Menopause Treatment Comparison Tool
This tool helps you understand which menopause treatments might work best for your specific symptoms and health profile. Based on guidelines from the North American Menopause Society and Endocrine Society.
Your Symptoms
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Recommended Options
When women start experiencing hot flashes, night sweats, vaginal dryness, or mood swings during menopause, many turn to hormone therapy. Conjubrook, a brand of conjugated estrogens, has been a go-to option for decades. But it’s not the only choice anymore. With newer formulations, plant-based options, and non-hormonal treatments available, it’s smart to compare what’s out there - especially if you’ve had side effects or are worried about long-term risks.
What is Conjubrook, really?
Conjubrook contains conjugated estrogens a mixture of estrogen hormones derived from pregnant mare’s urine, primarily estrone and equilin. It’s been available since the 1940s and is FDA-approved for treating moderate to severe hot flashes, vaginal atrophy, and preventing osteoporosis in postmenopausal women.
It comes in oral tablet form, usually taken once daily. Doses range from 0.3 mg to 1.25 mg. Many women find it effective - but not all. Side effects can include breast tenderness, bloating, headaches, and nausea. Long-term use has been linked to a slightly higher risk of blood clots, stroke, and breast cancer, especially when used alone without progesterone in women with a uterus.
That’s why doctors now recommend the lowest effective dose for the shortest time possible. And that’s also why so many women are looking at alternatives.
How does Conjubrook compare to other estrogen therapies?
There are several other estrogen-based treatments on the market. Here’s how they stack up:
| Therapy | Source | Form | Typical Dose | Key Advantages | Key Risks |
|---|---|---|---|---|---|
| Conjubrook (conjugated estrogens) | Pregnant mare urine | Oral tablet | 0.3-1.25 mg/day | Well-studied, widely available, effective for hot flashes | Higher risk of blood clots, potential for allergic reactions |
| Premarin | Pregnant mare urine | Oral tablet | 0.3-1.25 mg/day | Same active ingredients as Conjubrook, same effectiveness | Identical risks to Conjubrook |
| Estrogen patches (e.g., Climara, Vivelle-Dot) | Synthetic or plant-based | Transdermal patch | 0.025-0.1 mg/day | Lower risk of blood clots, steady hormone levels | Skin irritation, higher cost, less convenient |
| Oral estradiol (e.g., Estrace) | Synthetic, human-identical | Oral tablet | 0.5-2 mg/day | Mimics natural estrogen, lower liver impact | Still carries clot risk, may cause GI upset |
| Bioidentical estrogen creams | Plant-derived, compounded | Topical cream | Varies | Customizable doses, avoids first-pass liver metabolism | Not FDA-approved, inconsistent dosing, lack of long-term safety data |
Notice something? Conjubrook and Premarin are nearly identical - they’re both made from horse urine and have the same active compounds. If you’re switching from one to the other, you won’t notice a difference in how you feel. The real variation comes with non-oral routes like patches or gels. These bypass the liver, which reduces the risk of clotting and liver enzyme spikes. That’s why many doctors now recommend transdermal estrogen for women with a history of clotting disorders, high blood pressure, or obesity.
Non-hormonal options that actually work
Not everyone wants hormones. Maybe you’ve had breast cancer. Maybe you’re just uncomfortable with the idea. The good news? There are effective non-hormonal treatments now, backed by clinical trials.
- Paroxetine (Brisdelle): The only FDA-approved non-hormonal pill specifically for hot flashes. It’s a low-dose antidepressant. Studies show it reduces hot flashes by about 50%. Side effects include nausea and drowsiness.
- Fezolinetant (Veozah): A newer drug approved in 2024. It works by blocking a brain receptor that triggers hot flashes. In trials, women saw a 50-70% reduction in hot flashes within 4 weeks. No estrogen involved. Side effects: mild diarrhea, liver enzyme changes (monitored with blood tests).
- Gabapentin: Originally for seizures and nerve pain, it’s used off-label for nighttime hot flashes. Works best for sleep disruption. Doses are low (300-900 mg at bedtime). Dizziness and drowsiness are common at first.
