Estrace vs. Premarin: 7 Things to Know When Comparing These Vaginal Estrogen Creams
Key takeaways:
Some of the common symptoms of menopause include vaginal dryness or irritation and painful sex. Vaginal estrogen creams, such as Estrace (estradiol) and Premarin Vaginal Cream (conjugated estrogens), can help these symptoms.
Estrace and Premarin Vaginal Cream contain different forms of estrogen. But they both work similarly to help relieve vaginal menopause symptoms. Their side effects and medication interactions are also similar.
Estrace and Premarin Vaginal Cream are both available as brand-name medications. But you can also find Estrace as a lower-cost generic. GoodRx can help you access Premarin Vaginal Cream at an exclusive cash price of $249 per month. Manufacturer savings cards and patient assistance programs are also available.
Access savings on related medications
Table of contents
Menopause is the stage of life when menstruation stops for good. Common symptoms of menopause can include hot flashes and night sweats. But some women also experience uncomfortable urinary and/or vaginal symptoms. These are referred to as the genitourinary syndrome of menopause (GSM).
GSM can feel different for everyone, but it’s common to experience vaginal dryness and pain during sex. You may also have changes to how you urinate, such as frequent urges or pain while going. If these are your most bothersome menopause symptoms, your healthcare professional may suggest trying a vaginal estrogen medication. Two prescription-only vaginal estrogen creams are Estrace (estradiol) and Premarin Vaginal Cream (conjugated estrogens).
But what’s the difference between these two vaginal estrogens? Below, we review seven things to keep in mind when comparing Estrace versus Premarin Vaginal Cream.
Good to know: Estrace and Premarin also come as oral tablets. These dosage forms are prescribed for menopause symptoms that affect the whole body, such as hot flashes. This article will focus on the vaginal cream versions of Estrace and Premarin.
Estrace vs. Premarin Vaginal Cream at a glance
When comparing two medications, it can be helpful to have all the information for both side by side. Below is a quick comparison chart for Estrace and Premarin Vaginal Cream.
| Estrace | Premarin Vaginal Cream | |
|---|---|---|
| Active ingredient | Estradiol (a lab-made form of estrogen) | Conjugated estrogens (natural estrogens derived from the urine of pregnant horses) |
| FDA-approved uses | To relieve vaginal dryness and irritation caused by menopause |
|
| How it works | By raising levels of estrogen in and around the vagina that have dropped due to menopause | By raising levels of estrogen in and around the vagina that have dropped due to menopause |
| Manufacturer’s recommended maintenance dosage | Insert 1 gm into the vagina 1-3 times a week. |
|
| Common side effects |
|
|
| Available as a generic? | Yes | No |
*It’s common for prescribers to recommend a twice-weekly Premarin dosage for vaginal dryness and irritation.
1. Estrace and Premarin contain different forms of estrogen
Estrace contains a lab-made form of one type of estrogen, called estradiol. Your body uses this estradiol in a similar way to naturally-produced estrogens. Estrace comes in a tube that contains 0.1 mg of estradiol in every gram of cream.
Premarin Vaginal Cream contains conjugated estrogens. This means it’s a mixture of a few types of estrogen. These estrogens are derived from a natural source: the urine of pregnant horses. So if you typically avoid using animal products, let your prescriber know. Each tube contains 0.625 mg of estrogens in every gram of cream.
2. Estrace and Premarin have different FDA-approved uses
There’s a slight difference when it comes to what Estrace and Premarin are FDA approved for. Both are approved to relieve vaginal dryness and irritation caused by menopause. But Premarin is also approved to help relieve pain during sex that’s caused by menopause symptoms. However, it’s common for healthcare professionals to prescribe Estrace off-label for pain during sex, too.
Compare your options. Estrace (estradiol) and Premarin Vaginal Cream (conjugated estrogens) are two of several available menopause treatments. Learn about the different options and how to save on them.
Is menopause hormonal therapy safe? Here’s what to know about the risks and benefits of taking hormones to treat your menopause symptoms.
What does menopause feel like? Read these first-hand accounts to help you determine if your symptoms might be menopause-related.
