Just how disruptive are hot flashes?
One minute you’re working, exercising or just relaxing. Then there’s this feeling of warmth, rising from the chest to the neck and face. All of a sudden, you’re blushing, and little pools of sweat form on your arms and hands.
You wait for the moment to subside, finding a tissue to wipe yourself dry or grabbing a bottle of water. And yeah, suddenly you’re chilly. Now what were you doing again?
Since last year, the options have grown for treating hot flashes, the name given by women undergoing menopause for those sudden and intense feelings of warmth as the body’s temperature rises.
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In June 2023, fezolinetant, prescribed under the name Veozah, was approved as a first in its class drug to alleviate moderate to severe hot flashes.
“I think it’s a wonderful addition to the options that we can now offer to women,” said Dr. Tomas Luley, a doctor of osteopathic medicine with Novant Health Southeast OB/GYN.
Luley, who is certified as a practitioner with The Menopause Society, shares his thoughts here on Veozah (pronounced vee-O-zah) and its potential to stem one of the most annoying symptoms of menopause, which can last years for some women.
What triggers hot flashes?
Hot flashes are a byproduct of the loss of estrogen and progesterone when your reproductive system stops releasing eggs and your monthly periods end. It is one of dozens of symptoms described by women, some who begin menopause as early as their 40s.
Women might experience hot flashes as they enter perimenopause, the time before menstrual periods end altogether. And research has shown that Black women can experience more severe symptoms earlier than others.
Called vasomotor symptoms, hot flashes often begin as a feeling of warmth in the upper part of the body. It could feel like blushing, but it lasts longer, with an aftermath that often feels like chills as the body temperature returns to normal.
Hot flashes can feel uncomfortable and can cause difficulties at work, anxiety and even daytime fatigue, women tell Luley. At bedtime, hot flashes can disrupt sleep in the form of night sweats. Vasomotor symptoms occur in up to 80% of women during menopause, lasting a mean of seven to nine years. In a third of those women, hot flashes could last more than 10 years.
How does Veozah work?
It works in the hypothalamus part of the brain, which serves as a thermal regulator for the body. Veozah prevents the chemical neurokinin B from triggering hot flashes when it binds to a receptor in your brain.
Who would be a good candidate to take Veozah?
Women often turn to doctors when their hot flashes last more than a decade and are still frequent. Women also can consider Veozah if they are not a good candidate for hormone replacement therapy, which could increase the risk for stroke or heart disease in those with a history of blood clots or cardiovascular issues.
Women also might consider Veozah if they are taking hormone suppressants to lessen the risk of breast cancer recurrence.
Women can take Veozah if they are under 65 and can be a useful option for women with a history of heart attack, stroke, blood clots or those who choose not to choose HRT.
But, as Luley cautions, you need to discuss the benefits and potential risks with your doctor. Often women taking Veozah are monitored with regular blood tests to evaluate liver function.
Who shouldn’t be considered for Veozah?
Veozah is not recommended for women who have liver damage or cirrhosis, have kidney issues, or are taking CYP1A2 inhibitors, such as the antibiotic Cipro or the antidepressant Luvox. Some women taking Veozah have experienced elevated liver enzymes.
Other possible side effects include nausea, diarrhea, abdominal or back pain, or difficulty sleeping.
Are there other nonhormonal remedies available?
The development of Veozah helped pinpoint exactly how hot flashes are triggered and will most likely lead to other medications and mechanisms, Luley said.
In 2013, a low dose of a drug called paroxetine, or Brisdelle, was approved as a nonhormone medication to stem hot flashes. It works by decreasing blood flow to the skin to counter the vasal dilation.
Luley also has recommended a form of clinical hypnosis to control the hot flash symptoms. In this case, the patient can control her reaction to the hot flashes using a deeply relaxed state along with visualization of “cool” objects until the moment passes. Some antidepressants have been shown to stem hot flashes as well.
