Premarin
Premarin (conjugated estrogens) is an oral estrogen hormone tablet that's used to treat various conditions in adults. Most commonly, it relieves menopausal symptoms such as vaginal dryness and hot flashes. The medication is also used for treating low estrogen levels, certain advanced stages of breast or prostate cancers, and osteoporosis after menopause. Depending on what you're using it for, the medication can be taken daily or in cycles. Side effects include headache, stomach pain, nausea, and breast pain.
What is Premarin?
What is Premarin used for?
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness caused by menopause
Low estrogen levels due to certain conditions
Certain advanced stages of breast cancer
Certain advanced stages of prostate cancer
Prevention of bone loss (osteoporosis) after menopause
How Premarin works
Premarin 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 helps to relieve symptoms of menopause like vaginal dryness and hot flashes.
Premarin is also used to relieve symptoms of certain advanced breast and prostate cancers.
Drug Facts
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What are the side effects of Premarin?
Common Side Effects
- Headache (13-14%)
- Abnormal vaginal bleeding (2-13%)
- Breast pain (7-12%)
- Stomach pain (8-11%)
- Passing gas (4-6%)
- Vaginal discharge (4-5%)
- Back pain (3-5%)
- General pain (3-5%)
- Nausea (3-5%)
- Insomnia (3-5%)
- Depression (3-5%)
- Weakness (2-5%)
Other Side Effects
- Chest pain
- Swelling
- Yeast infection
- Pelvic pain
- Migraine
- Heart pounding
- Constipation
- Diarrhea
- Indigestion
- Dizziness
- Nervousness
- Hair loss
- Itchiness
- Weight gain
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: DailyMed
More on Premarin side effects
The following side effects have also been reported
Women rarely have severe side effects from taking estrogens to replace estrogen. Discuss these possible effects with your doctor:
The prolonged use of estrogens has been reported to increase the risk of endometrial cancer (cancer of the lining of the uterus) in women after menopause. This risk seems to increase as the dose and the length of use increase. When estrogens are used in low doses for less than 1 year, there is less risk. The risk is also reduced if a progestin (another female hormone) is added to, or replaces part of, your estrogen dose. If the uterus has been removed by surgery (total hysterectomy), there is no risk of endometrial cancer.
Although the incidence is low, the use of estrogens may increase you chance of getting cancer of the breast. Breast cancer has been reported in men taking estrogens.
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.
The following side effects may be caused by blood clots, which could lead to stroke, heart attack, or death. These side effects occur rarely, and, when they do occur, they occur in men treated for cancer using high doses of estrogens.
Check with your doctor immediately if any of the following side effects occur:
More common
Breast pain (in females and males)
fast heartbeat
hoarseness
increased breast size (in females and males)
irritation of the skin
itching of the skin
joint pain, stiffness, or swelling
rash
redness of the skin
shortness of breath
swelling of the eyelids, face, lips, hands, or feet
swelling of the feet and lower legs
tightness in the chest
troubled breathing or swallowing
weight gain (rapid)
Less common or rare
Changes in vaginal bleeding (spotting, breakthrough bleeding, prolonged or heavier bleeding, or complete stoppage of bleeding)
chills
heavy non-menstrual vaginal bleeding
lumps in, or discharge from, breast (in females and males)
pains in the stomach, side, or abdomen
yellow eyes or skin
Rare
for males being treated for breast or prostate cancer only
Headache (sudden or severe)
loss of coordination (sudden)
loss of vision or change of vision (sudden)
pains in the chest, groin, or leg, especially in the calf of leg
shortness of breath (sudden and unexplained)
slurring of speech (sudden)
weakness or numbness in the arm or leg
Incidence not known
Abdominal or stomach bloating
abdominal or stomach cramps
acid or sour stomach
backache
belching
blindness
blistering, peeling, or loosening of the skin
blue-yellow color blindness
blurred vision
change in vaginal discharge
changes in skin color
changes in vision
chest discomfort
clay-colored stools
clear or bloody discharge from nipple
confusion
convulsions
dark urine
decrease in the amount of urine
decreased vision
difficulty with breathing
difficulty with speaking
