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Case Reports
. 2025 Apr 1;17(4):e81582.
doi: 10.7759/cureus.81582. eCollection 2025 Apr.

Successful Treatment of Unscheduled Uterine Bleeding During Transdermal Menopausal Hormone Therapy Combined With Bazedoxifene

Tiger Koike  1 , Koji Koike  1 , Tomomi Shiga  2 , Motoki Takenaka  2 , Tatsuro Furui  2
Affiliations
Case Reports

Successful Treatment of Unscheduled Uterine Bleeding During Transdermal Menopausal Hormone Therapy Combined With Bazedoxifene

Tiger Koike et al. Cureus. .

Abstract

Abnormal uterine bleeding and withdrawal bleeding are noted as crucial causal factors for dropout of postmenopausal women during menopausal hormone therapy (MHT). We report the potential for treatment of unscheduled uterine bleeding during transdermal MHT by switching to transdermal 17-beta estradiol (TDE2) and bazedoxifene acetate (BZA) (TDE2/BZA) and evaluate the side effects of this treatment on the recurrence of climacteric symptoms in the five reported patients. Five postmenopausal women were treated with estrogen-progestin therapy (EPT) which included TDE2 and progestin formulation for MHT. The progestin formulation was replaced with BZA, a selective estrogen receptor modulator, due to unscheduled uterine bleeding. Four of five postmenopausal women were evaluated in terms of estrogen dynamics and recurrence of climacteric symptoms. In all cases examined in this report, unscheduled uterine bleeding resolved within one month. In two of four patients in whom climacteric symptoms recurred, their serum estradiol levels were surprisingly elevated three months after the start of TDE2/BZA. This is the first report, to our knowledge, of the successful treatment of unscheduled uterine bleeding by TDE2/BZA during MHT and a suggested correlation between estrogen dynamics and concomitant recurrence of side effects caused by TDE2/BZA.

Keywords: abnormal uterine bleeding; bazedoxifene; menopausal hormone therapy; tissue-selective estrogen complex; transdermal 17-beta estradiol.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The amount of bleeding during the three months before and after switching of treatment in Case 2
The maximum amount of menstrual blood volume for the patient’s young age (20–39 years old) was defined as Score three on the visual analogue scale (VAS). EPT, estrogen-progestin therapy; TDE2/BZA, transdermal 17-beta estradiol/bazedoxifene acetate.
Figure 2
Figure 2. Changes in serum estradiol levels before and after switching of treatment
TDE2/BZA, transdermal 17-beta estradiol/bazedoxifene acetate; 3M, three months after the switch of treatment.
See this image and copyright information in PMC

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