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Compare Prempro alternatives | Angeliq | Climara Pro | Femring | Estrace cream | Alendronate | Natural alternatives | How to switch meds
Menopause is certainly a time of change, but it need not be terribly uncomfortable. The decline in ovarian production of estrogen can bring with it hot flashes and vulvovaginal tissues changes that make intercourse painful. Lower estrogen levels can lead to depleted bone mineral density, increasing the risk of broken bones. Hormone replacement therapy (HRT), in the form of Prempro pills or others, can address these menopausal issues if need be. Prempro, or any HRT for that matter, is not always the right answer. Side effects are a significant reason why you might want to know about some alternatives. With that in mind, we will take you on a tour of the options besides Prempro for relief of menopausal symptoms.
What can I take in place of Prempro?
HRT can be provided in a number of ways. While Prempro is a combination hormone pill with both estrogen and progesterone components, other HRT products have only estrogen therapy, have a different synthetic progestin in combination with estrogen, or come in the form of an injection, patch, cream, or vaginal insert. Each hormonal product has its own niche, based on ease of use or unique adverse effect profile. Non-hormonal options also exist and may be best for some. Prempro is a brand name drug and currently does not have a generic version available on the market. Let’s review the alternatives to Prempro and focus on the most common choices.
Compare Prempro alternatives |
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| Drug name | Uses | Dosage | Savings options |
| Prempro (conjugated estrogens–medroxyprogesterone acetate) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause, prevention of postmenopausal osteoporosis | 0.3 mg/1.5 mg to 0.625 mg/5 mg once daily | Prempro coupons |
| Premarin (conjugated estrogens) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause, prevention of postmenopausal osteoporosis, hypoestrogenism, palliative treatment of metastatic breast cancer or advanced prostate cancer | 0.3 to 1.25 mg oral tablet once daily | Premarin coupons |
| Angeliq (drospirenone-estradiol) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause | 0.25 mg/0.5 mg to 0.5 mg/1 mg oral tablet once daily | Angeliq coupons |
| Duavee (conjugated estrogens-bazedoxifene) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), prevention of postmenopausal osteoporosis | 0.45 mg/20 mg oral tablet once daily | Duavee coupons |
| Climara patch (estradiol) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause, prevention of postmenopausal osteoporosis, hypoestrogenism | 0.025 to 0.1 mg per day patch applied once weekly | Climara coupons |
| Climara Pro patch (estradiol-levonorgestrel) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), prevention of postmenopausal osteoporosis | 0.045 mg/0.015 mg per day patch applied once weekly | Climara Pro coupons |
| Combipatch patch (estradiol–norethindrone acetate) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause, hypoestrogenism | 0.05 mg/0.14 mg to 0.05 mg/0.25 mg per day patch applied and changed twice weekly | Combipatch coupons |
| Estrogel topical gel (0.06% estradiol) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause | 0.75 mg per pump, one pump per day | Estrogel coupons |
| Evamist topical spray (estradiol) | Vulvovaginal atrophy of menopause | 1.53 mcg per actuation, one to three actuations per day | Evamist coupons |
| Femring vaginal ring insert (estradiol) | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), vulvovaginal atrophy of menopause | One ring vaginally and changed every 3 months (releases 0.5 to 1 mg per day) | Femring coupons |
| Estring vaginal ring insert (estradiol) | Vulvovaginal atrophy of menopause | One ring vaginally and changed every 3 months (releases 7.5 mcg per day) | Estring coupons |
| Vagifem vaginal tablet (estradiol) | Vulvovaginal atrophy of menopause | 10 mg vaginally twice a week | Vagifem coupons |
| Estrace vaginal cream (0.01% estradiol) | Vulvovaginal atrophy of menopause | 1 gram vaginally one to three times a week | Estrace coupons |
| Alendronate | Treatment or prevention of postmenopausal osteoporosis, treatment of male osteoporosis or steroid-associated osteoporosis | 35 mg oral tablet once weekly for prevention of postmenopausal osteoporosis | Alendronate coupons |
| Evista (raloxifene) | Treatment or prevention of postmenopausal osteoporosis, breast cancer prevention | 60 mg oral tablet once daily | Evista coupons |
| Paroxetine | Moderate to severe postmenopausal vasomotor symptoms (hot flashes), major depressive disorder, general and social anxiety disorders, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, premenstrual dysphoric disorder | 7.5 mg oral tablet once daily at bedtime for hot flashes | Paroxetine coupons |
Other alternatives to Prempro
- Estrace
- Menest
- Prefest
- Activella
- Amabelz
- Mimvey
- Jinteli
- Minivelle patch
- Vivelle-Dot patch
- Menostar patch
- Elestrin gel
- Divigel gel
- Depo-estradiol injection
- Delestrogen injection
- Yuvafem vaginal tablet
- Actonel
- Ibandronate
- Reclast injection
Top 5 Prempro alternatives
The following are some of the most common alternatives to Prempro.