dimpling of the breast skin
dizziness
double vision
fainting
fluid-filled skin blisters
full feeling in upper abdomen or stomach
full or bloated feeling or pressure in the stomach
headache
inability to move the arms, legs, or facial muscles
inability to speak
incoherent speech
increased urination
indigestion
inverted nipple
irregular heartbeats
light-colored stools
lightheadedness
loss of appetite
loss of bladder control
lump under the arm
metallic taste
migraine headache
mood or mental changes
muscle cramps in the hands, arms, feet, legs, or face
muscle spasm or jerking of all extremities
muscle weakness
noisy breathing
numbness or tingling of the hands, feet, or face
pain in the ankles or knees
pain or discomfort in the arms, jaw, back or neck
pain or feeling of pressure in the pelvis
pain, tenderness, swelling of the foot or leg
painful or tender cysts in the breasts
painful, red lumps under the skin, mostly on the legs
pains in the chest, groin, or legs, especially calves of the legs
partial or complete loss of vision in the eye
pelvic pain
persistent crusting or scaling of nipple
pinpoint red or purple spots on the skin
prominent superficial veins over affected area
red, irritated eyes
redness or swelling of the breast
sensitivity to the sun
severe headaches of sudden onset
skin thinness
skin warmth
slow speech
sore on the skin of the breast that does not heal
sores, ulcers, or white spots in the mouth or on the lips
stomach discomfort, upset, or pain
sudden loss of consciousness
sudden loss of coordination
sudden onset of shortness of breath for no apparent reason
sudden onset of slurred speech
sudden vision changes
swelling of the abdominal or stomach area
swelling of the fingers or hands
thirst
unpleasant breath odor
unusual tiredness or weakness
vomiting
vomiting of blood
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:
More common
Abnormal growth filled with fluid or semisolid material
accidental injury
bladder pain
bloated full feeling
bloody or cloudy urine
body aches or pain
coating or white patches on tongue
congestion
cough producing mucus
decrease in amount of urine
difficult, burning, or painful urination
discouragement
dryness of the throat
ear congestion or pain
excess air or gas in the stomach or intestines
fear
feeling of warmth
feeling sad or empty
frequent urge to urinate
general feeling of discomfort or illness
headache, severe and throbbing
increased clear or white vaginal discharge
irritability
itching of the vaginal, rectal or genital areas
lack of appetite
lack or loss of strength
loss of interest or pleasure
mild dizziness
neck pain
nervousness
pain during sexual intercourse
painful or difficult urination
pain or tenderness around the eyes and cheekbones
passing gas
redness of the face, neck, arms, and occasionally, upper chest
skin irritation or redness where skin patch was worn
shivering
sore mouth or tongue
sudden sweating
tender, swollen glands in the neck
thick, white vaginal discharge with no odor or with a mild odor
tiredness
trouble concentrating
trouble sleeping
unable to sleep
voice changes
Less common
Blemishes on the skin
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
burning or stinging of the skin
diarrhea (mild)
difficulty with moving
dizziness (mild)
increased hair growth, especially on the face
lower abdominal or stomach pain or pressure
mood or mental changes
muscle stiffness
painful cold sores or blisters on the lips, nose, eyes, or genitals
pounding in the ears
problems in wearing contact lenses
slow heartbeat
tooth or gum pain
unusual decrease in sexual desire (in males)
unusual increase in sexual desire (in females)
white or brownish vaginal discharge
Incidence not known
Abnormal turning out of cervix
changes in appetite
dull ache or feeling of pressure or heaviness in the legs
flushed, dry skin
fruit-like breath odor
increased hunger
irritability
large amount of triglyceride in the blood
leg cramps
patchy brown or dark brown discoloration of the skin
poor insight and judgment
problems with memory or speech
trouble recognizing objects
trouble thinking and planning
trouble walking
twitching, uncontrolled movements of the tongue, lips, face, arms, or legs
unexpected or excess milk flow from the breasts
Also, many women who are taking estrogens with a progestin (another female hormone) will start having monthly vaginal bleeding, similar to menstrual periods, again. This effect will continue for as long as the medicine is taken. However, monthly bleeding will not occur in women who have had the uterus removed by surgery (total hysterectomy).
