Background

Pills, creams, skin patches, and other products containing the female hormones estrogen and/or progestin are prescribed to treat the symptoms of menopause. But, as is now well known, these medicines increase the risk of heart disease, stroke, and some cancers. As a result, doctors today prescribe these medicines far more cautiously.

To help you and your doctor, Consumer Reports has evaluated these medicines based on their effectiveness, safety, ease of use, and cost. This brief is a summary of a 20-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a Menopause Drug?

You and your doctor may want to consider hormone treatment if your symptoms are moderate to severe and significantly disrupt your life. About 70 percent of women will have some menopause symptoms when they stop menstruating. But only about 20 percent who have any symptoms at all will have severe symptoms. Whether your doctor prescribes a hormone for you will also depend on your medical history and particularly your risk factors for heart disease and cancer.

Is Menopause to Blame?

Symptoms of Menopause

Hot Flashes and Flushing—Sensation of intense heat on your face, chest, or over the surface of your body. You may also perspire, feel chilled or feel faint.

Night Sweats—Hot flashes that occur at night.

Sleep disturbances—Awaken more easily, sleep more lightly, or cannot get back to sleep easily once you awaken.

Vaginal dryness—Lack of vaginal lubrication because of reduced estrogen. Intercourse can be uncomfortable and even painful.

Not Clearly Linked to Menopause

Mood swings, irritability depression, anxiety, fatigue—May be secondary to the symptoms above. For example, these symptoms may be triggered by getting too little sleep.

Reduced libido—May be secondary to vaginal dryness and pain on intercourse.

Mental lapses, forgetfulness, and cognitive difficulties—These increase as we get older. Men experience them, too.

Urinary incontinence—Hormone treatment may actually increase the risk.

Weight gain—It’s common as we age. Distribution of fat may also shift.

Our Recommendations

Medicines containing the female hormones estrogen and/or progestin reduce the frequency of hot flashes and night sweats by about 75 percent for most women who take them. They also reduce vaginal dryness.

But women and their doctors must carefully weigh the risks against the benefits of such drugs since all female hormone products increase the risk of serious adverse effects—heart disease, breast cancer, blood clots, and strokes. Recent research has helped clarify which women are most at risk for such problems. 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 or sleeping in a cooler room.

• Don’t take hormones if you have heart disease, or have had a stroke or cancer of the breast, ovaries, or uterus. Also, don’t take them if you have diabetes, high cholesterol, or high blood pressure.

• If hormone treatment is not precluded by the above factors, and your symptoms are moderate to severe, and if you are in the first five years of menopause, you may be a candidate for hormone treatment. The evidence is strong that women aged 50 to 59 who have entered menopause within the past five years incur no added risk of heart disease when they take hormones.

Taking a wide variety of factors, including cost, into account, we chose the following as Best Buys:

• Generic estradiol pills

• Gynodiol pills (estradiol)

• Menest pills (esterified estrogen)

• Generic estropipate pills

• Generic medroxyprogesterone pills

• Generic estradiol patch

• Estraderm (estradiol skin patch)

• Prempro (estrogen-progestin combination pill)

• Prefest (estrogen-progestin combination pill)

• Climara Pro (estrogen-progestin patch)

• Combipatch (estrogen-progestin 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 quite a bit less expensive. Most generic estradiol pills, for example, cost less than $15 a month, and could save you up to $400 a year compared to brand-name Premarin pills.

This information was last updated in October 2008.

Cost Comparison

Generic Name1

Brand Name2

Dose Ranges

Frequency of Use3

Average Monthly Cost4

Estrogen-only pills

Estradiol

Estrace

0.5-2.0 mg

1 daily

$49-$63

Estradiol

Generic

0.5-2.0 mg

1 daily

$7-$13

Conjugated equine estrogen

Premarin

0.3-1.25 mg

1 daily

$47-$48

Esterified estrogens

Menest

0.3-2.5 mg

1 daily

$18-$68

Estropipate

Ogen

0.625-2.5 mg

1 daily

$35-$85

Estropipate

Generic

0.625-3.0 mg

1 daily

$11-$25

Estrogen-only skin patches

Estradiol

Climara

0.025-0.1mg per 24 hours

1 weekly

$52-$53

Estradiol

Estraderm

0.05-0.1 mg per 24 hours

1 weekly

$23-$59

Estradiol

Vivelle, Vivelle Dot

0.025-0.1 mg per 24 hours

2 weekly

$48-$54

Estradiol

Generic

0.05-1.0 mg per 24 hours

2 weekly

$37-$38

Estrogen-only skin creams and sprays

Estradiol

Estrogel

1.25 grams

Once daily

$70-$105

Estradiol

Estrasorb

2.5 grams

Twice daily

$61

Estradiol

Divigel

0.25-1.0 mg

Once daily

$73

Estradiol

Evamist

1.53-4.59 mg

1-3 sprays daily

$52

Estrogen plus progesterone pills

Conjugated equine estrogen/medroxyprogesterone

Prempro, Premphase

0.3 mg/1.5 mg-0.625 mg/5.0 mg

1 daily

$60

Estradiol plus norgestimate

Prefest

1 mg/0.09 mg

1 daily

$58

Estradiol plus norethindrone

Activella

1 mg/0.5 mg

1 daily

$61-$65

Estradiol plus drospirenone

Angeliq

1 mg/0.5 mg

1 daily

$73

Estrogen plus progesterone skin patches

Estradiol plus levonorgestrel

Climara Pro

0.045 mg/0.015 mg per 24 hours

1 weekly

$53

Estradiol plus norethindrone

CombiPatch

0.05 mg/0.14 mg per 24 hours

2 weekly

$53

Estrogen-only vaginal creams, tablets, or rings

Conjugated equine estrogen

Premarin Cream

0.625 mg/gram

0.5 to 2 grams a day

$25-1005

Estradiol

Estrace Cream

1.5 mg/gram

1 to 2 grams a day

$50-1505

Estradiol tablet

VagiFem

0.025 mg

1 per day for two weeks then 10 a month

$42-$93

Estradiol

FemRing

0.05-0.1 mg per 24 hours

One every 3 months

$51-$55

Estradiol

Estring

0.0075 mg per 24 hours

One every 3 months

$53

1. Because of space restrictions, this is a sampling of hormone products. For the complete list, see the full report at CRBestBuyDrugs.org.

2. Generic means that this row has the average price of available generics.

3. As typically prescribed. May vary and that will affect the cost.

4. 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 Symphony Health Solutions. The company Destination Rx assisted in calculating dose ranges and average prices. Symphony Health Solutions is not involved in our analysis and recommendations.

5. The cost of these vaginal creams is highly dependent on use, and prices we obtained online and elsewhere for the exact same size tubes for both products varied three- to fourfold. Also, women use varying amounts to get relief, though typically the products are not intended for use more than 21 days per month. As a result, we have given a general price range for both.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

Menopause Drugs is a sample topic from the Consumer Reports Health.

To view other topics, please or purchase a subscription.

Learn more.

Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case