1. Angeliq
Angeliq and Prempro certainly have some similarities. They both combine the estrogen hormone estradiol with a progestin. By adding a progestin compound, the products reduce the risk of endometrial hyperplasia or thickening of the uterine lining that can occur when using estrogen-only drugs. This feature makes either a reasonable option for women who have not undergone a hysterectomy to remove the uterus. Where Angeliq and Prempro differ is the specific progestin. Prempro contains medroxyprogesterone acetate, a progestin with potential ill effects on cholesterol levels and consequently cardiovascular disease. Angeliq has favorable effects on cholesterol levels, so it may be preferable for you if cholesterol problems or heart disease are particular concerns of yours.
2. Climara Pro
You might view applying a Climara Pro patch to the skin once a week as a more convenient solution than taking a Prempro tablet every day. The advantage may be more substantial than that. One of the most worrisome risks associated with HRT is a higher rate of blood clots. Studies suggest that the rate of these vascular complications is lower with transdermal HRT products.
3. Femring
Convenience is the stand-alone argument for Femring, a vaginal insert that only needs to be replaced every 3 months. The small, flexible piece of plastic releases estradiol at a steady rate and high enough dose to produce systemic levels, making it an option for both hot flashes and vaginal dryness. Of note, a competitor, the Estring vaginal insert, releases a substantially lower dose of estradiol to assist with vulvovaginal symptoms of menopause but minimize systemic side effects of estrogen. Both Femring and Estring only contain estradiol, which means that adverse effects on the uterus must be considered.
4. Estrace cream
Vulvovaginal atrophy of menopause is associated with vaginal dryness, vaginal burning, painful intercourse, urinary frequency, and recurrent urinary tract infections. If these problems are your primary concern, topical estrogen products like Estrace cream may provide relief with application only a couple of times per week. The greatly reduced estrogen levels in the blood compared to Prempro may lessen your concern about the increased risk of blood clots, stroke, heart disease, and breast cancer seen in the Women’s Health Initiative study of HRT.
5. Alendronate
Steering clear of hormonal therapy altogether may be what you have in mind. If so, that does not mean that you cannot address menopausal issues. Prevention of postmenopausal osteoporosis can be accomplished with the drug class bisphosphonates, which includes alendronate. These non-hormonal agents reduce bone loss, leading to stronger bones that are more resistant to fracture. Alendronate is a bisphosphate that can be taken weekly and has Food and Drug Administration (FDA) approval at a lower dosage for prevention compared to treatment of osteoporosis. Likewise, the antidepressant paroxetine has FDA approval at a low dose to reduce hot flashes, which is useful if hormonal treatment options need to be avoided for that menopausal symptom.
Natural alternatives to Prempro
Not all menopausal symptoms require a prescription treatment. Instead, mild hot flashes could be addressed with the use of a fan, a lower room temperature at night, or weight loss. Taking 400 units of vitamin E daily could be worth a try too.
Adjusting your diet to include more plant-based, dietary estrogens might interest you as an option. Eating more soybeans, lentils, and chickpeas would increase your phytoestrogens (plant-based estrogens), but it may not be enough to eliminate some vasomotor symptoms like night sweats. You may also be disappointed with results using the herbal remedy black cohosh, based on negative findings in a review of its use for menopausal symptoms.
How to switch to a Prempro alternative
Whether you are now leaning toward an over-the-counter herbal supplement, a weight loss campaign, a different HRT option, or a non-hormonal prescription drug, the next call you make should be to your healthcare provider for medical advice. Notify your doctor or gynecologist if unexpected vaginal bleeding is your reason for seeking an alternative to Prempro. For postmenopausal women, vaginal bleeding may signal endometrial cancer. An appointment can be dedicated to reviewing your concerns about Prempro and your views on the alternatives you have learned about. Amongst the options, surely there is one that both you and the treating healthcare professional can settle on.