This medicine may cause loss or thinning of the scalp hair in some people.
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
Pros
Relieves multiple menopausal symptoms
Available in multiple strengths, allowing you to customize your dose
Comes as a tablet that you take by mouth
Cons
Raises your risk of certain cancers, blood clots, and strokes
Some people might need to take it with another hormone called progestin
Not a first-choice medication for treating bone loss after menopause
Pharmacist tips for Premarin
You can take Premarin with or without food.
Pay close attention to whether you should take Premarin every day or in cycles. Discuss with your prescriber over the best dosing schedule for you.
Take Premarin at the smallest dose that works for you for the shortest amount of time. Your prescriber should check in with you every 3 to 6 months to talk about your treatment and whether or not you still need it.
If you have a uterus, talk to your prescriber about adding a progestin while taking Premarin. Progestins are usually recommended to help lower the risk of uterine cancer.
If you're planning on having surgery or will be on bedrest, you might need to stop taking Premarin for at least 4 to 6 weeks beforehand. This medication can raise your risk of blood clots, which are more likely when you aren't moving around much, such as after surgery. Talk to your prescriber about possible stopping Premarin before the procedure.
If you notice Premarin tablets in your stool when you have a bowel movement, talk to your prescriber. This shouldn't happen and it could mean that you're not getting the full dose of medication.
Let your provider know if you experience unusual vaginal bleeding, lumps in your breast, changes to your vision, or sudden severe headaches after starting Premarin. These aren't common side effects and could be a sign of more serious problems.
Frequently asked questions about Premarin
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What are the risks and warnings for Premarin?
Premarin 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 without progestin for people with a uterus | Long-term use of Premarin
Vaginal bleeding after menopause can be a warning sign of uterine (endometrial) cancer, so let your provider know if you notice any unusual bleeding. Using estrogen replacement medications like Premarin for more than a year can raise your risk of this. If you still have your uterus, taking another hormone called a progestin along with Premarin 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 | Using Premarin and progestin together | Long-term use of Premarin
There is a higher risk of developing breast cancer when taking estrogen medications, such as Premarin, and progestin medications together. The longer you take this combination, the higher your risk is. That's why it's best to use Premarin only for the shortest amount of time needed. Call your healthcare provider 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 | Using Premarin with or without progestin | Obesity | History of lupus | Inactivity
Premarin 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 provider before starting Premarin 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 should never be used alone or in combination with progestin to lower the chances of heart disease. In fact, using estrogens like Premarin, 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 alone or with progestin
Females taking medications with estrogen, such as Premarin, 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 for the first time after age 65. Talk to your provider 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 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 provider or seek medical attention.
Premarin 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.
Vision problems
A blood clot that blocks part of your eye, known as retinal vascular thrombosis, can develop in females using estrogen products, like Premarin. If you suddenly can't see out of one or both eyes or if you have bulging eyes, double vision, or migraines, stop using Premarin and call your healthcare provider.
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. Your provider might order regular blood tests to watch for this while you're using Premarin. If you experience sudden stomach or back pain, nausea, vomiting, sudden weight loss, or a fast heart rate, contact your provider or seek medical care right away.
Low thyroid hormone levels (hypothyroidism)
Risk factors: Low thyroid hormone levels
Premarin 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 provider 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, might cause some fluid retention, or edema, and the chances are higher in people who have heart conditions, like congestive heart failure, or kidney damage. 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 provider 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 can lead to severely high calcium in females 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 healthcare provider if you have any of these symptoms because you might have to stop using Premarin.
Use Premarin 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 healthcare provider 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 dosage forms
Typical dosing for Premarin
Menopausal symptoms: The typical starting dose is 0.3 mg by mouth once a day.
You might be able to take the tablet once a day without stopping OR in cycles (e.g. taking it daily for 25 days, stopping for 5 days, and then starting the cycles again).
Low estrogen levels: The starting dose is based on the condition causing low estrogen. The starting dose ranges from 0.3 mg to 1.25 mg by mouth once a day taken in cycles (daily for 3 weeks, then no medication for 1 week, then repeat).
Breast cancer: The typical dose is 10 mg by mouth 3 times a day for at least 3 months.
