Duavee: Finally! A new approach to menopause

A decade into menopause, and I'm still hot (no, not that kind of hot, just middle-of-the-night way too warm hot).  For ten years I weighed estrogen pluses, namely good for the bones, brain, and heart, with estrogen negatives, that nagging worry regarding breast health, and I revisited that analysis annually.  Just this past year, estrogen yikes overtook estrogen yay, and I dropped my weekly dose to just a tick over negligible.  And subsequently lost two checks, a zillion pens, one notebook, my pedometer, my keys again and again, 5 pounds of muscle, and 1/2 inch of height. 


Enter a new kid on the menopausal treatment list, a so-called TSEC or tissue selective estrogen complex, also known by the not-so-catchy name of Duavee.  It was approved in October, 2013, but I only found out about it in the March issue of the journal "Menopause" which featured a long article and accompanying editorial about this drug.


Duavee is a combo drug, a pharmaceutical 'two-fer'.  It contains Premarin (no, I don't love that about it either, but more on that later) and bazedoxifine which is not approved as a stand-alone drug in the U.S. although it is available in Europe.  Each of these drugs interact with estrogen receptors in the body, but while Premarin stimulates the 'on switch' when it couples with cellular receptors, bazedoxifene turns some estrogen receptors on and some of them off depending on the specific tissue involved.  It is one of a class of drugs called selective estrogen receptor modulators (SERMs). 


Tamoxifen is also a SERM long-used to decrease risk of estrogen-receptor positive breast cancer or to prevent its recurrence. Tamoxifen, unfortunately, stimulates estrogen receptors in the uterus, thus increasing risk of uterine cancer, and some women do not like the way they feel when they're on it.  Another SERM that's been around for awhile is raloxifene or Evista which is prescribed for the prevention and treatment of osteoporosis.    Evista works well on preserving bone density, protects the breast against estrogen stimulation, but aggravates hot flashes.


The ideal treatment for the health challenges of menopause would turn on all the right estrogen receptors (bone, brain, vascular tissue, genitalia) and would turn off those better left quiescent in aging ladies (breast and uterus).  Estrogen works wonders on hot flashes also known vasomotor symptoms; in fact, it's the very thing.  It supports bone density and has a number of favorable effects on brain and cardiovascular health.  Unfortunately for women no longer in their reproductive years, it stimulates breast and uterine tissue in an unwanted sort of proliferative way that, over many years, increases risk of cancer and fibroids.  As a result, progesterone is added to hormone regimens to offset the estrogenic stimulation to the uterus, but this addition only increases the breast cancer risk.  In addition, the effect of oral estrogen, particularly non-human oral estrogen such as Premarin, has undesirable effects on inflammation and clotting in the body.  While many women did well for many years on the combo drug known as Prempro, the results of the Women's Health Initiative reported in 2002 included significant increases in incidence of stroke, heart attacks, breast cancer, and dementia in women on the Premarin/progesterone combination.  Of note, however, is that women taking only Premarin did not experience an increased risk of breast cancer.  Nevertheless, this study drastically changed prevailing opinion on the benefits of post-menopausal hormone therapy, and its use has since dramatically dropped.


The combination of bazedoxifene and estrogen is just short of perfect.  The estrogen component decreases hot flashes although the dose is lower than ideal to completely beat not only the heat but also genital atrophy (as in painful intercourse).  Better yet would be bazedoxifene all by itself to be used along with an estrogen skin patch.  For now, however, as I work on my personal equation of health goals vs. personal fears, Duavee gets a tentative one to two thumbs up.


Interested in more insider scoops on good health choices for the rest of your life?  Stay tuned for September announcements on small group seminars on menopause, osteoporosis, and cardiovascular health.