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Premarin (Conjugated Estrogen) is an FDA approved medication used as an estrogen replacement therapy to manage menopausal symptoms such as hot flashes, osteoporosis and vaginal dryness. It is also used to treat certain cancers. It comes in tablet and vaginal cream forms, with specific dosages tailored to each condition. This medication is used as an estrogen replacement therapy, besides helping with menopause symptoms. However, it carries risks like increased chances of blood clots, stroke, and certain cancers, and should not be used by everyone. Premarin is a brand-name medication, meaning there isn’t a generic version available, and it can only be obtained with a valid prescription provided by your healthcare provider. It’s crucial to follow a doctor’s advice on dosage and monitor for side effects.

Product Overview

Premarin, a form of Hormone Replacement Therapy (HRT), contains conjugated estrogens to address estrogen deficiency in women, especially during menopause. It’s available as tablets in various strengths and as a vaginal cream, each serving different therapeutic needs. For menopausal symptoms such as hot flashes, vaginal discomfort, and prevention of osteoporosis, the tablet form is commonly prescribed. The vaginal cream specifically targets vaginal dryness, itching, and pain during intercourse due to menopause.

The dosage of Premarin varies based on the condition being treated. For menopause symptoms and osteoporosis prevention, a lower dose is generally recommended, starting at 0.3 mg daily. For specific cancers, higher dosages may be necessary. Premarin’s effectiveness in alleviating menopausal symptoms, like night sweats and vaginal discomfort, stems from its ability to supplement the body’s declining estrogen levels. Additionally, it helps in the management of pain from certain cancers and in preventing bone loss.

However, Premarin is not without risks. It may increase the likelihood of developing blood clots, stroke, heart disease, and certain types of cancer, such as breast and endometrial cancer. Patients with a history of these conditions, liver issues, or those who are pregnant should avoid using Premarin. It’s also linked to side effects like headache, nausea, and abdominal pain. Monitoring and regular check-ups with a healthcare provider are crucial to adjust the dose as needed and mitigate potential risks.

Patients are advised to closely follow their doctor’s instructions when using Premarin, considering the balance between benefits and possible adverse effects. Lifestyle adjustments, including a diet rich in calcium and vitamin D, may also be recommended to enhance treatment outcomes.

Uses of Premarin

Premarin tablets are used to treat:

  • Hot flashes, flushes, and night sweats caused by menopause
  • Low levels of estrogen due to certain conditions
  • Vaginal pain and dryness caused by menopause
  • Pain caused by breast cancer that has spread to other parts of the body
  • Prevention of bone loss (osteoporosis) due to menopause
  • Pain caused by advanced prostate cancer

Premarin vaginal cream is used to treat:

  • Vaginal thinning, dryness, and pain
  • Severe itching and inflammation in the vagina
  • Pain during vaginal sex caused by menopause

How to Use Premarin?


Premarin (conjugated estrogens) comes in 2 forms:

  • Tablets
  • Vaginal creams

Premarin tablets come in these five strengths:

  • 0.3mg
  • 0.45mg
  • 0.625mg
  • 0.9mg
  • 1.25mg

Premarin vaginal creams come in a strength:

  • 30g of 0.625mg/g

Recommended Dosage for Premarin

Premarin Tablets

  • For Menopause Symptoms: Start with 0.3 mg taken by mouth once daily.
  • For Low Estrogen Levels: Your doctor will decide the starting dose, which can be between 0.3 mg and 1.25 mg, taken orally once a day for three weeks, followed by a week off (no tablets). Repeat this cycle.
  • For Breast Cancer: The usual dosage is 10 mg taken by mouth three times a day, continuing for at least three months.
  • For Prostate Cancer: Typically, the dose ranges from 1.25 mg to 2.5 mg taken by mouth three times a day.
  • To Prevent Bone Loss (Osteoporosis): The starting dose is usually 0.3 mg, taken by mouth once a day.

Premarin Vaginal Cream

  • For Vaginal Thinning (Not Due to Menopause): Use the provided applicator to insert 0.5 grams of cream into the vagina once daily for three weeks, followed by a week off. Repeat this cycle.
  • For Menopause-Related Vaginal Dryness and Irritation: Apply 0.5 grams of cream into the vagina using the applicator twice a week.

[Important Note: Premarin is also available as an injection for treating abnormal bleeding in the uterus caused by hormonal issues.]

How to Take It?

