Premarin vs. Divigel for Atrophic Vaginitis and Menopause: Important Differences and Potential Risks.

Key takeaways

Premarin vaginal cream (conjugated estrogens) and Divigel (estradiol) are both estrogen replacement therapies, but they have different uses and application methods. Premarin vaginal cream is used to treat vaginal symptoms of menopause, such as dryness and pain during sex, and is applied directly into the vagina. In contrast, Divigel is a gel applied to the skin, typically on the upper thigh or arm and is used to treat hot flashes and night sweats. Premarin is available only as a brand-name medication, while Divigel is available as a low-cost generic. Premarin is applied in cycles or twice a week, whereas Divigel is applied once daily. Both medications carry risks of serious side effects, including cancer and blood clots, but Divigel has the unique risk of transferring estrogen to others through skin contact.

Premarin tablet

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Estradiol gel

(Divigel)

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Summary for Premarin

Prescription only

Premarin (conjugated estrogens) oral tablet is an estrogen hormone replacement therapy (HRT) used to treat menopause symptoms, such as hot flashes and vaginal dryness, and other conditions caused by low estrogen levels. It can also help prevent osteoporosis after menopause and treat certain advanced breast or prostate cancers. Depending on why you're taking it, you might take it by mouth every day or in cycles. Common side effects include headache, stomach pain, nausea, and breast pain.

Indications for Premarin

Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness caused by menopause
Low estrogen levels due to certain conditions
Advanced breast cancer
Advanced prostate cancer
Prevention of bone loss (osteoporosis) after menopause

Pros and Cons for Premarin

Pros

Relieves multiple menopause symptoms
Available in multiple strengths
Comes as a tablet that you take by mouth

Cons

Raises your risk of blood clots, stroke, and certain cancers
Some people might need to take it with another hormone called progestin
Can cause vaginal bleeding and spotting

Common Side Effects for Premarin

Headache (13-14%)
Abnormal vaginal bleeding (2-13%)
Breast pain (7-12%)
Stomach pain (8-11%)
Passing gas (4-6%)
Vaginal discharge (4-5%)
Back pain (3-5%)
General pain (3-5%)
Nausea (3-5%)
Insomnia (3-5%)
Depression (3-5%)
Weakness (2-5%)

Warnings for Premarin

Blood clots, heart attacks, and strokes
Uterine (endometrial) cancer
Breast cancer
Dementia
Ovarian cancer
Liver or gallbladder problems
Changes in calcium levels in the blood
Vision problems
High triglycerides (fat) levels
Low thyroid hormone levels
Buildup of fluids in your body (fluid retention)
Worsening of certain other health conditions

Summary for Divigel

Prescription only

Estradiol gel (Divigel) is a hormone replacement therapy used to treat symptoms of menopause, such as hot flashes and night sweats. It comes as single-use packets, and the dose is applied to the skin on your upper thigh once a day. The gel is available as both a brand-name and a generic medication. Common side effects include vaginal yeast infections, breast tenderness, and abnormal vaginal bleeding.

Indications for Divigel

Hot flashes and night sweats due to menopause

Pros and Cons for Divigel

Pros

Relieves bothersome menopausal symptoms, such as hot flashes and night sweats
Applied directly to the skin on the thighs
Only need to use once a day
Available in multiple strengths to customize your dose

Cons

Raises your risk of certain cancers, blood clots, and strokes
Risk of exposing others to estrogen through skin contact
Might also need to take a progestin medication if you have a uterus
Need to wait for the gel to dry completely before bathing, showering, or swimming