3. Estrace and Premarin work in similar ways
Estrace and Premarin Vaginal Cream both work by raising estrogen levels that have dropped during menopause.
Estrogen affects many different tissues in your body. After menopause, your ovaries stop making estrogen, among other changes. As estrogen levels drop, you may experience menopause symptoms, like vaginal dryness. In the case of GSM, low estrogen causes symptoms in or around the vagina, vulva, and bladder.
By applying a vaginal estrogen cream, you can raise the estrogen level in those areas. This can help relieve GSM symptoms. However, vaginal estrogen creams only work locally (around where they’re applied). So they’re not helpful for widespread menopause symptoms, like hot flashes.
4. Estrace and Premarin have different recommended dosages
The way you apply Estrace and Premarin Vaginal Cream is similar, but the recommended doses are different. Both medications are inserted into the vagina with a reusable applicator. It’s important to wash the applicator with mild soap and warm water after every use.
It’s recommended to only use vaginal estrogen creams for the shortest time possible. This helps lower your risk of side effects. Your prescriber will work with you to decide if or when you should stop using your cream.
Estrace dosage
Estrace is usually started at a higher dose and lowered over a period of a few weeks. The recommended starting dose of Estrace is 2 to 4 gm once a day for 1 to 2 weeks. This will be lowered to a maintenance (steady) dose, typically 1 gm that’s applied 1 to 3 times per week.
Premarin Vaginal Cream dosage
Your Premarin Vaginal Cream dosage can vary depending on your GSM symptoms.
If your symptoms include vaginal dryness or irritation, you’ll likely start by applying 0.5 gm in the vagina once a day. But your prescriber may suggest lowering your dosage to twice a week after the first few weeks. If needed, your daily dose can be raised to a maximum of 2 gm.
If pain during sex is your primary GSM symptom, you’ll likely apply 0.5 gm into the vagina twice a week. This is both the starting and maximum recommended dosage for this use.
For both approved uses, Premarin’s manufacturer recommends using the cream in a cycle. They suggest applying the cream as directed for 3 weeks, followed by 1 week of applying no cream. But your prescriber may recommend using it continuously with no breaks. Always follow your prescriber’s instructions, even if it’s different from what the manufacturer recommends.
5. Estrace and Premarin are similarly effective for vaginal menopause symptoms
Estrace and Premarin Vaginal Cream are very effective for relieving GSM symptoms, especially vaginal dryness and pain during sex. When they were compared with each other, all available vaginal estrogen products (creams, tablets, and rings) were found to be similarly effective. So you can expect similar effects with either Estrace or Premarin Vaginal Cream.
Keep in mind that it may take 2 to 3 months before you feel the full effects of either cream. So try to be patient when you’re first starting Estrace or Premarin Vaginal Cream. And ask your prescriber about other at-home relief strategies you can try until they start working.
6. Estrace and Premarin have similar side effects
Most of the common side effects of Estrace and Premarin Vaginal Cream are experienced around where they’re applied. This is because a lower amount of medication is absorbed than with oral estrogen pills. This means that Estrace and Premarin Vaginal Cream are less likely to cause body-wide side effects.
Common side effects that are seen with vaginal estrogen creams include:
Vaginal discharge
Vaginal bleeding
Breast pain
Even though it’s a common side effect, you should always check with your prescriber if you experience any new or unusual vaginal bleeding. Vaginal bleeding after menopause can be a sign of more serious problems.
What are the serious side effects of Estrace and Premarin creams?
More serious risks may be seen with oral estrogen pills. Because of this, all estrogen-containing medications include warnings about potentially serious risks.
These more serious side effects include a higher risk for developing:
Breast cancer
Uterine cancer
Blood clots
Heart attack
Stroke
Some studies suggest that oral estradiol (oral Estrace) may have a lower risk of these complications than oral Premarin. But this isn’t the case when you compare vaginal estrogen creams. Both Estrace and Premarin Vaginal Cream have similarly low risks of serious side effects.
