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

Most common
Abnormal uterine bleeding
Breast tenderness/galactorrhea
Nausea
Headache

Divigel

Most common
Metrorrhagia (>5%)
Breast tenderness (>5%)
Vaginal mycosis (>5%)
Nasopharyngitis (>5%)

Provera vs. Divigel 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

Divigel

Dosage
Dosage Table
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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