<unk> s are used for various<unk> -related diseases, including treatment of ovulatory dysfunction in the management of infertility, treatment and prevention of postmenopausal osteoporosis, treatment and reduction in risk of breast cancer and treatment of dyspareunia due to menopause.<unk>  is also used in combination with conjugated<unk> s indicated for the treatment of<unk>  deficiency symptoms, and vasomotor symptoms associated with menopause.<unk> s are used dependent on their pattern of action in various tissues: Figure 2: Nolvadex (tamoxifen) 20-milligram tablets (UK) Tamoxifen is a first-line hormonal treatment of ER-positive metastatic breast cancer. It is used for breast cancer risk reduction in women at high risk, and as adjuvant treatment of axillary node-negative and node-positive, ductal carcinoma in situ. Tamoxifen treatment is also useful in the treatment of bone density and blood lipids in postmenopausal women. Adverse effects include hot flushes and more serious is two to three times higher relative risk of developing endometrial cancer compared to women of an age-matched population. Toremifene, a chlorinated tamoxifen derivative, causes fewer DNA adducts in liver than seen with tamoxifen in preclinical studies and was developed to avoid hepatic carcinomas. It is used as endocrine therapy in women with ER/PR-positive stage 4 or recurrent metastatic breast cancer and has demonstrated similar efficacy compared to tamoxifen as adjuvant treatment of breast cancer and in the treatment of metastatic breast cancer. Raloxifene is used for prevention and treatment of postmenopausal osteoporosis and breast cancer prevention in high-risk postmenopausal women with osteoporosis. Preclinical and clinical reports suggest that it is considerably less potent than<unk>  for the treatment of osteoporosis. It is associated with an acceptable endometrial profile and has not demonstrated tamoxifen-like effects in the uterus but has been associated with adverse effects such as venous thromboembolism and vasomotor symptoms, including hot flushes. Ospemifene is an analogous metabolite of toremifene. Unlike tamoxifen, toremifene is not a rat hepatocarcinogen and therefore ospemifene would also be a safer<unk>  than tamoxifen. It is used for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy associated with menopause. Clinical data on breast cancer are not available, but both in vitro and in vivo data suggest that ospemifene may have chemopreventive activity in breast tissue. Bazedoxifene is used as treatment for osteoporosis in postmenopausal women at increased risk of fracture. It has been shown to be relatively safe and well tolerated. It shows no breast or endometrial stimulation and in the first two years, the small increase is better in venous thromboembolism, and similar in the long term to other<unk> s. The advantage of bazedoxifene over raloxifene is that it increases endothelial nitric oxide synthase activity and does not antagonize the effect of 17β-estradiol on vasomotor symptoms. The first tissue<unk><unk>  complex (TSEC) combines conjugated<unk> s and the<unk>  bazedoxifene to blend their activities. The combination therapy is used in the treatment of moderate to severe vasomotor symptoms associated with menopause, prevention of postmenopausal osteoporosis as well as treatment of<unk>  deficiency symptoms in non-hysterectomized postmenopausal women. The combination allows for the benefits of<unk>  with regard to relief of vasomotor symptoms without<unk> ic stimulation of the endometrium. Available forms<unk> s marketed for clinical or veterinary use Name Brand name Approved uses Launch Notes Anordrin Zi Yun Emergency contraception 1970s Only in China, combined with mifepristone Bazedoxifene Duavee Osteoporosis prevention 2013 Combined with conjugated<unk> s Broparestrol Acnestrol Dermatology; Breast cancer treatment 1970s Discontinued Clomifene Clomid Female infertility 1967 Cyclofenil Sexovid Female infertility; Menopausal symptoms 1970 Mostly discontinued Lasofoxifene Fablyn Osteoporosis prevention, treatment; Vaginal atrophy 2009 Only in Lithuania and Portugal Ormeloxifene Saheli Hormonal contraception 1991 Only in India Ospemifene Osphena Dyspareunia due to vaginal atrophy 2013 Raloxifene Evista Osteoporosis prevention, treatment; Breast cancer prevention 1997 Tamoxifen Nolvadex Breast cancer treatment 1978 Toremifene Fareston Breast cancer treatment 1997 Sources: See individual articles.
Selective estrogen receptor modulator
Selective androgen receptor modulator
Selective estrogen receptor degrader
Selective progesterone receptor modulator
Antiestrogen
Antiandrogen
Aromatase inhibitor
Steroidal aromatase inhibitor