Understanding Duavee Side Effects

If you've been prescribed Duavee for hot flashes or osteoporosis prevention, you probably want to know what side effects to expect. Every medication comes with potential side effects, and Duavee is no exception.

The good news is that most women tolerate Duavee well. But it's important to know the difference between common, manageable side effects and serious warning signs that need immediate medical attention.

This guide covers everything you need to know about Duavee side effects — straight from the FDA labeling — so you can feel confident about your treatment.

What Is Duavee?

Duavee is a combination medication containing conjugated estrogens (0.45 mg) and bazedoxifene (20 mg). It's used to treat moderate-to-severe hot flashes in menopausal women and to prevent postmenopausal osteoporosis in women who still have a uterus.

Unlike traditional hormone replacement therapy (HRT) that pairs estrogen with a progestin, Duavee pairs estrogen with a SERM (selective estrogen receptor modulator). This unique combination protects the uterine lining without using progestin. For a deeper dive, see our guide on what Duavee is and how it's used.

Common Side Effects of Duavee

The following side effects were reported in clinical trials and are generally mild to moderate. They often improve as your body adjusts to the medication over the first few weeks:

• Muscle spasms — The most commonly reported side effect. Stretching and staying hydrated may help.
• Nausea — Usually mild. Taking Duavee with food can reduce this.
• Diarrhea — Typically temporary and resolves on its own.
• Dyspepsia (indigestion) — A feeling of discomfort or burning in your upper stomach.
• Upper abdominal pain — Mild stomach discomfort that usually goes away.
• Oropharyngeal pain (sore throat) — Occasional throat irritation.
• Dizziness — May occur, especially when standing up quickly.
• Neck pain — Reported by some patients in clinical studies.

These side effects affect a relatively small percentage of patients. If any of them become bothersome or don't go away after a few weeks, talk to your doctor.

Serious Side Effects and Warning Signs

Duavee carries a boxed warning — the FDA's most serious type of warning — about several potentially life-threatening risks. While these are rare, you need to know about them.

Blood Clots (Venous Thromboembolism)

Estrogen-containing medications can increase the risk of blood clots, including:

• Deep vein thrombosis (DVT) — A clot in the deep veins, usually in the legs
• Pulmonary embolism (PE) — A clot that travels to the lungs

Call your doctor or go to the ER immediately if you experience:

• Sudden leg pain, swelling, warmth, or redness
• Unexplained shortness of breath
• Chest pain, especially with breathing
• Coughing up blood

Stroke and Heart Attack

The Women's Health Initiative (WHI) studies found increased risks of stroke with estrogen therapy. Watch for:

• Sudden severe headache
• Sudden confusion, trouble speaking, or difficulty understanding speech
• Sudden numbness or weakness on one side of the body
• Sudden trouble seeing
• Chest pain or pressure, pain spreading to the arm or jaw

Breast Cancer

While the risk profile may differ from traditional estrogen-progestin combinations, the FDA advises that breast cancer risk should be assumed to be similar. Report any breast lumps, nipple discharge, or changes in your mammogram to your doctor promptly.

Dementia

In women aged 65 and older, estrogen therapy has been associated with an increased risk of probable dementia. This risk was identified in the WHI Memory Study.

Gallbladder Disease

Estrogen therapy increases the risk of gallbladder disease. Symptoms include sudden pain in the upper right abdomen, nausea, and vomiting, especially after eating fatty foods.

Severe Allergic Reactions

Though rare, anaphylaxis and angioedema (severe swelling) have been reported. Seek emergency help if you experience difficulty breathing, swelling of the face or throat, or a severe rash.

Specific Populations: Who Needs Extra Caution?

Women 65 and Older

Older women may face a higher risk of dementia and stroke with estrogen therapy. Duavee has not been studied in women over 75. Your doctor should carefully weigh the benefits against the risks.

Women with Liver Problems

Duavee is contraindicated in women with hepatic impairment or liver disease. If you have any liver issues, tell your doctor before starting treatment.

Women with a History of Blood Clots

If you've ever had DVT, pulmonary embolism, or a known clotting disorder (like protein C, protein S, or antithrombin deficiency), Duavee is not recommended for you.

Pregnant or Breastfeeding Women

Duavee is classified as Pregnancy Category X — it can harm a developing fetus. It's also not recommended for breastfeeding mothers.

How to Manage Common Side Effects

Most common side effects are manageable with simple strategies:

• For muscle spasms: Stay hydrated, stretch regularly, and consider magnesium supplements (ask your doctor first).
• For nausea: Take Duavee with food. Avoid taking it on an empty stomach.
• For dizziness: Stand up slowly from sitting or lying positions. Avoid alcohol, which can worsen dizziness.
• For digestive issues: Eat smaller, more frequent meals. Avoid spicy or fatty foods.
• For sore throat: Stay hydrated and use lozenges if needed.

If side effects persist beyond the first month or get worse, contact your doctor. They may adjust your treatment plan or explore alternative medications.

Keep Track of Your Symptoms

Consider keeping a simple log of any side effects you experience — when they started, how severe they are, and whether they're improving. This information is invaluable for your doctor when making treatment decisions.

When to Call Your Doctor

Contact your doctor if you experience any of the following:

• Side effects that don't improve after 2–4 weeks
• New or unusual vaginal bleeding
• Breast lumps or changes
• Persistent headaches or migraines
• Signs of jaundice (yellowing of skin or eyes)

Go to the emergency room immediately for:

• Signs of blood clots (leg swelling, chest pain, shortness of breath)
• Signs of stroke (sudden numbness, confusion, severe headache)
• Signs of heart attack (chest pain or pressure)
• Severe allergic reaction (throat swelling, difficulty breathing)

Final Thoughts

Duavee is an effective treatment for menopausal hot flashes and osteoporosis prevention, and most women tolerate it well. The common side effects — muscle spasms, nausea, and digestive issues — are usually mild and improve over time.

However, the serious risks are real and worth understanding. Have an honest conversation with your doctor about your personal risk factors, and don't hesitate to reach out if something doesn't feel right.

For more about how Duavee works and how to take it, check out our guides on how Duavee works and drug interactions to avoid. And if you're having trouble finding Duavee at your pharmacy, Medfinder can help you locate it in stock near you.