Provera vs. Bijuva

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

Key Takeaways

  • Provera is a progestin-only tablet used to treat abnormal bleeding and protect the uterus during estrogen therapy, while Bijuva combines estradiol and progesterone in one capsule to treat hot flashes.

  • Provera is dosed cyclically for limited courses, whereas Bijuva is taken once daily on an ongoing basis with food.

  • Provera costs far less out of pocket than Bijuva, which currently has no generic option.

Provera vs. Bijuva Drug Summary

Provera

Provera (medroxyprogesterone acetate) is a synthetic progestin taken as an oral tablet. It treats secondary amenorrhea and abnormal uterine bleeding, and it protects the uterine lining in postmenopausal women taking estrogen. It is typically taken for 5 to 10 days per cycle rather than every day.

Bijuva

Bijuva combines bioidentical estradiol and progesterone in a single oral capsule. It is FDA-approved to treat moderate to severe hot flashes caused by menopause in women who still have a uterus. It is taken once daily, with food, on an ongoing basis.

Provera vs. Bijuva Side Effects

Provera

Most common
Headache (rate not specified)
Breast tenderness (rate not specified)
Nausea (rate not specified)
Abnormal uterine bleeding (rate not specified)

Bijuva

Most common
Headache (up to 4.0%)
Breast tenderness (up to 10.4%)
Nausea (up to 3.5%)
Vaginal bleeding (up to 3.4%)

Provera vs. Bijuva Dosage

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

Bijuva

Dosage
Dosage Table
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

Provera vs. Bijuva Indications

Provera

Provera is prescribed when a woman's periods have stopped due to hormone imbalance or when uterine bleeding is abnormal. It is also added to estrogen therapy in postmenopausal women with a uterus, since progestin protects against endometrial overgrowth that estrogen alone can cause. Provera is not intended to treat hot flashes or other vasomotor symptoms of menopause.

  • Secondary amenorrhea (absent periods)

  • Abnormal uterine bleeding from hormonal imbalance

  • Endometrial hyperplasia prevention with estrogen therapy

  • Not approved for contraception or heart disease prevention

Bijuva

Bijuva is prescribed specifically for moderate to severe hot flashes and night sweats linked to menopause. Because it contains both estrogen and progesterone, it can be used in women who still have a uterus without needing a separate progestin pill. Bijuva is not approved for women without a uterus or for preventing heart disease or dementia.

  • Moderate to severe hot flashes from menopause

  • Vasomotor symptom relief in women with a uterus

  • Combined estrogen-progesterone therapy in one capsule

  • Not approved for use without a uterus

Provera vs. Bijuva Pros and Cons

Provera

Provera has been available since 1959, comes in low-cost generic tablets, and is only taken for short courses rather than daily. Because it contains no estrogen, it does not relieve hot flashes and cannot replace full hormone therapy on its own.

Pros

  • Generic tablet, low list price ($15 to $75 per month)

  • Long track record dating back to 1959

  • Taken only 5 to 10 days per cycle, not daily

  • Available in three dose strengths (2.5, 5, 10 mg)

Cons

  • Does not treat hot flashes or other menopause symptoms

  • Requires a separate estrogen product for full HRT

  • Side effect rates not clearly quantified on the label

  • Cyclic dosing schedule is easy to miss or misuse

Bijuva

Bijuva pairs bioidentical estradiol with bioidentical progesterone in one capsule, so patients do not need to combine two separate hormone prescriptions. It is FDA-approved specifically for hot flash relief, but it costs substantially more out of pocket and has no generic alternative yet.

Pros

  • One capsule covers both estrogen and progesterone

  • FDA-approved specifically for hot flash relief

  • Bioidentical hormone formulation

  • Simple once-daily dosing, no titration needed

Cons

  • Roughly $257 to $351 per month, no generic available

  • Must be taken with food, ideally a high-fat meal

  • Not approved for women without a uterus

  • Newer drug (2018) with shorter track record

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