NICE says about 500,000 people could benefit from fezolinetant, also called Veoza and made by Astellas Pharma, for moderate to severe hot flushes and night sweats when HRT is not suitable. Perimenopause is also being treated earlier, with conversations starting when symptoms are disrupting sleep, mood, work or relationships even while periods are still coming.
Which symptom patterns merit earlier treatment conversations
The clearest trigger is not age alone but pattern. If irregular periods are coming with sleep disruption, vasomotor symptoms, mood change, anxiety, tiredness, forgetfulness or migraines, that is enough to raise perimenopause with your GP. Women in their 40s can notice anxiety, tiredness, forgetfulness or migraines before they realise the cause is hormonal, Dr Louise Newson says.
Do not wait for symptoms to become severe enough to feel "normal". Perimenopause symptoms can be present for years before the final period, and they often hit the parts of life that are easiest to dismiss, such as concentration, night sleep, patience, and performance at work. If the symptoms are affecting your ability to function, the case for treatment discussion is already there.
What evidence-based care now looks like
NICE’s menopause guideline NG23, Menopause: identification and management, was first published in 2015 and updated in November 2024. The Menopause Charity's 2024 summary was last updated that month, with a planned review in November 2027.
The practical message is simple: hormone therapy is still part of the conversation where appropriate, but not every symptom is solved by oestrogen alone. Modern care is symptom-specific, which means matching treatment to the complaint, whether that is sleep, mood, migraines, vasomotor symptoms, genitourinary symptoms or cycle irregularity.
When HRT is not suitable
Fezolinetant is a daily pill that can be prescribed on the NHS for moderate to severe hot flushes and night sweats when HRT is not suitable.
The limit is important: fezolinetant is not a universal menopause treatment and it is not positioned as a fix for every symptom. It sits alongside, not instead of, a broader clinical review that still has to ask what symptoms are present, what is driving them, and whether HRT is suitable.
Why work is part of the clinical picture
The House of Commons Women and Equalities Committee published its report on menopause and the workplace on 2022-07-28, and University of Leicester research on the menopause transition and women’s economic participation followed in July 2017. More recent studies keep pointing in the same direction: menopausal symptoms are an employment issue.
One cross-sectional study found that the most common menopausal symptoms affecting employees more than 50% of the time at work were fatigue at 54% and difficulty sleeping at 47%. Another study found menopausal symptoms were associated with lower work ability, poorer self-rated health and more emotional exhaustion. Women with perimenopausal symptoms lose more work time and have lower work productivity than women before or after menopause.
The caveat is the one that matters in any cross-sectional evidence: these studies show association, not causation. They still tell a coherent story, and it is one clinicians are hearing directly from patients, but they do not prove that every productivity issue is caused by menopause or that one treatment will erase all of it.
NHS primary care versus private clinics
On the NHS, the first step is still primary care. That should mean a symptom-led history, review of bleeding pattern and a discussion of evidence-based treatment options, not a reflexive "come back later" because the final period has not happened yet. The updated NICE guidance gives more room for clinicians to treat earlier and more flexibly, especially when symptoms are affecting day-to-day life.
Private clinics can offer longer appointments and quicker access to menopause specialists, which is why many women turn there when they feel stuck. But the standard should still be the same: a clear explanation of why a treatment is or is not suitable, what it is meant to treat, and how it fits with the current guidance. If a clinic sells one product as if it can resolve anxiety, fatigue, forgetfulness, migraines and hot flushes at once, it is not reflecting how the evidence is being framed.
Dr Nighat Arif called the updated NICE guidance "a step in the right direction" but said it left "room for improvement". She called for more guidance on systemic HRT for people affected by cancer, endometriosis, PCOS, ADHD and neurodegenerative disease.