Transition from estrogen therapy to raloxifene in postmenopausal women: effects on treatment satisfaction and the endometrium—a pilot study

Abstract

Gradual conversion to raloxifene from low-dose estrogen, with a progression from 60 mg every alternate day to 60 mg/day, is a viable option in potentially symptomatic, postmenopausal women.

The effects of combined raloxifene and oral estrogen on vasomotor symptoms and endometrial safety

“…Women taking transdermal 17A-estradiol 25 Kg/day with RLX had lower vasomotor symptoms scores than women taking RLX alone, 17 similar to what occured with oral 17A-estradiol in this study, demonstrating that either administration regimen can produce systemic effects. Serum estrogen levels attained with exogenous estrogen therapy depend on a combination of dose, formulation (micronized 17A-estradiol or conjugated equine estrogens), and route of administration.…”

“…12 Endometrial thickness was significantly greater when transdermal estrogen (25 Kg/day) was given concomitantly with RLX than with RLX alone. 17 We cannot compare the current results with those seen in previous estrogen studies 20 because this study had no estrogen-only arm, baseline assessments were based on TVU and did not include an endometrial biopsy, and only two women had endometrial hyperplasia. Thus, we cannot draw a definitive conclusion about any effects of RLX on preventing histological changes in the endometrium in a manner similar to that of progestin when administered in combination with estrogen.…”

Endometrial effects of a tissue selective estrogen complex containing bazedoxifene/conjugated estrogens as a menopausal therapy

“…An appropriate TSEC would alleviate hot flushes, treat vulvar and vaginal atrophy, and protect against postmenopausal bone loss without stimulating the endometrium or the breast. Importantly, not all estrogen-SERM combinations will be effective; for example, endometrial stimulation was reported with estradiol-raloxifene combinations (4,5).…”

The Tissue Selective Estrogen Complex: A Novel Approach to the Treatment of Menopausal Symptoms

“…Moreover, clinical trials evaluating the effects of RLX in combination with estrogen on menopausal symptoms have shown evidence of endometrial stimulation. [40][41][42] These findings indicate that RLX, unlike BZA, does not adequately protect the endometrium from estrogen stimulation and that the neutral effects observed for BZA/CE on the reproductive tract may not apply to other SERM/estrogen combinations. Thus, the future development of other TSECs must involve thorough evaluation of efficacy and safety to ensure protection of the endometrium and breast.…”