- Cognitive behavioral therapy (CBT): Not a pill, but a proven method. A 2023 study in The Lancet showed CBT reduced hot flash severity by 40% after 12 weeks - just as effective as low-dose estrogen for some women. It teaches breathing techniques, thought restructuring, and sleep hygiene.
These options don’t fix vaginal dryness like estrogen does, but they’re excellent for hot flashes and night sweats. And they’re safe for women with a history of breast cancer, blood clots, or liver disease.
Plant-based and natural alternatives: Do they help?
You’ve probably seen ads for black cohosh, red clover, or soy isoflavones. They’re marketed as “natural estrogen blockers” or “phytoestrogens.” But here’s the truth:
- Soy isoflavones: Found in tofu, tempeh, and supplements. Some women report mild relief from hot flashes. A 2022 meta-analysis in Menopause journal found soy reduced hot flashes by about 20% - less than half the effect of low-dose estrogen. It’s safe for most, but avoid if you have thyroid issues or estrogen-sensitive cancer.
- Black cohosh: Popular in Europe. Studies are mixed. Some show slight benefit, others show no difference from placebo. It’s not regulated like prescription drugs, so potency varies wildly between brands. Rare cases of liver damage have been reported.
- Red clover: Contains isoflavones similar to soy. No strong evidence it helps with symptoms. May interact with blood thinners.
Bottom line: These aren’t magic bullets. They might help a little for some people, but they’re not reliable replacements for prescription therapy. And because they’re sold as supplements, there’s no guarantee of purity or dosage. The FDA doesn’t test them like drugs.
Which option is right for you?
There’s no one-size-fits-all. Your best choice depends on your health history, symptoms, and personal preferences.
- Choose Conjubrook or Premarin if: You have severe hot flashes, no history of clotting or breast cancer, and want a proven, low-cost option.
- Choose transdermal estrogen (patch or gel) if: You’re overweight, have high blood pressure, or a history of blood clots. These are safer for your heart and liver.
- Choose Veozah or Paroxetine if: You can’t take estrogen. Veozah is newer and more effective for hot flashes; Paroxetine is cheaper and covered by most insurance.
- Choose CBT if: You prefer non-drug approaches and want long-term tools to manage stress and sleep.
- Avoid compounded bioidentical creams if: You want predictable dosing and safety data. They’re not regulated, and studies show inconsistent hormone levels between batches.
Also, don’t forget: Hormone therapy doesn’t fix everything. Bone density loss? Add calcium and vitamin D. Sleep problems? Try sleep hygiene. Mood swings? Exercise helps - even 30 minutes of walking five days a week can reduce symptoms.
What do doctors recommend today?
In 2025, guidelines from the North American Menopause Society (NAMS) and the Endocrine Society are clear:
- Estrogen therapy is still the most effective treatment for moderate to severe menopausal symptoms.
- But it should be personalized - not prescribed by default.
- Transdermal estrogen is preferred over oral for most women.
- Non-hormonal options like Veozah and CBT are now first-line for women who can’t or won’t take hormones.
- Conjubrook is not outdated, but it’s not the only option - and not always the best.
Many women start with Conjubrook because it’s familiar. But if you’re not feeling better after 3 months, or if you’re experiencing side effects, it’s time to talk about alternatives. Your body, your symptoms, your choice.
Is Conjubrook the same as Premarin?
Yes, Conjubrook and Premarin contain the exact same active ingredients - conjugated estrogens derived from pregnant mare’s urine. They’re bioequivalent, meaning they work the same way in your body. The difference is usually just price and brand name. Generic conjugated estrogens are available and often cheaper than either brand.
Can I switch from Conjubrook to a patch safely?
Yes. Switching from oral estrogen to a patch is common and often recommended for women with higher risks of blood clots. Your doctor will match the dose - for example, 0.625 mg oral Conjubrook is roughly equivalent to a 0.0375 mg/day patch. You may feel a slight adjustment period as your body adapts to steady hormone delivery instead of spikes from daily pills.
Does Veozah cause weight gain?
No, Veozah is not linked to weight gain. In fact, some women report improved sleep and reduced stress eating after starting it, which can help with weight management. Unlike estrogen, it doesn’t affect fat storage or fluid retention. The most common side effects are mild diarrhea and occasional liver enzyme changes, which are monitored with routine blood tests.
Are bioidentical hormones safer than Conjubrook?
