Prometrium vs. Bijuva
See how Prometrium and Bijuva compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Prometrium is a standalone progesterone capsule used to protect the uterus during estrogen therapy, while Bijuva combines estradiol and progesterone in one pill for hot flashes.
Both use bioidentical hormones, but Prometrium is paired with a separate estrogen prescription while Bijuva delivers fixed-dose estrogen and progesterone together in a single capsule.
Prometrium carries a peanut oil warning and several off-label uses, whereas Bijuva is FDA-approved only for moderate to severe menopausal hot flashes.
Prometrium vs. Bijuva Drug Summary
Prometrium
Prometrium is an oral micronized progesterone capsule, chemically identical to the body's own hormone, taken at bedtime. It's FDA-approved to protect the uterine lining in postmenopausal women using estrogen therapy and to treat secondary amenorrhea, with several off-label uses in fertility and pregnancy care.
Bijuva
Bijuva is a combination oral capsule containing bioidentical estradiol and progesterone in a single dose, taken daily with food. It's FDA-approved specifically to treat moderate to severe hot flashes caused by menopause in women who still have a uterus.
Prometrium vs. Bijuva Side Effects
Prometrium
Bijuva
Prometrium vs. Bijuva Dosage
Prometrium
Bijuva
| STAGE | DOSE | WHEN |
| Starting dose | 200 mg once daily | At the start |
| Maximum dose | 400 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 0.5 mg/100 mg once daily | At the start |
| Maximum dose | 1 mg/100 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Prometrium
| STAGE | DOSE | WHEN |
| Starting dose | 200 mg once daily | At the start |
| Maximum dose | 400 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Bijuva
| STAGE | DOSE | WHEN |
| Starting dose | 0.5 mg/100 mg once daily | At the start |
| Maximum dose | 1 mg/100 mg once daily | If needed |
| Dose changes | 1 increase | As tolerated |
Prometrium vs. Bijuva Indications
Prometrium
Prometrium is approved to prevent endometrial hyperplasia in postmenopausal women taking estrogen and to treat secondary amenorrhea. Doctors also prescribe it off-label for fertility treatment, pregnancy support, and broader hormone replacement regimens.
Prevents endometrial hyperplasia with estrogen therapy
Treats secondary amenorrhea
Off-label: luteal phase support in IVF
Off-label: preterm birth prevention
Bijuva
Bijuva is approved only to treat moderate to severe hot flashes related to menopause in women who have a uterus. It is not indicated for endometrial protection alone, prevention of heart disease, or use after hysterectomy.
Treats moderate to severe menopausal hot flashes
Requires an intact uterus
Not approved for endometrial protection alone
Not approved for use without a uterus
Prometrium vs. Bijuva Pros and Cons
Prometrium
Prometrium has decades of use as a standalone progesterone and can be paired with any estrogen product, offering flexible dosing. It carries boxed warnings for cardiovascular and dementia risk when combined with estrogen, and its peanut oil base rules it out for people with peanut allergies.
Pros
Long track record since its 1998 approval
Can be paired with any estrogen product
Off-label uses in fertility and pregnancy care
Cons
Contains peanut oil; unsafe for peanut allergy
Requires a separate estrogen prescription
Boxed warning for cardiovascular and dementia risk
Typically costs more than Bijuva out of pocket ($497 to $936 vs $257 to $351 per month)
Bijuva
Bijuva combines bioidentical estrogen and progesterone in one capsule, simplifying dosing for hot flash relief. It has a narrower approved use than Prometrium and no generic option, though its cash price tends to run lower each month.
Pros
Single capsule combines estrogen and progesterone
Lower monthly cash price than Prometrium ($257 to $351 vs $497 to $936)
Only FDA-approved bioidentical combo pill available
Cons
Approved only for hot flashes, not other uses
Not approved for women without a uterus
No generic version currently available
Absorption depends on taking it with a fatty meal
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