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Menopause drugs: summary of recommendations

Over the last decade there has been conflicting research and advice about the safety of hormones. This report incorporates the latest evidence to help you make sense of an often confusing topic.

First, you should know that medicines containing various forms of the female hormones estrogen and progestin are highly effective at reducing the symptoms of menopause. Studies show that 70 to 90 percent of women experience an average 75 percent reduction in the frequency of hot flashes and night sweats. The drugs also reduce vaginal dryness.

But these benefits must be weighed against serious adverse effects that hormones can cause. They have been linked to a higher risk of heart disease, heart attack, blood clots, and strokes. Recent research, however, has helped clarify which women are most at risk for such problems and which can consider using hormone products. From that research we make the following general recommendations:

  • Don't take hormones if your symptoms are mild and can be managed by changing your lifestyle and habits, such as quitting smoking, sleeping in a cooler room, reducing stress, exercising regularly, and limiting caffeine and alcohol.
  • Don't take hormones if you have heart disease or have had a stroke or cancer of the breast, ovaries or uterus.
  • Don't take hormones if you have diabetes, high cholesterol or high blood pressure, all of which are risk factors for heart disease; hormones may add to that risk. Also consider avoiding hormones if your father or mother died early from heart disease.
  • If the factors above don't apply to you, if your symptoms are severe, and if you are in the first 5 to 10 years of menopause, talk to your doctor about hormones. They could significantly improve your quality of life and pose a low risk of adverse effects for you. The evidence is strong, for example, that women ages 50 to 59 who have a low risk of heart disease and who have entered menopause within the past five years incur no added risk of heart disease when they take hormones. However, they still face an increased risk of breast cancer, blood clots, and stroke.
  • Always take hormones for the shortest time possible and at the lowest dose.
  • Tell your doctor about your complete medical history. Ultimately, every decision about hormone use must be made on a case-by-case basis.
  • Hormones should never be used to treat mood swings, irritability, depression, anxiety, mental lapses, forgetfulness, cognitive difficulties, reduced libido, urinary incontinence, back pain, chronic pain, joint pain, stiffness, or fatigue. They don't help these conditions and could make them worse.
  • Be cautious if a doctor or pharmacist recommends using so-called bio-identical hormone products made in pharmacies. They are not regulated by the FDA and have not been shown to be better or safer than commercial products.

Studies continue to examine whether any one form of estrogen or estrogen plus progestin (there are many) is more effective or safer than others. Some forms of estrogen and some types of products may have advantages. But none of this research is definitive at this time.

More important, women differ in their responses to hormone products. For example, pills work better for some women while patches work better for others. Research has shown that hormone products containing estrogen alone pose less risk of heart disease and breast cancer than those containing both estrogen and progestin. However, women who have not had a hysterectomy (surgical removal of the uterus) should take both because estrogen-only products have been conclusively linked to a much higher incidence of cancer of the uterine lining (endometrial cancer).

Many hormone products are available as less-expensive generics, and some brand-name products are reasonably priced, too. Taking into account the wide array of products available to meet women's individual needs and preferences, we chose the following as Best Buys if you need a hormone product:

  • Generic estradiol pills
  • Gynodiols (estradiol pills)
  • Menest (esterified estrogen pills)
  • Generic estropipate (pills)
  • Generic medroxyprogesterone (pills)
  • Generic estradiol (skin patch)
  • Estraderm (estradiol skin patch)
  • Prempro (estrogen-progestin combination pill)
  • Prefest (estrogen-progestin combination pill)
  • Climara Pro (estrogen-progestin skin patch)
  • Combipatch (estrogen-progestin skin patch)
  • Premarin vaginal cream (conjugated equine estrogen)
  • FemRing (estradiol vaginal ring)
  • Estring (estradiol vaginal ring)

All these medicines are as effective as other hormone drugs, and several are considerably cheaper. Most generic estradiol pills, for example, cost less than $15 a month, and could save you up to $400 a year compared with brand-name Premarin, one of the best-selling products in this class. Likewise, we'd urge you to choose a generic estrogen-only hormone patch if that is clinically appropriate for you; it could save you around $300 a year.

This information was updated in October 2008.

