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Looks like Veozah caused liver injury in someone (https://www.fda.gov/drugs/drug-safety-and-availability/fda-adds-warning-about-rare-occurrence-serious-liver-injury-use-veozah-fezolinetant-hot-flashes-due). Makes me wonder if that's a risk of neurokinin-3 receptor antagonists. I'm guessing Bayer will be worried about that as well.

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Lots of medications do require monitoring of liver function, I don’t imagine this will be too arduous

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Eh... nobody wants to be going back to the doctor regularly or getting liver tested just for hot flashes. That's not a serious enough condition, imo. This is especially true because hormonal replacement therapy doesn't require any extra monitoring (besides annual mammograms, which women that age often get anyways), so doctors will be much more comfortable prescribing that.

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This would only be prescribed if HRT is contraindicated, not as first line

And getting a blood test every 3 months isn’t a big deal for most patients - particular those with a medical condition which contradicts HRT

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