Premarin vs. Provera

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

Key Takeaways

  • Premarin is an estrogen that treats hot flashes, vaginal dryness, and low estrogen levels, while Provera is a progestin that protects the uterus from estrogen's effects.

  • Women with a uterus who take Premarin usually need Provera or another progestin added to lower the risk of endometrial cancer.

  • Both drugs carry boxed warnings for heart attack, stroke, and dementia risk, especially when estrogen and progestin are used together long-term.

Premarin vs. Provera Drug Summary

Premarin

Premarin is an estrogen hormone medication used to treat moderate to severe menopausal hot flashes, vaginal dryness, and low estrogen levels from ovarian failure or surgery. It is also FDA-approved to help prevent osteoporosis after menopause and, in certain cases, to slow advanced prostate or breast cancer. Premarin is taken as a daily oral tablet, with the dose chosen based on the condition being treated.

Provera

Provera is a synthetic progestin used to treat abnormal uterine bleeding and secondary amenorrhea caused by a hormone imbalance. In postmenopausal women who still have a uterus, it is also added to estrogen therapy like Premarin to prevent endometrial hyperplasia, a precancerous thickening of the uterine lining. Provera is taken as a short course of oral tablets rather than as an ongoing daily medication.

Premarin vs. Provera Side Effects

Premarin

Most common
Headache (common)
Breast tenderness (common)
Irregular bleeding (common)
Nausea (common)

Provera

Most common
Headache (common)
Breast tenderness (common)
Irregular bleeding (common)
Nausea (common)

Premarin vs. Provera Dosage

Premarin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 0.3 mg once daily At the start
Maximum dose 10 mg three times daily If needed
Dose changes 5 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

Premarin vs. Provera Indications

Premarin

Premarin is FDA-approved to relieve moderate to severe hot flashes and vaginal dryness caused by menopause, and to treat low estrogen levels from ovarian failure, hypogonadism, or surgical removal of the ovaries. It is also approved to help prevent osteoporosis in postmenopausal women and, less commonly, to slow certain hormone-sensitive prostate and breast cancers.

  • Moderate to severe hot flashes and night sweats

  • Vaginal dryness and irritation from menopause

  • Low estrogen from ovarian failure or removal

Provera

Provera is FDA-approved to treat secondary amenorrhea and abnormal uterine bleeding caused by a hormone imbalance rather than a structural problem. In postmenopausal women taking daily estrogen like Premarin who still have a uterus, Provera is prescribed to prevent endometrial hyperplasia, an overgrowth of the uterine lining that can lead to cancer.

  • Secondary amenorrhea from hormone imbalance

  • Abnormal uterine bleeding from hormone imbalance

  • Endometrial hyperplasia prevention with estrogen

Premarin vs. Provera Pros and Cons

Premarin

Premarin has decades of clinical use and covers a wider range of FDA-approved uses than many estrogen products, from menopausal symptoms to certain cancers. It carries boxed warnings for endometrial cancer, stroke, blood clots, and dementia risk, and typically costs more each month than generic progestins like Provera.

Pros

  • FDA-approved for multiple menopause-related conditions

  • Also approved for advanced prostate and breast cancer

  • Long history of clinical use since 1942

Cons

  • No FDA-approved generic version in the U.S.

  • Boxed warning for endometrial cancer if uterus is intact

  • Roughly $240 to $290 per month without insurance

Provera

Provera is a low-cost, well-established progestin used mainly in short courses rather than continuous daily therapy. It does not treat hot flashes or other estrogen-deficiency symptoms on its own, but it plays a key safety role when combined with estrogen therapy in women who have a uterus.

Pros

  • Generic tablet available at low cost

  • Short 5 to 10 day courses instead of daily long-term use

  • Protects the uterine lining when combined with estrogen

Cons

  • Does not relieve hot flashes or vaginal dryness alone

  • Can cause mood changes, depression, or insomnia

  • Boxed warning for cardiovascular and dementia risk with estrogen

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