Prempro is a combination of conjugated estrogens and medroxyprogesterone, used as hormone replacement therapy. It is approved by the Food and Drug Administration to treat the symptoms of menopause and for osteoporosis treatment in postmenopausal women. Some women may not tolerate Prempro and will need to consider alternative medications.
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Alternative Progestin / Estrogen Combinations
As Prempro is a combination progestin/estrogen product approved for the treatment of symptoms of menopause and osteoporosis in women who have not had a hysterectomy (still have a uterus), hormone replacement therapy (HRT) with a similar product might be advisable. Use of progestin and estrogen provides both female sex hormones and may protect against the development of uterine cancer. Activella, Femhrt and CombiPatch all contain estradiol and norethindrone; Angeliq contains estradiol and drospirenone; Climara Pro contains estradiol and levonorgestrel; and Prefest contains estradiol and norgestimate. Selection of a particular product depends on the needs of the patient and her doctor's advice. All progestin/estrogen combination products, including Prempro, carry similar risks and warnings, such as potential breast tenderness, weight gain, mental changes and a slight increase for the risk of blood clots and several types of cancer.
Estrogen Only Products
Hormone replacement therapy using estrogen by itself may be an option as an alternative to Prempro, particularly for women who have had a hysterectomy. Available medications for estrogen only hormone replacement include oral medications, topical products and vaginal products. Oral conjugated estrogens (Premarin, Enjuvia) have long been the primary estrogen product used for hormone replacement, however many consider topical application to be more effective. Estradiol transdermal patches (Estraderm, Climara, Vivelle) and estradiol cream (Estrasorb) can be applied to skin as estrogen replacement. Estradiol vaginal ring (Femring) and estrogen vaginal cream (Premarin Vaginal) can be used in the vaginal area for estrogen replacement.
Women who have not been treated successfully with combination progesterone or single-agent estrogen products might consider an estrogen-testosterone combination as an alternative to Prempro hormone replacement therapy. Estrogen-testosterone combinations include Estratest and Valertest. Though they are not as commonly used for HRT as other methods, advantages of the testosterone combination include increased sex drive, increased physical stamina and heightened assertiveness. Testosterone use in women, even in combination with estrogen, may increase the risk for male sex characteristic development, such as increased body and facial hair, voice changes and facial thickening.
Some women decide to use natural alternatives to Prempro or other traditional HRT, including the use of bioidentical hormone treatment or the use of herbal supplements, such as black cohosh, wild yam extract, dong quai root, DHEA and red clover extract. The traditional medical community has been reluctant to endorse the use of natural remedies for post-menopausal symptoms. However, the National Institute for Complementary and Alternative Medicine is investigating these products and a number of other alternative treatments, such as mind-body connection, to help women relieve the symptoms of menopause.