WHERE ARE WE GOING

The story of menopause is very long. It has been going on for centuries. Currently scientists have started GENERATIONAL research on it. The first book on it was written by Robert Wilson in 1966. There are different views on it, that it was to improve the sale of drugs and earn money, however many women benefitted from it. It came to a tragic end when a lot of women started to developed  endometrial cancer and it was recognised that they needed progesterone along with oestrogens to prevent it. Many other problems started such as breast cancer, heart disease, deep venous thrombosis (DVT), but women suffering osteoporosis and many genitourinary problems continued.  In 2001 it was decided to instigate a research program called THE WOMENS HEALTH INITIATIVE and this started in the USA. This was not a great scientific study as the women selected belong to all age groups. The study was halted half way and when published almost 80 percent of women did not want to take HRT and suffered in silence. However further research has clarified that the HRT should be started early in menopause, before the age of 60 or within 10 years of menopause. This is called window of opportunity. A fair bit of help is now available in this area. Great concern remained about prevention of breast cancer and osteoporosis. There were a new group of drugs that came into play; they act both as oestrogens and anti-oestrogens, with oestrogen receptors at different sites in the body. There called selective oestrogen receptor modulators (SERMS). Tamoxifen is one such drug, it was first described in 1987. It has proven to be very useful for the chemo prevention of breast cancer. However one drawback of this is that it is oestrogenic on endometrial tissue causing to grow, thus increasing the risk of endometrial cancer.

Raloxifene is another SERM which is useful for the treatment of osteoporosis. It does not harm breast tissue or endometrial tissue. The risk of DVT is there. There are many SERMS for the treatment of osteoporosis.  

In the management of menopausal years, HRT helps with symptoms of hot flashes, prevents colon cancer, osteoporosis but there is risk of breast cancer, DVT, stroke, CHD, alzhiemers and poor cognitive function. The few most important SERMS are Tamoxifen , Raloxifene and Ospemifene. They help with breast cancer, and osteoporosis. They can cause stroke, hot flushes, musculoskeletal problems and DVT.

Soon I hope the world’s scientists and researchers can produce an ideal SERM that can help with hot flushes, no stroke or DVT, reduce CVD, no breast cancer, cure osteoporosis and fracture risk and no endometrial cancer. The SERMS that we have now, TAMOXIFEN, RALOXIFENE, DUVAVEE, OSPEMIFENE, TIBOLONE, and many others; will continue to help the ever growing population of post menopausal women.