The Newest Estrogen is the Oldest One – Duavee


For millions of women, Premarin® was a household name. Before the Women’s Health Initiative (WHI) was published in 2002, Premarin was one of the most widely used medications in the world. But after the WHI suggested that it caused an increase in breast cancer, blood clots, stroke and heart attacks, sales dropped and the medication was vilified.


Two things since create great irony: 1) many of the negative claims about Premarin have since been either proven wrong or were exaggerated (more on that can be found throughout and 2) the latest and greatest new estrogen teams up our old friend Premarin with a new SERM or selective estrogen receptor modulator called bazedoxifene. The brand name for this is called Duavee.


The excited about this medication is the bazedoxifene acts like a progestin meaning it blocks the potential negative side effects of the Premarin, but lets the Premarin continue to do its good stuff.


The March issue of the journal Menopause has two articles on Duavee and its beneficial affect on improving sleep in women coping with menopause. The study was part of the Selective  estrogens, Menopause, And Response to Therapy trials SMART trial that has been abbreviated SMART Trials.


In the study a total of 318 women with moderate to severe hot flashes and 459 patients with severe hot flashes and sleep disturbances. The women receiving Duavee had significantly improved hot flashes and sleep quality, mostly because their hot flashes got so much better it stopped waking them up. However, among the women with the most severe hot flashes, their sleep improved directly due to the medication affect on sleep.


The second study in the March Menopause issue studied the affects of Duavee on a woman’s sleep and health-related quality of life (HRQoL) after one year of treatment. In this study of 459 women with bothersome to severe hot flashes, the women received either Duavee, PremPro (which is Premarin + medroxyprogesterone – the medication in the WHI study) or a placebo.’


At the end of one year, the Duavee was as good as the PremPro for improving hot flashes and sleep and much, much better than placebo. But here is the interesting part: The Duavee has been shown to also protect bones from osteoporosis and prevent vaginal dryness while having no negative affect on breast or the uterine lining so no risk of uterine cancer. The difference is due to pairing up the Premarin with bazedoxifene rather than with medroxyprogesterone.


So there you have it; the newest estrogen is the oldest one. But the difference is by pairing it up with a better “other” medication, the Premarin can do the good things it was known to do but with far less risk for the potential negative side affects.  You can find more about this in and other new advances in menopause in My Menopause Magazine for the iPad and iPhone and soon for the Android in the Apple Newsstand.

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  • July 21, 2017

    I have been taking Premarin for a couple of years and now cannot live without it (I changed into the Incredible hulk when I tried and do not want to go there again)! My problem is now living in France it is not available, but I believe Duavive is. Can you tell me what the equivalent dosage would be so I can tell my doctor. I currently take 1.25 mg of Premarin. thank you so much in advance. Kind regards

  • March 2, 2018

    Hello, I just turned 50 this year and have not had a period for about 8 months. My dr says I am definitely in menopause. The hormonevtest indicated that I had nearly no estrogen. I have gained weight for the last two years. I exercise daily and eat no carbs and am very careful with my diet. I felt so frustrated. My dr put me on duavee. I have been on duavee for about 5 weeks now. My hot flashes are not gone. I sleep slightly better; however I attribute that to an increase in exercise. Be for duavee, I was using progesterall cream. I stopped that when the dr put me on duavee. I am seeing not an ounce of difference in my weight. Does duavee help or hurt in the weight loss department?This extra 40 pounds has really effected my life and it was the main reason I went to the dr .What can I do? I don’t want to take this duavee if it keeps me from being at a healthy weight. Please help.

    • admin
      May 28, 2018

      Hi and thanks for you note. Weight gain is a common complaint in perimenopause and menopause. And there are definitely things you can do to help control weight. I can imagine that this is a very frustrating time for you. DuaVee should not play a major role in weight gain, and estrogen in general is able to help control weight. Forty pounds is a large amount of extra weight to carry. If you would like my help, you can visit and fill in the short form. We can set up a time to for a 15 minute strategy call to see what your goals are and if you’d like my help. I look forward to hearing from you.
      Dr Mache Seibel

    • June 1, 2020

      Hi my doctor is starting me on this next week. My mom had estrogen based breast cancer so not much for helping my menopause. Will ths medicine give me any energy back and I have ADHD and my medicine for it doesn’t work for me anymore bc of the low level of estrogen and one more thing well I get my sex life back

      • admin
        August 7, 2020

        Duavee should be a good choice for someone with your history. Unfortunately, I can’t say much more without speaking with you about your full history and discussion about benefits and risks and options. If it is of interest to you, I do offer coaching to women via phone and we could then create a plan to help you. You can look into this at

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