Monday, November 24, 2014

Duavee review

Since last I wrote about Duavee, I have had several e-mails from a scientist heavily involved with hormone research, specifically the development of an ideal selective estrogen receptor modulator (aka SERM) for post-menopausal use. Our communications have convinced me that this medication is the best solution currently available for those of us aging ladies unhappy with the physical effects of no estrogen on the quality of our lives yet worried about the downside of hormone therapy.


SERMs are, as I mentioned, synthetic molecules that act like estrogen insofar as they can occupy estrogen receptor sites on cell membranes.  However, unlike estrogen which activates cellular machinery in a stimulatory sort of way, these compounds can activate or turn-off estrogen effects depending on the specific tissue involved.  For instance, the SERM tamoxifen is used to prevent the development or recurrence of estrogen-receptor positive breast cancer (a tumor whose growth and spread is spurred on by its interaction with estrogen) through a blockade of estrogen receptors in the breasts. Raloxifene (brand name Evista) is prescribed for the prevention and treatment of post-menopausal bone loss because it stimulates bone in an estrogen sort of way but has tamoxifen-like effects on breast estrogen receptors.  Due to this latter property of the drug, it has the possible beneficial side effect of decreasing risk of estrogen-driven breast cancer but is not FDA approved for this purpose.


Duavee contains bazedoxifene, the newest addition to available SERMs. This compound turns on estrogen receptors in bone while turning off those in breast and uterine tissue.  When paired with a touch of conjugated estrogens (Premarin), it promotes bone health while blocking detrimental effects of its estrogen partner on breasts and uterus. Meanwhile, the estrogen squashes hot flashes and favorably affects vaginal dryness although the dose is low enough that it may not completely eliminate these problems. This is exactly what I was looking for in menopause support as my bone density is going downhill along with my height, and my sleep continues disturbed by hot flashes.


If you've been researching menopausal remedies, you are aware that the ongoing use of hormones after menopause can stimulate unwanted cell proliferation in both the breasts and the uterus and, over time, can induce a malignant transformation in either of these tissues.  For those of us who have never had a hysterectomy, hormone replacement therapy has routinely included progesterone in order to protect the uterus from estrogenic stimulation.  Progesterone, however, is fraught with side effects including breast swelling and tenderness, bleeding, drowsiness (especially from natural progesterone), and depression.  Worst of all, the estrogen/progesterone combo, whether 'natural' (molecules produced synthetically but just like those you had through your reproductive years) or 'unnatural', is the actual culprit behind the very small but real increase in breast cancer risk associated with HRT.


I'm just like you, who wants breast cancer, uterine cancer, drowsiness, underwear-ruining spotting, or just big old breasts that hurt every time you bounce downstairs?  I have loved and used transdermal estrogen patches through the years.  I have tried natural progesterone but it makes me so goofy the day after that I can't get a sentence out without fumbling word choice or pronunciation.  I have taken norethindrone rarely to counteract the estrogen, but honestly I can only say that it creeps me out when my breasts get sore.


Three months into Duavee, I feel great.  I pretty much felt great before I started Duavee but my sleep was disturbed by middle-of-the-night hot flashes which now are gone. While backaches and fretting can still plague me in the wee hours, I mostly awaken now refreshed instead of grumpy and reluctant to rise. My breasts do not feel altered in any big or sore sort of way.  I think I'm less scatter-brained, but only time--and my husband!--will tell on that one.  And finally, another time-telling sort of thing, I am hopeful based on the well-researched science of Duavee and its carefully formulated blend of estrogen and SERM (9 different combinations were tested) that my bone density, decreasing over the last two years along with my dose of estrogen, will stabilize when I check it next year.


If your 'change' is not for the better, and you're trying to make a decision about what to do about it, talk to your doc about Duavee.  I went through menopause a decade ago so I can't be sure how well it works for those just starting on journey, but I am pleased with this choice for residual flashing, bone density support, and less worry about breast cancer.



76 comments:

Anonymous said...

Glad to hear its working for you Doc!

K said...

Also glad to hear it's working for you, Doctor. You and I have been on it for about the same time. I'm one of those just starting on the mp journey, and can tell you that I am very satisfied. Sleep-disrupting flushing (with added black cohosh) is all but gone. Vaginal dryness/lesions/cysts: gone. Debilitating back and other pain: gone.(No longer must I run hot water over my hands to get them to work in the morning.) Brain fog: gone. -At least back to my pre-mp spacey self. For symptom relief, I highly recommend it. For breast safety, I'm your guinea pig. Low-grade stage zero tumor removal a year ago. But did my homework on CEE (the estrogen in Duavee) and BZA (the other part). I am comfortable, and even a bit excited that it is the perfect drug for post-mp women who want help with bone, brain, joints, etc but are scared to death of chemo (and who is not?) Believe me, it took a LOT of homework to buy me this confidence. But confident I am. Here is a breast cancer forum thread with some great discussion on this that you might find interesting. (My handle there is Alpine Artist). As you say, doctor, this SERC might just be the postmenopausal cocktail we've been waiting for. -Cautiously celebrating. Cheers!


