New Therapy for Vaginal Dryness and Pain with Intercourse
By Beverly Vaughn, MD
Medical Coordinator, Menopause and You Program
Hot flashes occur in 80 percent of menopausal women. As many of you
know, they can be uncomfortable and disruptive, effecting quality of
life. Two new medications are now, or will soon be available, in early
2014, to add to currently used treatment options. One is an SSRI
(selective serotonin reuptake inhibitor); the other is a combination of
estrogen with a class of medication known as a TSEC (tissue selective
estrogen complex). The first, Brisdelle™, was FDA approved in 2013 and
became available in the fall. Brisdelle™ is an SSRI that demonstrated,
in studies, reduction of symptoms in healthy menopausal women with
moderate to severe hot flashes. Using SSRI’s for hot flashes is not new.
Health care providers have used them for women who can’t take estrogen
due to medical conditions such as breast cancer or heart disease and in
women who prefer not to take estrogen for personal reasons.
SSRI’s are familiar because they are frequently used to treat
depression. They work DIFFERENTLY to treat hot flashes. The SSRI’s act
on the center for temperature control in the brain making it less
sensitive to changes in the core body temperature. Paxil™ is effective
and has been commonly used. Brisdelle™ and Paxil™ are almost identical
but the dose of Brisdelle™ is smaller. Women tolerated Brisdelle™ well
and had few side effects. This makes it a very good addition to
selection of drugs available.
The second medication is an estrogen in combination with a TSEC (tissue
selective estrogen complex). This sounds cumbersome but, simply put the
TSEC is a medication that in some tissue acts like an estrogen and in
others acts as an anti-estrogen. Examples of TSEC’s that may be familiar
to you are Evista™ and Tamoxifen™. The new combination medication is
called Duavee™ and contains estrogen and bazedoxifene. It will be
available sometime in early 2014.The bazedoxifene replaces the
progestagen (synthetic or natural progesterone) that needs to be taken
by women on estrogen who have their uterus. In studies Duavee™ reduced
hot flashes and had a positive effect on bone density. Why come up with
a different combination? For one, there are women who have a difficult
time tolerating synthetic progestins. It has also been postulated that
the synthetics may play a role in the development of breast cancer.
Though this has not been established with certainty. Duavee™ was studied
in the short term for symptom relief. It has not been studied long
enough to make any determination about breast cancer or heart disease
risk. With that in mind it will be an option that is effective for
symptom relief and maintenance of bone health and should be prescribed
within the same guidelines as traditional hormone therapy.
For additional information about these therapeutic choices, always speak
with your health care provider.
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