Premarin Cream (Conjugated Estrogens)

Premarin Vaginal Cream is a prescription estrogen treatment used to relieve vaginal symptoms caused by menopause. It contains conjugated estrogens, hormones made from the urine of pregnant mares. The cream works by applying estrogen directly to vaginal tissue, which helps restore moisture and thickness after menopause. It is commonly used to manage vaginal dryness, burning, irritation, and pain during intercourse caused by menopausal changes.

Directions

Premarin Vaginal Cream is applied inside the vagina using the applicator that comes with the medication. For treating moderate to severe symptoms of vulvar and vaginal atrophy, the typical starting dose is 0.5 grams daily for 21 days, followed by 7 days off before repeating the cycle. Another common dosage involves using 0.5 grams twice weekly (such as Monday and Thursday).

Fill the applicator to the marked line to measure the correct dose. Some women may find the cream messy, so wearing a panty liner can help protect clothing. Insert the cream deeply into the vagina, preferably at bedtime. After each use, wash the applicator with mild soap and warm water.

Ingredients

Premarin contains conjugated estrogens as its active ingredient.

Cautions

• Before using this medication, you may want to consult a healthcare provider about the following:
  • Any existing health conditions
  • Any allergies
  • A list of all medications currently being taken
• Even though Premarin vaginal cream is used locally, some estrogen can be absorbed into the bloodstream, so there may be risks similar to oral estrogen.
• Estrogen therapy can increase the risk of blood clots, stroke, heart attack, and deep vein thrombosis. Stop using Premarin and seek medical care right away if symptoms like chest pain, sudden shortness of breath, leg swelling, or weakness on one side occur.
• Using estrogen alone can increase the risk of endometrial (uterine) cancer in women who still have a uterus. Adding a progestin lowers this risk, and any unusual vaginal bleeding should be evaluated by a healthcare provider.
• Estrogen combined with a progestin has been linked to a higher risk of breast cancer, especially with longer use. Regular breast exams and mammograms are important while using hormone therapy.
• Hormone therapy may slightly increase the risk of ovarian cancer, particularly with current or recent use.
• In women over age 65, estrogen therapy may increase the risk of dementia and is not recommended to prevent memory loss.
• Estrogens can increase the risk of gallbladder disease that may require surgery.
• Rare but serious vision problems have been reported; stop treatment and get medical care for sudden vision loss or severe eye symptoms.
• Estrogen can raise calcium levels in certain cancers and may worsen triglyceride levels, which can increase the risk of pancreatitis.
• Women with liver disease or a history of estrogen-related jaundice should use Premarin with caution and stop treatment if symptoms return.
• Estrogen may affect thyroid medication needs, so thyroid levels may need monitoring if you take thyroid replacement therapy.
• Fluid retention can occur, which may worsen heart or kidney conditions.
• Serious allergic reactions, including swelling of the face, lips, tongue, or throat, have been reported and require immediate medical attention.
• Premarin vaginal cream may weaken latex condoms, diaphragms, or cervical caps, making them less effective for pregnancy or STI prevention.

Contraindications

Avoid taking or using this medication if any of the following apply:

• Undiagnosed abnormal genital bleeding
• Known, suspected, or history of breast cancer
• Known or suspected estrogen-dependent cancer
• Active deep vein thrombosis, pulmonary embolism, or history of these conditions
• Active arterial thromboembolic disease (such as stroke or heart attack) or history of these conditions
• Known liver dysfunction or disease
• Known protein C, protein S, or antithrombin deficiency or other blood clotting disorders
• Known or suspected pregnancy
• Known hypersensitivity to estrogens or any ingredients in the cream

Side Effects

Common side effects of Premarin vaginal cream include:

• Headache
• Breast pain or tenderness
• Irregular vaginal bleeding or spotting
• Stomach or abdominal cramps and bloating
• Nausea or vomiting
• Hair loss
• Fluid retention
• Vaginal yeast infection
• Vaginal burning, irritation, or itching related to application

These effects are generally mild to moderate and often improve as your body adjusts to treatment. Because Premarin vaginal cream is used locally, systemic side effects may be less common, but some estrogen can still be absorbed. Tell your healthcare provider if vaginal irritation, bleeding, or other symptoms continue without getting better.

More serious side effects can occur and are similar to those seen with oral estrogen therapy. These include blood clots, heart attack, stroke, breast or ovarian cancer, cancer of the uterine lining, gallbladder disease, liver problems, high blood pressure, dementia, and severe allergic reactions. Premarin may also affect calcium levels, thyroid hormones, triglycerides, or blood sugar. Seek immediate medical care for new breast lumps, unusual vaginal bleeding, sudden vision or speech changes, severe headaches, chest or leg pain, shortness of breath, or swelling of the face, lips, or tongue.