K said...

The forum link did not post. Will try again.
https://community.breastcancer.org/forum/73/topic/806271?page=2#post_4128313
Good week,
-K

Anonymous said...

My Doc just switched me from Prempro after 4 years. Six weeks into Duavee. my hot flashes and night sweats are back with a vengeance..should I wait it out? Is it because my body is adjusting to a switch?

denverdoc said...

Hi Anon, Sorry to hear so far so hot (or not so hot...). Depending on your dose of PremPro, this is probably a step down in estrogen for you, and fluctuating estrogen levels are a definite trigger for hot flashes. I hope you can give it a bit longer, but it sounds like a rough transition. I'm not sure how I would've done with this level of estrogen when I was just 4 years out from menopause.

A Don said...

Duavee isn't working for me, Ugh !
I feel so bloated... upper and lower abdomen, my back hurts... I just feel awful.Don't feel like eating or exorcising. I'm done with it !

denverdoc said...

Hi A Don, Well yuck, this med is so not for you. Thanks for the view from the downside! I hope you can find another solution. I would be curious to hear where you're at in menopause, and what else you've tried.
Judy

Shelly said...

Hi, just started Duavee yesterday. I'm 53 and just going into menopause, suffering from hot flashes, night sweats and sleep troubles. Hope this works!!
Shelly from VA

Anonymous said...

I have been taking this since August. I think it has really helped. Clearer head, less moody, hot flashes are gone. I did notice an increase in heart palpitations at first but seems to be less now. And It did bother my stomach for the first month but that has subsided. I was glad to find your blog & review.

Anonymous said...

Duavee has brought me back from horrid night flashes, aching hands and joints and vaginal dryness. However I just experinced a full fledge period of mestruation after 20 months of none. Should I stop, run to Dr or wait this out to see what comes of it? I haven't felt so good for months, I really hate to change things up again

denverdoc said...

I appreciate everyone's comments. This is a fairly new drug, and this gives me an opportunity to hear feedback--good and bad. I'd like to hear what else you've tried and how far you are into menopause, and revisit with updates if you have a moment!

To last poster: You should have this bleeding episode checked out. Perhaps you already had a build-up of uterine lining even before the Duavee. Post-menopausal thickening of the endometrium (the innermost layer of the uterus) as manifested by bleeding should be investigated as it can indicate abnormal cells that have cancerous potential.

Anonymous said...

Have been on estrace/prometrium for 3 yrs now with a reoccurrance of almost gone hot flashes. I'm also taking a larger dose than originally..now 1 mg. Is this medicine not working anymore and should I switch to something else like duavee? Any help would be greatly appreciated. CD

denverdoc said...

Hi anon, I'll get back to you tomorrow!

denverdoc said...

Hi CD: There are several possibilities as to why you've got hot flashes again. Could be you are running low on testosterone which trails off after estrogen exits. You might ask your MD to check your levels on that. Also, taking estrogen orally can cause your liver to increase sex hormone binding globulin (SHBG) which is a carrier protein that makes hormones unavailable to your cellular receptors when hormones are bound to the protein. A switch to an estrogen skin patch would be helpful. I have no reason to think Duavee would affect your recurrent hot flashes as the estrogen component of this combo drug (Premarin, .45 mg) is no more and probably less estrogen than you're getting now. The only difference might be that Premarin could last longer in your system than estrace does, so it would have a longer duration of hot-flash-reducing action.
Good luck!
Judy

Anonymous said...

hi, I noticed more lubrication, plus some leg cramps and alot more hot flashes than before using the drug as well as heart cramps. two subsided, the hot flashes remain. now only take duavee 2-3x/wk.

Anonymous said...

I have been on Duavee for four weeks and although I think my mood is better, I am still having hot flashes. The nights are the worse. Does this mean this medication is not going to work for me? Should I give it more time?

denverdoc said...

Anon with heart cramps: What does that feel like? Are they gone?
Anon with ongoing hot flashes: Some women find that .45 mg of Premarin is not enough to stop hot flashes. Give it a bit longer, but this may not be the right med for you, especially if you are fairly new to menopause.
Judy

Anonymous said...

I had my hysterectomy in December 2013 with a follow-up surgery 4 months later due to complications. I was 47 when I had it. Had really bad endometrosis. I am not dealing with no sleep, no concentration and been diagnosed with bipolar which I do not think is correct. I have burning in my head and neck/shoulder already and have not started Duavee yet. I am to start tomorrow. When is the best time to take it? I think the burning is from Hot flashes but I'm not sweating at all... There is constant burning and my gyn thinks it may be from menopause. Anyone ever have anything like this? Thank you

denverdoc said...

Dear Post-hysterectomy Anon,

If you've been without hormones at age 47, no surprise that you're not sleeping or concentrating, having mood swings and having burning sensations. I hope Duavee is helpful, although the estrogen content may be a little too low for you.

