Brand Name
Premarin cream

Common Name
conjugated estrogens vaginal cream

Conjugated estrogens belong to a class of medications commonly known as estrogen replacement therapy. Estrogen is a female hormone produced by the ovaries. Once menopause is reached, the ovaries produce less estrogen and symptoms of menopause may occur. Conjugated estrogens are an estrogen replacement hormone used in the management of the menopausal symptoms of vaginal dryness and shrinking of vaginal tissues (atrophy).

Use of this medication

The recommended adult dose of conjugated estrogens cream will range from 2 g to 4 g of cream daily. Depending on the severity of the symptoms, the cream may be applied to the outside areas of the vagina, inserted into the vagina using the applicator provided, or both. The cream is used in a regular cycle, with three weeks on and one week off.

Women who also take conjugated estrogens tablets may need to adjust the dose of their tablets as recommended by their doctor when they start applying the cream. Women who have not had their uterus removed should also take a progestin for ten to fourteen days of each month, or every day (depending on the strength and whether a menstrual period is desired or not). Talk with your doctor about which dosing schedule will work best for you.

Body weight, other medical conditions, and other medications can affect the dosage of this medication. Do not change the way that you are taking the medication without consulting your doctor, even if it is different than what is listed here.

Precautions

Conjugated estrogens cream may weaken the latex rubber of condoms and diaphragms.

People with diabetes or with a predisposition to diabetes should monitor their blood glucose closely to detect any changes in blood glucose control that may occur with the use of estrogens.

An increase in risk of gallbladder disease has been reported in post-menopausal women taking oral estrogens.

Several studies have shown evidence that estrogen replacement therapy increases the risk of cancer of the uterus (endometrium). Taking a progestin appropriately with the estrogen reduces the risk to the same level as that of a woman not taking estrogen. For this reason, all women who have not had their uterus removed should also be taking a progestin if they are using estrogens.

Some studies have found an association between an increase in the risk of developing breast cancer and the use of hormone replacement therapy in menopause. Women with a strong family history of breast cancer or who develop breast nodules, fibrocystic disease of the breast, or abnormal mammograms should approach the use of this medication with caution. Discuss this risk with your doctor so you may make an informed choice about the use of this medication.

Estrogen may cause salt and water retention; thus, people with epilepsy, asthma, or kidney or heart dysfunction should be cautious about using this medication, as symptoms could exacerbate.

People with kidney disease should be cautious about the taking of estrogen.

People with hypercalcemia (increased calcium in the blood) should be cautious about taking estrogen.

This medication may worsen fibroids, causing sudden enlargement, pain, or tenderness. If you notice these symptoms, contact your doctor.

Estrogen should not be used during pregnancy. Contact your doctor if you become pregnant while using this medication.

Estrogen is not safe for use during breast-feeding. A decision should be made whether to discontinue nursing or to discontinue the medication, discussing with your doctor the importance of the medication to the mother.

The safety and effectiveness of this medication for use by children have not been established.

Side effects

If you are concerned about side effects, discuss the risks and benefits of this medication with doctor.

The following side effects may subside as your body becomes used to the medicine; check with your doctor if they continue or become worse..

Less common:
clear vaginal discharge (this usually inidicates that the medication is working properly)
abdominal or back pain

Check with your doctor as soon as possible if any of the following side effects occur:

headache
breast pain
stinging or redness of the genital area
thick, white vaginal discharge without odour or with a mild odour
enlarged breasts
itching of the vagina or genitals
nausea
unusual or unexpected uterine bleeding or spotting

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Interactions

The following medications may affect how estrogen works or increase the risk of side effects:

phenytoin
barbiturates (e.g., phenobarbital)
protease inhibitors (e.g., ritonavir)
rifampin
topiramate carbamazepine
meprobamate
phenylbutazone

The following medications may be affected by estrogen:

blood pressure-lowering medications (e.g., propranolol, enalapril, diltiazem)
corticosteroids (hydrocortisone, prednisolone, prednisone)
warfarin
antidiabetic medications (e.g., insulin, glyburide)

If you are taking any of these medications, speak with your doctor.

Other medications may interact with this medication as well. Tell your doctor about all prescription, non-prescription, and herbal medications that you are taking. Tell them also about any supplements you are taking. Caffeine, alcohol, nicotine from cigarettes, or street drugs can also affect many medications, you should let your doctor know if you use any of them.

Who should NOT take this medication?

This medication should not be used by anyone who:

has undiagnosed abnormal vaginal bleeding
has had a stroke
has a history of known or suspected estrogen-dependent tumours such as breast or uterine cancer
has classical migraines
has had vision changes due to ophthalmic vascular disease
is allergic to any of the ingredients of the medication
is suspected to be pregnant
has active liver disease or dysfunction, especially of the obstructive type
has active thrombophlebitis, thrombosis, or thromboembolic disorders (blood clotting problems)
has endometrial hyperplasia

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