Hormone medicines

Bazedoxifene

A selective estrogen receptor modulator whose US use is in a specific combination for menopausal symptoms and osteoporosis prevention.

Randomized menopausal combination evidence; selected trial reviewed 2026-10-01

Also known as: Duavee

Bazedoxifene molecular structure — Structure reference · C30H34N2O3

Practical use

Clinical purpose, evidence and review questions

Identify the formulation: Record whether the source studied bazedoxifene alone or bazedoxifene with estrogens.
State the goal: Separate hot-flash relief, bone-density change and actual fracture outcomes.
Bring relevant history: Discuss unexplained bleeding, clot history and the complete hormone-medication list with the treating team.

SMART-5: endometrium and bone density

US prescribing information; checked October 1, 2026

Overview

Bazedoxifene acts differently across estrogen-sensitive tissues. In the US, Duavee combines it with conjugated estrogens for moderate-to-severe menopausal hot flashes and prevention of postmenopausal osteoporosis in women with a uterus. The combination is not an aromatase inhibitor or a general treatment for high estradiol.

Risks and limitations

The combination carries clot and stroke concerns and is contraindicated with unexplained uterine bleeding, certain cancers, prior thromboembolism and liver disease. New postmenopausal bleeding requires assessment. Chest pain, sudden breathlessness or focal neurological symptoms need emergency care.

How to read this

Keep the estrogen component visible when interpreting a study. A selective receptor effect does not mean every tissue is protected or that findings transfer to men using androgens.

Research explained

SMART-5: endometrium and bone density

Who was studied

1,843 postmenopausal women aged 40–65 with an intact uterus, randomized in a blinded trial to combination therapy, bazedoxifene alone, another hormone therapy or placebo. Primary outcomes were assessed at 12 months.

What was found

Endometrial hyperplasia occurred in fewer than 1% and was similar among groups. Bazedoxifene/estrogen combinations increased spine and hip bone density versus placebo. Bleeding and breast-tenderness patterns differed from the estrogen/progestin comparator.

What it cannot establish

The outcomes were one-year endometrial histology and bone density, not a comprehensive demonstration of fracture prevention, cancer prevention or cardiovascular safety.

Read the original study

A receptor modulator is tissue-specific

Bazedoxifene limits estrogen stimulation of the endometrium in the studied combination. That does not make it interchangeable with medicines that reduce estrogen synthesis.

Supporting source