I find there's no difference in my benefits from Duavee based on time of day taken. Start it and see how it goes; all of your troubles sound familiar to me based on my own experience and hundreds of ladies I've seen in my practice over the years (but not treated with Duavee as it's only been available for about a year and a half). I believe you'll feel better although some fine-tuning on estrogen dosing may be in order. Let us know how you're doing!
Best,
Judy

Anonymous said...

Hi. Any idea why they combined the great bazedoxifine with a conjugated estrogen made from pregnant mare urine, rather than estradiol? I cant wrap my head around that one :) PS-Im 51 and have been on long cycle HRT for about 2 years and just switched to Duavee due to progest intolerance.

Anonymous said...

I just started Duavee this week and have had the majority of the basic side effects such as stomach pain, light headed, nausea and diarrhea. Do these symptoms go away quietly or is there a possibility that they will last for a long period of time? This is the first time that I have been on any type of estrogen product.

Anonymous said...

Hi ladies,

Just wondering about Duavee in case Osphena doesn't work for me. My dr. originally prescribed Duavee but I opted to take Osphena (only on it for 2 weeks). I'll give it the full 3 months to see if it helps my vaginal dryness due to low estrogen. I'm 51 and 2 yrs postmenopausal. Just doing my research. My dr. said its all trial and error to see what works. All I know is I'm still young and not ready to dry up and not enjoy sex anymore. Any thoughts on Duavee vs. Osphena from the doctor here or anyone? Any help or comments are much appreciated. Thanks so much!

Anonymous said...

Hi again, Is this board still active? I was also wondering if anyone taking Duavee is bothered by it being a conjugated estrogen from horses and what it does to them to get this estrogen?
Thanks for any help or comments :)

denverdoc said...

Dear Osphena user, As I mentioned in an e-mail to you, I don't have any experience with Osphena. My take on Osphena vs. Duavee is that the former only covers the problem of vaginal dryness whereas Duavee, with the added estrogen, would address hot flashes. In my case, my general dissatisfaction with the way I felt off HRT was completely reversed with the use of Duavee.

Dear Anon wondering re the horse-derived estrogen,
I know there is an anti-Premarin movement with strong feelings about the use of pregnant mares to produce this drug. If you're not comfortable with the process but still wishing to try some kind of HRT, there are synthetic estrogen products derived from plants that work well.

Darene Staniszewski said...

Thank you denverdoc, I appreciate your comments in the email and answering me here also. Only time will tell so since its been only a little over 2 weeks for me on Osphena I will give it the full 3 months and see if I get the results I want if not I'm seriously considering Duavee or maybe the combi patch.

Good luck ladies :)

tara05 said...

I am 51. I had a total hysterectomy 7 weeks ago, but I was well into menopause before surgery. My doctor has me on Duavee. I started over a week ago. I've noticed more severe hot flashes, migraines, bloating, and horrible leg cramps. Should I ride it out? The leg cramps alone have me wanting to stop.

Darene Staniszewski said...

hi Tara,

I'm going to start Duavee also. My dr. called it in to my mail order prescription service. I'm sorry to hear that you're experiencing but I think you need to give it some time. I'm switching from Osphena to Duavee. I am only on Osphena for 3 weeks, by the time I get the Duavee and start that it will be a month. I haven't seen any improvement at all in my low sex drive due to low estrogen and also my vaginal dryness is still there. Hope it gets better for you, good luck :)

annmarie said...

Yikes im starting duavee tonight and im now scared after reading these posts :-( im 39 and dont want to have problems when i get older

denverdoc said...

I so appreciate all the comments reporting benefits and side effects. I am still on Duavee and loving it, but, again, I'm a decade into menopause so it's possible that a formulation that suits an older lady (yes that's me!) might not sit well with a younger woman. That said, Annmarie, while I appreciate your reluctance to try meds, remember that there are problems associated with being out of hormones at age 39 whether due to surgery or early menopause. And any decision we make at any point in time regarding our personal health choices should be revisited as often as necessary--at least once a year--to make sure it's still the right way to go.

Would love to hear back from Tara with an update.

Darene Staniszewski said...

Hi all,
Next Wed. will be a month for me on Duavee. I have no side effects whatsoever, i feel great, my mood seems to be better, vaginal dryness has improved a little although I use Estrace vaginal cream also. My libido is up and I'm thinking about sex more which is great whereas before my brain was not tuned in at all. I never had any hot flashes so that wasn't an issue for me. Since it hasn't been a month for me yet I expect it to get better as time goes on as far as vaginal lubrication goes. I like the way Duavee makes me feel so no complaints here. I'm also glad its helping my osteopenia so hopefully when i get another bone density test that will improve also. :)

Unbelievableada said...

I have been on Duavee, it stopped all my hot flashes and night sweats, but I get headaches almost every day. I forgot to take it twice in a week, and I got a terrible migraine and hot flashes are back. I have not gained weight but I exercise 5 days week.

Anonymous said...

