, longer use for 5 years or more is associated with increased thromboembolic disorders and bone fractures.[68–71] Therefore, there has been a cautionary recommendation associated with the long-term use of hormone replacement; women at risk of cardiovascular disease or malignancies including endometrial or breast have limited therapy options.[68,72–74] This review attends to the increasing demand for efficacious and novel treatment that can function as an alternative to hormone replacement therapy.

Although these studies offer valuable insights into the potential benefits of NK3R antagonists for postmenopausal women experiencing vasomotor symptoms, the short-term nature and varying concerns about the risk of bias in some trials highlight the need for further research to establish long-term safety and efficacy profiles.

While a preliminary safety and efficacy profile has been generated; further studies are required to corroborate existing knowledge of the intervention to confirm long-term safety. NK1/3 receptor antagonists generate optimistic evidence for menopausal women, the results of this study must be used with caution until more safety and efficacy testing are conducted to elucidate the effectiveness. Current randomized controlled trials provide moderately strong evidence that NK3R antagonists are a promising target for further pharmacological and clinical studies to limit the frequency and severity of hot flushes. The implications of the non-hormonal therapy extend beyond the scope of menopausal women only and can be used among women for estrogen deprivation in breast cancer and prostate cancer for androgen deprivation. There is also potential for NKB/NK3R signaling pathways to manage sex-hormone-dependent diseases that ought to be explored.

12) Conklin, Melissa, and Nanette Santoro. “Neurokinin receptor antagonists as potential non-hormonal treatments for vasomotor symptoms of menopause.” Therapeutic Advances in Reproductive Health 17 (2023): 26334941231177611.

In summary, estrogen deficiency in menopause leads to the upregulation of NKB and its receptor (NK3R) via the median preoptic nucleus, which receives input and projects to the autonomic thermoregulatory pathway leading to the hallmark symptom of cutaneous vasodilatation, VMS.11

The current mainstay of treatment for VMSs [vasomotor symptoms] of menopause is hormone therapy and it remains the most effective treatment. Systemic hormone therapy with estrogen alone or in combination with progestin is the most effective treatment for VMS.1 In users of oral estrogen or oral estrogen plus progestin compared to placebo showed a 75% reduction
in weekly hot flush frequency.1 Estrogen can be administered orally or transdermally via
patches, gels or sprays.

However, in standardized clinical trials that conform to the FDA guidance for studies of VMS treatment (which includes criteria that participants should have a minimum average of 7 hot flashes a day or 49 per week and the test agent must be compared to a concurrent placebo group), the NK3R antagonist compounds compare favorably to estrogen. This is remarkable, given that none of the nonhormonal alternatives
currently available for treating VMS have such efficacy.

Taken together, the newer NK targeting compounds appear to have high efficacy against VMS and reduce both frequency and severity. When additional measures have been sought, there appears to be an improvement in sleep, particularly for the NK3R antagonists.

Despite decades of research, the anatomical source of VMS has only recently been localized to the KNDy neurons in the hypothalamus. Prior to this discovery, estrogen
was the mainstay for the treatment of VMS and, for many years, was the only FDA-approved treatment for VMS. Women in whom estrogen was contraindicated were, therefore, often without recourse.

Targeting the NK3R on the KNDy neuron has proven to be a successful strategy for reducing or eliminating the bothersome VMS associated with menopause.

Management of Menopause Life Extension

13) Menopause & Perimenopause 06/2023 Contributor(s): Maureen Williams, ND; Shayna Sandhaus, PhD; Stephen Tapanes, PhD; Scott Fogle, ND; Franco Melis; Shanti Albani, ND

Importantly, while menopause is not a disease, it is associated with long-term changes in health and chronic disease risk, including:

Increased risk of cardiovascular disease 6
Alterations in glucose and lipid metabolism, leading to increased risk of overweight, obesity, and type 2 diabetes7
Bone loss and increased risk of osteoporosis 7
Declining muscle mass and strength, and increased risk of sarcopenia8
Brain changes, cognitive impairment, and increased risk of dementia 7,9

14) Nappi RE, Chedraui P, Lambrinoudaki I, Simoncini T. Menopause: a cardiometabolic transition. Lancet Diabetes Endocrinol. Jun 2022;10(6):442-456.

