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Understanding Vaginal Estrogen: Types, Uses, and Costs
In this episode, I dive into the benefits, forms, and costs associated with vaginal estrogen for women at different stages of life. I discuss how vaginal estrogen can help during menopause, perimenopause, postpartum, and while using hormonal contraception. Discover the various forms available, including creams, suppositories, pills, and vaginal rings, and get insights into their application, advantages, and potential costs. I also address common concerns, such as irritation and waste, and provide practical tips on finding the best option for your needs and budget. Learn how to navigate medication websites for coupons and discounts, ensuring you get the most cost-effective and suitable treatment.
Additional information can be found at the following links:
Timeline
00:28 Introduction to Vaginal Estrogen
00:33 When to Use Vaginal Estrogen
01:09 Forms of Vaginal Estrogen
01:27 Benefits and Safety of Vaginal Estrogen
01:50 Different Methods of Administration
02:21 Cost Considerations
03:44 Detailed Overview of Creams
08:24 Suppositories and Pills
10:46 Vaginal Rings
12:42 Comparing Dosages and Efficacy
13:46 Conclusion and Recommendations
Hi there. I wanted to talk to you today about vaginal estrogen. So women make estrogen in their bodies and there are different times of life when you can benefit from vaginal estrogen. So some women can benefit from this when they're menopausal, sometimes when you're perimenopausal, sometimes if you are using a hormonal form of estrogen.
birth control that drives down your estrogen levels. Some women can also benefit from it when they're postpartum, um, because of hormonal contraception, but also because of breastfeeding, those things drive your estrogen levels down. There are different ways that we can give you estrogen. We can give you a pill, you can take it by mouth, we can give you a patch.
But we frequently give women vaginal estrogen. And that's because if you have vaginal or bladder symptoms, you need the estrogen in the vagina, but not necessarily in the rest of your body. Also, when we give you vaginal estrogen, it is the safest form of estrogen. If you take it at the prescribed levels, then your blood level of estrogen actually doesn't increase.
So there are No increased risk of heart disease or of cancer. And so if you just have vaginal or bladder symptoms, that is our preferred way of giving it to you. But there are lots of different ways that we can give you vaginal estrogen. So there are creams that you can put in the vagina. There are suppositories that you can put in the vagina.
There is a pill that you can put in the vagina. And there is a ring that you can put in the vagina. And the ring you actually leave for three months and it slowly releases estrogen. So I just want to talk to you about these different forms. Um, because some women definitely prefer one form over the other for lots of different reasons.
Um, and also cost because there are different costs associated with these. The cost associated with medications doesn't always make a lot of sense in the United States and it definitely depends on your own insurance and your own insurance plan. But I'm just going to give you some rough ideas of the costs and where you can go to kind of check things out.
So let's start with Cream. So there are two prescription creams that are available in the United States. There is Estrace and there is Premarin Cream. You can also have cream compounded at a compounding pharmacy. So Estrace Cream contains Estrace, Estradiol and estradiol is an estrogen that we make. So you consider that can consider this to be a bio identical hormone.
It is exactly what your body makes. And, uh, the estroids that we give women is 0. 01%. So that means that there's a hundred micrograms of estradiol in it. Now, if you're someone who really cares about, um, what you're putting in your body and you want to, uh, know all of the different chemicals that are in estrous cream, um, you should go to the website and you should look at it.
I will tell you that there is some alcohol in the base and for some women, the alcohol is very, very irritating and they'll feel like it burns. And these are patients that we usually move on to compounding so that we can, um, give them an estrogen with a different base that doesn't have the alcohol in it.
Usually it's a glycerin base. When you, um, buy a tube of esters, that tube is 42. 5 grams. Um, it comes with a plastic applicator and you fill the applicator up with cream and then you insert it. The usual standard, um, prescription is for two to four grams to be placed in the vagina every night for one to two weeks.
And then after that, one gram, um, two times a week. Um, so when you're in that maintenance phase, you're just placing it, um, twice a week. You have to be really careful to not waste the cream. A lot of people don't feel like the cream will last for their whole prescription. Transcription by https: otter. ai You want to be careful there and pay attention.
Retail costs of Estrese cream is around 137. If you go to the website, good Rx, um, it's around 30. And if you go to cost plus drugs, It is 13. You should always look at the medications website because sometimes there are coupons involved, but in this case, going to cost plus drugs, um, which is a website where you can, um, get your medications.
You do need to have a prescription. They don't have all medications, but for the medications that they have, they charge you the manufacturing Price, plus a 15 percent markup, plus a 5 pharmacy charge. And so that frequently is much less than you can get through kind of standard routes. Premarine cream is a different cream.
The estrogen in premarine cream is actually made from, um, pregnant mare urine. And so there is a mixture of conjugated estrogen and some of those estrogens are estradiol, which is a form of estrogen that you see in the human female. But there are also some other forms of estrogen that are only found in horses.
Some women don't like the idea of Premarin because they don't consider it to be bio identical. It is a different form of estrogen that we naturally make, but it has been well studied and well tested and is safe for use and also helps with various vaginal conditions. Um, it too has a base in it and that base also has some alcohol in it.
And again, you should look at the website and look at the different chemicals that are in there if you're someone who tends to be a little bit more sensitive. Each tube is 30 grams and with primer and cream, usually we give you half a gram twice a week from the start. The amount of estrogen, of the conjugated In it is 0.625 milligrams per gram.