I have been on Duavee for 9 weeks. It took a full 7 weeks for the hot flashes and the vaginal dryness to stop. Previously, I was on an estrogen patch and progesterone, but had bleeding issues.
I'm very happy with Duavee so far, especially as I've been diagnosed with Osteopenia. Hang in there I'd you're just starting. It isn't instant an instant gratification drug :)

Anonymous said...

Hi, in reply to anonymous, you sound like me :), this wednesday will be a complete 3 months on Duavee. I'm also very happy with it. No side effects, weight gain or any problems. I also have osteopenia and don't want it to get any worse. I was thinking of asking my dr. about using the vaginal estrogen ring along with the Duavee as I'm still not as lubricated as I'd like to be. I'm wondering if I should just wait it out or not. I'm using estrogen cream (Estrace) twice a week now instead of once a week so maybe that would be sufficient. Guess I should give it more time. Other than that Duavee is great :) Any of you ladies have any experience with Estring the vaginal estrogen ring? I was wondering if that would work out better than the cream? Thanks for any help :)

Lorraine said...

I'm on day 18 and starting on day 15 I experienced stomach pain and diarrhea. My hot flashes and insomnia have really reduced so I'm also hoping these side effects are temporary. Doctor says give it a few days to see if body adjusts. I will see

Susan said...

Hi- I'm 57, am 10 years into menopause, and have been on HRT for the duration I switched from the estrogen patch 0.75 mg / progesterone 200 mg to Duavee 6 months ago. My nocturnal hot flashes were well controlled before the switch but they returned immediately after I started Duavee. I will check my testosterone level- good thought! Perhaps I'll need to supplement with a patch if that's not the issue. Thanks

Anonymous said...

I've taken Duavee for almost 3 months. I'm 55 and I've just now gone 12 months without a period, and have had a rough few years prior. . I was miserable with night sweats and lack of sleep, but have always been afraid of HRT. My doctor said it would take 4 full weeks to take effect. The good news: I sleep better and I don't have night sweats. I also noticed my hair is growing faster and my fingernails are stronger. I'm now weighing the benefits against my side effects, which include weight gain in my upper belly especially. My arms also flush red and itch. Also, I am angry all the time, and mean! I also take wellbrutin as a mood stabilizer so I'm no stranger to mood fluctuations, but this is constant. I'm going to call my dr about this but wondered if anyone else shares these symptoms?

Mary Halfmann said...

I am 63, stopped menstruating at 55. Had severe menopause symptoms. Was on prempro for 7 years, until it stopped working. I started having continuous hot flashes, severe anxiety out of the blue, back and joint aches. I felt like an old lady and wanted to crawl under a rock somewhere and just die. Dr. Switched me to duavee a month ago and all of my symptoms have disappeared. I feel great and even had a compliment from a guy as to how great l look. I have my life back, work part time and swim 3000 meters 4 times a week. This med has saved my life.

Patty said...

Duavee has completely changed my life. I am 52 and have been using it for 2 years. Before taking Duavee I had severe vaginal atrophy with bleeding during intercourse and severe pain. I tried Premarin and Estrace with only minor results obtained. I tried many hrt pills but had constant bleeding. Then I tried Duavee. Two years later my vaginal is literally in the same condition as I was in my twenties. I feel great again. I sleep all night and can totally enjoy sex like I always have. Duavee has given me my life back and I don't plan on not taking it. I have yearly breastfeeding screenings, pap tests, and a yearly uterine biopsy. My Dr. Swears by it and monitors all the women taking it. There is now hope for people suffering with lack of estrogen problems.

Tanya in Dallas said...

My problem is osteoporosis in my hips. I've been off hormones (combi patch) for 1 yr and been on Evista since Dec 2014. I had been on the combi patch maybe 3-4 yrs and it caused a lot of spotting (hated this part!). There was a time when I was taking both the combi patch and evista but stopped the evista maybe Dec 2013 because my primary didn't want me on both. My obgyn prescribed had both. I've never had any serious menopause symptons, a few hot flashes here and there, but nothing this past year since being on just the evista. My bone density had been fairly stable, initially declining a little, but the hormones seemed to stabilize it. This past year since being on just the evista my hips went to -2.6 and -2.4, so my primary wanted me to get on a hormone again. So Duavee has come in to play but I haven't started it yet. I'm 59 and wondering if I try evista for 1 more year would it start working for the osteoporosis?

Besides the spotting, The other problem I had when being on the combi patch-- it caused my breast tissue to be very very fibrous. Also my fingernails are very very weak but this may be because I'm currently on Accutane yet this should end by April 2016.

Am I being too fearful about the Duavee? Also Duavee isn't long term, right? So what happens when Duavee is stopped? And just how long can one stay on Duavee? My primary also brought up the bisphosphonates, but this is out because I am getting a tooth implant.

Thank you for any advice/help!

Anonymous said...

