Can't fill your Prempro 0.625/2.5 28 Day prescription? Here are real alternatives your doctor can prescribe, including other combination HRT options.
There's nothing more frustrating than needing your menopause medication and being told it's unavailable. If you've been unable to fill your Prempro 0.625/2.5 28 Day prescription — whether due to a shortage, a pharmacy stocking issue, or cost concerns — you're probably wondering what your options are.
The good news is that several alternative medications work similarly to Prempro. In this article, we'll explain what Prempro is, how it works, and walk you through the best alternatives to discuss with your doctor.
Prempro is a combination hormone replacement therapy (HRT) pill that contains two active ingredients:
It's taken as one tablet daily in a continuous combined regimen, meaning you take the same pill every day with no breaks. The 28-day pack provides a full month's supply.
Prempro is specifically designed for postmenopausal women who still have a uterus. If you've had a hysterectomy, you typically wouldn't need the progestin component, and your doctor would likely prescribe estrogen alone. For a deeper dive, see our article on what Prempro is and how it's used.
During menopause, your ovaries stop producing estrogen and progesterone. This drop in hormones causes the symptoms most women associate with menopause — hot flashes, night sweats, sleep disruption, mood changes, and vaginal dryness.
Prempro replaces both hormones:
For more details, read our guide on how Prempro works.
The following medications are in the same class as Prempro — combination estrogen-progestin HRT — and treat the same conditions. Only your doctor can determine which is right for you, so bring this list to your next appointment.
What it is: Activella is a continuous combined HRT tablet containing Estradiol (a bioidentical form of estrogen) and Norethindrone Acetate (a progestin). It comes in two strengths: 1 mg/0.5 mg and 0.5 mg/0.1 mg.
How it compares to Prempro: The key difference is the type of estrogen. Prempro uses Conjugated Estrogens (derived from natural sources), while Activella uses Estradiol, which is identical to the estrogen your body naturally produced. Some women and doctors prefer bioidentical hormones. The progestin is also different — Norethindrone Acetate instead of Medroxyprogesterone — but both serve the same protective purpose.
Availability: Activella is available in both brand and generic forms, and many pharmacies keep it in stock. The generic version is typically priced between $25 and $60 with a discount card.
What it is: Angeliq combines Estradiol with Drospirenone, a progestin that also has mild diuretic (anti-bloating) properties. It comes in a 0.25 mg/0.5 mg and 0.5 mg/1 mg strength.
How it compares to Prempro: Angeliq uses bioidentical Estradiol and offers the unique benefit of Drospirenone's mild diuretic effect, which may help women who experience bloating or water retention with HRT. However, Drospirenone can raise potassium levels, so it's not appropriate for women with kidney disease or those taking potassium-sparing diuretics.
Availability: Angeliq is a brand-name product and may be more expensive than generic Prempro. Check with your insurance for coverage details.
What it is: Bijuva is a newer combination HRT that pairs bioidentical Estradiol (1 mg) with bioidentical Progesterone (100 mg) in a single capsule taken daily.
How it compares to Prempro: Bijuva is the only FDA-approved combination product that uses bioidentical progesterone (rather than a synthetic progestin). Some studies suggest bioidentical progesterone may carry a lower risk of breast cancer compared to synthetic progestins like Medroxyprogesterone, though more long-term data is needed. Bijuva is a good option for women who want a fully bioidentical HRT regimen.
Availability: Bijuva is brand-only as of 2026, so it tends to be more expensive. Manufacturer savings programs may be available.
What it is: Premphase uses the same active ingredients as Prempro but in a different dosing schedule. You take Conjugated Estrogens alone for the first 14 days of the cycle, then Conjugated Estrogens plus Medroxyprogesterone for the remaining 14 days.
How it compares to Prempro: Since Premphase contains the same ingredients, the switch is straightforward from a pharmacological standpoint. The cyclic regimen may cause a monthly withdrawal bleed (similar to a period), which some women prefer while others find inconvenient. Prempro's continuous regimen is designed to eventually stop monthly bleeding.
Availability: Premphase availability can vary, as it's made by the same manufacturer. However, it's worth asking about if Prempro specifically is out of stock.
Not being able to fill your Prempro prescription is stressful, especially when you're dealing with menopause symptoms that affect your daily life. But you do have alternatives. Medications like Activella, Angeliq, Bijuva, and Premphase can provide similar relief, and your doctor can help you choose the best fit.
Before switching, try using Medfinder to check whether Prempro or its generic equivalent is available at a pharmacy near you. And if a switch makes sense, work with your doctor to find the right alternative for your body and your budget.
You focus on staying healthy. We'll handle the rest.
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