Premarin Vaginal Cream
Premarin (conjugated estrogens) vaginal cream is an estrogen hormone cream used to treat adults with vaginal symptoms due to menopause, such as vaginal dryness and pain during sex. Depending on what you're taking the vaginal cream for, the dosage can be different. You might apply it in cycles (daily for 3 weeks, then no cream for 1 week) or simply just twice a week. Common side effects include headache, pelvic pain, and breast pain.
What is Premarin vaginal cream?
What is Premarin vaginal cream used for?
Pain during sex caused by menopause
How Premarin vaginal cream works
Premarin vaginal cream is a combination of different estrogens, which are natural hormones in your body. This medication replaces the estrogen that your body loses due to menopause. By replacing estrogen, Premarin vaginal cream helps to relieve vaginal symptoms of menopause like vaginal dryness and irritation. This can then lead to less pain during sex.
Drug Facts
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What are the side effects of Premarin vaginal cream?
Common Side Effects
- Breast pain (2-5%)
- Headache (2-4%)
- Pelvic pain (3%)
- Vaginal discharge (2-3%)
Other Side Effects
- Stomach pain
- Yeast infection
- Muscle cramps
- Dizziness
- Acne
- Itchiness
- Vaginal bleeding
Serious Side Effects
- Severe allergic reaction: rash, itching, swollen lips or tongue, trouble breathing, stomach pain, vomiting
- Heart attack: chest pain or tightness, shortness or breath, sweating, nausea, pain that radiates up to your shoulder, arm, neck, or jaw
- Stroke: sudden trouble talking or walking, numbness on one side of your body or face, severe headache, dizziness, confusion
- Blood clot: chest pain, shortness of breath, dizziness, fast heart rate, swelling, pain, or redness in the arms or legs
- Cancer: lumps, pain, swelling, or changes in the breasts; swollen lymph nodes, unusual or heavy vaginal bleeding, bloating, extreme tiredness, stomach-area pain
Source:Â DailyMed
More on Premarin vaginal cream side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Breast pain
change in vaginal discharge
cough or hoarseness
fever or chills
increased clear or white vaginal discharge
itching of the vagina or genital area
lower back or side pain
pain during sexual intercourse
pain or feeling of pressure in the pelvis
painful or difficult urination
thick, white vaginal discharge with no odor or with a mild odor
vaginal bleeding
Less common
Feeling faint, dizzy, or lightheaded
feeling of warmth or heat
flushing or redness of the skin, especially on the face and neck
headache
sweating
Incidence not known
Abdominal or stomach bloating
abnormal uterine bleeding or spotting
bloody or cloudy urine
breast tenderness, enlargement, pain, or discharge
chest pain or discomfort
decreased vision or other changes in vision
difficulty with swallowing
enlargement of the penis or testes
fast heartbeat
frequent urge to urinate
growth of pubic hair
itching of the vagina or outside genitals
pain during sexual intercourse
pain or discomfort in the arms, jaw, back, or neck
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid increase in height
shortness of breath
stomach pain
sudden shortness of breath or troubled breathing
sweating
tightness in the chest
unusual tiredness or weakness
vomiting
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common
Body aches or pain
congestion
increased dryness or soreness of the throat
tender, swollen glands in the neck
trouble with swallowing
voice changes
Incidence not known
Abdominal or stomach cramps
changes in weight
decreased or increased interest in sexual intercourse
difficulty with moving
headache, severe and throbbing
inability to have or keep an erection
increased hair growth, especially on the face
irritability
itching of the vagina or genitals
leg cramps
loss of scalp hair
loss or increase in sexual ability, desire, drive, or performance
mood changes
muscle pain or stiffness
nervousness
pain in the joints
patchy brown or dark brown discoloration of the skin
poor insight and judgment
problems with memory or speech
swelling of the breasts or breast soreness in both females and males
trouble recognizing objects
trouble thinking and planning
weakness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Premarin vaginal cream
Pros
Is applied directly into the vagina to relieve symptoms locally
Good option if for those who have trouble swallow pills
Smaller amounts are absorbed into the body compared to tablets or injections
Cons
Applying the cream can be messy
Need to remember stop taking it for a week if your dosage is in cycles
Can take several weeks to improve symptoms
Pharmacist tips for Premarin vaginal cream
Premarin vaginal cream only treats vaginal symptoms of menopause. If you are also having hot flashes or night sweats, this isn't the best option for you. Speak with your prescriber about alternatives.
