Comprehensive medication guide to Menest including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$10–$60 copay depending on plan tier; covered as Tier 2–3 on most commercial and Medicare Part D plans; prior authorization typically not required for standard menopausal indications.
Estimated Cash Pricing
$92+ retail for brand Menest (30-day supply); as low as $86 for generic esterified estrogens 0.625 mg (30 tablets) with a GoodRx coupon.
Medfinder Findability Score
55/100
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Menest is a brand-name oral estrogen medication manufactured by Pfizer. Its generic name is esterified estrogens — a mixture of synthetic estrogen compounds derived from both equine (horse) and plant sources, including sodium estrone sulfate and sodium equilin sulfate. Menest has been used for decades to help women manage hormonal changes during menopause and related conditions.
Menest is FDA-approved for moderate to severe menopausal vasomotor symptoms (hot flashes, night sweats), vulvar and vaginal atrophy, female hypogonadism, female castration, primary ovarian failure, and as palliative therapy for advanced breast and prostate cancer. It is not FDA-approved for osteoporosis prevention.
Menest comes as film-coated oral tablets in three strengths: 0.3 mg, 0.625 mg, and 1.25 mg. The 2.5 mg strength was permanently discontinued by Pfizer. Generic esterified estrogen tablets are available in the same strengths at lower cost and with better pharmacy availability than the brand.
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Menest works by replacing the estrogen that the body is no longer producing in sufficient quantities. During menopause, the ovaries gradually reduce estrogen output, which triggers symptoms like hot flashes, night sweats, vaginal dryness, and mood changes. Menest restores estrogen levels in the blood, reducing these symptoms.
After you swallow a Menest tablet, the esterified estrogen compounds are absorbed from the gastrointestinal tract into the bloodstream. They undergo first-pass metabolism in the liver before entering systemic circulation. The active estrogens then bind to estrogen receptors (ERα and ERβ) found in cells throughout the body — in the uterus, vagina, breasts, brain, bones, and cardiovascular system — activating biological processes that depend on estrogen.
For menopausal symptoms, this receptor activation calms the hypothalamus (reducing hot flashes), restores vaginal tissue moisture, and supports mood and sleep. For women with an intact uterus, a progestin must be taken alongside Menest to prevent the uterine lining from growing excessively — which reduces endometrial cancer risk. Women who have had a hysterectomy can take Menest alone.
0.3 mg — tablet
Lowest available strength; used to establish minimal effective dose for menopause symptom control
0.625 mg — tablet
Most commonly prescribed strength; first-line for moderate to severe menopausal vasomotor symptoms
1.25 mg — tablet
Used for more severe symptoms, ovarian failure, or female castration; cyclical dosing typical
As of 2026, Menest (esterified estrogens) is not on the FDA's official drug shortage list, but real-world availability is inconsistent at many pharmacies — particularly large chains like CVS and Walgreens. Intermittent supply issues are driven by a massive surge in HRT demand (estrogen prescriptions up 184% from 2018–2026), a concentrated manufacturing base, demand spillover from the widespread estradiol patch shortage, and chain pharmacy stocking gaps for lower-volume brand-name drugs.
The 0.625 mg strength is the most commonly prescribed and generally the easiest to source. The 0.3 mg and 1.25 mg strengths may face more limited availability at some locations. Generic esterified estrogen tablets are typically easier to find than brand Menest. Independent pharmacies and mail-order pharmacies generally have better access.
If you are having trouble locating your prescription, medfinder calls pharmacies near you to check which ones have Menest (or generic esterified estrogens) in stock and texts you the results — saving you from hours of phone calls.
Menest (esterified estrogens) is not a controlled substance and has no DEA scheduling restrictions. Any licensed prescriber with prescriptive authority in their state can prescribe it, including physicians, nurse practitioners, and physician assistants — without special DEA registration or controlled substance requirements.
OB-GYNs and Gynecologists — most common prescribers; specialists in hormone therapy and progestin co-management
Primary Care Physicians (PCPs) — family medicine and internal medicine doctors; routinely manage menopause
Endocrinologists — specialists for complex hormonal conditions including hypogonadism and primary ovarian insufficiency
Nurse Practitioners (NPs) and Physician Assistants (PAs) — full or supervised prescriptive authority in most states; can prescribe independently
Certified Nurse Midwives (CNMs) — manage women's reproductive health including menopause care within scope of practice
Telehealth has dramatically expanded access to Menest prescriptions. Platforms like Midi Health, Alloy Women's Health, Gennev, Winona, and Elektra Health offer online consultations with licensed prescribers who specialize in menopause care. Many can evaluate patients and send a Menest prescription to a pharmacy within 24–48 hours — making it easy to start treatment without an in-person visit.
