Compare Premarin vaginal cream vs. estradiol / norethindrone

Head-to-head comparisons of medication uses, side effects, ratings, and more.

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Relieves vaginal dryness and pain during sex due to menopause.

Premarin vaginal cream (conjugated estrogens) has less side-effects than estrogen pills, but only works for localized symptoms of menopause.

Relieves menopause symptoms and lowers your risk of osteoporosis.

Activella (estradiol / norethindrone) helps relieve menopausal symptoms and prevent bone loss. There can be many side effects, so it's important to talk to your doctor about the benefits and potential hassles of this drug before using it.

Upsides
  • Works locally in the vagina, so it has less side effects than estrogen pills.
  • Works better than over-the-counter lubricants to relieve pain during sex caused by menopause.
  • Can be dosed twice a week to relieve painful sex due to menopause.
  • Replaces estrogen in your entire body and relieves multiple symptoms of menopause.
  • Lowers your risk of fractures by keeping your bones healthy.
  • Improves mood, energy, and mental alertness for some people.
  • Generic available, so cost is usually lower.
Downsides
  • Vaginal estrogens can weaken latex (rubber) condoms, cervical caps, and diaphragms. Do not rely on these methods to protect against sexually transmitted infections for up to 72 hours after using Premarin vaginal cream (conjugated estrogens).
  • Premarin vaginal cream (conjugated estrogens) increases risk of uterine cancer so women with intact uterus should not use it by itself.
  • Available as a branded product only, so it may be expensive.
  • More potential side effects since Activella (estradiol / norethindrone) exposes your whole body to two hormones.
  • Raises your risk of developing a stroke and blood clots.
  • You may get irregular bleeding and spotting that can last a few months to a year.
  • Should only use if you still have a uterus.
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Used for
  • Vaginal dryness and inflammation due to menopause
  • Painful sex due to menopause
  • Hot flashes
  • Vaginal dryness and inflammation
  • Prevention of postmenopausal osteoporosis
Dosage forms
  • Cream
  • Pill
Price
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Reviews
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Side effects
6possible side effects
  • Pelvic pain
    3%
  • Vaginal discharge
    3%
  • Headache
    2%
  • Breast pain
    2%
  • Vaginal inflammation
    2%
  • Other problems with the vagina or vulva
    2%
See more detailed side effects
10possible side effects
  • Breast pain
    21%
  • Headache
    17%
  • Nausea
    10%
  • Upper airway infection
    10%
  • Post-menopausal bleeding
    10%
  • Sinus infection
    7%
  • Ovarian cyst
    7%
  • Back pain
    3%
  • Difficulty sleeping
    3%
  • Accidental injury
    3%
See more detailed side effects
Risks and risk factors
  • Endometrial cancer
    • Using estrogen for more than one year
    • Higher dose of estrogen
  • Breast cancer
    • Personal or family history of breast cancer
    • Using estrogen and progestin for more than one year
  • Increased risk of blood clots and stroke
    • Personal or family history of blood clots
    • Smoking
    • Obesity
    • Systemic lupus erythematosus (SLE)
  • Increased risk of heart disease
    • Smoking
    • Obesity
    • High blood pressure
    • High blood sugar
    • High cholesterol
    • Age 50 or older
  • Dementia
    • Age 65 or older
  • Pancreas swelling (pancreatitis)
    • High levels of triglycerides
See more detailed risks and warnings
  • Endometrial cancer
    • Using estrogen for more than 1 year
  • Breast cancer
    • Personal or family history of breast cancer
    • Using estrogen for more than one year
  • Increased risk of blood clots and stroke
    • Personal or family history of blood clots
    • High blood pressure
    • Smoking
    • Obesity
    • High cholesterol
    • Systemic lupus erythematosus (SLE)
  • Dementia
    • Age 65 or older
  • Pancreas swelling (pancreatitis)
    • History of high triglycerides
See more detailed risks and warnings