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Key takeaways
Premarin, a hormone replacement therapy derived from pregnant mare’s urine, is used to manage menopausal symptoms but may not suit everyone, leading to the consideration of alternatives like Estrace, EstroGel, Prempro, Estring, or Vivelle-Dot.
Alternatives to Premarin vary in form, including oral tablets, topical applications, and vaginal inserts, to cater to different symptoms and patient preferences, highlighting the importance of personalized treatment plans.
All hormone replacement therapies, including Premarin and its alternatives, carry risks such as blood clots, strokes, and certain types of cancer, underscoring the necessity of medical supervision and prescription.
Non-pharmaceutical options, including dietary adjustments and supplements like vitamin D and omega-3 fatty acids, offer natural alternatives to manage menopause symptoms, though they do not replace hormones directly.
Compare Premarin alternatives | Estrace | EstroGel | Prempro | Estring | Vivelle-Dot | Natural alternatives | How to switch meds
Menopause can be a challenging phase of life for some women. Hormonal changes can be uncomfortable and affect mood and quality of life. Hormone replacement therapy (HRT) medicines can be helpful in managing moderate to severe symptoms of menopause.
Premarin conjugated estrogens are isolated from the urine of pregnant mares. Premarin has been approved by the Food and Drug Administration (FDA) for the treatment of menopausal symptoms such as hot flashes, vaginal pain, vaginal dryness, palliation for certain types of cancer, and prevention of osteoporosis in postmenopausal women.
Premarin may not be the right medication for every woman experiencing symptoms of menopause. There are many alternatives to Premarin and several forms of estrogen therapy available. Some formulations may also include progesterone or synthetic progestins. The formulation that’s chosen will depend on which specific symptoms are being experienced and patient tolerance and desire for a certain type of medication. These include:
- Oral estrogen tablets
- Topical moisturizers, creams, lotions, gels, and sprays
- Vaginal creams
- Other vaginal estrogen inserts such as vaginal rings and vaginal tablets
HRT medications are not available as over-the-counter medicines. They are prescription drugs that are typically prescribed by a gynecologist or healthcare provider with training and interest in women’s health. These medications are all associated with severe side effects including an increased risk of blood clots, stroke, heart attack, retinal vein thrombosis, and certain types of estrogen-sensitive tumors including an increased risk of breast cancer, endometrial cancer, and ovarian cancer. It is important to follow medical advice while taking these medications and to use them only as prescribed.
RELATED: Estrogens: Uses, common brands, and safety information
Compare Premarin alternatives |
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| Drug name | Uses | Dosage | Coupons |
| Premarin | Vasomotor symptoms, vulvovaginal atrophy, osteoporosis prevention, hypoestrogenism, palliative treatment for metastatic breast or advanced prostate cancer, dysfunctional uterine bleeding, uremic bleeding | Cream: 0.625 mg conjugated estrogens applied to vagina daily for 2 weeks then tapered Tablet: 0.3-10 mg conjugated estrogens by mouth depending on indication Injection: 0.6mg/kg OR 25 mg conjugated estrogens bolus depending on indication |
Premarin coupons |
| Estrace |
Vasomotor symptoms, vulvovaginal atrophy, osteoporosis prevention, hypoestrogenism, palliative treatment for metastatic breast or advanced prostate cancer | Cream: 0.01% estradiol applied to vagina 1-3 days per week Tablet: 0.5-2 mg estradiol by mouth, cycled 21 days on and 7 days off |
Estrace coupons |