15) Lobo RA, Gompel A. Management of menopause: a view towards prevention. Lancet Diabetes Endocrinol. Jun 2022;10(6):457-470.

16) Buckinx F, Aubertin-Leheudre M. Sarcopenia in Menopausal Women: Current Perspectives. International journal of women’s health. 2022;14:805-819. doi:10.2147/IJWH.S340537.

17) Jett S, Schelbaum E, Jang G, et al. Ovarian steroid hormones: A long overlooked but critical contributor to brain aging and Alzheimer’s disease. Front Aging Neurosci. 2022;14:948219. doi:10.3389/fnagi.2022.948219.

Genito-Urinary Symptoms of Menopause

vaginal itching, burning, and irritation, pain with intercourse and sexual dysfunction,
urinary frequency, urgency, pain, and incontinence, recurring vaginal and urinary tract infections

18) Nappi RE, Martini E, Cucinella L, et al. Addressing Vulvovaginal Atrophy (VVA)/Genitourinary Syndrome of Menopause (GSM) for Healthy Aging in Women. Front Endocrinol (Lausanne). 2019;10:561. doi:10.3389/fendo.2019.00561.

19) Brady PH, Gin GT, Rosenblum E, Wilkinson LD. Female Pelvic Conditions: Genitourinary Syndrome of Menopause. FP essentials. Apr 2022;515:32-42.

20) Peters KJ. What Is Genitourinary Syndrome of Menopause and Why Should We Care? Perm J. May 2021;25doi:10.7812/TPP/20.248.

Weight Gain

Approximately 60–70% of women experience weight gain as a symptom of menopause. On average, women gain about 1.5 pounds per year between ages 50 and 60 years.

21) Kodoth V, Scaccia S, Aggarwal B. Adverse Changes in Body Composition During the Menopausal Transition and Relation to Cardiovascular Risk: A Contemporary Review. Womens Health Rep (New Rochelle). 2022;3(1):573-581. doi:10.1089/whr.2021.0119.

Sleep Problems

Anxiety and Depressed Mood

22) Bromberger JT, Kravitz HM, Chang Y, et al. Does risk for anxiety increase during the menopausal transition? Study of women’s health across the nation. Menopause. May 2013;20(5):488-95. doi:10.1097/GME.0b013e3182730599.

23) Bromberger JT, Schott LL, Kravitz HM, et al. Longitudinal change in reproductive hormones and depressive symptoms across the menopausal transition: results from the Study of Women’s Health Across the Nation (SWAN). Archives of general psychiatry. Jun 2010;67(6):598-607. doi:10.1001/archgenpsychiatry.2010.55.

Cognitive Dysfunction

24) Maki PM, Henderson VW. Cognition and the menopause transition. Menopause. Jul 2016;23(7):803-5. doi:10.1097/GME.0000000000000681.

25) Mosconi L, Berti V, Dyke J, et al. Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition. Sci Rep. Jun 9 2021;11(1):10867. doi:10.1038/s41598-021-90084-y.

Physical and Mental Exhaustion

More women report physical and mental exhaustion during perimenopause than in the premenopausal stage, and the percentage increases after menopause, even when stress levels are low.22

26) Giannini, Andrea, et al. “Neuroendocrine changes during menopausal transition.” Endocrines 2.4 (2021): 405-416.

However, early treatment initiators will probably gain more profit than harm by improving
bothersome symptoms, while obtaining offset benefits like cardiovascular risk reduction,
increase in bone mineral density and reduction in bone fracture risk, decrease in colorectal cancer risk and in overall mortality [62].

Menopause is the last phase in a long and complex cascade of events occurring both
in the CNS and in the ovaries. Several neuroendocrine changes and hypoestrogenism play a key role in these modifications and to cause vasomotor symptoms, migraine, depression or anxiety, cognitive disorders.

Hair Loss

27) Rinaldi, Fabio, et al. “The Menopausal Transition: Is the Hair Follicle “Going through Menopause”?.” Biomedicines 11.11 (2023): 3041.

