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.