Pilot Study of Effects of Duavee® on Imaging and Blood Biomarkers In Women With Menopausal Symptoms

Inclusion Criteria:

* Women who report vasomotor symptoms (hot flashes or night sweats)
* No menstrual periods for at least 3 months
* Must have at least one ovary (hysterectomy is permitted; bilateral salpingo- oophorectomy is excluded).
* BMI \<36 kg/m2
* Moderate risk of developing breast cancer based on having any one or more of the following:

  * First or 2nd degree relative with breast cancer
  * Known carrier of moderate to high penetrance germline mutation
  * Prior breast biopsy showing proliferative breast disease or multiple biopsies
  * High mammographic density (Volpara® categories c or d or BIRADs density assessment as heterogeneously or extremely dense (c or d).
  * IBIS Breast Cancer Risk Evaluation Version 8 10-year relative risk of \>2X that for the population for age group.

Exclusion Criteria:

* Risk: A prior biopsy showing LCIS, DCIS, or invasive breast cancer.
* Medical Conditions:

  * Have a predisposition to or prior history of thromboembolism, deep venous thrombosis, pulmonary embolism, or stroke
  * History of renal or liver disease
  * Prior invasive ovarian or endometrial cancer
* Medications

  * Current anticoagulant use other than low dose aspirin
  * Taking systemic hormones within two months (eight weeks) prior to baseline MRI and mammogram.
  * Taking tamoxifen, raloxifene, Duavee, or any selective estrogen receptor modulator, or an aromatase inhibitor within 12 months prior to baseline MRI and mammogram.