  • Follow your doctor’s instructions closely for using this medication. Avoid using it more than recommended, more frequently, or longer than prescribed to prevent side effects.
  • Take this medicine by mouth, following your doctor’s instructions. You can take it with or without food.
  • To avoid an upset stomach, you might prefer taking it with food or immediately after eating.
  • If you are using the extended-release tablets:
    • Do not chew, crush, or break them apart.
    • Swallow the tablets whole to prevent too much medicine from being released at once, which could lead to more side effects.
  • Your doctor will decide the amount you need to take based on your health and how well you respond to the medicine.
  • For the best results, make sure to take this medicine regularly as prescribed.
  • Eating a balanced diet is important. Make sure to include enough calcium and vitamin D, which are found in dairy products like milk. 
  • Additionally, taking calcium and vitamin D supplements as advised while on this medication is also recommended.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Premarin (Conjugated Estrogens) Work?

Premarin (conjugated estrogens) is a therapy also known as HRT (Hormonal Replacement Therapy). This medication contains estrogen, which is a natural hormone found in the female body. This drug helps make up for the estrogen your body stops making during menopause. By adding back estrogen, Premarin can make bones stronger and ease menopause symptoms like dryness and irritation in the vagina, hot flashes, and sweating at night. This medication can also ease pain associated with certain advanced stages of breast and prostate cancer when taken in tablet form. Also, when used as a vaginal cream, Premarin works directly in the vagina where it’s applied, helping specifically with vaginal dryness and irritation.

Important Safety Information of Premarin

Side Effects

Common Side Effects of using Premarin Tablets and Vaginal cream:

  • Headache
  • Stomach pain 
  • Breast pain
  • Abnormal vaginal bleeding 
  • Passing gas 
  • Pelvic pain 
  • Vaginal discharge

Mild Side Effects of Premarin include:

  • Nausea
  • Depression
  • Back pain
  • Itchy skin
  • Trouble sleeping
  • Vaginal pain
  • Vaginal yeast infections
  • Menstrual cramps

Contact your healthcare provider immediately if you experience any of the following serious side effects of Premarin:

  • Severe Allergic Reaction:
    • Rash
    • Swollen tongue or lips
    • Itching 
    • Stomach pain
    • Vomiting
    • Trouble breathing 
  • Heart Attack:
    • Chest pain or tightness 
    • Shortness of breath 
    • Nausea 
    • Sweating 
    • Pain that radiates up to your neck, arm, jaw, or shoulder
  • Stroke:
    • Sudden trouble walking or talking 
    • Numbness on one side of your face and body
    • Severe headache
    • Confusion
    • Dizziness
  • Blood Clot:
    • Chest pain
    • Fast heart rate
    • Shortness of breath
    • Swelling 
    • Pain or redness in the legs or arms
  • Cancer:
    • Pain, Lumps, or swelling
    • Changes in the breasts, swollen lymph nodes
    • Heavy and unusual vaginal bleeding
    • Extreme tiredness
    • Bloating 
    • Stomach-area pain

[Note: If you experience severe side effects from taking Lipitor, immediately contact your doctor. In cases where the side effects appear life-threatening or you believe you are facing a medical emergency, call 911 or your local emergency services without delay.]

Warnings & Precautions

Premarin may lead to serious health problems, and these risks could increase for some people. Here are some warnings and precautions to consider while on Premarin medication.

Endometrial Cancer: If you have vaginal bleeding after menopause, it could be a sign of endometrial cancer (cancer in the uterus lining), so it’s important to tell your doctor if you experience any unusual bleeding. Being on estrogen therapy like Premarin for more than a year might increase your chances of getting this cancer. If you have a uterus, you can lower this risk by also taking a hormone called progestin with Premarin. Progestin works by countering estrogen’s effects, which helps slow down the growth of the lining in your uterus.

Breast Cancer: Taking estrogen medicines like Premarin with progestin medicines can increase your chance of getting breast cancer. The more time you spend taking these medicines together, the greater your risk becomes. It’s recommended to use Premarin for only as long as necessary. If you spot any unusual changes, or if you feel any lumps, pain, or swelling in your breasts, please get in touch with your healthcare provider.

Blood Clots and Stroke: Premarin (a type of estrogen medication) can increase your chance of getting blood clots, which is serious and can lead to conditions like stroke, a clot in your lungs (known as a pulmonary embolism), or a clot in your legs (called deep vein thrombosis). It’s important to tell your healthcare provider about all your health history, both past and present, before you start taking Premarin to help reduce your risk of getting a blood clot. If you experience leg or arm pain, chest pain, very bad headaches, difficulty breathing, or sudden changes in how you speak or see, you should get medical help right away.