| Delestrogen | Vasomotor symptoms, vulvovaginal atrophy, hypoestrogenism, palliative treatment for advanced prostate cancer | Injection: 10-30 mg estradiol valerate every 4 weeks | Delestrogen coupons |
| Prempro | Vasomotor symptoms, vulvovaginal atrophy, osteoporosis prevention | Tablet: 0.3 mg/1.5 mg conjugated estrogens/medroxyprogesterone once per day | Prempro coupons |
| Vivelle-Dot | Vasomotor symptoms, vulvovaginal atrophy, hypoestrogenism, osteoporosis prevention | Patch: 0.025-0.01 mg estradiol applied twice per week | Vivelle-Dot coupons |
| Vagifem | Vulvovaginal atrophy | Tablet: 10 mcg estradiol per vagina daily for two weeks, then taper | Vagifem coupons |
| Estring | Vulvovaginal atrophy | Ring: 7.5 mcg estradiol per 24 hours per vagina, change ring every 3 months | Estring coupons |
| Climara | Vasomotor symptoms, vulvovaginal atrophy, hypoestrogenism, osteoporosis prevention, abnormal uterine bleeding | Patch: 0.025-0.1 mg estradiol applied once per week | Climara coupons |
| Premphase | Vasomotor symptoms, vulvovaginal atrophy, osteoporosis prevention | Tablet: 0.625 mg estrogens for 14 days followed by 0.625 mg/5 mg conjugated estrogens/medroxyprogesterone for 14 days | Premphase coupons |
| Combipatch | Vasomotor symptoms, vulvovaginal atrophy, hypoestrogenism | Patch: 0.05 mg/0.14 mg – 0.05mg/0.25 mg estradiol/norethindrone acetate applied twice per week | Combipatch coupons |
| Climara Pro | Vasomotor symptoms, osteoporosis prevention | Patch: 0.045 mg/0.015 mg estradiol/levonorgestrel applied once per week | Climara Pro coupons |
| Menostar | Osteoporosis prevention | Patch: 0.014 mg estradiol applied once per week | Menostar coupons |
| EstroGel | Vasomotor symptoms, vulvovaginal atrophy | Gel: 0.06%, 0.75 mg estradiol per pump applied one pump per day | EstroGel coupons |
| Divigel | Vasomotor symptoms | Gel: 0.1%, 0.25-1.25 mg estradiol per packet applied once per day | Divigel coupons |
| Imvexxy | Menopausal dyspareunia | Insert: 4-10 mcg twice per week | Imvexxy coupons |
| Evamist | Vasomotor symptoms | Spray: 1.53 mg estradiol per spray, use 1-3 sprays per day to inner surface of forearm | Evamist coupons |
Other alternatives to Premarin
- Estrasorb tablet
- Femring vaginal ring
- Elestrin gel
- Menest oral tablet
- Osphena oral tablet
- Minivelle transdermal patch
Top 5 Premarin alternatives
The following are some of the most common alternatives to Premarin.
1. Estrace
Estrace is one brand name used for estradiol preparations. While Premarin contains conjugated estrogens, which include estrogen and estradiol metabolites, Estrace contains estrogen only. Both are very effective at mitigating symptoms of menopause and have similar side effect profiles.
Premarin vaginal cream has one indication over Estrace, in that it is also used to treat dyspareunia (painful intercourse) that occurs as a result of atrophic vaginitis, or painful thinning and inflammation of the vaginal tissues from lack of estrogen.
Both are available as a tablet or cream for at-home use.
RELATED: Estrace vs. Premarin
2. EstroGel
EstroGel is a topical gel consisting of 0.06% estradiol.
Premarin cream is applied directly to the vaginal tissues while one pump of EstroGel is to be applied to clean, unbroken skin on the inside and outside of the arm. Many women like the application of gel products as they absorb faster than lotions or creams and can be used as part of their daily bathing or showering routine.
While Premarin has a broad spectrum of uses, EstroGel is primarily used to reduce moderate to severe vasomotor symptoms, which include hot flashes and night sweats.
RELATED: Estradiol side effects
3. Prempro
Prempro is an oral tablet preparation of 0.3 mg/1.5 mg conjugated estrogens/medroxyprogesterone. Prempro contains progesterone as well as the same conjugated estrogens found in Premarin.
