New Hormone-Free Hot Flash Treatments
Hot flashes are having a moment. In recent years, celebrities, including former first lady Michelle Obama, have gone public with their personal experiences with hot flashes and other symptoms of menopause.
This spotlight on menopause has helped spread a simple, but important message: You don’t have to suffer from symptoms in silence. There are options for relief.
Several recent studies show hormone-free options offer relief from hot flashes and night sweats (called vasomotor symptoms by doctors) — a well-known side effect of some breast cancer treatments, such as chemotherapy and hormonal therapy.
Veozah reduces hot flashes for at least six months
Veozah (chemical name: fezolinetant) is a daily pill approved by the U.S. Food and Drug Administration (FDA) for the treatment of hot flashes in 2023. It’s a type of drug called a neurokinin 3 (NK3) receptor antagonist. Veozah works by blocking some of the activity of cells in the brain that trigger hot flashes when estrogen levels are low.
Veozah is a non-hormonal treatment, meaning it doesn’t contain estrogen or progesterone like hormone replacement therapy (HRT) does. This is important because HRT isn’t an option for most women with a history of breast cancer because HRT can increase the risk of recurrence (the cancer coming back).
The FDA’s approval of Veozah was based in part on a 12-week study showing women taking Veozah had less frequent and less severe hot flashes and better sleep than women who didn’t take this medicine. Researchers were curious if women who took the medicine longer would continue to see benefits.
They put together a 24-week study, called the DAYLIGHT study. It included 453 women ages 40 to 65 who were having moderate to severe hot flashes and couldn’t take hormone replacement therapy. The researchers randomly assigned the women to one of two groups:
one group took a Veozah pill (45 mg) each day for 24 weeks
the other group took a placebo pill (pill that looks identical to Veozah but doesn’t contain medicine) each day for 24 weeks
Compared with women taking placebo, women who took Veozah had less frequent and less severe hot flashes during the 24 weeks. Women taking Veozah experienced less frequent hot flashes within the first day of taking the medicine and throughout the 24-week study. Women taking Veozah didn’t have any serious side effects from the medicine.
Researchers presented the findings at the European Congress of Endocrinology in Stockholm in May.
Editor’s note: In 2024, the FDA issued a statement warning that Veozah could cause rare but serious liver injury and added a boxed warning to the medicine’s label.
Elinzanetant reduces hot flashes and improves sleep
Another non-hormonal medicine in the works for treating hot flashes is elinzanetant. Like Veozah, it blocks the activity of brain cells that can trigger hot flashes. It also blocks the activity of a protein called NK1, which may help improve mood and sleep.
To test how well the medicine works, researchers recruited women ages 45 to 65 years who had been through menopause and were seeking treatment for hot flashes to join two studies: OASIS-1 and OASIS-2. In both studies, about 400 women were randomly assigned to take two capsules of elinzanetant (120 mg) or placebo pills once a day for 12 weeks.
Compared with women taking placebo, women who took elinzanetant reported less frequent and less severe hot flashes symptoms as early as week one of taking the medicine, and this continued throughout the 12 weeks. By week 12, women who took elinzanetant also reported fewer sleep disturbances and better quality of life. The most common side effects reported by the women taking elinzanetant were headaches and fatigue.
“These results are exciting news for women who suffer from moderate to severe hot flashes and build on our confidence that elinzanetant may be a potential non-hormonal solution for them,” JoAnn Pinkerton, MD, a professor and director of Midlife Health at UVA Health, said in a statement. Pinkerton was an investigator on the OASIS-1 study.
The researchers presented these findings at the annual meeting of the American College of Obstetricians and Gynecologists in May. Earlier this month, Bayer, the maker of elizanetant, submitted data from these studies to the FDA seeking approval of the medicine.
Acupuncture reduces hot flashes caused by hormonal therapy
Studies looking at natural remedies for treating hot flashes are also ongoing.
A small study published in June in the journal Cancer found that two sessions of acupuncture per week for 10 weeks eased hot flashes and improved quality of life among women taking hormonal therapy for early-stage, hormone receptor-positive breast cancer.
For the study, researchers combined data from separate clinical trials that took place in the United States, China, and South Korea. The trials involved 158 women (93% of whom were Asian or white) between the ages of 25 and 73 years who had been diagnosed with stage 0 to stage III breast cancer and were taking hormonal therapy. These women reported having about six hot flashes a day on average.
For all of the trials, the researchers randomly assigned the women to one of two groups:
immediate acupuncture: received acupuncture twice weekly for 10 weeks followed by no acupuncture for 10 weeks
delayed acupuncture: received usual care for 10 weeks followed by acupuncture once per week for 10 weeks
The researchers used a standard questionnaire called the FACT-Endocrine Symptoms to track symptoms like hot flashes, night sweats, and vaginal dryness throughout the trials. They also asked the women about their physical, social, and emotional well-being.
After 10 weeks, women who received immediate acupuncture had about a five-point improvement in their average FACT-Endocrine Symptom scores, while women in the delayed acupuncture group had only a 0.2 point improvement in their scores. Women receiving acupuncture also had an eight-point improvement in their average quality of life scores, while women receiving usual care had their scores drop by 0.01.
“By managing side effects, our approach makes it easier for patients to continue their prescribed medication, which has the potential to reduce the risk of cancer recurrence and improve long-term outcomes for breast cancer survivors,” lead author Weidong Lu, MB, PhD, MPH, of the Dana-Farber Cancer Institute, said in a statement. “In practice, patients interested in using acupuncture for this purpose might begin with a short trial period to assess their response to the treatment, particularly in terms of reduction in hot flashes and other symptoms. If the trial period yields positive results, patients may then engage in a long-term program, receiving regular acupuncture sessions throughout the duration of their anti-hormonal medication regimen.”
Interested in learning about acupuncture for people with breast cancer? Listen to the episode of The Breastcancer.org Podcast featuring an interview with Dory Ellen Fish, an acupuncturist with additional training in cancer care.
Acupuncture to Ease Breast Cancer Treatment Side Effects
Sep 17, 2020There are lots of other ways to reduce symptoms of hot flashes.
Cano, A. et. al. Early Response with Fezolinetant Treatment of Moderate-to-Severe Vasomotor Symptoms Associated with Menopause in Women Considered Unsuitable for Hormone Therapy: Phase 3b DAYLIGHT Study. 2024 European Congress of Endocrinology. Abstract P352.
Pinkerton JV. "First phase 3 trial evaluating the efficacy and safety of elinzanetant for the treatment of vasomotor symptoms associated with menopause (OASIS 2)" ACOG 2024.
Simon JA. "Second phase 3 trial OASIS 1 confirms efficacy and safety of elinzanetant for the treatment of vasomotor symptoms associated with menopause" ACOG 2024.
Lu W. Acupuncture for hot flashes in hormone receptor-positive breast cancer: A pooled analysis of individual patient data from parallel randomized trials. Cancer. Online ahead of print doi: 10.1002/cncr.35374.
— Last updated on March 29, 2025 at 6:55 PM