Heart Disease and Heart Attacks: Do not use Premarin by itself or with progestin to reduce heart disease risk. Taking estrogen products like Premarin may increase your chance of experiencing a heart attack. If you notice symptoms such as chest pain or tightness, difficulty breathing, feeling sick to your stomach, throwing up, feeling dizzy, sweating, or a rapid heartbeat, seek immediate medical assistance.

Dementia: Women who take medicines that contain estrogen, like Premarin, may be more likely to get dementia. Doctors aren’t certain why this occurs, but the risk is greatest if you begin taking Premarin after you turn 65. If you experience any changes in your ability to concentrate or remember things while on this medication, it’s important to discuss this with your healthcare provider.

Gallbladder and Liver Problems: Premarin can cause issues with your gallbladder. Some people even had to remove their gallbladder after they started using this medicine. If you have stomach pain, feel sick or keep vomiting, have a fever, or notice your skin and eyes turning yellow (this is called jaundice), talk to your doctor or get medical help right away. Premarin is processed in the liver, so if your liver isn’t working directly, you might have more side effects from this medicine. If you’ve ever had liver problems, including issues with your liver when you were pregnant, you should not take Premarin.

Vision Problems: Using estrogen products like Premarin can lead to a condition where a blood clot blocks part of your eye, called retinal vascular thrombosis. This can happen in women. If you suddenly lose vision in one or both eyes, or if your eyes look swollen, you see double, or have migraines, stop taking Premarin and talk to your doctor immediately.

High Triglycerides: Estrogens can increase the levels of fats in your blood, known as triglycerides. This can lead to heart problems or swelling of the pancreas. Your doctor may perform regular blood tests to check for this while you are taking Premarin. If you suddenly feel stomach or back pain, feel sick or throw up, lose weight quickly, or your heart beats very fast, get in touch with your doctor or seek medical help right away.

Low Thyroid Hormone Levels (Hypothyroidism): Premarin can change the levels of thyroid hormone in your blood. If you’re already taking medicine for low thyroid hormone (hypothyroidism), you may need to take more of your thyroid medicine. Your doctor will likely ask for frequent blood tests to monitor your thyroid hormone levels.

Fluid Retention: Taking estrogen medications, such as Premarin (conjugated estrogen), can lead to the body holding onto more water than usual, known as edema. This is especially true for individuals with heart problems, like congestive heart failure, or those with kidney issues. If you see swelling in any area of your body or if you gain weight quickly in a short time, it’s important to tell your healthcare provider.

Changes in Calcium Levels in the Blood: Premarin may affect calcium levels in your blood as it contains the female hormone estrogen. For women with breast cancer that has spread to bones, taking Premarin could cause a significant increase in calcium levels. Symptoms of high calcium include:

  • feeling very thirsty
  • stomach pain
  • feeling sick or throwing up
  • constipation
  • pain in the bones
  • weakness in muscles 
  • feeling confused

If you experience any of these, you should inform your doctor, as it may be necessary to stop taking Premarin. It’s also important to be cautious with Premarin if you have a condition called hypoparathyroidism, where your parathyroid glands (located behind your neck) do not produce enough hormone, leading to low calcium levels in your body. Symptoms of low calcium include:

  • A burning or tingling sensation in your toes, fingers, or lips
  • Muscle cramps and pain
  • Feeling confused

Make sure to tell your healthcare provider if you notice any of these signs.

Worsening of Health Conditions: If you have health issues like asthma, diabetes, lupus, seizures, or migraines, or if you’re taking medications that could trigger seizures, it’s important to consult your doctor before using Premarin, which contains conjugated estrogens. This is because estrogen-based medicines may make these conditions worse. For instance, they can increase your blood sugar levels, possibly affecting diabetes management or provoking asthma attacks.

Premarin Contraindications

Precautions are important to follow when taking any medication to ensure your safety. If you experience any of the conditions listed below, or if they apply to you, it’s crucial to inform your healthcare provider. Taking Premarin may not be safe for you under these circumstances.

  • Unusual bleeding from the vagina
  • Any cancer that grows with the help of estrogen
  • If you’ve ever had breast cancer (with certain exceptions for managing cancer pain)
  • Conditions related to blood clot formation
  • Issues with your liver
  • Previous occurrences of stroke or heart attack
  • If you are pregnant

Missed Dose

  • In case of a missing dose of Premarin. Take it as soon as you possibly can.
  • If the next dose is almost due, skip the missed dose.
  • Take your next dose at its usual time. 
  • Do not take two doses to make up for the one you missed.

