Premarin vs. Elestrin for Menopause: Important Differences and Potential Risks.

Key takeaways

Premarin (conjugated estrogens) and Elestrin (estradiol gel) are both estrogen replacement medications used to relieve menopausal symptoms like hot flashes and night sweats. However, they differ in several ways. Premarin is an oral tablet, while Elestrin is a topical gel applied to the skin. Premarin is used for a wider range of conditions, including certain types of cancer and preventiong osteoporosis, whereas Elestrin is specifically for menopausal symptoms. Premarin is taken daily or in cycles, while Elestrin is applied to the skin on your upper arm once daily. Both medications are only available in a branded version. Common side effects of Premarin include headache, stomach pain, and breast pain, while Elestrin may cause breast tenderness and upper respiratory infections. Both medications carry risks of serious side effects like blood clots and certain cancers. Neither medication contains a progestin, so if you have a uterus you may need to take progestin separately.

Premarin

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Elestrin

(estradiol gel)

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Summary for Premarin

Prescription only

Premarin (conjugated estrogens) is an oral estrogen hormone tablet that's used to treat various conditions in adults. Most commonly, it relieves menopausal symptoms such as vaginal dryness and hot flashes. The medication is also used for treating low estrogen levels, certain advanced stages of breast or prostate cancers, and osteoporosis after menopause. Depending on what you're using it for, the medication can be taken daily or in cycles. 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
Certain advanced stages of breast cancer
Certain advanced stages of prostate cancer
Prevention of bone loss (osteoporosis) after menopause

Pros and Cons for Premarin

Pros

Relieves multiple menopausal symptoms
Available in multiple strengths, allowing you to customize your dose
Comes as a tablet that you take by mouth

Cons

Raises your risk of certain cancers, blood clots, and strokes
Some people might need to take it with another hormone called progestin
Not a first-choice medication for treating bone loss after menopause

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

Uterine (endometrial) cancer
Breast cancer
Blood clots and stroke
Heart disease and heart attacks
Dementia
Gallbladder and liver problems
Vision problems
High triglycerides
Low thyroid hormone levels (hypothyroidism)
Fluid Retention
Changes in calcium levels in the blood
Worsening of other health conditions

Summary for Elestrin

Prescription only

Elestrin (estradiol gel) is a hormone replacement therapy used to relieve menopausal symptoms like hot flashes and night sweats. It comes as a pump bottle, and the dose is applied to the skin on your upper arm once a day. The gel is only available as a brand-name medication because there is no generic version. Common side effects include breast tenderness, abnormal vaginal bleeding, and upper respiratory infections.

Indications for Elestrin

Hot flashes and night sweats due to menopause

Pros and Cons for Elestrin

Pros

Relieves bothersome menopausal symptoms, such as hot flashes and night sweats
Starts at a lower estrogen dose compared to other estrogen gel pumps
Applied directly to the skin on your upper arm
Only need to use once a day

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