Duavee
Duavee pairs conjugated estrogens with the SERM bazedoxifene to treat hot flashes in women with a uterus, without needing a separate progestogen.
How it works
Duavee is a tissue-selective estrogen complex (TSEC) — a novel approach that pairs conjugated estrogens with bazedoxifene, a selective estrogen receptor modulator (SERM). The estrogen component treats vasomotor symptoms; bazedoxifene acts as an antagonist in the uterine lining, replacing the role of a progestogen by blocking estrogen's proliferative effect there, while allowing the estrogen to act beneficially in other tissues. This means Duavee can be used without a separate progestogen in women with a uterus — a practical distinction from standard estrogen-only or combined HRT.
Clinical trials (SMART trials) showed Duavee reduced hot flash frequency by approximately 75% compared to placebo at 12 weeks. It is not appropriate for women who need a separate progestogen for other reasons, or for those with a history of estrogen-sensitive cancers. Duavee should not be combined with additional estrogens or progestogens.
How to track Duavee
- Hot flash frequency and severity — the primary vasomotor response indicator; the SMART trials measured frequency as the primary endpoint.
- Breakthrough bleeding or spotting — even though bazedoxifene provides uterine protection, any bleeding should be logged and reported to a physician.
- Sleep quality and night sweats — secondary vasomotor response measures.
- Mood and energy — estrogen's systemic effects on brain signaling are similar regardless of the progestogen strategy.
- Side effects specific to SERMs: leg cramps, which are a recognized bazedoxifene side effect.
- Establish a hot flash baseline for one to two weeks before starting — the SMART trials showed rapid response (within weeks), so your log will show the curve of improvement clearly.
- Log any bleeding or spotting immediately with date and description — bazedoxifene replaces the progestogen, but any unexpected bleeding warrants prompt physician review.
- Track leg cramps separately from other side effects — they are a recognized bazedoxifene effect and are dose-related.
- Avoid adding other estrogen or progestogen products while on Duavee without physician approval — the formulation is designed as a complete unit.
- Compare weekly hot flash averages to your pre-treatment baseline at the four- and twelve-week marks — those were the primary evaluation intervals in the SMART trials.
Questions to ask your physician
- My pre-treatment hot flash baseline was [X] per day. At [N] weeks on Duavee, my current average is [Y]. Is that response consistent with the SMART trial data?
- I've been logging [X] episodes of spotting or bleeding since starting Duavee — here is the pattern. Does that require further evaluation?
- My log shows leg cramps [frequency and severity]. Is that within the expected range for bazedoxifene, and does it warrant any adjustment?
- I'm taking [other supplements or medications] alongside Duavee. Are there interactions I should know about that might appear in my tracking data?