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    Includes Expert Content
    What's your opinion on Duavee?
    avatar
    dkazmercyk posted:
    My gynecologist is highly advocating I go on Duavee for 8 years for my menopause symptoms which are at this point sleeplessness and hot flashes. I had intended to just march on through this without help as I have been doing for the last year or so but he doesn't understand why I would not want the added benefits of better skin, hair, breast cancer prevention, not to mention better quality of life without hot flashes and difficulty sleeping. That all sounds lovely but my research online kind of scares me with mentions of high risk of clotting etc. Plus, won't I just be delaying the inevitable menopause symptoms once I go off it in 8 years?
     
    avatar
    Mary Jane Minkin, MD responded:
    Dear dkazmercyk,
    Just a couple of thoughts. First of all, whenever starting any sort of menopausal intervention, hormonal or otherwise, I would encourage an open mind on how long to take it: two days, two years, whatever. See how you feel on it, and if you don't like it, you can stop. Duavee is certainly a reasonable choice for women who have significant vasomotor symptoms. What it is is estrogen, combined with a medication called bazedoxifene, to protect the lining of the uterus from overgrowth. (before this medication was tested, we had to use progestins to do this; it has been now nicely shown that bazedoxifene can do this as well). Now what is nice about bazedoxifene is that it also can help blocking estrogens' effects on the breast.
    The major health risk is that there is a slight increased risk of blood clots (thrombophlebitis) that can be seen with any oral form of estrogen.
    When you decide to go off of estrogen, you might get some hot flashes, but you might not-hot flashes are not inevitable.
    So it is certainly a good option, if you do choose intervention for your symptoms.
    Good luck,
    Mary Jane
     
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    jtaylor53 replied to Mary Jane Minkin, MD's response:
    Hello. It seems as though the side effects listed are similar for any hormonal therapy, including the popular birth control pills. What concerned me was the list of common and rare side effects listed on WebMd for this drug.

    Common and Rare Side Effects for conjugated estrogens-bazedoxifene oral

    Has anybody any knowledge of these side effects? Duavee sounded too good to be true, until I read this page. I have been on HRT for a while: Continuous Sequential Vivelle and Combipatch and my doc wants me to change. I have had no trouble side effects from this, but...

    I have read that the bazedoxifene is easily tolerated by women who had gastro problems with other osteo meds, biophosphates (?) like fosamx, etc.

    Finding info is not easy to do with Duavee. Any relevant sites would be welcomed.
     
    avatar
    Mary Jane Minkin, MD replied to jtaylor53's response:
    Dear jtaylor53,
    Indeed the side effects are very similar to regular estrogen therapy. The addition of a medication like bazedoxifene could be associated with some leg cramping, but it is unusual. Most women tolerate the medication well,
    Good luck,
    Mary Jane
     
    avatar
    jtaylor53 replied to Mary Jane Minkin, MD's response:
    Thank you, Dr. Minkin, for your reply. I have found some further information on bazedoxifene alone and it appears that it may work well for me. I will return to this discussion and let you know how I do.

    The women in my family are very sensitive to estrogen level change and I am planning to stay on a form of HRT as long as I can. It is not an anti-depressant that I need, but a degree of estrogen to keep my quality of life at healthy and happy. Been there, done that and the results were not good.

    Thank you, again.
     
    avatar
    rungirl1 replied to jtaylor53's response:
    Good morning,
    My gyne prescribed Duavee for me in early February. I've been on it approximately 2 months. During the first 30 days, I found I was sleeping longer through the night and felt much more rested. It took a really long time (3 weeks) to see a reduction in hot flashes. And I did see a reduction on the amount and severity, but - I am still getting them regularly, just not as severe and the last two weeks, I find my restfulness that I had seen is dissipating and I am again waking very early and finding it hard to return to sleep. When it is time to go to work, I haven't fallen asleep and go to work tired (and cranky). Mind you, I've continued my 5mg of Ambien and 5mg of Melatonin as well. I am pretty sure I am going off Duavee because the results for the cost and taking a hormone haven't proved sufficient for me.
     
