Affordable Estradiol: Improving women’s quality of life

Written by Jordan Burns, CPhT | Posted April 17, 2024

Most women have heard, or experienced firsthand, the terrors of living through a menopausal life. They can tell you all about the hot flashes, the sleepless nights lying awake sweating, and the brain fog. Estrogen can be boosted to help reduce the side effects of menopause. Luckily, after 1960, women living through menopause and beyond were able to access viable hormone replacement therapies (HRTs) to increase estradiol, the strongest form of estrogen, giving the hope of alleviating symptoms. 

Estradiol (estrogen) is a sex hormone present in both men and women. It is predominant in women before entering into menopause, the time that marks the end of a woman’s menstrual cycle. According to The Johns Hopkins University School of Medicine, in addition to regulating the menstrual cycle, estrogen affects the reproductive tract, the urinary tract, the heart and blood vessels, bones, breasts, skin, hair, mucous membranes, pelvic muscles, and the brain. The National Library of Medicine reported that the majority of women will enter a menopausal state by age 51. Because life expectancy has increased in The United States to over 80 years of age, most women will live three decades of their lives in a state of too-low estrogen (hypoestrogenism), resulting in the need for hormone replacement. HRT for estrogen comes in various forms of the chemical component called estradiol. Estradiol itself also comes in many forms of medications. You can find estradiol patches, creams, vaginal inserts, sprays, as well as oral medications.

The U.S. Food and Drug Administration (FDA) has approved many estrogen-only medications as HRTs. These medications date back to the early 1930s, but the first FDA-approved medication for HRT was Premarin – branded estradiol – in 1942. It appears that Premarin was actually re-patented in 1998. For a medication that has been approved for decades, there doesn’t seem to be a direct authorized generic. Why not? The answer to this is complicated, as are most things that involve the intellectual property of pharmaceutical companies. In the late 1990s, the FDA rethought the approval process for generic medications. The FDA put the burden of proof not only on the safety of the generic but also on its efficacy. When this move was made, all generic forms of estradiol were removed from the marketplace leaving just branded Premarin. Although there isn’t a direct estradiol generic version of Premarin, there are generic estradiols available as authorized versions of popular brand names, such as Climara, Vivelle-Dot, Vagifem, Menostar, Divigel, Estrace, etc. 

How can I affordably access Estradiol?

Estradiol comes in many formulations to treat numerous women’s health disease states. In the United States, a month's supply of generic Vagifem will cost, on average, around $152.73 out-of-pocket; with insurance, the copay is usually around $60-80. Generic Vagifem (estradiol 10 mcg) is a vaginally inserted form of estrogen that can help minimize moderate to severe menopausal changes in and around the vagina. Vagifem is available through international mail order at a much lower cost and can be purchased at online pharmacies accredited through the PharmacyChecker International Pharmacy Verification Program. A patient could save as much as $78 per month by comparing prices among accredited online pharmacies. 

For those patients needing brand name Vagifem, you can expect a price tag of over $208 per month at a retail pharmacy in the United States. You can find Vagifem for as low as $18.88 per month at That is a 90% savings compared to Vagifem sold in the U.S. 

Compare Vagifem (estradiol) 10 mcg Prices Internationally

Drug  Strength Quantity U.S. Average Retail Price  PharmacyChecker U.S. Discount Card Price Accredited Canadian Pharmacy Price Accredited International Pharmacy Price Greatest Percentage Savings
Vagifem 10 mcg (3 month Supply) $904.11  $656.26 $222.05 $84.95 90.2% savings by purchasing from an accredited international pharmacy
Estradiol 10 mcg  (3 month supply) $281.59 $140.35 N/A $59.95 79% savings by purchasing from an accredited international pharmacy

Sources: Average U.S. Retail Price, U.S. Discount Card Price based on availability at pharmacies near White Plains, NY as compared on Accredited International Pharmacy Prices based on prices compared on

If you are experiencing pre-menopause or are currently seeking a cheaper solution to your hormone replacement therapy, I suggest you speak with your healthcare provider regarding your options.

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