For postmenopausal women who experience breast discomfort or persistent vaginal bleeding while receiving menopausal hormone therapy, switching to a tissue-selective estrogen complex (TSEC) may be beneficial, according to a study published in Menopause.

A group of investigators from Seoul, Republic of Korea, conducted a retrospective cohort study to determine the outcomes of switching from menopausal hormone therapy to TSEC in women who experience vaginal bleeding or breast discomfort.

The researchers evaluated 82 postmenopausal women (mean age, 56.9 years; mean age since menopause, 5.8 years) who switched from hormone treatment to TSEC and recorded any changes in symptoms of previous adverse events.

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Nearly all women (97.6%) reported improvements after switching from hormone therapy; however, 27% of women experienced worsening vasomotor symptoms, which were more frequently associated with estradiol dosage changes from 2 mg (41.7%) than with changes from 1 mg (16.7%). Breast lesions and leiomyoma changes were unremarkable after 1 year of switched medication (88.4% and 97.8%, respectively).

“This was the first study to evaluate the effects of switching to TSEC in women who experienced breast discomfort or vaginal bleeding during [menopausal hormone therapy],” the investigators noted.

“[O]ur study suggests [that] when breast discomfort or vaginal bleeding does not improve during [menopausal hormone therapy], a switch to TSEC might be beneficial and is supported by safety profiles from studies using TSEC,” continued the investigators.

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The authors added, “This study suggests that TSEC may be a good option for women who have breast pain/tenderness or persistent bleeding/spotting during other hormone therapies, when the difference in estrogen does is taken into consideration.”


Kim S.E., Lee D-Y, Choi DS. Tissue-selective estrogen complex for women who experience breast discomfort or vaginal bleeding when on hormone therapy [published online October 8, 2018]. Menopause. doi: 10.1097/GME.0000000000001244