“If we were having this conversation in the context of drug prices being reasonable across the board — hey, good news,” said Cynthia Pearson, the executive director of the National Women’s Health Network, a consumer group. “It’s just infuriating that the price has gone up and up and up for no good reason.”

She said the issue has not gotten more attention because “how many people will say ‘vagina’ in a public setting?”

Some companies are using a playful marketing approach, signaling the issue is not as taboo as it once was. The website of Imvexxy — which rhymes with sexy — features an image of a ripe, juicy peach, boasting the product is “distinctly designed for sweet relief.” A similar product, Intrarosa, which does not contain estradiol, features a photo of a nude older woman, her head thrown back in pleasure.

Some of these products may soon come down in price. In October 2016, a generic of Vagifem, called Yuvafem, entered the market at a slightly reduced list price. Then, in July of last year, Teva Pharmaceuticals began selling a second generic at an even cheaper price. But the pharmacy cash price for Teva’s product — $163.91 for a month’s supply of eight tablets in May — is still higher than what Vagifem cost in 2015, according to the GoodRx analysis.

If more generic manufacturers enter the market, the price could tumble more and Vagifem could become an inexpensive drug like many cholesterol or blood pressure medicines. The same could become true for Estrace cream, which lost its patent protection at the end of last year and now has several generic competitors.

With two generics for Vagifem now available, the drug companies are most likely negotiating big discounts with insurers, meaning patients with coverage may see their costs drop. Elizabeth Traynor, an illustrator in Guntersville, Alabama, had tried virtually every estradiol product and balked at the prices, frequently doing without. But she recently called her insurer, the Government Employees Health Association, and learned she would have to pay $20 for a three-month supply of Yuvafem. “It’s about time,” she said. “Hooray!”

Estradiol has been around for so long that it has survived several rounds of debate over high prices. In 1959, a Senate inquiry found that the drug maker Schering, now part of Merck, had marked up estradiol — which comes in many forms — by more than 7,000 percent over the cost of materials.

In an echo of modern-day industry talking points, a Schering executive was quoted in an article in The New York Times, saying the high prices were necessary to finance new medical research. “The consumers of today must contribute to the benefits which the future will bring,” the drug executive said.