"Are SERMS for you?"
Excerpted with permission of the author from "The Estrogen Alternative"
by Steven R. Goldstein, MD, hosted by Sue Spataro, RN, BSN
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Should you phone your physician tomorrow and ask about a prescription for Evista? Despite all the positive qualities of this SERM, unfortunately it isn't for every woman. Many of my patients have been interested in Raloxifene since the news about it was reported in the media. I have this advice for most women already on HRT: "Wait. Stay on HRT. Let's reevaluate in a year."

I also had more than forty patients on my "waiting list", who wanted to be phoned as soon as raloxifene was released so that they could get a prescription. These women knew the pros and cons, and I knew they were the ideal candidates.

How do doctors make the distinction between a good candidate for the new SERM and a woman who will be better served through other means? How can you make the distinction, so you can better discuss this option with your doctor? This chapter will help you answer the question "Is Raloxifene for me?"

WHO IS THE IDEAL CANDIDATE FOR RALOXIFENE?
Most doctors agree that raloxifene would be a very viable choice for women who are past menopause and have the following characteristics:

• You can not, should not or will not take estrogen.
• You don't have the vasomotor symptoms of menopause. You aren't suffering from bad hot flashes, night sweats or palpitations secondary to the hot flashes, either because you are over them or you never really got them. If you do have these symptoms, they are mild enough not to be bothersome or able to be controlled by over-the counter remedies.
• Avoiding breast cancer is your major concern, perhaps because of your family history, or just because you fear the disease.
• You want to prevent osteoporosis.
• You tried HRT, but you did very poorly. Perhaps you had a hard time with the progestin phase of HRT. Or, for whatever reason, after trying HRT over a period of time, you just couldn't tolerate it.

MAKING YOUR DECISION
If you find that you're a good candidate for Raloxifene, what else might you consider before you see your doctor?

This brief questionnaire can help confirm your decision. Read the questions below and choose the answer that comes the closet to what's truest for you:

1. How often do you see your gynecologist?
   a. Twice a year b. Once a year c. When I'm having a problem d. It's been several years, I think
2. When did you last have a mammogram?
   a. Within the past year b. Within the last 2 years c. Two or more years ago d. I have never had a mammogram
3. Which of the following statements is true about your cholesterol?
   a. I know my cholesterol levels and they are in an acceptable range. b. I know my cholesterol levels and they are higher than I'd like them to be. c. I don't know my cholesterol levels, but I'm sure I've been tested. d. To my knowledge, I haven't had my cholesterol tested.
4. When you are taking a prescription drug, which statement is most true about you?
   a. I take it steadily as directed and have a discussion with my doctor if I want to stop. b. I sometimes get so busy I forget to take it or refill it. c. I rarely take prescription drugs. d. I avoid all medications and prefer to treat myself with diet or herbal remedies.
5. The prospect of taking a pill each day indefinitely
   a. Doesn't bother me if it will help protect me from illness.
   b. Bothers me a little, but I guess I'd do it if I thought I would benefit.
   c. Bothers me a great deal, and I think I'd resent it.
   d. I would never do it, for any reason, unless it was keeping me alive.
6. If I got mild leg cramps or hot flashes from medication
   a. It wouldn't be the end of the world; I could deal with it if there was a benefit in exchange.
   b. I might stop taking the medication if they were bad.
   c. I would definitely stop taking medication that brought on leg cramps or hot flashes, however mild. I take medication to feel better, not worse.
   d. I wouldn't even try a medication that could have these things as side effects.
7. How do you feel about taking conventional HRT (hormone replacement therapy)?
   a. I either can not, will not, or should not take estrogen.
   b. There's nothing in my family history to prevent me from taking it, but I fear increasing my risks of breast cancer.
   c. I'm currently on HRT, but I'm not fully convinced that it's the right decision.
   d. I'm doing great on HRT and I've been on it for more than five years.
8. If you were given a prescription for a drug that had only been on the market for a year, how would you feel?
   a. Fine with it, if my doctor is fine with it.
   b. Concerned enough to do a lot of reading about it.
   c. Very concerned; I would probably not take it.
   d. Totally concerned. I would worry that down the road the drug causes problems no matter how convincing the testing of the drug was.
9. If your doctor recommended raloxifene and you found your health insurance did not cover it, how would that influence your decision?
   a. It wouldn't matter to me, if I thought I should be on it. My health is worth spending money on, so whether or not my health insurance over something isn't the sole deciding factor for me.
   b. I would have mixed feelings about taking it, especially if the policy DID cover HRT, but I wouldn't rule it out completely.
   c. I wouldn't or couldn't fill a prescription that wasn't covered on my health plan.
   d. I do not have health insurance, and medical bills are a burden for me.

See Dr. Goldstein's Interview
and Laurie Ashner's interview

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