Estrace vs. Provera

See how Estrace and Provera compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Estrace is an estrogen used for menopause symptoms and low-estrogen conditions, while Provera is a progestin used mainly to control abnormal bleeding and protect the uterus during estrogen therapy.

  • Women with a uterus who take Estrace usually need a progestin like Provera added to lower the risk of endometrial cancer from unopposed estrogen.

  • Both drugs carry boxed warnings for cardiovascular events, blood clots, and dementia risk, especially when estrogen and progestin are combined in postmenopausal women.

Estrace vs. Provera Drug Summary

Estrace

Estrace is a form of estrogen (estradiol) used to relieve menopause symptoms like hot flashes and vaginal dryness, treat low estrogen from ovarian failure or surgery, and help prevent osteoporosis after menopause. It comes as an oral tablet taken once daily at doses of 0.5 mg to 2 mg, though higher doses are used for certain cancers.

Provera

Provera is a synthetic progestin (medroxyprogesterone) used to treat abnormal uterine bleeding and absent periods, and to protect the uterine lining in women taking estrogen therapy. It is an oral tablet typically taken once daily for a set course of 5 to 10 days, rather than as an ongoing daily medication.

Estrace vs. Provera Side Effects

Estrace

Most common
Headache (reported)
Breast tenderness (reported)
Nausea (reported)
Vaginal bleeding (reported)

Provera

Most common
Headache (reported)
Breast tenderness (reported)
Nausea (reported)
Uterine bleeding (reported)

Estrace vs. Provera Dosage

Estrace

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.5 mg daily At the start
Maximum dose 10 mg three times daily If needed
Dose changes 4 increases As tolerated

Provera

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5 mg or 10 mg daily At the start
Maximum dose 10 mg daily If needed
Dose changes 1 increase As tolerated

Estrace vs. Provera Indications

Estrace

Estrace is FDA-approved for menopausal hot flashes, vaginal atrophy, and low estrogen after ovary removal or hypogonadism. It also slows bone loss after menopause and, at higher doses, serves as a palliative treatment for certain breast and prostate cancers.

  • Moderate to severe hot flashes and night sweats

  • Vaginal dryness and irritation from vulvar/vaginal atrophy

  • Low estrogen from ovarian failure, hypogonadism, or ovary removal

  • Palliative treatment for certain breast and prostate cancers

Provera

Provera is FDA-approved for absent periods and abnormal uterine bleeding caused by hormonal imbalance. It is also added to estrogen therapy in women with a uterus, to prevent the uterine lining from overgrowing and raising cancer risk.

  • Absent periods (secondary amenorrhea) from hormone imbalance

  • Abnormal uterine bleeding due to hormonal imbalance

  • Protecting the uterine lining in women on estrogen therapy who still have a uterus

  • Given as short defined courses of 5 to 10 days, not continuous daily use

Estrace vs. Provera Pros and Cons

Estrace

Estrace covers more FDA-approved uses than Provera, spanning menopause symptoms, hypoestrogenism, and osteoporosis prevention. It comes in several tablet strengths, but its boxed warnings for cancer, cardiovascular events, and dementia apply to long-term daily use.

Pros

  • FDA-approved for a broad range of menopause and hormonal conditions, including osteoporosis prevention

  • Available in multiple tablet strengths for flexible dosing

  • Long track record, approved since 1975, with decades of safety data

Cons

  • Carries boxed warnings for endometrial cancer, cardiovascular events, dementia, and breast cancer risk

  • Requires an added progestin, like Provera, for women with a uterus to protect against endometrial cancer

  • The 2 mg tablet contains tartrazine dye, which can trigger allergic-type reactions in sensitive people

Provera

Provera is used in shorter, defined courses rather than continuous daily dosing, most often to trigger a period or protect the uterus during estrogen therapy. Its boxed warnings mirror Estrace's when the two are combined for hormone replacement, and it carries additional contraindications around liver disease and clotting risk.

Pros

  • Specifically indicated to protect the uterine lining when taking estrogen

  • Also approved on its own for abnormal uterine bleeding and secondary amenorrhea

  • Shorter, defined treatment courses of 5 to 10 days rather than open-ended daily dosing

Cons

  • Same boxed warning risks as Estrace when the two are combined for hormone therapy

  • Contraindicated in liver disease, active blood clots, undiagnosed vaginal bleeding, and certain cancers

  • Distinct from injectable Depo-Provera products, which can cause confusion about dosing and indications

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