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Grand Rounds

Can Switching to Combined Estrogen/ Bazedoxifene Improve HT Side Effects?

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BACKGROUND AND PURPOSE:

  • The use of progestogen for menopausal hormone therapy (HT) can result in side effects such as breast discomfort and vaginal bleeding
    • A tissue-selective estrogen complex (TSEC), consisting of a conjugated estrogen (CE) combined with bazedoxifene (BZA), is a SERM-based progestin-free alternative
  • Kim et al (Menopause, 2019) evaluated the potentially beneficial effects of switching from other HTs to TSEC in women with vaginal bleeding or breast discomfort

METHODS:

  • Retrospective cohort study
  • Participants
    • Menopausal women on HT for VMS
    • Intact uterus
    • Switched to a TSEC following side effects from other HTs
  • TSEC: 0.45 mg conjugated estrogens and 20 mg bazedoxifene
  • Primary outcomes
    • Changes in symptoms
    • If fibroids or breast lesions present, follow up imaging at 1 year was performed to assess changes

RESULTS:

  • 82 women | 46 with fibroids | 43 with breast lesions
    • Mean age: 56.9 years | Mean time since menopause: 5.8 years
  • Reason for switch to TSEC (multiple choices permitted)
    • Vaginal bleeding: 56.1%
    • Breast discomfort: 47.6%
  • Improvement in adverse events after switching to TSEC: 97% 
  • Worsening of VMS occurred in 27% and was experienced by
    • 41.7% who had been using 2 mg of estradiol (P <0.05 when compared to 1 mg estradiol)
    • 16.7% who had been using 1 mg of estradiol
    • 30% who had been using 0.625 mg conjugated estrogen
    • 12.5% who had been using tibolone
  • There was no change in images of breast lesions and fibroids following the switch to TSEC

CONCLUSION:

  • TSEC is a good alternative for women who experienced breast discomfort or persistent bleeding during MHT
  • It is important to consider the differences in estrogen dose when switching

Learn More – Primary Sources:

Tissue-selective estrogen complex for women who experience breast discomfort or vaginal bleeding when on hormone therapy

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Related ObG Topics:

North American Menopause Society: Hormone Therapy Statement
Hormone Therapy and VTE: Quantifying Risk Based on Preparation and Route of Administration
Genitourinary Syndrome of Menopause: New Name, Old Problem
The WHI Randomized Trials: Is Menopausal Hormone Therapy Associated with Long-Term Mortality?
Which Menopausal Hormone Therapies Improve Sleep Quality? 
Risk of Stroke and Use Of Menopausal Hormone Therapies: Does Route of Administration Matter?

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