While Premarin has more indications for use, Prempro is primarily used for vasomotor symptoms of menopause and vulvovaginal atrophy. However, for women who have not had a hysterectomy (removal of the uterus), the addition of progestins in medications like Prempro may be preferable. Estrogen-only therapy may cause unwanted thickening of the lining of the uterus and lead to vaginal bleeding and endometrial cancer.
4. Estring
Estring is an estradiol-releasing vaginal ring. Estring is unique in that the inserted vaginal ring is placed and then changed every three months. It’s a good option for women with busy lifestyles that don’t want to worry about taking a pill or applying a cream every day. Estring is also a great option for women who are primarily only experiencing vaginal pain, dryness, and discomfort as symptoms of menopause.
5. Vivelle-Dot
Vivelle-Dot is an estradiol-releasing transdermal patch. It is applied to the skin of the abdomen twice per week. Vivelle-Dot is used in the management of vasomotor symptoms, vulvovaginal atrophy, and to prevent osteoporosis in postmenopausal women. In some women, transdermal HRT may be preferable as the medications in these preparations bypass liver metabolism and may not have the associated adverse effects.
Natural alternatives to Premarin
Many women are interested in non-pharmaceutical options for vasomotor symptom relief. While there are no supplements that are identical replacements of estrogen or progesterone, there are other options available that are considered safe and relatively effective. Hormone changes with age are normal and expected.
Estrogen is a steroid hormone with an important role in lipid metabolism. Dysregulation of lipid metabolism due to alterations in estrogen levels may affect body fat mass and distribution and increase the risk of heart disease and diabetes. It is recommended that postmenopausal women eat lower-calorie, balanced diets with adequate protein, vitamin D, vitamin B-12, antioxidants, fiber, fresh fruits, fresh vegetables, and hydrating fluids.
RELATED: The best diet for menopause
Vitamins
Vitamins are important cofactors the body needs to function normally. Vitamins do not increase estrogen levels but may need to be supplemented when they are not adequately present in the diet.
Vitamin D
Vitamin D deficiency is associated with bone mineral density loss and, inadequate intake is protective for certain types of cancers. Women going through menopause or who are postmenopausal and do not receive adequate sunlight should consider increasing dietary vitamin D or vitamin D supplementation.
RELATED: How much vitamin D should I take?
Omega-3 fatty acids
Omega-3 fatty acids cannot be synthesized by the body and must be obtained by the diet. Omega-3 fatty acids are cardioprotective, anti-inflammatory, insulin-sensitizing, and have been reported to protect against obesity and metabolic syndrome in postmenopausal women. Omega-3 fatty acids can be found in some nuts and their oils such as flaxseeds, walnuts, and soybeans, as well as wild-caught fish.
Antioxidants
Lower estrogen states are associated with oxidative stress. Oxidation damages biological tissues, increases inflammation, and is associated with obesity, diabetes, insulin resistance, and cardiovascular disease. Postmenopausal women are recommended to increase their intake of antioxidants which may include vitamin C, vitamin A, vitamin E, plant flavonoids, and soy isoflavones.
S-equol
Most supplements available as alternatives to Premarin contain the ingredient S-equol. S-equol is a compound from soy that can attach to estrogen-receptor beta. It is naturally present in small amounts in individuals with certain bacteria in their gut. Since these compounds bind the estrogen receptor, they can alleviate vasomotor symptoms and reduce bone loss. In the limited studies available, these isolated compounds have been found to be safe and effective in certain populations of women.
RELATED: How to absorb vitamins better
How to switch to a Premarin alternative
Changing prescription medications is usually done with informed decision-making between an individual and their healthcare provider. Depending on which preparation of Premarin you are taking (vaginal cream or tablet), you may need to taper your medication before starting a new one. In most cases, the new medication can be started as soon as Premarin is discontinued. It is important to talk with your healthcare provider about changing medications prior to discontinuing them. Using a prescription discount card from SingleCare may help reduce the cost of Premarin and Premarin alternatives at local pharmacies.