New Haven, CT—
New types of hormone therapies are expanding treatment options for postmenopausal vasomotor symptoms. A conference presentation gives pharmacists some insights into what treatments are being increasingly used or are emerging.

The presentation during the 2020 Pre-Meeting Symposium of The North American Menopause Society (NAMS) discussed the introduction in the past decade of new selective estrogen receptor modulators (SERMs) and the use of estrogens together with SERMs to replace progestins. 

Hugh S. Taylor, MD, of Yale School of Medicine advised that fetal estrogens might be one of the newest promising developments because their unique properties distinguish them from estradiol, although they have some SERM-like properties.

“Estrogens have many beneficial properties, yet treatment also has risks,” according to the review. “Attempts to identify novel estrogens or selective estrogen receptor modulators (SERMs) with substantial benefit and minimal risk have not produced superior products. The past decade has brought improvements including new SERMs and use of estrogens together with SERMs to replace progestins.”

Taylor notes that estriol and estetrol are now more commonly used in clinical practice because of characteristics that distinguish them from estradiol. He points out that estetrol decreases hot flashes and leads to beneficial cardiovascular changes but counteracts estradiol stimulation of the breast, while estriol also acts a as a weak estrogen but can counteract some negative effects of estradiol. 

“While most estrogens activate estrogen receptors alpha and beta, leading to coactivator or corepressor recruitment, fetal estrogens also have an essential function in programming human development,” according to the presentation. “We have recently found that, in fetal life, estriol interaction with ER recruits epigenetic modifiers allowing long lasting changes in DNA methylation. Fetal estrogens may be weak estrogens when function is assessed using the classic definition of estrogen action, however they are powerful epigenetic agents. These estrogens may have added benefits that are yet to be fully explored.”

More options mean that clinicians have a better chance to improve patients’ health and well-being, pointed out Stephanie Faubion, MD, MBA, NAMS medical director. “This presentation promises to offer some great insights into the future of hormone therapy,” she added. “It’s important for healthcare providers to understand that these SERMS and estrogens have different biological characteristics, and some may have benefits over others, increasing opportunities for personalizing care for women.
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