Follow the directions on your prescription label very closely. Some people using Premarin vaginal cream will apply the medication for a few weeks and then have a certain amount of time where they apply no cream. Speak with your prescriber or pharmacist if you have questions.
Premarin vaginal cream can weaken or damage latex condoms, diaphragms, and cervical caps. Use other methods of protection while you're using this medication.
Wash your hands before and after applying Premarin vaginal cream with warm water and soap. Be sure to also wash the applicator with soap and water after each use to prevent vaginal infections.
Let your prescriber know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or sudden severe headaches after starting Premarin vaginal cream. These aren't common side effects and could be a sign of more serious problems.
How to use Premarin vaginal cream cream:
Take the cap off the tube and screw on the provided applicator.
Squeeze the tube using the marks on the applicator to measure out the correct dose. Then unscrew the applicator from the tube.
Lie on your back with your knees bent and insert the applicator as far as you can into your vagina. Then gently press the plunger all the way down to release the medication.
Frequently asked questions about Premarin vaginal cream
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What are the risks and warnings for Premarin vaginal cream?
Premarin vaginal cream can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Uterine (endometrial) cancer
Risk factors: Using Premarin vaginal cream without progestin for people with a uterus | Long-term use of Premarin vaginal cream
Although studies have shown that Premarin vaginal cream likely won't lead to uterine (endometrial) cancer, it's still important to report any vaginal bleeding you experience after taking this medication. Using estrogen replacement medications like Premarin vaginal cream for more than a year might raise your risk of this. If you still have your uterus, taking another hormone called a progestin along with Premarin vaginal cream can help lower your risk because progestin balances out estrogen's effects by slowing the growth of your uterine lining.
Breast cancer
Risk factors: Personal or family history of breast cancer | Taking Premarin vaginal cream and progestin together | Long-term use of Premarin vaginal cream
There is a higher risk of developing breast cancer when taking estrogen medications, such as Premarin vaginal cream, and progestin medications together. The longer you take this combination, the higher your risk is. That's why it's best to use Premarin vaginal cream only for the shortest amount of time needed. Call your prescriber if you notice any abnormal changes or feel lumps, pain, or swelling in your breasts.
Blood clots and stroke
Risk factors: History of blood clots or stroke | Postmenopausal females using estrogen products | Taking Premarin vaginal cream with or without progestin | Obesity | History of lupus | Inactivity
Premarin vaginal cream can raise your risk of blood clots. This can be very dangerous and lead to a stroke, blood clot in the lungs (pulmonary embolism), or blood clot in the legs (deep vein thrombosis). Be sure to discuss all your past and present medical conditions with your prescriber before starting Premarin vaginal cream to lower your risk of a blood clot. Call 911 or seek immediate medical attention if you have pain in your legs or arms, chest pain, sudden severe headaches, trouble breathing, or sudden changes in your speech or vision.
Heart disease and heart attacks
Risk factors: History of heart attack | Heart disease | High blood pressure | High cholesterol | Diabetes | Obesity | Smoking tobacco
Premarin vaginal cream should never be used alone or in combination with progestin to lower the chances of heart disease. In fact using estrogen, like Premarin vaginal cream, can raise your risk of having a heart attack. If you have any signs of a heart attack, such as chest pain, chest tightness, trouble breathing, nausea, vomiting, dizziness, sweating, or a fast heartbeat, get emergency help right away.
Dementia
Risk factors: Age over 65 | Using Premarin vaginal cream alone or with progestin
People taking medications with estrogen, such as Premarin vaginal cream, might have a higher risk of developing dementia. While experts aren't sure why this happens, the risk is highest if you start using Premarin vaginal cream for the first time after age 65. Talk to your prescriber if you notice changes in your focus or memory while taking this medication.
Gallbladder and liver problems
Risk factors: History of or current liver problems
Premarin vaginal cream can cause you to have problems with your gallbladder. Some people needed to have their gallbladder removed after starting this medication. If you experience stomach pain, nausea or vomiting that doesn't go away, fever, or a yellowing of the skin and eyes (jaundice), speak with your prescriber or seek medical attention.
Premarin vaginal cream is broken down by the liver, so if it's not working properly, you might experience more side effects from this medication. If you have or have had any problems with your liver, including liver problems during a past pregnancy, you shouldn't use Premarin vaginal cream.
