Grand Rounds

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

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

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

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

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

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