Hi Doc,
I am 52, and have experienced menopause symptoms since I was in my early 40's. I have reached a point where I have not had a period in close to 2 years, and the low dose b-control pill I was on was not taking care of the symptoms any longer. I have been on Duavee for 2 months now and that little pill is brilliant! I feel great, I'm mentally alert, and the complete dryness and 24/7 hot flashes are gone. My hair and skin seem to benefit also. I have been using Duavee samples my doctor gave me, then checked with the pharmacy yesterday on the cost. I have great 80/20 Blue Cross/Blue Shield coverage through the county I work for, but my out of pocket on Duavee (after insurance works it's magic) is still $50 a month! I am wondering if I can take Duavee every other day to cut down on the cost?

Thank you for all the questions and your answers on this feed. It is great to know it is helping so many other women. I'm just concerned about the cost, since I am a single income household.

denverdoc said...

I am grateful to all of you who have commented on your experience with Duavee both positive and negative (also to those of you with questions and concerns regarding whether or not to even consider this drug). Once the holiday rush is over, I look forward to updating you on my ongoing experience and addressing the issues you've brought up.

To anonymous whose post is just above, I took 1/2 Duavee daily for quite awhile, but ending up breaking two pill cutters because the outer shell is so tough. Now I take it every other day. There are no studies investigating whether or not the benefits of Duavee continue at a lower dose. I do feel good on the every other day dosing but I am also more than a decade older than you! If low dose BCPs didn't work for you, I doubt that you will be satisfied on a lower albeit less expensive regimen.

denverdoc said...

p.s. Tanya in Dallas, I have not forgotten about you!

Tanya in Dallas said...

Thank you! I am patient and have taken the time to read all the posts regarding this drug. Still taking just the Evista and will decide once I hear your thoughts:) Happy Holidays!

Anonymous said...

Hi Doc. Thanks for the info. I'm 58 yrs, been in menopause for 2 and a half with horrible hot flashes. Started Duavee 3 days ago with no results. My Gyno said it should start working immediately. I was surprised to hear her say it starts working immediately, it hasn't for me. Any input/advice? Thanks again! Marlene in San Diego

denverdoc said...

Hi All, I appreciate your ongoing input on Duavee. I've been doing some reading on the latest research on Duavee, and it still looks great to me (and I'm still using it). I plan a new post soon with updated information. Meanwhile, Marlene in San Diego, there is such a small dose of conjugated estrogens in this combo drug that it could take awhile for it to have a favorable effect on your hot flashes. It's possible the dose is insufficient to get you where you'd like to go in the hot flash department, but if you think this is a good choice for you with respect to bone protection and breast protection, stick it out for several months to judge the final benefits.
Judy

Anonymous said...

I just started Duavee today. I'm 36 and I have been in surgical menopause since Feb. 9 2016. I do not have ovaries or a uterus. I had endometriosis and recurring ovarian cysts that ruptured often causing severe pain. I have been thrown into menapause at 100mph and it's been tough. Hot flashes, night sweats, crying, vaginal dryness, loss of sexual sensation, red face... All of these symptoms were severe over night! I'm hoping Duavee is the drug for me although I worry about all of the long term effects of early surgical menopause and HRT.
Molly

Andie Rogers said...

Thank you for all your post. It's so daunting trying to figure out what's works or doesn't work. I am 44 and have been prescribed Duavee but am nervous about taking any medicine. I have never been on any birth control and never have had any issues with my cycles. with 3 kids I feel I don't have time to be dealing with side effects. I had my ovaries removed in Nov 2015 because I have the BRCA 2 gene and am suppose to be in surgical menopause. I had been using the combipatch but was getting my period every other week so my ob/gyn suggested I use Duavee. He states my periods will stop. I have stopped the patch for 2 weeks now and feel fine but know I should start something soon cause I am afraid what menopause might due. I am wondering has anyone tried any bio identical hormones?I just trying to figure out what route would be best. I am close to slapping that patch back on and dealing with a period every other week cause I haven't had any menopause issues while on the patch. Also I like the idea of every other day, didn't know that was a possibility.
Thanks for any advice/help!
Andie

Anonymous said...

I have been taking Premarin and Prometrium for a number of years and it has been very good to me. Recently I had to change doctors and I have not found one who will prescribe these for me. The latest doctor wants me to use Duavee. I wonder why change what is already working for me. He said something about the progesterone being too high in Prometrium. Is this so? I am worried about the new prescription, but have to try it at this point.

denverdoc said...

Hi All, Again

I appreciate everyone leaving comments on their own experiences with Duavee, on their concerns, and with questions about this choice of HRT.

To Anon who is 36 and had a total hysterectomy in 2016: you are right to be concerned about the long-term effects of a surgical menopause. Estrogen has a lot of benefits for women, and you are way short of the average age at which many of us run out of that useful hormone. Because you don't have a uterus, you could be on just an estrogen-only replacement program. No uterus means no need to balance the effects of estrogen on the uterine lining which, over many years, could cause that lining to become thickened and at-risk for cancer. Women who still have their uterus need progesterone (synthetic or natural) or bazedoxefine which is an ingredient in Duavee that also protects the uterus as well as promotes bone density. Duavee has Premarin in it, but perhaps not enough to free you of some of the unpleasant side effects of low estrogen including hot flashes. If you are not satisfied with the way you feel on Duavee, talk to your doctor about an estrogen-only product which may suit you better at this point of life.

