You've probably heard of breast cancer, or osteoporosis. Today we're going to talk about a special class of drugs used to treat both of these conditions. They're called Selective Estrogen Receptor Modulators, or SERMs for short. While the name may sound a bit scientific, the way they work is pretty simple. Let's take a look at what SERMs are and how they affect our bodies.
Simply put, what are these SERMs?
SERMs are a type of medication that controls or changes the way the hormone estrogen in our body works. Think of estrogen as a key. Our body's cells have receptors that fit this key. When estrogen binds to these receptors, those cells receive certain messages. For example, a message telling them to "grow."
SERMs do a wonderful job. They block estrogen from entering the keyhole in some parts of the body. And, in other parts of the body, these drugs act like estrogen . That means the same drug does two things, depending on the location. It's like the same person acting as a protector at one time and as a helper at another.
Two of the most commonly used drugs in this group are tamoxifen and raloxifene .
How do these SERMs work?
As we said before, these work differently in different places. Let's explain that a little more.
1. Regarding breast cancer: There are some types of breast cancer that are helped to grow by the hormone estrogen. We call these hormone receptor (HR) positive or estrogen receptor (ER) positive breast cancer. These types of cancer cells have sites on their surface where estrogen binds. When estrogen binds to these sites, the cancer cells receive a message telling them to "divide and grow more." SERMs work by blocking these sites before estrogen does. It's like putting the wrong key in a keyhole. Then the right estrogen can't get to the key and bind. This stops the cancer cells from getting the message to grow.
2. Bone health: On the other hand, estrogen is a hormone that is very important for keeping our bones strong. Especially after menopause, women's estrogen levels decrease, which increases the risk of bone loss, or osteoporosis . At this point, SERMs act on bone cells in the same way that estrogen does . That is, they go to the bones and give them the message, "Stay strong, don't lose calcium."
Do you understand? The same drug blocks the action of estrogen in the breasts, while acting like estrogen in the bones and protecting the bones. This is the specialty of these drugs.
In what cases are SERMs used?
Doctors mainly recommend this medication in several situations.
For breast cancer
- For women at increased risk of ER-positive breast cancer: If someone in the family has had this cancer, or if genetic testing has confirmed that they have genetic mutations that increase the risk of cancer, they are given this medication to prevent cancer before it develops.
- For those who have had surgery for breast cancer: After surgery, these medications are given to prevent the cancer from coming back (recurrence). They also help prevent cancer from developing in the other healthy breast.
- For DCIS (Ductal Carcinoma in Situ): This is a very early stage of breast cancer. SERMs are used to prevent this condition from spreading further.
- For breast cancer that has spread to other parts of the body (Metastatic Breast Cancer): This medicine is given to control the cancer.
- For male breast cancer: Yes, men can get breast cancer too. Tamoxifen is also used for ER-positive cancers.
For osteoporosis
A drug called raloxifene is used to control bone loss after menopause and reduce the risk of fractures.
How successful is this treatment?
Yes, these are very effective treatments. Let's look at some of the findings from studies:
- Giving tamoxifen to high-risk women who have not gone through menopause can reduce the risk of breast cancer by about 40% .
- If someone who has had surgery for cancer in one breast takes tamoxifen, the risk of developing cancer in the other breast is reduced by 50% .
- Tamoxifen helps reduce the risk of recurrence by 30% to 50% for someone with early-stage breast cancer.
- Studies have shown that the drug raloxifene reduces the risk of spinal fractures in postmenopausal women with osteoporosis.
What are the possible side effects of taking this medicine?
Like any medication, SERMs can cause side effects. However, it is important to remember that not everyone will experience all of these side effects . Also, the benefits of these medications often outweigh the side effects. Your doctor will explain all of these to you.
In the table below, we have separated the common and rare side effects of this medication.
| Type of medicine | Side effects |
|---|---|
| Tamoxifen - for women | |
| Common side effects |
|
| Rare but potentially serious side effects |
|
| Raloxifene - for women | |
| Common side effects |
|
| Tamoxifen - for men | |
| Side effects |
|
The most important thing is to talk to your doctor about any discomfort you experience. There are simple ways to manage some of the side effects.
Can the discomfort caused by side effects be reduced?
Yes, you definitely can. There are a few things you can do to help reduce discomfort, especially symptoms similar to menopause (hot flashes, insomnia, vaginal dryness).
- Reduce hot flashes: Reduce caffeine (coffee, tea) and spicy foods. Some people find relief by eating foods that contain phytoestrogens, such as soybeans, chickpeas, and lentils.
- For sleep problems: Daily exercise helps you get better sleep.
- For vaginal dryness: There are special vaginal moisturizers that can be used for this. You can ask your doctor about these.
When should you seek immediate medical advice?
If you feel that the common side effects are getting worse, let your doctor know. However, there are some serious conditions that can rarely occur with SERMs. If you experience any of the following symptoms, don't delay. Go to the nearest hospital emergency room (ETU) immediately.
- Numbness or weakness on one side of the body or face.
- Difficulty speaking, slurring of words.
- A sudden, severe headache.
- Sudden difficulty breathing.
- Severe pain in the chest, arm, shoulder, or jaw that occurs for no apparent reason.
These could be signs of a stroke or pulmonary embolism, so you should be very careful about these.
Take-Home Message
- SERMs are a special type of medication that changes the way the hormone estrogen works in the body.
- These are used very successfully to prevent and treat some types of breast cancer and to control bone loss.
- The specialty here is that the same drug blocks the action of estrogen in one part of the body, while acting like estrogen in another part.
- Like all medicines, side effects can occur. However, not everyone gets them. Talk to your doctor about any discomfort you experience.
- Be aware of serious symptoms such as stroke or blood clots. If you experience any of these symptoms, go to a hospital's Emergency Department (ETU) immediately.
- If you are at risk for breast cancer or have osteoporosis, talk to your doctor about whether this SERM treatment is right for you and make sure you understand the benefits and risks.
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