The good news for women: a drug to limit hot flushes. The bad: it could cost you £430 a month | Devi Sridhar
After years of being overlooked, there is now a growing interest in pharmaceutical research on menopause and its effects on women’s quality of life. This week, there is buzz around a new drug that has the potential to significantly improve women’s lives.
A significant factor in this is the increasing acknowledgement of the immense market size: according to the NHS, approximately 13 million women in the UK are currently experiencing perimenopause or menopause, comprising around one-third of the female population. The primary and widespread symptom is hot flashes, which can greatly affect women’s overall health and efficiency, along with fatigue, mood changes, and muscle weakness.
Dr Sigi Joseph, who is a GP and leading expert on treating menopause says, “Perimenopausal and menopausal women are the fastest-growing workforce and we are losing one in 10 to symptoms, therefore it has huge socioconomic impacts. Focusing research and developing on supporting these women will have far-reaching benefits.”
Previously, women seeking assistance with managing their menopausal symptoms had limited choices. The most common solution, hormone replacement therapy (HRT), has shown effectiveness but cannot be utilized by individuals with a personal medical history of ovarian or breast cancer, blood clots, or untreated hypertension. Furthermore, taking oestrogen and progesterone can cause unwanted side effects that may be difficult for some women to endure. As a result, the only option available to doctors was to either prescribe HRT or nothing at all.
The widespread need for assistance with symptoms of menopause, combined with the limited options provided by the medical field and lack of available support, has caused a buzz around the announcement of a new drug called Veoza (also known as fezolinetant). According to data published in the Lancet, this drug has shown promise in reducing the frequency and severity of hot flushes over a 12-week period for women aged 40 to 65, compared to a placebo. The study included participants from various ethnicities, and the results suggest that the drug is equally effective for Black, Asian, Latina, and White women.
Veoza works by targeting specific neurons in the brain responsible for temperature regulation. These neurons are largely controlled by the hormone oestrogen, and when levels fall during menopause they become enlarged. Unable to assess the real temperature of the body, they release the protein neurokinin-B, which triggers hot flushes. Veoza works by containing a compound that binds to these neurons and blocks the release of the proteins (which are responsible for triggering hot flushes).
Like any medication, it can have potential adverse reactions, including harm to the liver, discomfort in the abdominal area, diarrhea, and discomfort in the back. In May 2023, when the FDA approved Veoza in the United States, they suggested that all patients undergo blood tests to screen for potential liver damage before taking it. After starting the medication, routine blood tests every three months are recommended to monitor its effects on the body. As a newly developed drug, more extensive data on its long-term effects in the population will become available with continued use.
Is the rollout of Veoza planned for the NHS? Although the MHRA has deemed it safe and effective, it has not yet been recommended for use in the NHS. The primary obstacle is its cost as Veoza, created by a Japanese pharmaceutical company, is a daily pill that costs $550 (£430) for a 30-day supply in the US. Nice, with a restricted budget and numerous competing health concerns, will evaluate the drug’s benefits and cost to determine if it is worth allocating public funds towards.
Even though it has been referred to as a “blockbuster” medication, it is not a complete solution for menopause and its effects on the body. While it effectively addresses one major symptom, there is still more work to be done in this field. Additionally, it has not yet been authorized in the United Kingdom for individuals over 65 years old, as they were not part of the clinical trial.
In 2023, it is surprising that doctors have limited options to assist their patients. This issue also applies to birth control and severe morning sickness in pregnant women. Women are often advised to simply endure these symptoms, particularly if they are caused by hormones. As a result, treatment options for these conditions are limited, hindering the daily lives of those affected. Research funding and solutions are usually only allocated once a condition is recognized as a problem and scientific understanding is gained.
However, the situation is changing as more resources are being put into studying the biological factors behind these changes and creating treatments that specifically address these cellular processes. It is hoped that Veoza will be just one of many medications to come out of this research. However, as indicated by its high cost, developing and approving a new drug is only part of the equation. The other crucial aspect is collaborating with pharmaceutical companies to lower the price and make it accessible for all women who wish to use it. Otherwise, while it may make for catchy headlines, it will not significantly improve the lives of those struggling to sleep and function during the day.
Devi Sridhar is the head of the global public health department at the University of Edinburgh.