TISSUE SELECTIVE ESTROGEN COMPLEX – TSEC. WHAT IS IT?

 

 

Dr Steven R. Goldstein is a leading Menopause Specialist in NYC. He is a Certified Menopause Practitioner with the North American Menopause Society and a past President of the International Menopause Society as well as a past President of the North American Menopause society. In private practice for over 25 years in New York City, Dr Goldstein has successfully helped thousands of women cope with the symptoms of menopause.

 Dr Goldstein, a Menopause Specialist in NYC says one of the novel “new” hormone therapies for coping with menopause is the Tissue Selective Estrogen Complex” (TSEC). The concept grew out of the women’s health initiative. There were 2 arms, the Premarin and Provera arm which news broke in 2002 that the use resulted in an increase in breast cancer and cardiovascular disease. Little mention was given to the fact that women who had hysterectomy and took Premarin by itself had a 25% reduction in breast cancer when followed up over 11.3 years and no increase in heart disease over the long haul. So clearly the culprit was the Provera, the progestogen.

 

This progestogen was given to protect the endometrium for those who had a uterus. Question is, can you protect the uterus without giving the progestogen? The answer is Estrogen plus a SERM (Selective Estrogen Receptor Modulator). Examples of these SERMs are Raloxifene, Tamoxifen, Bazedoxifene etc. SERMS are unique compounds that can be estrogenic in some tissues and estrogen antagonistic in other tissues. For instance:

 All of them are Estrogen-like in bone and estrogen blockers in the breast

 In the endometrium (the innermost lining layer of the uterus), they are variable. For instance, Basodoxifene has been shown to reduce endometrial thickness under transvaginal ultrasound. So, the Premarin was paired with the SERM Basodoxifene instead of with the progestogen. This combination became approved after clinical trials for treating vasomotor symptoms in menopausal women such as hot flashes and night sweats. The occurrence of these vasomotor symptoms was reduced from around ten to two per day in menopausal women.  

 Where would this one pill combination be best used instead of traditional hormone replacement therapy like estradiol and estrogen? Dr Steven R. Goldstein, a leading hormone specialist in NYC, says it is best used to reduce breast cancer risk because each component in it is an anti estrogen in breast.

 The type of patient this would be best for is any woman who would be considered for combination oral therapy. She should be considered for this Tissue Selective Estrogen Complex (TSEC) first. Dr Goldstein remains in practices as a Menopause Specialist in NYC and continues to help menopausal women find relief from the troublesome symptoms by using hormone replacement therapy (HRT) involving SERMs and TSEC.