Androgens, SERMs and Other Drugs for Menopause

Androgen replacement

There is evidence that many women might benefit from taking an androgen such as testosterone or DHEA in addition to estrogen and progesterone/progestin. Androgen replacement has been shown to have positive effects on libido, sexual function, bone, and well-being in some women. Appropriate androgen replacement may be especially useful for younger women who have experienced surgical menopause and have lost the androgens (as well as estrogen and progesterone) produced by the ovaries. Also, since oral estrogen therapy tends to lower free testosterone levels, some women who use oral estrogen may find androgen replacement useful in restoring libido.

What are SERMs?

SERM is an acronym that stands for Selective Estrogen Receptor Modulator. SERMs are drugs that act on some parts of the body (such as bones) much like estrogen does. But they do not have estrogen-like effects on other parts of the body. In fact, SERMs can block the effects of estrogen on certain body tissues.

SERMs work by binding (attaching) to estrogen receptors and selectively modulating the effects of estrogen in different body tissues. Since not all estrogen receptors are the same, these differences allow SERMs to have one effect in one kind of tissue and a different effect in another kind of tissue.

Tamoxifen, a synthetic drug used in breast cancer prevention and treatment, was the first SERM and is now prescribed for about half of all women diagnosed with breast cancer in the United States. It blocks the effects of estrogen on the breast and has been shown to reduce the risk of cancer recurrence and of cancer developing in the other breast. Side effects of tamoxifen include an increased risk of certain visual disturbances, fatal pulmonary embolism, and cancer of both the endometrium and the body of the uterus. The anti-estrogenic effects of tamoxifen on breast cells appear to reverse after five years. The drug may then becomes cancer-promoting, for reasons that are not clear. This article, Tamoxifen: Questions and Answers, is a comprehensive resource from the National Cancer Institute, Cancer Facts.

Raloxifene (brand name Evista) was the second such synthetic drug on the market, and it is similar in some ways to tamoxifen. It is currently prescribed to protect women against osteoporosis and heart disease without increasing their risk for breast cancer. However, it doesn't protect bones as well as estrogen does. And both tamoxifen and raloxifene may increase the risk for colon cancer.

Other SERMs are being developed. Ideally, a SERM would have all the benefits of estrogen and none of the risks. No SERM is yet available in the U.S. that meets that standard. However, SERMs such as raloxifene may be a better choice than estrogen for some women.

What other drugs are used to treat conditions related to menopause?

Antidepressant drugs are used to treat menopause-related symptoms of depression or mood changes, and have reduced hot flashes in some studies.

Thyroid function sometimes changes at menopause and causes depression that may be relieved by appropriate thyroid hormone replacement.

Vitamin E and clonidine, a drug typically used for high blood pressure, can help reduce hot flashes. Drugs used to slow bone loss include bisphosphonates (such as alendronate), raloxifene and calcitonin.

Cholesterol-lowering drugs called statins are proven to help reduce the risk of heart disease and are being explored to prevent osteoporosis.

All of these drugs can have side effects and may or may not be right for a particular woman, so discuss their use with your healthcare provider.

Please read on...
	What Is Hormone Replacement Therapy (HRT) and Why Would I Need It?
	What Hormones Are Used in HRT? and How Is HRT Taken?
	About Estrogen
	About Progesterone
	Benefits, Risks and Side Effects of ERT, HRT, and NHRT
	HRT and Breast Cancer
	Androgens, SERMs and Other Drugs for Menopause
NEXT:	What Are Some Alternatives to Standard HRT?
	Resources and References

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Updated 09/29/2010