No. Menest (esterified estrogens) is not a controlled substance and has no DEA schedule. It does not require a DEA number to prescribe and can be prescribed by any licensed healthcare provider with prescriptive authority in their state, including physicians, nurse practitioners, and physician assistants.
Because Menest is not scheduled, it can be prescribed via phone or telehealth without special restrictions, and pharmacies can dispense it without the controlled substance log requirements that apply to Schedule II–V medications. It can also be refilled by phone or electronically without the limitations that apply to controlled substances.
Most patients tolerate Menest well, especially at the lowest effective dose. Common side effects include:
Nausea (reduced by taking with food)
Breast tenderness or enlargement
Headache
Breakthrough bleeding or spotting
Bloating or abdominal discomfort
Weight changes (gain or loss)
Changes in libido
Hair thinning
Melasma (skin pigmentation changes on face)
Stroke (sudden numbness, severe headache, slurred speech)
Blood clot / pulmonary embolism (chest pain, difficulty breathing)
Deep vein thrombosis (leg pain, swelling, redness)
Heart attack (chest pain, jaw pain, sweating)
Liver problems (jaundice, dark urine, severe abdominal pain)
Unexplained vaginal bleeding (may indicate endometrial cancer — report immediately)
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Premarin (conjugated estrogens)
The most widely known brand-name oral estrogen; derived from equine estrogens; FDA-approved for osteoporosis prevention (unlike Menest); no generic available; oral tablets are generally available despite some regional stock-outs
Estradiol (Estrace, generic)
The most commonly prescribed and lowest-cost estrogen in the US; widely available as a generic in oral, patch, gel, and spray forms; approximately equivalent to Menest at estradiol 1 mg ≈ esterified estrogens 0.625 mg (clinical approximation only)
Cenestin / Enjuvia (synthetic conjugated estrogens)
Plant-derived synthetic estrogens with similar profile to Premarin; not bioequivalent to Premarin; a good plant-based alternative to both Menest and Premarin
Estradiol gel (EstroGel, Divigel)
Transdermal estradiol gel applied daily to skin; widely available in 2026 while estradiol patches remain in shortage; bypasses liver first-pass metabolism, potentially lower clot risk than oral estrogens
Prefer Menest? We can find it.
Rifampin
majorPotent CYP3A4 inducer; significantly reduces Menest blood levels; may make hormone therapy less effective at controlling symptoms
Carbamazepine (Tegretol)
majorAntiepileptic CYP3A4 inducer; reduces Menest efficacy; monitor hormone therapy effectiveness closely
Phenytoin (Dilantin)
majorAntiepileptic CYP3A4 inducer; reduces Menest levels in the blood
Ospemifene (Osphena)
majorContraindicated — additive estrogenic effects increase endometrial cancer risk; do not combine with Menest
Anastrozole (Arimidex)
majorContraindicated — Menest reduces anastrozole's effectiveness as a breast cancer treatment; do not combine
Warfarin
moderateMenest increases clotting factor production, counteracting warfarin's anticoagulant effect; monitor INR closely when starting or stopping Menest
Ketoconazole / Itraconazole
moderatePotent CYP3A4 inhibitors; increase Menest blood levels; monitor for increased estrogen side effects
Erythromycin
moderateCYP3A4 inhibitor; increases Menest levels; monitor for increased side effects
St. John's Wort
moderateHerbal CYP3A4 inducer; can significantly reduce Menest levels and hormone therapy effectiveness
Levothyroxine (thyroid medication)
moderateOral estrogens increase thyroxine-binding globulin; may require higher thyroid medication dose to maintain euthyroid state
Grapefruit juice
minorInhibits intestinal CYP3A4; increases Menest absorption; regularly consuming large amounts may increase estrogen side effects
Menest (esterified estrogens) is a well-established oral estrogen with decades of clinical use for menopause symptom management. The November 2025 FDA removal of misleading black box warnings for cardiovascular disease, breast cancer, and dementia has helped restore confidence in HRT for many clinicians and patients. The endometrial cancer warning for estrogen-alone therapy in women with an intact uterus remains important and should guide progestin co-prescription decisions.
While not on the FDA shortage list, real-world availability has been inconsistent in 2025–2026 due to surging HRT demand and supply chain pressures. Patients who are prescribed Menest should know to ask for the generic (esterified estrogens) if the brand is unavailable, to try independent pharmacies, and to consider mail-order for more consistent supply.
If you have a prescription and are struggling to find Menest in stock, medfinder calls pharmacies near you to find which ones can fill your prescription — and texts you the results. No hold music, no repeated explanations.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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