Prostate cancer: The typical dose is 1.25 mg to 2.5 mg by mouth 3 times a day.
Prevention of bone loss (osteoporosis): The typical starting dose is 0.3 mg by mouth once a day.
You might be able to take the tablet once a day without stopping OR in cycles (e.g. taking it daily for 25 days, stopping for 5 days, and then starting the cycles again).
More on Premarin dosage forms
Interactions between Premarin and other drugs
More on Premarin interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.
- Dasabuvir
- Ombitasvir
- Paritaprevir
- Ritonavir
- Tranexamic Acid
Using medicines in this class 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.
- Abametapir
- Amifampridine
- Amoxicillin
- Ampicillin
- Amprenavir
- Anagrelide
- Apalutamide
- Aprepitant
- Armodafinil
- Artemether
- Bacampicillin
- Betamethasone
- Bexarotene
- Boceprevir
- Bosentan
- Brigatinib
- Bupropion
- Carbamazepine
- Carbenicillin
- Cefaclor
- Cefadroxil
- Cefdinir
- Cefditoren
- Cefixime
- Cefpodoxime
- Cefprozil
- Ceftazidime
- Ceftibuten
- Cefuroxime
- Cenobamate
- Ceritinib
- Clavulanic Acid
- Clobazam
- Cloxacillin
- Colesevelam
- Conivaptan
- Cyclacillin
- Cyclosporine
- Dabrafenib
- Darunavir
- Dexamethasone
- Dicloxacillin
- Donepezil
- Doxycycline
- Efavirenz
- Elagolix
- Elvitegravir
- Encorafenib
- Enzalutamide
- Eslicarbazepine Acetate
- Etravirine
- Fosamprenavir
- Fosaprepitant
- Fosnetupitant
- Fosphenytoin
- Fostemsavir
- Glecaprevir
- Griseofulvin
- Guar Gum
- Isotretinoin
- Ivosidenib
- Lesinurad
- Lixisenatide
- Lorlatinib
- Lumacaftor
- Minocycline
- Mitotane
- Modafinil
- Mycophenolate Mofetil
- Mycophenolic Acid
- Nafcillin
- Nelfinavir
- Netupitant
- Nevirapine
- Octreotide
- Oxacillin
- Oxcarbazepine
- Oxytetracycline
- Paclitaxel
- Paclitaxel Protein-Bound
- Penicillin G
- Penicillin G Procaine
- Penicillin V
- Phenobarbital
- Phenylbutazone
- Phenytoin
- Pibrentasvir
- Piperaquine
- Pitolisant
- Pixantrone
- Prednisone
- Primidone
- Red Clover
- Rifabutin
- Rifampin
- Rifapentine
- Ritonavir
- Rufinamide
- Secobarbital
- St John's Wort
- Sugammadex
- Sultamicillin
- Tazemetostat
- Telaprevir
- Tetracycline
- Theophylline
- Ticarcillin
- Tigecycline
- Tizanidine
- Topiramate
- Troglitazone
- Ulipristal
- Valproic Acid
How much does Premarin cost?
Premarin 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?
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness caused by menopause
Low estrogen levels due to certain conditions
Certain advanced stages of breast cancer
Certain advanced stages of prostate cancer
Prevention of bone loss (osteoporosis) after menopause
Hot flashes, night sweats, and flushes caused by menopause
Vaginal dryness caused by menopause
Low estrogen levels due to certain conditions
Certain advanced stages of breast cancer
Certain advanced stages of prostate cancer
Prevention of bone loss (osteoporosis) after menopause
Treatment of vaginal itching, dryness, and burning due to menopause
What is the latest news about Premarin?
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References
Best studies we foundBoyd, K. (2024). What is a retinal vein occlusion? American Academy of Ophthalmology.
Delgado, B. J. (2023). Estrogen. StatPearls.
Eastell, R., et al. (2020). Pharmacological management of osteoporosis in postmenopausal women guideline resources. Endocrine Society.
Get Palliative Care. (n.d.). Prostate cancer and palliative care.
Wyeth Pharmaceuticals LLC, a subsidiary of Pfizer Inc. (2024). Premarin- estrogens, conjugated tablet, film coated [package insert]. DailyMed.
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