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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.

Both Emerita and Prevaleaf Oasis are natural vaginal moisturizers.

Shop Comfort and Vaginal Health Products

One more option might be an oral nutritional supplement, Stronvivo, which some research shows improves vaginal moisture. It does this by improving blood flow, and that circulation also supports tissue health.




  • 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

  • Had a hysterectomy years ago, only ovaries left. No HRT at the time. Years later suffered menopause symptoms and put onto Premarin. Been on this for 7 years or more. I suffer from extremely dry and thin skin. If bumped bleeds and bruises easily. Also on Blood pressure tablets. Could premarin be reason for my dry and thin skin. I’m looking for an alterative as I’ve been told continual use of premarin can lead to breast cancer. Regards Janet UK.

    Janet on

  • Gita, There is no risk in continuing on premarin and if there are symptoms that it is helping then continuing is likely a good idea. The risk is if a woman has known heart disease and then later starts estrogen that there is risk, but for women who started early in menopause and have continued there isn’t added heart disease risk. This is what we call the ‘timing hypothesis’, there is a window of time that it is safest to initiate estrogen therapy, and that window is early in menopause. The oral estrogen (vs transdermal), like premarin has a small increased risk of blood clot formation, so that is a risk that should be assessed for each individual. And, no there isn’t a natural source of estrogen, estrogen is prescription only.

    Dr Barb on

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