To Andie with BRCA2 gene mutation: You are facing some tough decisions. Research suggests that hormone therapy for women like you after a total hysterectomy does not raise the risk of breast cancer. These women were in their 30s or early 40s. I don't know how long the study followed these women to determine the outcome. I haven't found many women who like the Combipatch for the very reason you cite. Duavee could be a good choice for you as the selective estrogen receptor modulator (bazedoxefine) in this combo pill is known to block the effects of estrogen on breast tissue. Premarin is disliked by many due to its equine (horse) origin, but it is less potent in its breast stimulation than bio-identical estradiol. If you and your doctor are comfortable with ongoing HRT as you age, Duavee strikes me as a good option.

Anon whose new doc wants to switch to Duavee: The concern of ongoing use of Premarin and Prometrium is that combination HRT raised the risk of breast cancer in women in the Women's Health Initiative study (the product used in the study was a combination of Premarin and medroxyprogesterone) compared to the negligible risk seen in women on just Premarin. Duavee has Premarin in it paired with bazedoxefine which actually blocks estrogen receptors in breast tissue. It might be a good choice for you, but if you are currently taking a higher dose of Premarin compared to the .45 mg amount in Duavee, you might experience some hot flashes/night sweats during the transition.

Kind regards to all,
Judy Paley, MD

Mary said...

I am 73 years old and have had hot flashes since post menopause. I was on Premarin, then estradoil. My GYN took me off all estrogens. The hot flashes turned into day and night sweats. I began getting bladder infections every 2 months. My GP put me on Premarin cream and the bladder infections stopped. I recently had 2 fractured toes (not at the same time). I wanted to get on an estrogen again. My GP put me on Duavee a week ago. It's probably too soon to get results but my sweats seem to be worse. And because you are not suppose to take Premarin cream if on Duavee, I have stopped that. However, I am starting to feel some variginal burn- irritation return. I definitely do not want another bladder infection and am wondering if I can do the Premsrin cream for another month while I give the Duavee a try.

bruggerbunch said...

I'm 45 and I almost lost my 14 year old daughter to sepsis. My doc thinks my body went into shock and just stopped making hormones. My estrogen was 20 and my FSH was 40. I have the worst month of hot flashes and no sleep. Lost 12 pounds. I have never missed a period or even been late. Even when I had the bad month my period was still not late. I tried claim pro patch for two weeks but it tore my skin up then doc switched me to Duavee. 4 days into Duavee I am having a period. So technically this period is just 3 weeks late not missed. Do I keep taking the drug bcs obviously I have a problem with my blood work. I am super confused. But it's been such a bad month;( help!

denverdoc said...

Hi Mary and Bruggerbunch, I will get back with you shortly.
Judy Paley, MD

denverdoc said...

Mary, I'm not sure why your doc took you off estrogen, but of course that's a change that can set off all sorts of symptoms including hot flashes and dry vagina with associated discomfort and bladder infections. I'm assuming your GP chose Duavee to cover both the lack of estrogen as well as a low bone density. As it has estrogen in it, there's a standard 'warning' to not use additional estrogen, but oral low-dose estrogen does not always improve vaginal symptoms. Some experts are dismayed by this label info and confirm that locally used Premarin along with Duavee is not a problem.

Bruggerbunch, Oh my, what an ordeal you've been through! It is certainly possible that your family health crisis with high stress and weight loss messed up your hormonal balance big-time. This could resolve back to regular periods or may herald peri-menopause which perhaps you were close to reaching anyway although you're pretty young for that. I think the bleeding that came with Duavee indicated the return of hormones; you probably would've bled whether or not you started the Duavee. Hard to say what will happen next. You and your doctor should explore whether or not to stop Duavee (which is not the greatest choice for early peri-menopause if that's what you're going through) and seeing what happens next, perhaps considering some supplemental estrogen if you develop symptoms of low estrogen. I wish you and your family a speedy return to normal life!

Best,
Judy Paley

Lola said...

Hi, I have been on duavee about 3 months. After startimh, my hot flashes are gone. I sleep better and am more calm. I am having severe leg feet and hand swelling
Also leg and foot pain. Is this normal? Suggestions?
Thx
Lola

denverdoc said...

5/9/16
Hi Lola,

Well, muscle cramps are the most common reported side effect, so kinda' common but completely unacceptable. This is apparently not a good fit for you.

I hope you consider other solutions for hot flashes, insomnia, and anxiety with your doc!

Good luck!
Judy

B&B said...

Has anyone experienced an increase in acne since starting on Duavee?

Leslie said...

While my night hot flashes are so much better while taking DuaVee, the leg cramps have been utterly horrendous. I thought it was something else until I found this blog. Is there and advice on continuing to to the DuaVee and eliminating the cramps? Is there a vitamin or increase in fluids? My overall experience has been so good. Just the cramps.

