It is too early to tell, but promising research may yet come up with improved hormone replacement therapy for post-menopausal women. There's only one medical pearl in this issue, but you can count on more to come regarding the use of raloxifene (Evista) as an alternative to estrogen. Raloxifene is a selective estrogen receptor modulator (SERM) that has the good benefits of estrogen but fewer adverse effects. Namely, this class of pharmaceuticals helps decrease osteoporosis and cardiovascular disease without increasing the risk of breast cancer. Apparently, raloxifene was originally designed to prevent and treat breast cancer, but it didn't work as well as tamoxifen. Now, the medicine is often used as a second line hormone replacement therapy because of its favorable effects on bone density and heart disease. At this point in time, however, estrogen remains my first choice because of the extensive research demonstrating proven, and clinically significant, positive effects upon the prevention of osteoporosis, heart disease, and dementia. Unfortunately, the significance of the effects of raloxifene is still largely unproven.