She had breast cancer at 48. Five years later the treatment is behind her, but the hot flushes are not: fifteen a day, eight a night, soaking the sheets. HRT is off the table. For years the alternatives offered to women like her were antidepressants, blood pressure tablets or nerve-pain medication used off-label, with modest effects and side effects of their own.
That has changed. Two new medicines, fezolinetant and elinzanetant, work in a completely different way, aimed at the part of the brain that triggers the flush itself. Both are now licensed in the UK.
They are a real step forward. They are also not the miracle some coverage suggests. Here is what they do, who they are for, what the trials actually showed, and what they will not do.
Hot flushes start in the brain, not the skin. A group of nerve cells in the hypothalamus, the brain's thermostat, helps regulate body temperature. They are known as KNDy neurons, after the three signalling chemicals they use: kisspeptin, neurokinin B and dynorphin.
Oestrogen normally keeps these neurons in check. When oestrogen falls at menopause, they become overactive and release more neurokinin B. The thermostat effectively narrows, so tiny changes in core temperature trigger a full cooling response: blood vessels in the skin open, you flush and sweat, and then often feel cold.
HRT works by putting the oestrogen back. The new drugs work further down the chain, by blocking the receptor that neurokinin B acts on.
Fezolinetant blocks the neurokinin-3 receptor. It is a tablet taken once a day, at a dose of 45mg.
In the two main trials, SKYLIGHT 1 and 2, women had on average around eleven moderate to severe hot flushes a day at the start. By week 12, those on placebo had dropped to about seven a day, and those on fezolinetant to about four. The difference attributable to the drug was roughly two and a half fewer moderate to severe hot flushes a day than placebo.
Two things about that result are worth knowing. First, the placebo effect in hot flush trials is large, which is why "it reduced my flushes by half" is a poor guide to whether a treatment works. Second, the effect on severity was smaller than the effect on frequency.
In March 2026, NICE recommended fezolinetant for women with moderate to severe hot flushes for whom HRT is unsuitable, or who choose not to take it.
Elinzanetant blocks both the neurokinin-1 and neurokinin-3 receptors. It is taken once a day, usually in the evening, at a dose of 120mg. In July 2025 the UK's medicines regulator, the MHRA, became the first in the world to approve it.
In the OASIS 1 and 2 trials, which together included around 800 women, elinzanetant reduced the frequency and severity of hot flushes compared with placebo from the first week, with the effect maintained through 26 weeks. It also improved sleep disturbance and menopause-related quality of life, which matters because night sweats are often the symptom that wrecks everything else.
The neurokinin-1 effect is thought to explain part of the sleep benefit. It may also explain the most common side effects: headache, tiredness and drowsiness, which is one reason it is usually taken in the evening.
Both drugs can affect the liver in a small number of women. In fezolinetant's case, the warnings are significant enough that blood tests to check liver function are needed before starting and regularly in the early months of treatment. Elinzanetant's trials showed raised liver enzymes rarely, at rates close to placebo, but your prescriber will advise on monitoring.
Neither is suitable for women with significant liver disease. Report yellowing of the skin or eyes, dark urine, unusual tiredness, itching or pain in the upper right side of the abdomen straight away.
This is the part that matters most when comparing them with HRT.
The clearest candidates are women with moderate to severe hot flushes who cannot take HRT or prefer not to. That includes many women with a history of blood clots or stroke, women with certain liver or cardiovascular conditions, and women who simply do not want hormones.
Women who have had breast cancer are a special case. Because these drugs are not hormones, they are an attractive option, but suitability depends on individual circumstances and on any current cancer treatment. That decision belongs with your oncology team.
For women who can take HRT and want broad symptom relief and bone protection, HRT usually remains the first choice. The truth about HRT research covers its risks and benefits.
The new drugs join a list of treatments that have been used for years. NICE recommends offering menopause-specific CBT, and other options doctors use include:
Herbal remedies such as black cohosh and red clover have inconsistent evidence and can interact with other medicines. See black cohosh and supplements for women's hormones.
Bring numbers. Keep a two-week record of how many hot flushes and night sweats you have each day and night, how severe they are, and how they affect your sleep and work. Moderate to severe symptoms are what these medicines are licensed for, so specific numbers help.
Explain why HRT is not right for you, whether that is a medical reason or your own preference. Ask about liver tests, side effects and how long to try the medicine before deciding whether it is working.
Hot flushes and night sweats: what helps covers the everyday measures that work alongside any treatment.
What is fezolinetant?
A once-daily tablet that blocks the neurokinin-3 receptor in the brain's temperature-control centre. In trials it reduced moderate to severe hot flushes by about two and a half a day more than placebo. NICE recommended it in 2026 for women who cannot or choose not to take HRT.
What is elinzanetant?
A once-daily medicine, usually taken in the evening, that blocks both neurokinin-1 and neurokinin-3 receptors. The UK approved it in July 2025. Trials showed reduced hot flushes from the first week and improved sleep and quality of life.
Are they better than HRT?
They have not been directly compared in large trials. HRT remains the most effective treatment for women who can take it, and it also protects bone. The new drugs are a strong option for women who cannot or do not want to use HRT.
Can I take them after breast cancer?
They are not hormones, which makes them attractive, but suitability depends on your history and current treatment. Discuss it with your oncology team.
Do they need blood tests?
Fezolinetant requires liver function tests before starting and regularly early in treatment. Ask your prescriber about monitoring for elinzanetant.
Will they help vaginal dryness or mood?
They are designed for hot flushes and night sweats. Better sleep may help mood, but they do not treat vaginal dryness or protect bone.
Sources: Lederman S et al., Fezolinetant for treatment of moderate-to-severe vasomotor symptoms associated with menopause (SKYLIGHT 1), Lancet 2023;401(10382):1091-102 · Johnson KA et al., Efficacy and safety of fezolinetant in moderate to severe vasomotor symptoms associated with menopause (SKYLIGHT 2), J Clin Endocrinol Metab 2023;108(8):1981-97 · Pinkerton JV et al., Elinzanetant for the treatment of vasomotor symptoms associated with menopause: OASIS 1 and 2, JAMA 2024 · Medicines and Healthcare products Regulatory Agency, approval of elinzanetant, July 2025 · National Institute for Health and Care Excellence, fezolinetant recommendation, March 2026, and Menopause: identification and management (NG23) · Educational only, not medical advice.
Keep reading: Hot flushes and night sweats: what helps · The truth about HRT research · How hormones hijack your sleep · What helps with hot flushes? · Protecting your bones · Take the free Hormone Quiz