28) Zouboulis, C. C., et al. “Skin, hair and beyond: the impact of menopause.” Climacteric 25.5 (2022): 434-442.

29) Bravo, Bruna, et al. “Dermatological Changes during Menopause and HRT: What to Expect?.” Cosmetics 11.1 (2024): 9.

Muscle Pain

30) Watt FE. Musculoskeletal pain and menopause. Post Reprod Health. Mar 2018;24(1):34-43. doi:10.1177/2053369118757537.


VAsomotor Symptoms

31) Thurston RC. Vasomotor symptoms: natural history, physiology, and links with cardiovascular health. Climacteric : the journal of the International Menopause Society. Apr 2018;21(2):96-100. doi:10.1080/13697137.2018.1430131.

The average duration of frequent or moderate-to-severe menopausal hot flashes is 7–10 years! And many women have mild hot flashes even longer.15


32) Mehta J, Kling JM, Manson JE. Risks, Benefits, and Treatment Modalities of Menopausal Hormone Therapy: Current Concepts. Front Endocrinol (Lausanne). 2021;12:564781. doi:10.3389/fendo.2021.564781.


33) Veozah by KevinMD

Enter Veozah, also known as fezolinetant, the pioneer non-hormonal drug sanctioned by the FDA to treat moderate to severe hot flashes in menopausal women. It works by latching onto these hyperactive NK3 receptors in the brain, pacifying the neurons that spark off hot flashes, and effectively stepping into estrogen’s shoes in temperature control. Clinical trials indicate that Veozah cuts down the frequency and intensity of hot flashes significantly more than a placebo. Moreover, its effectiveness was maintained over a year-long research period, suggesting it could offer lasting benefits.

Veozah provides an alternative solution for women who cannot or do not wish to take hormone therapy. However, it’s worth highlighting the potential advantages of estrogen. Hormone therapy has shown its effectiveness in easing hot flashes and providing lasting health benefits, including improved bone density, heart health, mood, and sexual health

Veozah’s approval is a glimmer of hope for women struggling with menopausal hot flashes. Yet, its price tag—$550 for a month’s supply as set by the maker, Astellas Pharma—is a serious consideration. To help with affordability, Astellas Pharma has introduced a support program.

34) Veozah Is A New Non-Hormonal Drug for Hot Flashes  Peoples Pharmacy
Veozah (fezolinetant) is a new non-hormonal treatment for the hot flashes of menopause. How well does it work and what are the downsides? Joe Graedon
-May 30, 2023

On May 12, 2023 the FDA announced that it “approved Veozah (fezolinetant), an oral medication for the treatment of moderate to severe vasomotor symptoms, or hot flashes, caused by menopause…It works by binding to and blocking the activities of the NK3 [neurokinin 3] receptor, which plays a role in the brain’s regulation of body temperature.

Estrogen reduces hot flashes by 75 to 90 percent,

women in the Veozahtrials averaged about 10 to 11 hot flashes a day before starting the clinical trial. Taking the placebo resulted in 3 to 4 fewer hot flashes a day.

Before starting Veozah, make sure your doctor has ordered liver function tests. Only take this drug if your liver is functioning normally. Once you start taking Veozah make sure you follow up with blood tests at 3, 6, and 9 months to make sure your liver is still OK.

“projected” price will be around $550 a month


35) AJN, American Journal of Nursing November 2023, Volume :123 Number 11 , page 22 – 23 [Free]  Second Nonhormonal Drug for Menopausal Hot Flashes

Fezolinetant is a neurokinin 3 (NK3) antagonist that binds to NK3 receptors, blocking the activity of the receptor. The NK3 pathway helps to regulate gonadotropin-releasing hormone secretion and has been implicated in the generation of hot flashes. Too much NK3 signaling in the preoptic area of the brain produces abnormal temperature regulation when estrogen levels are low, causing the body to try to dissipate heat quickly. This leads to the vasomotor symptoms experienced by menopausal women.2

While estrogen is very effective at treating vasomotor symptoms, its widespread use has fallen out of favor. The only other nonhormonal drug approved for treating hot flashes is the selective serotonin reuptake inhibitor paroxetine (Brisdelle).

Jeffrey Dach MD
7450 Griffin Road, Suite 190
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