    avatar
    Mary Jane Minkin, MD replied to rungirl1's response:
    Dear Rungirl1,
    If you'd like to stay with estrogen, you might need a higher dose of it. Duavee contains 0.45 mg of conjugated estrogens; and only comes in the one strength. You might do better with a somewhat higher dose of estrogen; for example, Prempro comes in a dose with 0.625 mg of conjugated estrogens. You of course could try other forms of estrogen as well, for example the Combipatch or ClimaraPro patch. And there are other non hormonal options as well. Brisdelle is a 7.5 mg dose of paroxetine, and is prescribed for hot flashes and night sweats; and in studies shows that women do tend to sleep better on it. So if you are still uncomfortable, do check in with your health care provider regarding other options.
    Good luck,
    Mary Jane
     
    avatar
    jtaylor53 replied to Mary Jane Minkin, MD's response:
    Hello. I would like to give an update on myself on Duavee, since starting it December of 2014. I had been using Vivelle dot and Combipatch on a continuous sequential program...started 5 years after menopause. The Duavee seemed to good to be true, but the good side effects of it are even better when considering the UK studies. I immediately began having more energy. My sleep is good and restful, but that was not a problem before. I feel warmer...less cold-natured. It does not control hot flashes as well as my old HRT, but they are so mild and infrequent that it took me a couple of months before I realized what was happening. I cannot take the meds for osteopenia and my life without hormones is of very poor quality. I plan to stay on Duavee for as long as my doctor will allow me. It tested as well on women 75 as on younger women. It does not do as well on vaginal health and I find I must use a lubricant every time we have sex. I am not sure if I experienced "weight-creep" or if the holidays and winter made it seem that way, but I found the extra five pounds harder to get off afterward. So...I am going to be extra careful on the weight watching. Well...that is just my experience, but I thought it might be worth something to someone. I am 61 years old now, have no cancer that runs in my family and am willing to be part of this "experiment" hoping that progress will continue to be made for all the women who are living well into their 80s and 90s. I was part of the birth control pill "experiment" as well. The women in my family do not do well without hormones and so far our using HRT has caused no problems. My mother was on estrogen alone since 1960 and combination from 1982 until her death at age 89. My sister has been taking either birth control or HRT since she was in her teens. But that is just us. My daughter is very, very sensitive to hormone fluctuation during her own cycle and in cycles controlled by birth control pills, of which she and her Gyn try to switch around trying to find something that works well for her. Kudos to women who do not need to use HRT and hugs to those who suffer without it because they cannot use it. I am just glad it is there for the women in my family and I am glad that Duavee or something like it will be there for my daughter when she needs it.

    -Jeanne
     
    avatar
    Mary Jane Minkin, MD replied to jtaylor53's response:
    Dear Jeanne,
    Thanks much for the update, and sharing your information. I'm delighted you are doing very well on the Duavee-and I hope it will continue to work this well for you.
    Stay well,
    Mary Jane
     
    avatar
    jtaylor53 replied to Mary Jane Minkin, MD's response:
    Hello all.

    This is an update on my experience with Duavee, which I started in December 2014. I did have "weight creep" but have kept it to a minimum that I can live with by being vigilant. I still run warmer, but the initial energy boost had more to do with the fact that my former mild-to-none mood swings have altered to noticeable but mild with my peaks a tiny bit higher and my valleys a tiny bit lower. My anxiety is not addressed as well, either"026but the minute dose of xanax that worked before has only doubled to what is still a minute dose at bedtime, excepting those days when the mood swing may cause some higher anxiety. Really"026all very easily dealt with and no cause for alarm by me or my PCP. Just FYI.

