Key takeaways
Premarin vaginal cream (conjugated estrogens) and Estrace vaginal cream (estradiol) are both estrogen replacement therapies used to treat vaginal symptoms of menopause, such as dryness and pain during sex. Premarin is made from a combination of natural sources of estrogens, such as urine from a pregnant horse, while Estrace contains man-made estradiol, a form of estrogen produced by the body. Premarin is typically applied in cycles (once daily for 3 weeks, then no cream for 1 week) or twice a week, whereas Estrace is usually applied daily for a few weeks and then reduced to 1 to 3 times per week. Estrace is available as a lower-cost generic, while Premarin is only available as a brand-name medication. Both medications can cause side effects like breast pain and headaches, but Premarin is more likely to cause pelvic pain, while Estrace can cause vaginal burning and irritation. Both treatments carry risks of serious health issues such as cancer, blood clots, and heart problems, but this risk may be lower compared to whole-body estrogen medications.