Studies of vaginal estrogens have shown that the risks of more serious side effects are no different than if you weren't using a vaginal estrogen. And researchers haven’t found one vaginal estrogen to be safer than others. This better safety profile is why vaginal estrogen is a preferred option if you’re experiencing GSM and have no other symptoms.
However, you should still discuss these risks with your healthcare team before starting Estrace or Premarin Vaginal Cream. This is especially true if you have a personal or family history of any of the conditions listed above.
7. Estrace and Premarin have similar interactions
Since Estrace and Premarin Vaginal Cream are only absorbed in small amounts, medication interactions are less likely. But even though the risk is low, certain medications may still interact with them.
The effects of Estrace and Premarin Vaginal Cream might be lessened by:
Phenobarbital
Carbamazepine (Tegretol)
Rifampin (Rifadin)
St. John’s wort — an over-the-counter (OTC) herbal supplement
These medications and products may raise your risk of side effects from Estrace or Premarin Vaginal Cream:
Erythromycin (Ery-Tab)
Clarithromycin (Biaxin XL)
Itraconazole
Ritonavir (Norvir) or ritonavir-containing medications like Kaletra (lopinavir / ritonavir)
Always discuss all medications and OTC supplements you take with your prescriber and pharmacist. They can tell you whether you can safely combine them.
Premarin Vaginal Cream can also weaken latex condoms. While unintended pregnancies may not be a worry after menopause, condoms are important for preventing sexually transmitted infections (STIs) at every age. Premarin Vaginal Cream could make latex condoms less effective. Estrace isn’t known to have this effect.
Can you use Estrace and Premarin creams together for menopause symptoms?
No. It wouldn’t be helpful to use Estrace and Premarin Vaginal Cream together. Even though Estrace and Premarin contain different types of estrogens, they work similarly. Combining them could expose your body to more estrogen than is recommended.
But what if you’re using one of these vaginal creams and still have uncomfortable symptoms? In that case, contact your prescriber. They may have you change how you use your cream. They may also suggest using a different type of menopause treatment to see if it works better for you.
How to save on Estrace and Premarin Vaginal Cream
There are ways to save on Estrace and Premarin Vaginal Cream. Both are available as brand-name medications. But you can also find Estrace as a lower-cost generic. GoodRx can help you navigate ways to save on your prescription.
Save with GoodRx. Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a tube of Premarin Vaginal Cream at an exclusive cash price of $249. GoodRx can also help you save over 60% off the average retail price of the generic version of Estrace. Generic Estrace’s price at certain pharmacies is as low as $24.00 with a free GoodRx discount.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, Premarin Vaginal Cream’s price is as little as $25 per prescription using a copay savings card from the manufacturer.
Save with patient assistance programs. If you’re uninsured or underinsured, you may be eligible for Premarin Vaginal Cream’s patient assistance program, which offers the medication free of cost.
Frequently asked questions
No, there is no generic form of Premarin available. Talk to your prescriber if cost is preventing you from filling your prescription. There are ways to help lower the cost of Premarin. There are also other menopause treatments available that may have a lower cost.
Yes, since Premarin Vaginal Cream and Estrace are similarly effective, you can switch from one to the other if needed. But there’s no standard dose conversion when changing medications. So be sure to follow your prescriber’s instructions when switching. They can recommend the best dose for you.
Estriol and estradiol are two forms of estrogen that your body makes before menopause. Estriol is the main form that your body makes during pregnancy. Estradiol is the most common estrogen that the body makes before menopause when you’re not pregnant. Lab-made estradiol is the most common form of estrogen included in FDA-approved menopause hormonal therapies.
The bottom line
Vaginal estrogen creams are a safe, effective way to improve certain menopause symptoms, such as vaginal dryness and pain during sex. Estrace (estradiol) and Premarin Vaginal Cream (conjugated estrogens) are two popular vaginal estrogen creams. They contain different forms of estrogen. But they work similarly to help vaginal menopause symptoms. Estrace and Premarin Vaginal Cream share side effects and interactions, too.
If you’re experiencing vaginal menopause symptoms, discuss your options with your healthcare team. Together, you’ll find the right menopause treatment that works for you.
Why trust our experts?
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