When Duavee Isn't Available, You Still Have Options

If you've been prescribed Duavee and can't find it at your pharmacy — or if the cost is too high — you may be wondering what else is out there. The good news: several effective alternatives exist for treating menopausal hot flashes and preventing osteoporosis.

In this article, we'll explain what Duavee is, how it works, and walk you through the most common alternatives your doctor might consider. Every woman's situation is different, so talk to your prescriber before making any changes to your medication.

For more on why Duavee is hard to find, see our article: Why is Duavee so hard to find in 2026?

What Is Duavee and How Does It Work?

Duavee is a once-daily tablet that combines two ingredients:

• Conjugated estrogens (0.45 mg): A form of estrogen that relieves hot flashes and helps prevent bone loss after menopause.
• Bazedoxifene (20 mg): A selective estrogen receptor modulator (SERM) that protects the uterine lining from estrogen's effects, eliminating the need for a progestin.

This combination makes Duavee unique — it's the only FDA-approved estrogen/SERM combination for menopause. It's specifically designed for women who still have a uterus and want hormone therapy without a progestin.

For a deeper dive into how the drug works, read our article on Duavee's mechanism of action.

Why Might You Need an Alternative?

There are several reasons you might be looking for a Duavee alternative:

• Availability: Duavee has been consistently hard to find at pharmacies due to limited supply and no generic version.
• Cost: Without insurance, Duavee costs $300–$500 per month. Even with insurance, copays can be high.
• Side effects: Some women experience side effects that make them want to try a different option.
• Insurance requirements: Your insurer may require you to try other medications first (step therapy).

Alternative #1: Prempro (Conjugated Estrogens/Medroxyprogesterone)

Prempro is one of the most commonly prescribed combination hormone therapies. It pairs conjugated estrogens with medroxyprogesterone acetate (a progestin) to treat hot flashes and prevent osteoporosis in postmenopausal women with a uterus.

How it compares to Duavee:

• Uses a progestin instead of a SERM to protect the uterus
• Has been on the market much longer, with extensive clinical data
• Available as a generic, making it significantly cheaper (often $15–$50 per month)
• May cause progestin-related side effects like breast tenderness, bloating, and mood changes

Best for: Women who need an affordable, widely available HRT option and can tolerate progestin side effects.

Alternative #2: Bijuva (Estradiol/Progesterone)

Bijuva is a combination capsule containing bioidentical estradiol and progesterone. It's FDA-approved for treating moderate-to-severe vasomotor symptoms in women with a uterus.

How it compares to Duavee:

• Uses bioidentical hormones (17β-estradiol and progesterone) rather than conjugated estrogens
• May appeal to patients who prefer bioidentical over synthetic hormones
• Brand-name only (no generic), so cost may be similar to Duavee ($200–$400 per month)
• Contains progesterone rather than a SERM

Best for: Women who prefer bioidentical hormone therapy and want a single-pill combination.

Alternative #3: Activella (Estradiol/Norethindrone Acetate)

Activella combines estradiol with norethindrone acetate (a progestin). It treats hot flashes and prevents osteoporosis in postmenopausal women with a uterus.

How it compares to Duavee:

• Uses estradiol instead of conjugated estrogens
• Generic versions are available, bringing the cost down to $20–$60 per month
• Well-established safety and efficacy profile
• May cause progestin-related side effects

Best for: Women looking for an affordable generic option with estradiol rather than conjugated estrogens.

Alternative #4: Premarin + Separate Progestin

Some doctors prescribe Premarin (conjugated estrogens alone) alongside a separate progestin like Provera (medroxyprogesterone) or micronized progesterone (Prometrium). This gives more flexibility in dosing each component independently.

How it compares to Duavee:

• Allows dose adjustments of estrogen and progestin separately
• Generic versions of both components are available
• Requires taking two pills instead of one
• Combined cost can be quite low ($20–$80 per month for both generics)

Best for: Women who need flexible dosing or whose doctors want to adjust each component independently.

A Quick Comparison

Here's a summary to help you and your doctor discuss the options:

• Duavee: Estrogen + SERM, no progestin needed, brand-only, $300–$500/month
• Prempro: Estrogen + progestin, generic available, $15–$50/month
• Bijuva: Bioidentical estradiol + progesterone, brand-only, $200–$400/month
• Activella: Estradiol + progestin, generic available, $20–$60/month
• Premarin + Provera: Separate pills, flexible dosing, generics available, $20–$80/month

Final Thoughts

Duavee's unique estrogen/SERM combination isn't easily replicated by another single product. But if you can't find Duavee or it's too expensive, there are well-studied alternatives that can effectively manage your menopausal symptoms and protect your bones.

Talk to your doctor about which option is best for your specific situation. And if you'd still prefer Duavee, try using Medfinder to locate it in stock near you, or explore ways to save money on Duavee.

For more information about this medication, see our full guide: What is Duavee? Uses, dosage, and what you need to know.