- Osteoporosis Prevention in postmenopausal women
-
Hormone Replacement in postmenopausal women
- Beyond hot flash stage
- Estrogen Replacement contraindicated (Breast Cancer)
- Breast Cancer Prevention in post-menopausal women
- Breast Cancer risk >1.66% in 5 years
- Venous Thromboembolism
- Perioperative period
- Prolonged immobilization (discontinue 72 hours before expected immobilization)
- History of Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA)
- Pregnancy
- See Selective Estrogen Receptor Modulator
- Positive Estrogen effects
- Stimulates bone mineralization
- Improves lipid profile
- Anti-Estrogenic effects
- No Breast stimulation
- No uterine stimulation
- Raloxifene 60 mg orally daily
- Course of 5 years if used for breast Cancer Prevention
- See Selective Estrogen Receptor Modulator
- Precautions
- Thromboembolism and Cardiovascular Risk are FDA black box warnings
-
Venous Thromboembolism (DVT, PE)
- More likely to occur in first 4 months of treatment
- Similar to risk with Estrogen Replacement
-
Cerebrovascular Accident
- Avoid in Coronary Artery Disease or cardiovascular disease risk factors
-
Hot Flashes (Anti-Estrogen effects)
- See Hot Flashes for management
- Avoid symptomatic management with agents contraindicated following Breast Cancer
- Avoid Estrogen and Phytoestrogens
- Other effects
- Avoid in pregnancy
- Avoid in Lactation
- Lower efficacy than Tamoxifen for breast Cancer Prevention (but lower Venous Thromboembolism, Endometrial Cancer Risks)
- No Uterine endometrial stimulation (unlike Estrogen)
- Does not require concurrent Progestin use
- Does not stimulate Breast tissue (unlike Estrogen)
- No Breast swelling, tenderness, or pain
- No data yet on Breast Cancer
- Increases Bone Mineral Density
- Modest effect (1-2%) at hip, spine, and long bones
- Not as effective as Estrogen Replacement
- Positive lipid effects
- Lowers LDL 10-12%
- Lowers Total Cholesterol 6-7%
- Helps stabilize pelvic floor
- Protects against Uterine Prolapse
- Decreases Incidence of Urinary Incontinence
- Reduces pelvic surgery rate by 50%
- Goldstein (2001) Obstet Gynecol 98:91-6 [PubMed]