Dr. Mary Claire Haver

Let me be clear.

50% of you will have unscheduled vaginal bleeding.

It is normal, it is expected, and it is not pathologic.

Your uterus is getting used to having hormones thrown at it again, and it tends to bleed.

Now, good news, it usually goes away on its own with no treatment.

You do not need a biopsy or a workup.

And if any clinicians are listening, do not put these women through biopsies and hysteroscopies and DNCs until it's been six months and the bleeding has not resolved.

You can go lower on the estrogen, go higher on the progestogen to get the bleeding.

As long as you've determined you've done an exam and the bleeding is not coming from the vagina, it's coming from the endometrium,

You can monitor her for a few months, change the doses around, see.

Now, if the bleeding is persistent and you've done a workup and everything's normal, we have options.

There is something called Duave or Duave, I don't even know how to pronounce it correctly.

D-U-A-V-E-E.

It is a combination of premarin plus basodoxafine.

Basodoxafine is a serum similar to tamoxifen, okay, tamoxifen.

But it binds, blocks, and downregulates the estrogen receptors only in the breast tissue and the uterus.

So for my patients, our patients who are having persistent bleeding or...

Very high risk for breast cancer.

We are usually going with Duivy for those patients to find, block, and down-regulate the estrogen receptors in the breast.

And then they don't bleed.