[Note: Ask your doctor what to do when you miss your doses. Your healthcare provider may suggest some methods to remind you when your dosing time is near so you don’t forget to take it.]


If you or someone else has overdosed on Premarin and is experiencing severe symptoms like fainting or difficulty breathing, get medical attention right away, and if it’s not that serious, then contact a poison control center immediately. Signs of overdose may include: 

  • Intense vomiting or feeling very sick
  • Unexpected bleeding from the vagina

[Note: If you consumed more than the recommended dose, get medical help right away, or call the Poison Help line at 1-800-222-1222.]


  • Store it at room temperature in a closed container.
  • Keep it away from direct light, moisture, and heat. 
  • Keep it away from freezing.
  • Keep it out of the reach of children.
  • Dispose of any outdated medicine or those in no need.

[Note: Your doctor may advise you on how to store your medicine and when to dispose of it.]

Premarin Interactions 

When it comes to taking Premarin, which contains conjugated estrogens, it’s crucial to be aware of its interactions with other drugs. These interactions can affect how Premarin works or increase the risk of side effects. Here’s a simplified guide to understanding these interactions:

Drugs to Avoid with Premarin

Certain medications should not be taken with Premarin because they can cause serious interactions. These include:

  • Antiviral medications like:
    • Dasabuvir
    • Ombitasvir
    • Paritaprevir
    • Ritonavir
  • Blood clot prevention drugs, such as:
    • Tranexamic Acid.

Drugs That Require Caution

While some drugs are not recommended with Premarin, your doctor might still prescribe them together in special cases. If so, adjustments to dosages or usage frequency might be needed. Examples include:

  • Antibiotics like Amoxicillin and Ampicillin
  • Seizure medications such as Carbamazepine
  • Certain Antifungal medications 
  • Blood pressure medications

Key Points to Remember

  • Always inform your healthcare provider about all the medications (including over-the-counter drugs), herbs, and supplements you’re taking.
  • Your doctor may need to adjust your treatment plan if you’re taking drugs that interact with Premarin.
  • Never start or stop any medication without consulting your healthcare professional.

[Note: It is crucial to understand how Premarin interacts with other drugs that can help manage your health effectively. Always communicate with your healthcare provider for the safest treatment advice.]

Premarin Alternatives

Other Alternatives to Premarin

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

Quick Tips

  1. Know the power of Premarin in treating menopausal symptoms with this guide.

Frequently Asked Questions

What is the difference between Premarin tablets and vaginal creams?

Premarin tablets are a type of medicine you take by mouth. They can help with symptoms in the vagina caused by menopause, like dryness or discomfort, and can also be used for other health conditions. Premarin vaginal cream is applied inside the vagina and is specifically designed to ease symptoms such as dryness, itching, and irritation that come with menopause or other conditions. Both the tablets and the cream are Premarin brand products and contain conjugated estrogens, but they are used in different ways depending on the symptoms they are meant to treat.

How long will I have to be on Premarin?

How long you need to take Premarin depends on why you’re taking it. If it’s for symptoms you have because of menopause, you should only use it for as short a time as necessary. You and your healthcare provider will decide when it’s okay to stop. If you’re taking Premarin pills to help with bone health, low estrogen levels, or cancer, you may need to use it for a longer time. Taking Premarin for a long time can increase your risk of serious health issues, including breast cancer and blood clots. It’s important to talk to your healthcare provider about your specific risks before and while you are taking Premarin.

Can I have sex after applying Premarin vaginal cream?

It’s advised not to engage in vaginal intercourse immediately after using Premarin vaginal cream. This is because men can unintentionally absorb the estrogen from the cream through their skin. Additionally, women who apply the cream may not get the full benefit of the medication if they have sex too soon after application. Due to these reasons, it’s important to wait for a certain period after applying the cream before having sex. If you’re unsure about how long you should wait, discuss it with your healthcare provider for advice specific to your situation. You can also consult how much medication you need when you buy Premarin cream online.

How long does it take Premarin to work?

Premarin’s effects can differ for each person. However, some individuals may begin to notice a reduction in hot flashes around four weeks after they start taking Premarin pills. For the vaginal cream, it might take up to 12 weeks before you experience less discomfort during sexual intercourse. It’s important to be patient and to inform your healthcare provider if your symptoms worsen at any time while using this medication.

What to avoid when taking Premarin?

When taking Premarin, avoid smoking or using tobacco. Smoking while using estrogen can increase your chances of getting strokes, blood clots, high blood pressure, and heart attacks. This is especially true for women over 35. For more information or advice specific to you, please talk to your doctor.

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