The Newest Estrogen is the Oldest One – Duavee

By: Red Hot Mamas

Published: June 18, 2014

Before the Women’s Health Initiative (WHI) was published in 2002, Premarin® was a household name and one of the most widely used medications in the world. But after the WHI suggested that it caused an increase in breast cancer, blood clots, stroke and heart attacks, Premarin usage dropped drastically and the medication was vilified.

Since the WHI, two things have happened that you need to hear about: 1) many of the negative claims about Premarin have since been either proven wrong or were not quite right (more on that can be found throughout and 2) the latest and greatest new estrogen teams up Premarin with a new SERM or Selective Estrogen Receptor Modulator called bazedoxifene. The brand name for this is called Duavee.

The exciting thing about this medication is that bazedoxifene acts like a progestin, meaning it blocks the potential negative side effects of the Premarin, but still lets the Premarin continue to do its helpful stuff.

The March issue of the journal Menopause has two articles on Duavee and its beneficial affect on improving sleep in women coping with menopause. The study was part of the Selective estrogens, Menopause, And Response to Therapy trials SMART trial that has been abbreviated SMART Trials.

In the study a total of 318 women with moderate to severe hot flashes and 459 patients with severe hot flashes and sleep disturbances. The women receiving Duavee had significantly improved hot flashes and sleep quality, mostly because their hot flashes got so much better it stopped waking them up. However, among the women with the most severe hot flashes, their sleep improved directly due to the medication affect on sleep.

The second study in the March Menopause issue studied the affects of Duavee on a woman’s sleep and health-related quality of life (HRQoL) after one year of treatment. In this study of 459 women with bothersome to severe hot flashes, the women received either Duavee, PremPro (which is Premarin + medroxyprogesterone – the combination medication in the WHI study) or a placebo.

At the end of one year, the Duavee was as good as the PremPro for improving hot flashes and sleep (which is very good) and much, much better than placebo. But here is the interesting part: The Duavee has been shown to also protect bones from osteoporosis and prevent vaginal dryness while not increasing breast cancer risk or the risk of cancer of the uterine lining. The difference is due to pairing up the Premarin with bazedoxifene rather than with medroxyprogesterone.

So there you have it; the newest estrogen is the oldest one. But the difference is by pairing it with a better choice for the “other” medication, Premarin can do the good things it was known to do but with far less risk for potential negative side affects. You can find more about this in and other new advances in menopause in My Menopause Magazine for the iPad and iPhone and soon for the Android in the Apple Newsstand.
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Mache Seibel, MD