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Q: Is there a “natural” replacement for Premarin?

Q: Is there a “natural” replacement for Premarin?

by Dr. Barb DePree MD

In a sense, the most “natural” replacement for lost estrogen is estrogen, which is a prescription product (like Premarin or Estrace vaginal cream, Estring, Vagifem, or the non-estrogen Osphena).

You asked. Dr. Barb answered.If, for a number of reasons, you prefer not to take that path, the next-best option is to maintain vaginal tissues by using a moisturizer regularly, two to three times a week. Moisturizers are designed to bring more moisture--no surprise--into the vagina to prevent the progressive dryness that occurs in menopause with the absence of estrogen.

You might also try Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.


  • GH, a much less expensive option is oral estradiol. At your current dose you could likely use 0.5 mg (or 1/2 of a 1 mg tab). Most women can make that transition without disruption.

    Dr Barb on

  • I have been on oral Premarin (.045mg/day) for decades!

    The price even with Part Dnis horrible and I want to stop or take a more cost effective medication. I have had a partial hysterectomy.

    I have asked my OBGYN whom I love but he looks at me and says…”do you want to turn into an old lady”…..I am now 69 this October, so I’m sort of already there although I feel good other than a few aches and pains.

    Any recommendations???

    GH on

  • Lise, using estrogen (either systemic or localized) will be of benefit to improve the integrity of those healing tissues and promote blood supply to get a better postsurgical result. It doesn’t have to be localized premarin, it can be estradiol cream, vagifem, or Imvexxy, or oral Osphena. There is also a ring, Estring, but I would not recommend that in a postsurgical patient, early in recovery. There isn’t a ‘natural’ alternative that gets the same result. And remember estrogen production from your ovaries was natural for 40 years.

    It’s not clear to me if the prior use of premarin was oral or vaginal. For this indication vaginal should work great and shouldn’t cause dizziness (that would also be rare for oral), but there are additional options to consider.

    Dr Barb on

  • I had pelvic floor reconstruction due to a prolapsed bladder, falling vagina and rectal impact, on 12/16/20. My bladder is dropping some again, no rectal impact, and my surgeon wants me to use premarin. I have used before and it makes me dizzy. He wants me to use to help strengthen the integrity of my vaginal skin. Is there a natural alternative that will accomplish same thing? I believe the concern is the dryness and thinning of vaginal skin which does not help support my bladder

    Lise on

  • Janet, Premarin should help integrity of skin, if anything, and will not make it worse. Mostly skin condition is a result of aging and genetics. Premarin is not a risk for breast cancer and in fact, women who have had a hysterectomy (and don’t use progesterones), like you, have less chance of breast cancer than women who didn’t use premarin. You can continue safely if this is helpful to you and your menopausal symptoms.

    Dr Barb on

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