What is the cheapest alternative to Premarin (conjugated estrogens) cream?

From the Guidelines

The cheapest alternative to Premarin cream is generic estradiol vaginal cream, which typically costs 50-70% less than brand-name Premarin. Estradiol cream contains the same active hormone (estrogen) and works similarly to relieve vaginal dryness, irritation, and painful intercourse associated with menopause, as supported by the most recent study 1. The typical dosage is 2-4 grams applied vaginally once daily for 1-2 weeks, then reduced to 1-2 grams 1-3 times weekly for maintenance therapy. Other affordable alternatives include estradiol vaginal tablets (Vagifem generic) or the estradiol vaginal ring (Estring generic), which may be more convenient but slightly more expensive than the cream. These medications work by replacing estrogen that decreases during menopause, helping to restore vaginal tissue thickness and increase moisture production. Some key points to consider when choosing an alternative to Premarin cream include:

• The safety and efficacy of vaginal estrogen therapy, as shown in a large cohort study of almost 50,000 patients with breast cancer 1
• The potential benefits and risks of using vaginal androgens, such as DHEA, which have been shown to be effective in reducing dyspareunia in postmenopausal individuals, but have limited safety data in survivors of hormonally mediated cancers 1
• The availability of other treatment options, such as ospemifene, a selective estrogen receptor modulator (SERM) that has been studied in several large trials and found to effectively treat vaginal dryness and dyspareunia 1 For those who cannot use estrogen products, over-the-counter options like Replens or vitamin E suppositories provide some relief but are less effective. Always consult with your healthcare provider before switching medications to ensure the alternative is appropriate for your specific health situation.

From the Research

Alternatives to Premarin Cream

• Ovestin cream is a potential alternative to Premarin cream, as it has been shown to have similar effects on vaginal atrophy in post-menopausal women, but with fewer undesirable effects on estrogen levels and endometrium 2.
• Estropipate, estradiol, and progesterone are FDA-approved alternatives for the relief of menopausal symptoms, and may be considered as cheaper alternatives to Premarin cream 3.
• Bioidentical hormones, such as estriol, may also be effective for relieving menopausal symptoms, although they are not FDA-approved 3.

Cost-Effectiveness

• The cost-effectiveness of these alternatives may vary depending on the specific product and dosage form.
• A study comparing the continuation of postmenopausal hormone replacement therapy found that women who started with oral conjugated estrogens were more likely to continue treatment than those who started with transdermal estradiol 4.
• However, the study did not provide a direct comparison of the costs of these alternatives.

Hormone Replacement Therapy

• Hormone replacement therapy (HRT) is a common treatment for menopausal symptoms, and several products are available, including estrogens, progestogens, and combination therapies 5, 6.
• The choice of HRT product and dosage form should be individualized based on the woman's symptoms, medical history, and preferences.
• The potential benefits and risks of HRT should be carefully considered, and women should be monitored regularly for any adverse effects 5, 6.