Can't fill your Intrarosa prescription? Learn about real alternatives like Vagifem, Estrace, Premarin Cream, and Osphena for menopausal dyspareunia.
If you've been prescribed Intrarosa (Prasterone) but can't find it at your pharmacy — or the cost is too high — you're probably wondering what other options are available. The good news is that there are several effective alternatives for treating painful intercourse caused by menopause.
Before switching medications, always talk to your doctor. But it helps to know what's out there so you can have an informed conversation.
Intrarosa is a vaginal insert containing Prasterone (DHEA), a naturally occurring hormone that your body converts into both estrogens and androgens at the vaginal tissue level. It's FDA-approved for treating moderate to severe dyspareunia — painful intercourse — caused by vulvar and vaginal atrophy due to menopause.
What makes Intrarosa unique is that it works locally. The DHEA is converted into active hormones right where it's needed, which means minimal systemic hormone exposure. You insert one 6.5 mg vaginal insert at bedtime each night using a disposable applicator.
For a deeper dive into the science, see our article on how Intrarosa works.
There are several reasons you might be looking for an Intrarosa alternative:
Estradiol vaginal inserts are one of the closest alternatives to Intrarosa. Like Intrarosa, they're inserted into the vagina and work locally to relieve symptoms of vaginal atrophy.
How they work: These inserts deliver a low dose of Estradiol (a form of estrogen) directly to vaginal tissues to improve moisture, elasticity, and comfort during intercourse.
Dosing: Typically one insert daily for two weeks, then one insert twice weekly for maintenance.
Key differences from Intrarosa: Estradiol inserts deliver estrogen directly, while Intrarosa delivers DHEA that gets converted into both estrogen and androgen. Generic versions (Yuvafem) are available, which can significantly reduce cost.
Cost: Generic Estradiol vaginal inserts can cost around $50 to $120 per month with a discount card, making them much more affordable than brand-name Intrarosa.
Estradiol vaginal cream is a widely available option for treating vaginal atrophy symptoms. It's been used for decades and has a well-established safety profile.
How it works: You apply a small amount of cream inside the vagina using an applicator. The Estradiol is absorbed locally to help restore vaginal tissue.
Dosing: Typically used daily for one to two weeks, then reduced to one to three times per week.
Key differences from Intrarosa: Estrace is a cream rather than an insert, which some women prefer and others find messy. Generic Estradiol cream is widely available and much less expensive.
Cost: Generic Estradiol cream can cost $20 to $80 per month, depending on the pharmacy and whether you use a discount card.
Premarin Vaginal Cream contains conjugated estrogens derived from natural sources. It's one of the most well-known vaginal hormone therapies.
How it works: Similar to Estradiol cream, it delivers estrogen directly to vaginal tissues to reduce dryness, irritation, and painful intercourse.
Dosing: Typically 0.5 g applied intravaginally, used cyclically (such as 21 days on, 7 days off).
Key differences from Intrarosa: Premarin uses conjugated estrogens rather than DHEA. It's brand-name only (no generic available for the vaginal cream), so it can also be pricey — but it's more widely stocked at pharmacies than Intrarosa.
Cost: Around $200 to $280 per month without insurance, though manufacturer coupons may be available.
If you prefer an oral medication over a vaginal product, Ospemifene (Osphena) is the only FDA-approved oral treatment for moderate to severe dyspareunia due to menopause.
How it works: Osphena is a selective estrogen receptor modulator (SERM) that acts like estrogen on vaginal tissues to improve moisture and reduce pain during intercourse, taken as a daily pill.
Dosing: One 60 mg tablet taken by mouth once daily with food.
Key differences from Intrarosa: Osphena is taken by mouth rather than inserted vaginally, which is a major advantage for women who prefer not to use vaginal products. However, because it's a systemic medication, it carries a boxed warning about the risk of endometrial cancer and venous thromboembolism.
Cost: Around $200 to $300 per month without insurance. A manufacturer savings program may be available.
If you can't fill your Intrarosa prescription, there are real alternatives worth discussing with your doctor. Your best choice depends on your preferences (vaginal vs. oral), your budget, your insurance coverage, and your medical history.
If you'd rather keep trying to find Intrarosa, check out our guide on how to find Intrarosa in stock near you, or use Medfinder to search pharmacies in your area. For help with the cost, see our article on saving money on Intrarosa.
You focus on staying healthy. We'll handle the rest.
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