Advancing Menopause Care: Non-Hormonal Treatments for Vasomotor Symptoms

Hot flushes and night sweats are often dismissed as a routine part of menopause. What do people misunderstand about these symptoms, and how can effective treatment change day to day life for patients?

One of the biggest misunderstandings is that hot flushes (vasomotor symptoms) and night sweats are simply "uncomfortable" and do not significantly impact daily life. In reality, for around 25–30 % of women, these vasomotor symptoms can be severe and debilitating. Up to 75–80 % of women experience them at some point during menopause.

The impact extends far beyond the symptoms themselves. They can disrupt sleep, affect relationships, reduce motivation for exercise, and influence dietary choices. When these symptoms are effectively managed, patients often experience better sleep quality, reduced anxiety and brain fog, and an overall improvement in well-being.

Why is the NICE recommendation of a non-hormonal option like fezolinetant a meaningful step for people experiencing moderate to severe symptoms?

The NICE recommendation represents a significant step forward because it expands the treatment options available to women. Many patients have historically been told there are no alternatives when hormone replacement therapy is not suitable for them.

This decision reinforces the importance of personalised care. It gives clinicians and patients more flexibility to make informed decisions based on individual needs, preferences, and clinical circumstances, which is essential in menopause management.

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From a clinical perspective, who is most likely to benefit from this treatment?

Fezolinetant is particularly beneficial for women who cannot take hormone replacement therapy, whether due to medical contraindications or personal choice. These individuals have historically had limited licensed treatment options available to them.

From a clinical perspective, the treatment landscape in the UK also includes off-label prescribing. However, NICE Clinical Knowledge Summary guidance is clear that selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), or clonidine should not be routinely offered as first-line treatment for vasomotor symptoms alone.

Having fezolinetant as an option allows clinicians to better tailor menopause care. It supports a more individualised approach, ensuring treatment decisions are aligned with each patient’s specific needs and circumstances.

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Fezolinetant works differently from hormonal treatments. How would you explain its mechanism in simple terms? 

Fezolinetant works by targeting the system in the brain that regulates temperature, rather than replacing hormones. During menopause, hormonal changes like oestrogen can overstimulate certain signals in the brain that trigger hot flushes and night sweats.

This treatment blocks one of those key signals, known as neurokinin B, helping the body regulate temperature more effectively. For patients who cannot or prefer not to use hormones, this offers a completely different and targeted approach.

What were the most important findings from the SKYLIGHT clinical trials?

The SKYLIGHT Phase 3 programme included large, global, randomised, placebo-controlled trials involving thousands of participants. This broad dataset increases confidence that the findings are applicable in real-world clinical practice.

The trials demonstrated that fezolinetant significantly reduced both the frequency and severity of vasomotor symptoms compared to placebo. Improvements were seen as early as the first week and were maintained over 52 weeks.

The studies also provided reassuring safety data, showing that the treatment was generally well tolerated, while highlighting the importance of liver function monitoring as a precaution.

Fezolinetant requires liver function monitoring. How should this be communicated to patients?

It is important to reassure patients that monitoring is a routine precaution and not an indication that problems are expected. Many medications require similar checks.

Patients should understand that liver function tests (taken as a blood test) will be carried out before starting treatment, monthly for the first three months, and then as clinically appropriate. This allows clinicians to detect and manage any potential changes early.

For patients who have struggled with other treatments, how quickly might they notice improvements? 

Treatment success is highly personalised due to the wide variation in the frequency and severity of hot flushes and other menopausal symptoms experienced. Clinical trial data show that many women begin to notice improvements as early as the first week of treatment. By week four, reductions in both the frequency and severity of symptoms are typically evident.

By week 12, further improvements are often seen, with many patients experiencing continued reductions in both the number and intensity of symptoms, suggesting that benefits can build over the first few months of treatment.

Ultimately, treatment success is individual, but it generally means symptoms becoming manageable enough to allow women to function in daily life. This may include helping someone improve their relationships, keep working, regain motivation for exercise, or make healthier dietary choices.

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What needs to happen at a system level to ensure equal access to menopause care across the NHS?

We’ve made real progress in menopause care across the UK, but access remains far too inconsistent and often depends on where someone lives or the drive of individuals within local services. That is not acceptable for something that affects such a large proportion of the population. We need clear, nationally consistent clinical pathways, alongside better education and practical guidance, so all healthcare professionals can deliver high-quality, evidence-based care.

In fezolinetant, enabling prescribing in primary care is essential. This reflects how menopause treatments, including HRT, are already managed across the NHS. Restricting access to specialist settings risks widening inequalities and delaying treatment. More broadly, we need to be bolder and use this as a catalyst for wider change, shifting menopause care into community settings where many patients can be effectively managed.

From my own experience in Oxfordshire, a primary care menopause service led by British Menopause Society specialists significantly reduced referrals to secondary care and cut waiting times from up to nine months to just four to eight weeks. That kind of model shows what is possible. We must now move from pockets of excellence to consistent, high-quality menopause care for every woman, wherever she lives.

What is the key message you would like patients to take away from this NICE recommendation?

My takeaway message is that menopause care is moving toward greater choice and personalisation, something all women deserve.

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Where Can Readers Find More Information?

• British Menopause Society 

About Dr Katie Barber

Dr Katie Barber is a practising GP who has been delivering clinical care and teaching in Oxfordshire since 2006. She is also a published academic and experienced educator, supporting both healthcare professionals and the public across the UK.

Dr Barber was motivated to work in women’s health following her GP training in gynaecology. She obtained her advanced certificate in menopause care from the Faculty of Sexual and Reproductive Healthcare and British Menopause Society in 2019 and is a Registered British Menopause Society Menopause Specialist.

From 2019 to 2021, Dr Barber was Clinical Lead for the NHS Menopause Service at the John Radcliffe in Oxfordshire. She then became Clinical Lead for the NHS Community Gynaecology Service in Oxfordshire, where she continues to work as a women’s health GP and menopause specialist.

Dr Barber also has a personal motivation to work in menopause care, having witnessed her mother’s experience of induced menopause due to breast cancer. She describes seeing her mother suddenly plunged into distressing symptoms:

Sources:

• NICE GUIDELINES: Menopause: identification and management (NG23): Recommendations
• NICE GUIDLINES: Fezolinetant for treating moderate to severe vasomotor symptoms caused by menopause
• SKYLIGHT TRIAL

Journal references:

• National Institute for Health and Care Excellence (NICE) (2026). Fezolinetant for treating moderate to severe vasomotor symptoms caused by menopause (Technology appraisal guidance TA1143). Available at: https://www.nice.org.uk/guidance/ta1143/documents/674 (Accessed: 29 April 2026).
• National Institute for Health and Care Excellence (NICE) (2015, updated 2026). Menopause: identification and management (NG23): Recommendations. Available at: https://www.nice.org.uk/guidance/ng23/chapter/recommendations (Accessed: 29 April 2026).
• ClinicalTrials.gov (2019). A study to find out if fezolinetant helps reduce moderate to severe hot flashes in women going through menopause (Skylight 1). ClinicalTrials.gov Identifier: NCT04003155. Available at: https://clinicaltrials.gov/study/NCT04003155 (Accessed: 29 April 2026)