Premarin Green, depending on your, um, insurance, tends to be a little bit more expensive. There are, um, coupons on their website, and you can save $150 per prescription. Um, and you can use that twice a calendar year. On GoodRx, uh, primary cream is about $450 for a tube. Um, and at Cost Plus Drugs, uh, it's about 4.
30 for a tube. This comes with an applicator as well. And one of the things that we hear a lot from patients is, um, patients really don't like cleaning the applicator. They, you know, find it hard to make sure that it's getting, um, clean and they don't like that fuzz. Some patients really don't like the cream because they feel like it just leaks out and it's a little bit more messy.
If you react to the base, then once again, we can have that compounded for you. In compounding pharmacies, the cost is usually about 50 a month. I use Estrace cream a lot. I will frequently start my patients on it and then Um, because I think it does a really good job of conditioning, uh, the tissue and getting the tissue to be healthier and more elastic and more lubricated.
And then once you just need maintenance, then I'll frequently switch you to a different form if you don't like the cream. There's also a suppository. So the suppository is called Ivey, so I-M-V-E-X-X-Y, and it comes in two different um, strengths, four micrograms and 10 micrograms, and it has estradiol in it as well.
So it is light pink, it's tear shaped. When you get it, you get a blister pack and so you just pop them out and you use, um, two. Two per week, right? So you're just going to use that twice a week. If you go to their website, they have an online pharmacy and you can use their online pharmacy and then it is about 50 a month.
For good Rx, it would be 85 a month and they don't have this particular medication on cost plus drugs. Um, but some patients really like the suppository instead just because of the less mess factor. And because you're not using an applicator, you just use your finger to put it in the vagina, and the four microgram dose is the lowest dose that's currently on the market.
So if that's something that is really important to you and you wanna use the lowest dose, then I think the suppository is a great idea. There's also a pill that you can put in the vagina. And this is, uh, contains estradiol as well. And it is 10 micrograms. So again, a very, very low dose. And you're just going to put that in the vagina twice a week.
Pill comes preloaded on an applicator. So some patients really like that because they're not having to clean the applicator. Um, but there is a lot of waste, right? Because you're throwing that applicator out each time. Um, the pill is really small. It's six millimeters in diameter. It is called Vagefem, so V A G I F E M.
Um, the generic version is Uvafem, Y U V A F E M. There's no alcohol in the Vagifem, um, or the Invexie for that matter, um, but if you want to see all of the different components, you can find that on the website. There are no saving coupons, um, but if you're on the generic at GoodRx, that is 40 to 85. Um, and at Cost Plus Drugs, it is 113.
So those are good places for, for you to, um, look for discounts. And then the last form of vaginal estrogen is the S string. So E S T R I N G. And this is, um, You put in the vagina, you leave it there for three months and it slowly secretes estrogen. So this is cream free. It's great for people who just want to place it and not, um, think about it.
You can definitely be sexually active with it in place. There's two milligrams of estradiol in in the ring, and it releases 7. 5 micrograms per day. The ring is very flexible. The outer diameter is 55 millimeters, so it's, it's not very big. Um, and there have been studies, uh, comparing this to the cream, and it looks like it is equally eff There is equal efficacy, uh, to the cream.
The S string, again, it depends on your insurance, but, um, it can be a lot more expensive. There are saving coupons on the website and you can get a maximum annual savings of 400, but at GoodRx, it is 550. And cost plus drugs, it is 4. 22. So those prices always seem, um, incredibly high to me and, um, you know, really eliminate that as an option for a lot of women.
So if you need vaginal estrogen, I think it's important for you to know. the different forms that are out there and the different costs associated with them. You should know that anytime you get a medication, you should go to that medications website and look for coupons. You should look on good RX and it will tell you, um, the cheapest pharmacy, uh, for that particular medication for your insurance in your neighborhood.
And you should also look at cost plus drugs to help you determine if that is a cheaper option for you. The dosing on the medications, on the different forms of vaginal estrogen, sometimes that's a little bit confusing. Um, you have to do a little bit of math to be able to compare how much estrogen is in each one.
Um, for the VagFem and the UvFem, it, if you're doing it twice a week, it's 20 micrograms per week. For the Invexi, depending on what strength, that's 8 to 20. Um, micrograms per week for the estrous cream. It's 200 micrograms per week. And for the Premarin, you're getting, um, 625 micrograms of conjugated estrogen.
So it, it's different for all of them. The, the lowest forms of estrogen, um, are in the Infexi and the Vagifem. So if you're someone who really wants to be on the lowest dose, that's a great place to start. But, um, the creams definitely have, um, a higher dose of estrogen. But one that has been well studied and is felt to be very safe.
Vaginal estrogen helps with a lot of different symptoms. It can help with vaginal dryness. It is, um, an excellent UTI preventative. Um, it can help with urgency incontinence. It has been shown to help with stress incontinence. It helps with general urinary syndrome of menopause. There are a lot of different things that it can help with.
One thing that I would warn you about is when you get vaginal estrogen, The warnings that come with it are the warnings that are given for vaginal estrogen as well as oral estrogen. Oral estrogen or patch estrogen has different risks. Um, this is something that the menopause society is currently lobbying the FDA to change those warnings because it's, it doesn't really apply to vaginal estrogen and it's very concerning to people, but there is not an increased risk of heart disease or.
Cancer with vaginal estrogen. So I hope that helps you Decide which type of estrogen is best for you You might pick a less messy treatment. You might pick the cheapest treatment But it's just good for you to know the different things that are out there. That might be a good treatment for you