No. The term “bioidentical” sounds natural and safe, but compounded bioidentical creams aren’t FDA-approved. They’re made in specialty pharmacies with inconsistent dosing - one batch might have twice the estrogen of another. There’s no long-term safety data. The same risks as conventional estrogen apply, but without the oversight. Stick to regulated products unless your doctor has a specific reason to recommend compounding.
How long should I take estrogen therapy?
Most women take it for 3-5 years, or until symptoms fade. The risk of breast cancer increases slightly after 5 years of combined estrogen-progestin therapy, but not with estrogen-only therapy in women without a uterus. The key is using the lowest dose that works and reevaluating every year. Many women stop after 2-3 years because their symptoms improve naturally over time.
Next steps: What to do now
If you’re on Conjubrook and happy, keep going - but have your doctor check in yearly. If you’re experiencing side effects, or if you’re unsure whether this is still the right choice, ask about alternatives. Bring a list of your symptoms, how long they’ve lasted, and what you’re worried about.
Don’t assume you have to choose between “hormones or nothing.” There’s a middle ground - patches, non-hormonal pills, therapy, and lifestyle changes - and your doctor can help you find the right mix. Menopause isn’t a disease to be cured. It’s a phase to be managed. And you have more options than you think.
Comments (11)
Ankita Sinha
I switched from Conjubrook to a patch last year and my bloating vanished overnight. No more midnight bathroom runs either. Honestly, I didn’t think it would make that much difference, but the steady release is a game-changer. Also, no more headaches. If you’re on oral estrogen and still feeling off, just ask for a patch. It’s not magic, but it’s close.
Also, side note: I started taking magnesium glycinate at night and my sleep improved like 300%. Not a cure, but it helps.
Kenneth Meyer
It’s funny how we treat menopause like a medical failure instead of a natural transition. We’ve turned a biological phase into a problem that needs fixing with pills, patches, or protocols. But maybe the real issue isn’t estrogen levels-it’s that our culture has no space for women to age without being told they need to be fixed.
Veozah works? Great. CBT helps? Fantastic. But what if the answer isn’t more intervention, but more permission-to rest, to grieve, to just be? The body knows what to do. We just keep giving it more stuff to process.
Donald Sanchez
LMAO at people saying bioidenticals are ‘unsafe’ 😂 Bro, the FDA doesn’t regulate your protein powder either but you still buy it. Compounded creams? Yeah they’re not FDA approved, but neither is your turmeric supplement from GNC. I’ve been on a custom cream for 2 years and my hot flashes are GONE. My lab results are clean. Who cares if it’s ‘not standardized’? My body likes it. That’s all that matters.
Also, Premarin is made from HORSE PEE. Like… really? We’re okay with this? I’d rather have something made from soy than some horse farm’s runoff. 🤢
Also, Veozah is a miracle. I took it for 3 weeks and my husband said I stopped screaming at him at 2am. Worth every penny. 💸🔥
Danielle Mazur
Did you know that the original Premarin trials were funded by pharmaceutical companies with ties to the horse farming industry? The entire estrogen market was built on a lie-that women needed horse hormones to survive menopause. Now we’re told transdermal is safer? Of course it is-because they had to make a new product to sell after the WHI study blew up. This isn’t medicine. It’s profit-driven narrative engineering.
And don’t get me started on Veozah. The FDA approved it based on a 12-week trial with 1,200 women. Where’s the 10-year data? Who’s monitoring liver enzymes for millions of women on this? They’re not. And you’re the guinea pig.
Why not just eat more cruciferous vegetables and stop stressing? Your body was designed to handle this. You’re being sold fear, then a solution. Classic.
Freddy Lopez
I think the real question isn’t which treatment is best-it’s which version of ourselves we’re willing to become in the process. Do we want to be the woman who takes a pill to silence her body’s signals? Or the one who learns to listen, adapt, and reframe?
Conjubrook, patches, Veozah, CBT-they’re all tools. But none of them replace the need for community, rest, and dignity in aging. The medical model gives us options. The human model gives us meaning.
Maybe the most effective ‘treatment’ isn’t a drug at all-it’s being seen, heard, and allowed to change without being pathologized.
