Selective estrogen receptor modulators (SERMs) are a class of drugs used to increase estrogen levels in pre- and postmenopausal women. Raloxifene (Evista) is a common SERM that is FDA-approved for the prevention and treatment of osteoporosis in postmenopausal women and to reduce the risk of invasive breast cancer in postmenopausal women at high risk or with osteoporosis. SERMs were developed to harness the benefits of estrogen while avoiding its potential side effects. Raloxifene acts like estrogen on bones, protecting bone density, but acts as an anti-estrogen on the uterine lining. Studies show that raloxifene can increase bone density and lower LDL cholesterol with no stimulative effect on the uterine lining, which means it is unlikely to cause uterine cancer. However, raloxifene can also cause hot flashes and increase the risk of blood clots, including deep vein thrombosis and pulmonary embolism. Patients taking raloxifene should avoid tobacco use and prolonged immobility to reduce blood clot risk. Raloxifene decreases the risk of spine fractures in postmenopausal women but does not appear to decrease the risk of hip fractures. Another SERM combination drug, bazedoxifene-conjugated estrogen (Duavee), is FDA-approved to reduce hot flashes and osteoporosis in postmenopausal women.