Provera vs. Divigel
See how Provera and Divigel compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Provera is an oral progestin that treats abnormal bleeding and amenorrhea, while Divigel is an estrogen gel approved specifically for menopausal hot flashes.
Doctors often prescribe Provera alongside Divigel to protect the uterine lining from estrogen-related overgrowth in women who still have a uterus.
Provera costs far less out of pocket than Divigel, though the two drugs serve different roles rather than acting as interchangeable alternatives.
Provera vs. Divigel Drug Summary
Provera
Provera is a synthetic progestin taken as an oral tablet to treat secondary amenorrhea and abnormal uterine bleeding caused by hormone imbalance. It is also used alongside estrogen therapy to protect the uterine lining from overgrowth. It has been available since 1959 and is typically taken for 5 to 10 days per cycle.
Divigel
Divigel is an estrogen gel applied once daily to the thigh, approved to treat moderate to severe hot flashes associated with menopause. It comes in four measured doses that allow gradual adjustment based on symptom control. Because unopposed estrogen raises endometrial cancer risk, women with a uterus usually need an added progestin such as Provera.
Provera vs. Divigel Side Effects
Provera
Divigel
Provera vs. Divigel Dosage
Provera
Divigel
| 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 |
| STAGE | DOSE | WHEN |
| Starting dose | 0.25 g once daily | At the start |
| Maximum dose | 0.25 g once daily | Same as starting |
| Dose changes | None | Fixed dose |
Provera
| 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 |
Divigel
| STAGE | DOSE | WHEN |
| Starting dose | 0.25 g once daily | At the start |
| Maximum dose | 0.25 g once daily | Same as starting |
| Dose changes | None | Fixed dose |
Provera vs. Divigel Indications
Provera
Provera is FDA-approved to treat secondary amenorrhea and abnormal uterine bleeding caused by hormonal imbalance. It is also approved to prevent endometrial hyperplasia in postmenopausal women who still have a uterus and are taking daily estrogen. It is not approved for contraception or for preventing heart disease or dementia.
Secondary amenorrhea
Abnormal uterine bleeding from hormonal imbalance
Endometrial hyperplasia prevention with estrogen therapy
Divigel
Divigel is FDA-approved to treat moderate to severe hot flashes associated with menopause. It is sometimes used off-label for vaginal dryness and atrophy, and off-label as part of gender-affirming hormone therapy. It is not approved to prevent cardiovascular disease or dementia.
Moderate to severe menopausal hot flashes
Vaginal dryness and atrophy (off-label)
Gender-affirming hormone therapy (off-label)
Provera vs. Divigel Pros and Cons
Provera
Provera is a low-cost oral progestin used alone to treat abnormal bleeding or amenorrhea, or added to estrogen therapy to protect the uterine lining. It does not relieve hot flashes and carries warnings about cardiovascular and cancer risks when combined with estrogen.
Pros
Costs roughly $15 to $75 a month, far less than Divigel
Oral tablet with no risk of transferring hormone to others
Directly treats abnormal bleeding and amenorrhea, not just symptoms
Cons
Does not treat hot flashes or other vasomotor symptoms
Boxed warning for heart attack, stroke, breast cancer, and dementia risk when combined with estrogen
Only two dosing regimens, less flexibility than Divigel's four strengths
Divigel
Divigel is an estrogen gel approved specifically for menopausal hot flashes, applied once daily in one of four measured doses. It costs significantly more than Provera and typically must be paired with a progestin like Provera in women who still have a uterus.
Pros
FDA-approved specifically for moderate to severe hot flashes
Four measured doses allow gradual, individualized titration
Topical gel bypasses the liver, unlike swallowed pills
Cons
Costs roughly $650 to $900 a month, far more than Provera
Gel can transfer to children or pets through skin contact
Carries boxed warnings for endometrial cancer, blood clots, stroke, and dementia risk
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