Unknown said...

I have been on Duavee for a couple of years now - still having hot flashes and started having severe leg cramps. Doctors said to drink tonic water which help some. Just made the connection that it might be a side effect of Duavee. Stop taking it yesterday and no cramps last night. We will see if this was the culprit.

denverdoc said...

Thanks unknown and everyone else for all feedback. The more experience we gather here, the better informed we are on our choices thru menopause and beyond!

Linda said...

I’m 55 and in menopause. I’d been using Vivelle Dot and Prometrium for several years but had frequent spotting so switched to Duavee and that symptom went away, but night sweats and mood swings increased. If I took a pill late or forgot to take one (I had to write dates on pill push-out sheets to remember whether or not I’d taken them. Birth control was always dated, why not Duavee?) The expense of the Duavee and the fact that it didn’t seem to solve things prompted me to look at natural alternatives. Two months ago, I started taking Estroven Max Strength + Energy and 1000 mg St. John’s Wort in a.m., 500 mg at lunch, and use ½ of a Vitamin E (30 iu) vaginal suppository at night for dryness. I can honestly say I feel better than I’ve felt in years. I was so scared to cut the cord on prescription meds, and had a few days of emotional instability, but it was worth it. (My husband was fully warned…) Spotting did not return. I have a hot flash after drinking wine or eating too much hot spice, and occasionally have night sweats (but I had that with the Duavee). I can definitely live on these new terms. Less money, less worry.

Rita said...

I am 71 and my most recent bone density scan showed osteoporosis in my spine. I have been menopausal since age 43 when the hot flashes and night sweats began. After 10 years of Prempro and then 10 years of bioidentical natural hormone therapy, my gyn took me off of everything. The hot flashes came back, and after much trial and error with natural products, I found something that worked pretty well to alleviate them--PM Phytogen Complex (Thai kudzu) by Solgar. I take 2 tablets daily. I have just started taking Duavee to stop the bone loss, and combined with daily walking and some weight lifting, which I view as a necessity, not optional, I hope to reverse the bone loss. I am happy to find this blog and all the feedback and advice from Dr. Judy! I hope the Duavee works for me.......will stay in touch.

Anonymous said...

I am 53. My last period was when I was 47. I went through the hot flashes and miserable sleep cycles by taking citalopram because my mother had estrogen positive breast cancer when she was 67 (she's fine at 83). I weaned myself off of citalopram over 3 years ago. Earlier this year, I started exercising daily and reduced my caloric intake to 1500 calories. I haven't lost a pound. My OB/GYN gave me a prescription for Duavee which I started taking a week ago. Is Duavee supposed to help with menopausal weight gain? I have gained over 50 pounds since menopause. I have hypothyroidism and take 50mcg. of Synthroid, which they reduced down from 75 because they said my levels were too high. What are people's experience with weight changes on this drug?

Anonymous said...

Hello all! I am 43 years old and post menopausal. I do not know why I entered menopause so early, but it may have something to do with having one ovary removed in 2012. I think the remaining one gave up. I've been on Duavee for about ten days now. I haven't noticed any significant changes, but I'm going to give it some time. I believe I do need a higher estrogen dose, but there is only one strength of Duavee. Has anyone ever been on two Duavee tablets a day? Has anyone been on an estrogen patch and taken raloxifene with it? There must be some other options that combine estrogen and a SERM. It's such a novel idea.

Profe A.J. said...

I have been taking. Duavee for almost 2 years. I am 55 and have completed one full
Year without a period. I have had no side effects to speak of while on this medication . However I have experienced at 4-6 month intervals night hot flashes and wondered if I should supplement my dosage with something else and if this is a common occurance....has anyone else complained of "breakthrough" hot flashes while on Duavee? Thank you in advance for your reply!

Profe A.J. said...

Hello all, I am 55 and have been one full
Year without a period. I have been suffering hot flashes day and night for over a year and since on Duavee- 1 year and a half, the hot flashes have pretty much disappeared . I have had no side effects from this medication . However, recently for the entire month of July and still these last few nights I have suffered from interrupted sleep from night flushes ....should I increase my dose of Duavee ? Is this a common occurance? Should should I supplement with something else ? Thank you in advance for your time?

Marion Hess said...

I am 54 years old and have been taking Duavee for one year. In the past month I have been having a terrible period of hot flashes day and night. This seems consistent with some of the other notes I have read on this blog. Has anyone found a solution? Is it safe to take 2 pills? Is there another supplement to take along with Duavee. It seems to meet that eating, worry, body heat (hugging) all bring on a day time hot flash. Night hot flashes and interrupted sleep are the same as I had pre-Duavee.

Molly said...

I am 50 and was on pill since 47 to address peri-men symptons. In April, blood work showed my estrogen = 0 so started taking Duavee. Initially hot flashes - mood swings went away. Yet interrupted sleep/insomnia compounded by leg sensation at night (maybe Restless Legs?) surfaced. Dr. then put me on Duavee + Premarin but insomnia/leg sensation continued. Now I am only on Duavee. And the insomnia continues creating irritability and mood swings. It seems the only benefit of Duavee for me is lack of flashes and I am now considering going off of it.

denverdoc said...

