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 tablet

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Elestrin

(estradiol gel)

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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 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