Menopause drugs: drug comparison
CR Best Buy Hormones Cost Comparison
Generic Name Brand Name1 Dose Ranges
(or concentration)
Frequency of Use2 Average Monthly Cost3 Compare Prices
Estrogen-only pills
  Estradiol Estrace 0.5-2.0mg 1 daily $49-$63
best buy Estradiol Generic 0.5-2.0mg 1 daily $7-$13
best buy Estradiol Gynodiol 1.0-2.0mg 1 daily $10-$16
  Estradiol Femtrace 0.45-1.8mg 1 daily $48-$62
  Conjugated equine estrogen Premarin 0.3-1.25mg 1 daily $47-$48
  Synthetic conjugated estrogen Cenestin 0.3-1.25mg 1 daily $51-$52
  Synthetic conjugated estrogen Enjuvia 0.3-1.25mg 1 daily $48
best buy Esterified estrogens Menest 0.3-2.5mg 1 daily $18-$68
  Estropipate Ogen 0.625-2.5mg 1 daily $35-$85
best buy Estropipate Generic 0.625-3.0mg 1 daily $11-$25
Estrogen-only skin patches
  Estradiol Climara 0.025-0.1mg per 24 hours 1 weekly $52-$53
best buy Estradiol Estraderm 0.05-0.1mg per 24 hours 1 weekly $23-$59
  Estradiol Menostar 0.014mg per 24 hours 1 weekly $58
  Estradiol Vivelle, Vivelle Dot 0.025-0.1mg per 24 hours 2 weekly $48-$54
  Estradiol Alora 0.025-0.1mg per 24 hours 2 per week $43-$48
best buy Estradiol Generic 0.05-1.0mg per 24 hours 2 per week $37-$38
Estrogen-only skin creams
  Estradiol Estrogel 1.25 grams Once daily $70-$105
  Estradiol Estrasorb 2.5 grams Twice daily $61
  Estradiol Divigel 0.25-1.0mg Once daily $73
Estrogen-only spray
  Estradiol Evamist 1.53-4.59 mg 1-3 sprays daily $52
Estrogen plus progesterone pills
best buy Conjugated equine estrogen/medroxyprogesterone Prempro, Premphase 0.3mg/1.5mg-0.625mg/5.0mg 1 daily $60
best buy Estradiol plus norgestimate Prefest 1mg/0.09mg 1 daily $58
  Estradiol plus norethindrone Activella 1mg/0.5mg 1 daily $61-$65
  Ethinylestradiol plus norethindrone Femhrt 0.5mg/2.5mcg -1.0mg/5.0mcg 1 daily $59-$61
  Estradiol plus drospirenone Angeliq 1mg/0.5mg 1 daily $73
Estrogen plus progesterone skin patches
best buy Estradiol plus levonorgestrel Climara Pro 0.045mg/0.015mg per 24 hours 1 weekly $53
best buy Estradiol plus norethindrone CombiPatch 0.05mg/0.14mgper 24 hours 2 per week $53
Estrogen-only vaginal creams, tablets or rings
best buy Conjugated equine estrogen Premarin Cream 0.625mg/gram ½ to 2 grams a day $25-$1004
  Estradiol Estrace Cream 1.5mg/gram 1 to 2 grams a day $50-$1504
  Estradiol tablet VagiFem 0.025mg 1 per day for two weeks then 10 a month $42-$93
best buy Estradiol FemRing 0.05-0.1mg per 24 hours One every 3 months $51-$55
best buy Estradiol Estring 0.0075mg per 24 hours One every 3 months $53
  Estradiol Elestrin .0125 mg 1 to 2 pumps daily $121
Progesterone pills
  Medroxy-progesterone Provera 2.5mg 1 per day $25-$27
  Medroxy-progesterone Provera 5mg to 10mg 1 per day part of month $40-$55
best buy Medroxy-progesterone Generic 2.5mg 1 per day $3-$8
best buy Medroxy-progesterone Generic 5mg to 10mg 1 per day part of month $2-$16
  Norethindrone Aygestin 5mg 1 per day, part of month only $37
  Norethindrone Generic 5 mg 1 per day, part of month only $30-$46
  Progesterone Prometrium 100mg, 200mg Usually part of the month $23-$45
(1) "Generic" means that this line quotes the average price or price range of several or many generic versions.

(2) As typically prescribed. May vary and that will affect the cost.

(3) Prices reflect nationwide average retail price for June, 2008, rounded to nearest dollar. Monthly cost ranges reflects varying price of different doses. Lower doses are less expensive, higher doses more expensive. Prices were derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health Pharmaceutical Audit Suite. The company Destination Rx assisted in calculating dose ranges and average prices. Wolters Kluwer Health is not involved in our analysis or recommendations.

(4) The cost of these vaginal creams is highly dependent on use. They come in tubes that cost from $25 to over $100. As we sought prices for the products online and through Wolters Kluwer Health, we learned that prices for the exact same size tubes for both products are quite variable. Also, women use varying amounts to get relief, though typically they are not intended for use more than 21 days per month. As a result, we have given a general price range for both.