Hi All,

I appreciate the time everyone has taken to visit my blog and post their experiences with Duavee. I just spent some time looking through the latest medical literature on Duavee, and the results of clinical trials show ongoing favorable results in users with respect to diminished number and severity of hot flashes, preservation and small improvements in bone mineral density, better vaginal lubrication, and overall satisfaction with quality of life. All these parameters are positive for the .45 conjugated estrogen/20 mg bazedoxifene approved here in the US with slightly better results with the higher dose (.625 of estrogen/same dose of bazedoxifene) which is not available at this time. In addition, there was no increase noted in breast tissue density (denser breasts are more biologically active tissue with greater risk of breast cancer) which is a change seen with use of estrogen and progesterone combination regimens. Also, no increased risk of breast cancer, and the uterine lining is protected by the combination found in Duavee. Insomnia improves in the majority of women whose hot flashes are relieved by Duavee, but, as we can see from sleepless Molly above, this isn't always the case.

That said...not everybody loves this drug! I notice a trend in people posting here that dissatisfaction and ongoing or recurring hot flashes seems more like in younger women nearer to the menopause transition. Also, leg cramps are listed as an adverse effect in 9% of women who participated in clinical trials. Restless leg syndrome is common in postmenopausal women, but the one study I found on this suggested that hormone use seemed to have a favorable effect. Molly, it may be that you have RLS independent of Duavee use, and perhaps you should discuss options with your doc including a trial of something else for menopause and/or a medication directed strictly at RLS.

I'm still on this medication, and my first DEXA scan is coming up next week. I was one tick denser than the osteoporosis range when last checked; here's hoping that Duavee has had a favorable effect. Remember when considering my satisfaction, I am now 12 years into menopause.

Thanks again for stopping by and contributing to the conversation,
Judy Paley, MD

Anonymous said...

I have been on Duavee for a little over a month now. I am 44, went through menopause naturally at the age of 31. This is the first med I have taken that has truly helped with vaginal dryness and aided in me sleeping better. After reading through all the post, I am curious if anyone has had breast tenderness or pain? The past few days my breast have become incredibly sore. I've got a call in to my OB, but was just curious if anyone has had this happen to them and what they did to help the tenderness? Thanks!

Rita said...

After being on Duavee for 3 weeks, I realized I was experiencing several side effects which could only be attributed to this drug---arthritic pain, joint swelling, nausea (off and on) and extreme fatigue. So I quit taking, it, and my symptoms cleared up nearly overnight. Sorry to quit Duavee, as I had such high hopes.......

ℑαmmy said...

I'm 35 going though surgical menopause. I have been on Duavee for well over a week. I am still waking up through out the night with hot flashes and night sweats. I wake up in the morning to start my day with nausea and a headache. How long does it take for Duavee to start working? (I am also on Premarin 0.5 grams 2x a wk.)

brin3m said...

Hi, I am new to Duavee. I have been only on it for a week and no problems so far. I have a question though. My doctor also wants me to use a DHEA suppository nightly for 3 months..... seems like a lot of hormones .... but i am trying them anyway. my problem is they won't stay in so I am curious how to keep them in . Only one stayed in overnight. .... any thoughts on DHEA Suppositories?

wheaty said...

I started taking Duavee 3 weeks ago and feel much better with the hot flashes and mood swings and vaginal dryness but not able to acheive an orgasm! I am frustrated (sexually) My husband is too :) Will this side effect go away?? HELP

Anonymous said...

Hi dec 1-2016 I was just prescribed Duvaee and I too am scared of all the side effects. It's daunting to read all the studies and possibility of uterine cancer and breast and so forth. Also leg cramps... I have vaginal dryness and mild but annoying hot flashes and can't sleep. I have never been on any hormone meds. I'm 58 and healthy so should I use this or not??? All,of your posts are helpful but I too am fearful.
May33

Anonymous said...

May33 - also I want to feel better but should,I just try it and if I get any side effect just stop??? I haven't had a period in 3 years just annoying hot flashes And dryness vaginally and I'm also on Effexor for anxiety and small amount of lisinipril for hypertension and borderline cholesterol family has it. I'm concerned about stroke and blood clots and all that please comment doctor if you can . Thanks to all the bloggers

KB said...

Hello - I'm 59 and almost 10 yrs into menopause. One option my doc gave me for hair loss and sleep issues is Duavee. The hair loss started the past couple of years. I don't believe the sleep issues are from hot flashes - they have never been a problem. I have restless legs syndrome which acts up periodically. Is Duavee something you would suggest for the hair loss and sleep issues? Im concerned about risk of eye issues with it - my father had a stroke in his eye in his 70's. doc suggested I take vitamin e which thins blood if I am concerned but supposedly its a very small risk. Appreciate your thoughts. KB