Tetracyclic heteroatom containing derivatives useful as sex steroid hormone receptor modulators

1. A method of treating a disorder mediated one or more sex steroid hormone receptors selected from the group consisting of hot flashes, vaginal dryness, osteopenia, osteoporosis, hyperlipidemia, loss of cognitive function, degenerative brain diseases, cardiovascular diseases, cerebrovascular diseases, hormone sensitive cancers, hormone sensitive hyperplasia, endometriosis, uterine fibroids, osteoarthritis, prostate carcinoma, benign prostatic hyperplasia (BPH), hirsitutism, alopecia, anorexia nervosa, breast cancer, acne, AIDS, cachexia, endometriosis, myoma, dysfunctional bleeding, tumors containing steroid receptors, for male contraception, for female contraception, for male performance enhancement, and for hormone replacement in a subject in need of treatment thereof comprising administering to the subject a therapeutically effective amount of a pharmaceutical composition comprising a pharmaceutically acceptable carrier and a compound having the following structure:

wherein X is —O—;

R 1 is selected from the group consisting of hydrogen, hydroxy, C 1-6 alkyl, —C(O)—C 1-6 alkyl, —C 1-4 alkyl-NR C R D and -L 1 -R 4 -(L 2 ) c -R 5 ;

 is phenyl;

a is 1;

R 2 is selected from the group consisting of C 1-4 alkoxy, —O-aralkyl, —OC(O)—C 1-4 alkyl, —O—SO 2 —C 1-4 alkyl, —O—SO 2 -(halogenated C 1-4 alkyl) and —O—Si(CH 3 ) 2 (t-butyl);

b is 1;

R 3 is selected from the group consisting of halogen, hydroxy, carboxy, oxo, cyano, nitro, amino, C 1-4 alkylamino, di(C 1-4 alkyl)amino, C 1-4 alkyl, C 1-4 alkoxy, halogenated C 1-4 alkyl, —O-aralkyl, —C(O)—C 1-4 alkyl, —C(O)O—C 1-4 alkyl, —OC(O)—C 1-4 alkyl, —O—SO 2 —C 1-4 alkyl, —O—SO 2 -(halogenated C 1-4 alkyl) and —O—Si(CH 3 ) 2 (t-butyl);

R 4 is selected from the group consisting of a five to six membered aryl and a five to six membered heteroaryl;

c is an integer selected from 0 to 1;

L 2 is selected from the group consisting of —C 1-4 alkyl-, —C 2-4 alkenyl-, —O—C 1-3 alkyl-, —S—C 1-3 alkyl- and —NR B —C 1-3 alkyl-; wherein R B is selected from hydrogen or C 1-4 alkyl;

R 5 is selected from the group consisting of —NR C R D , —C(O)—C 1-4 alkyl, —CO 2 H, —C(O)O—C 1-4 alkyl and —OC(O)—C 1-4 alkyl;

wherein R C and R D are independently selected from hydrogen or C 1-4 alkyl; alternatively, R C and R D are taken together with the nitrogen atom to which they are bound to form a five to seven membered aromatic, partially aromatic or saturated ring structure; wherein the ring structure optionally contains one to two additional heteroatoms selected from O, N or S;

or a pharmaceutically acceptable salt thereof.