Vision problems
A blood clot that blocks part of your eye, known as retinal vascular thrombosis, can develop in people using estrogen products, like Premarin vaginal cream. If you suddenly can't see out of one or both eyes or if you have bulging eyes, double vision, or migraines, stop using the medication and call your prescriber.
High triglycerides
Risk factors: High levels of triglycerides
Estrogens can raise your body's blood fats (triglycerides), which can cause heart problems or inflammation of the pancreas. If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your prescriber or seek medical care right away.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Premarin vaginal cream can affect thyroid hormone levels in your blood. If you take medications for low thyroid hormone levels, you might require higher doses of thyroid replacement therapy. Your healthcare professional might have you perform regular blood tests to check your thyroid hormone levels.
Fluid Retention
Risk factors: History of heart or kidney problems
Using estrogen products, like Premarin vaginal cream, might cause some fluid retention, or edema, and the chances are higher in people who have heart or kidney problems. If you notice unusual swelling in any part of your body or if you suddenly gain weight over a short period of time, let your healthcare professional know.
Changes in calcium levels in the blood
Risk factors: History of breast cancer | Cancer that has spread to the bones | Low parathyroid hormone levels
Using Premarin vaginal cream can lead to severely high calcium in people with breast cancer that's spread to their bones. If your calcium is high, you might feel thirsty, have stomach pain, nausea, vomiting, constipation, bone pain, muscle weakness, or confusion. Tell your prescriber if you have any of these symptoms because you might have to stop using Premarin vaginal cream.
Use Premarin vaginal cream carefully if you have low parathyroid hormone levels (hypoparathyroidism), a condition that affects the glands in the back of your neck and leads to low calcium in your body. Let your prescriber know if you have signs of low calcium such as burning or tingling of your fingers, toes, or lips, muscle pain and cramps, or confusion.
Worsening of other health conditions
Risk factors: History of asthma or diabetes | History of lupus | History of seizures or migraines | Taking other medications that can cause seizures
Premarin vaginal cream dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 30g of 0.625mg/g | 1 tube | $249.00 | $249.00 |
Typical dosing for Premarin vaginal cream
Vaginal dryness and irritation: Apply 0.5 to 2 grams into the vagina once a day for 3 weeks, then apply no cream for 1 week. Repeat this cycle.
Pain during sex caused by menopause:
Apply 0.5 grams into the vagina once a day for 3 weeks, then apply no cream for 1 week. Repeat this cycle. OR
Apply 0.5 grams into the vagina twice a week.
More on Premarin vaginal cream dosage forms
Interactions between Premarin vaginal cream and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Etoricoxib
- Ginseng
- Levothyroxine
- Licorice
- Tipranavir
How much does Premarin vaginal cream cost?
Premarin vaginal cream contraindications
Abnormal vaginal bleeding
History of breast cancer
Cancer that depends on estrogen for growth
Blood clots or blood clotting conditions
History of stroke or heart attack
Liver problems
Currently pregnant
What are alternatives to Premarin vaginal cream?
Pain during sex caused by menopause
Treatment of vaginal itching, dryness, and burning due to menopause
Vaginal dryness, thinning, and irritation caused by menopause - generic estradiol, Vagifem, and Yuvafem
Moderate-to-severe painful sex due to vaginal dryness and thinning caused by menopause - Imvexxy only
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References
Best studies we foundBoyd, K. (2024). What is a retinal vein occlusion? American Academy of Ophthalmology.
Chamli, A., et al. (2023). Lichen schlerosus. StatPearls.
Constantine, G. D., et al. (2019). Endometrial safety of low-dose vaginal estrogens in menopausal women: A systematic evidence review. Menopause.
Delgado, B. J., et al. (2023). Estrogen. StatPearls.
Pfizer Inc. (2021). How to apply Premarin vaginal cream.
The Menopause Society. (n.d.). Menopause topics: Hormone therapy.
Women’s Health Initiative Steering Committee. (2004). Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: The Women's Health Initiative randomized controlled trial. Journal of the American Medical Association.
Writing Group for the Women’s Health Initiative Investigators. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. Journal of the American Medical Association.
Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer Inc. (2024). Premarin- conjugated estrogens injection, powder, lyophilized, for solution [package insert]. DailyMed.
Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer Inc. (2024). Premarin vaginal- conjugated estrogens cream [package insert]. DailyMed.
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