09/14/2026
“Nonhormonal” does not mean “risk-free.”
Veozah is often presented to women who want relief from hot flashes but are afraid of estrogen, particularly because they have been told hormone therapy may increase their risk of cancer. But women deserve the full picture when comparing their options.
Veozah, also known as fezolinetant, is a relatively new medication. It was FDA approved in 2023 for moderate to severe menopausal hot flashes. It works by blocking neurokinin 3 receptors involved in the brain’s temperature-regulation system. It can reduce hot flashes, but it does not replace estradiol or provide the other physiological effects that estrogen has throughout the body.
And being nonhormonal does not make it free of significant risks. Veozah now carries an FDA BOXED WARNING for hepatotoxicity because rare but serious liver injury has occurred after the medication reached the market. Women taking it require liver testing before treatment, monthly testing during the first three months, and additional testing at months 6 and 9.
There is another issue women should at least be aware of. During the clinical development of fezolinetant, FDA reviewers identified a numerical imbalance in malignancies between women receiving the medication and those receiving placebo, with the highest rate occurring in the 45 mg group, which is the dose ultimately approved.
This does NOT mean researchers have proven that Veozah causes cancer. The FDA concluded that the available evidence was not sufficient to establish a causal relationship and did not include a cancer warning in the prescribing information.
However, the discussion did not end there. More recent researchers have continued examining the neoplasm signal and the possible biological effects of blocking the NK3 receptor pathway. There are hypotheses involving kisspeptin signaling and other pathways associated with tumor growth, angiogenesis and metastasis. These are still areas of investigation, not proof that the medication causes cancer, but they are legitimate questions that require longer-term research.
And this is where perspective matters. We have decades of research on estrogen therapy and an enormous body of scientific literature examining its benefits, risks, dosing, routes of administration and long-term health effects. Estradiol has been studied in women for far longer than fezolinetant, a drug that has only been FDA approved since 2023.
That does not mean estradiol is appropriate for every woman, and it does not mean Veozah is a bad medication. Veozah may be an important option for women who cannot or do not want to use hormone therapy.
But women should not be told that one option is “dangerous because it is hormonal” while another is automatically “safer because it is nonhormonal.”
Every medication has benefits, risks and unanswered questions. Women deserve to know the known risks of estradiol. They also deserve to know the known risks and remaining uncertainties surrounding newer nonhormonal medications.
That is what informed consent should look like.
