Dear Dr. Roach: I read your recent column from the woman with vaginal atrophy. I am experiencing the same problem. The next problem is that a small tube of Premarin cream is $250. Im wondering if progesterone cream applied topically can do any good. Im currently using an OTC moisturizer. I cant afford the $250 Premarin, and there is no generic. I have had recurring UTI issues for over 20 years, and this may explain them. M.M.
Answer: I received a lot of mail about the cost of vaginal estrogen. I found a coupon through goodrx.com for generic estradiol cream. It is similar to, but not exactly the same as, Premarin, which is conjugated equine (horse) estrogens. Estradiol is the bioidentical human hormone, manufactured to be molecularly identical. The estradiol is $95, which is better than $250.
Over-the-counter vaginal moisturizers are a good place to start for women with symptomatic dry vagina from atrophic vaginitis, but estrogen creams are more effective and are much more likely to prevent urine infections. Another writer told me that Premarin vaginal cream is available in Canadian pharmacies for $60 for a three-month supply.