High cost of Premarin has reader looking for cheaper solution

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I read your recent column from the woman with vaginal atrophy. I am experiencing the same problem. The next problem is that a small tube of Premarin cream is $250. I’m wondering if progesterone cream applied topically can do any good. I’m currently using an OTC moisturizer. I can’t afford the $250 Premarin, and there is no generic. I have had recurring UTI issues for over 20 years, and this may explain them. — M.M. ANSWER: I received a lot of mail about the cost of vaginal estrogen. I found a coupon through goodrx.com for generic estradiol cream. It is similar to, but not exactly the same as, Premarin, which is conjugated equine (horse) estrogens. Estradiol is the bioidentical human hormone, manufactured to be molecularly identical. The estradiol is $95, which is better than $250. Over-the-counter vaginal moisturizers are a good place to start for women with symptomatic dry vagina from atrophic vaginitis, but estrogen creams are more effective and are much more likely to prevent urine infections. Another writer told me that Premarin vaginal cream is available in Canadian pharmacies for $60 for a three-month supply. Progesterone has not been shown to be effective. The lining of the vagina gets thicker and healthier with estrogen. Progesterone is being studied for use in treating vaginal atrophy, and I hope that this may be an additional option, but I am skeptical. *** DEAR DR. ROACH: Just wondering about good versus bad cooking oils. At one time, coconut oil was said to be a bad oil, but now I’m reading that it’s really a good oil. Some even say you should eat a spoonful each day to boost your health! So, which is it? Is coconut oil good or bad? — J.Z. ANSWER: Coconut oil is “bad,” at least compared with healthier oils like olive oil and canola oil. It has a high saturated fat content, and people who consume coconut oil have an increase in their total cholesterol and unhealthy LDL cholesterol. If you love the taste of coconut oil, it’s reasonable in moderation, but don’t consume it thinking it is good for your health or your heart. The available evidence does not support that. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.