    For my vaginal health, I tried Replens for months and it helped, but I still had to use lubricant every time we had sex. My GYN added topical estrogen to use only on my outer genitalia because that area was thin skinned and often tore or had abrasion from even the careful sex I had with my husband's gentleness. I still had zero libido and zero response.

    My PCP suggested replacing the Replens and estrogen cream with DHEA vaginal suppositories and I started them March 2016. I had read great stuff about return of response and libido along with vaginal health. The first week my vaginal health seemed to backslide, but I kept up the program. By the second week of daily usage, I was able to have sex without lubrication and without any irritation. There was plenty of my own lubrication. When I entered the weeks that I started using the suppositories only twice a week, I decided that the cost was worth it for me. I still have very little response, but sex is no longer uncomfortable, so I am more likely to want to cuddle"026even though I still have no libido. I am going to add a different topical cream with arginine that is used only before sex to see if I get some response action. I will let you know.

    My PCP found though blood work that my Progesterone levels were very low, although within range for a menopausal woman and, of course, that is the problem with my vaginal health and libido/response. Can't alter my Progesterone in any manner because that just blows the balance of Duavee's estrogen-with-protection.

    So far, what I am doing works for me, but maybe in the future women will be able to get the all the benefits of HRT without the drawbacks. One thing for certain, life for me is better on Duavee than it was without it.

    -Jeanne
     
    avatar
    Mary Jane Minkin, MD replied to jtaylor53's response:
    Dear Jeanne,
    Thanks for the updates. A couple of thoughts: you really do not need progesterone to balance out the effect on the lining of the uterus as you are taking bazedoxifene for that purpose. The hormone you could consider adding is testosterone; that would be the hormone most likely to help libido. In the US, there is no testosterone officially approved by the FDA for women (in the low dose that we can use)-but almost all compounding pharmacies do make a testosterone cream (to be used daily)-and there is certainly data to support its use (you may want to go to the North American Menopause Society's website, menopause.org, to read more about its use.)
    But it sounds like you are doing better, and that's terrific.
    Good luck,
    Mary Jane
     
    avatar
    jtaylor53 replied to Mary Jane Minkin, MD's response:
    Thank you, Dr. Minkin. I actually tried an Arginine gel for a bit, which did bring some warmth to the area in about 15 minutes"026not much else, though.

    My doctors and pharm tech actually discussed with me the idea of Testosterone cream, but we each felt a bit off with that inclusion to my genitals. I am just sort of settled into not having much response anymore and am happy to sometimes have desire. I remember what it felt like to have passionate sex with the man I love and am satisfied to be able to keep him happy still as we grow older together. His libido and sexual ability is diminished due to chronic pain and its treatment, however ineffective in the hyper-controlled atmosphere of today"026and we are doing okay in our mutual dysfunction.

    I hope this column will be of help to other women, but it seems that not many doctors even know about Duavee still. I will follow up on that website. Thanks again.

    -Jeanne
     
    avatar
    jtaylor53 replied to jtaylor53's response:
    I just tried to search for Duavee here on this website and came up empty. Even this discussion does not show up when searched for. At the NAMS website a search for Duavee brings up nothing.

    Is this drug really that rare? Am I the only person using it? I sort of feel like that. Are no doctors prescribing it?

    -Jeanne
     
    avatar
    Mary Jane Minkin, MD replied to jtaylor53's response:
    Dear Jeanne,
    I assure you you are not the only one using Duavee! Of course, Duavee can be prescribed for most women who have a uterus who need hormone therapy. There are certain women who are especially good candidates-namely, women who have "flunked" progestin therapy for one reason or another-but still would like to take estrogen. Why do some women not like progestins? Some hate the bleeding that progestins can produce; women on Duavee tend to have no significant bleeding. Some women have breast soreness on progestins; because Bazedoxifene blocks estrogen actions at the breast, women tend to have less breast soreness. And many women feel very moody on progestins; they don't feel moody on basedoxifene. So these women are particularly happy on Duavee, in general.
    Good luck,
    Mary Jane


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