Brad Samuels
My mom was on Conjubrook for 8 years. She developed a blood clot and barely survived. After that, we switched her to a patch, added CBT, and she started walking every morning. She’s 72 now, feels better than most 50-year-olds, and hasn’t taken a hormone in 5 years.
It’s not about ‘beating’ menopause. It’s about moving with it. I’ve seen too many women get stuck in the ‘pill cycle’-try one, side effects, try another, side effects again. Meanwhile, they’re not sleeping, not moving, not connecting.
Start with movement. Start with sleep hygiene. Then, if you still need more, talk to your doctor. But don’t rush to the pharmacy. Your body’s trying to tell you something.
Herbert Scheffknecht
Okay, but let’s be real-Conjubrook is basically the Viagra of menopause. Everyone knows it works, but nobody wants to admit they’re on it because it sounds like something your grandma took in 1987. Meanwhile, Veozah is the new Tesla-expensive, trendy, and everyone’s pretending they don’t care if they get one.
And don’t even get me started on the ‘bioidentical’ cult. People are spending $300 a month on creams made by some guy in Nebraska who says ‘the body knows best.’ Bro, your body also thinks it’s 1998 and still listens to Nirvana. It doesn’t know what it’s doing.
Also, CBT? I tried it. I sat there breathing and thinking ‘I am not my hot flash’ while sweating through my shirt. It didn’t help. But I got a really nice journal out of it. So… win?
Jessica Engelhardt
Why are we even talking about this? America is outsourcing menopause care to Big Pharma while the government cuts Medicare. You think this is about health? No. It’s about control. Women’s bodies are profit centers. Conjubrook? Premarin? Veozah? All designed to keep you dependent. The real solution? Stop trusting doctors who get paid by drug reps. Go plant-based. Do yoga. Drink dandelion tea. Your body doesn’t need horse urine to function. It needs freedom.
Also, if you’re taking anything with ‘estrogen’ in it, you’re already part of the problem. Wake up.
And yes, I know I’m radical. Good. The system needs burning down.
PS: I stopped all meds. My hot flashes are worse. But I’m free. And that’s worth more than a pill.
PPS: Fuck the FDA. They approved opioids too.
Lauren Hale
Just wanted to say thank you for writing this. I’ve been on the fence about switching from Conjubrook for months. Your breakdown of the alternatives-especially the part about transdermal being safer for people with high blood pressure-was exactly what I needed.
I’m 58, had a stroke in my 40s, and I was terrified to touch hormones again. But the patch option? That gave me hope. I’m scheduling my appointment next week.
And to everyone arguing about bioidenticals or the FDA-please, just listen to your own body. No one else can do that for you. But don’t let fear or marketing make your choice for you either.
You’re not broken. You’re not late. You’re just… changing. And that’s okay.
Greg Knight
Look, I’ve been coaching women through menopause for over 15 years, and the biggest mistake I see isn’t choosing the wrong hormone-it’s waiting too long to do anything at all. You think you’ll just ‘get used to it’? You won’t. Hot flashes don’t fade on their own. They get worse. Sleep gets worse. Mood gets worse.
But here’s the good news: you don’t have to pick one thing. You can combine. Patch + CBT + walking. Or Paroxetine + magnesium + reducing caffeine. It’s not all or nothing.
And if you’re scared of side effects? Start low. Go slow. Track your symptoms. Talk to your doctor like a partner, not a judge.
You’re not failing. You’re evolving. And you’ve got more power here than you think.
rachna jafri
Conjubrook? Premarin? Horseshit. They’re both made from the piss of pregnant mares locked in cages, forced to pee into buckets 24/7. That’s not medicine, that’s animal torture wrapped in a prescription. And you’re okay with that? You’re okay with funding a billion-dollar industry built on the suffering of horses so you can feel ‘normal’?
Meanwhile, in India, women eat flaxseed, drink ashwagandha tea, and squat every morning. No pills. No patches. No drama. Just food, movement, and ancestral wisdom.
Why are we so obsessed with Western pharmaceuticals when we have centuries of plant-based solutions? Because they’re cheaper. Because they’re profitable. Not because they’re better.
Stop buying the lie. Eat turmeric. Walk barefoot. Breathe. Your body remembers how to heal. You just forgot to listen.