Premarin belongs to a class of drugs referred to as hormone replacement therapy. This drug supplements the estrogen hormone as conjugated estrogen in women who have estrogen deficiencies during and after menopause.

Since low estrogen can be caused by many conditions, you should consult a qualified medical practitioner for a proper diagnosis of the condition that may result in estrogen deficiencies in your body. Different conditions are treated differently so be sure of your prevailing condition before using Premarin as your medication.

Low estrogen levels in your body results in the following symptoms;

  • Hot flashes and night flashes
  • Osteoporosis, whereby your bones become weak and brittle
  • Weight gain, especially around your belly
  • Low sex drive and pain during sex
  • Vaginal dryness
  • Autoimmune diseases, like multiple sclerosis; around 85% of patients are women
  • Eating disorders like bulimia
  • Genetic disorders, for instance, turner syndrome
  • Hypothalamic amenorrhea, which mostly affects athletes who are of childbearing age
  • Conditions that affect the normal functioning of your pituitary gland. The pituitary gland induces hormone secretion in your body

How Does it Work?

Estrogen is a sex hormone. It’s produced by your sex organs and plays a critical role in the development and growth of your reproductive health, skeletal system, and neuroendocrine system.

However, as you get to the menopause age of around 45 to 55 years of age, its production starts to decrease. A common symptom experienced by most women is the stopping of their follicular functions including the end of menstrual cycles. As your blood estrogen levels drop, you’ll also experience symptoms like moodiness and irritability, a decreased sex drive, and vaginal dryness.

Your doctor may prescribe you Premarin to supplement your body with the much-needed estrogen hormone. Premarin will help you maintain your body’s normal functioning and avoid estrogen deficiency symptoms.

Women who have had their wombs or uterus removed can take Premarin alone and it could still work. However, those with a womb have to take it with progestogen to balance the effects of increased estrogen or risk developing uterine cancer.

Premarin Forms

Premarin comes in different forms; tablets, and creams. The different forms are effective in treating different conditions of estrogen deficiency in your body. So, your healthcare provider should conduct an estrogen test to determine the right form of Premarin to use for your medication. An estrogen test will check for the following hormones;

  • Estrone hormone- Common in your menopause and post-menopause age
  • Estradiol hormone- Present in your reproductive age
  • Estriol hormone- Which your body makes during pregnancy

Premarin Tablets

Premarin-conjugated estrogen tablets are administered orally. They come in different concentrations and their main ingredient is a mixture of conjugated estrogen hormones.

The tablets work by boosting your blood estrogen levels. You need to consult your doctor for the appropriate dosage as the medication may lead to serious complications, like uterine cancer.

Premarin Cream

Premarin vaginal cream works by assisting in the rebuilding of your vaginal muscles, making sex more enjoyable and comfortable. Clinical trials have shown that 0.5 g of Premarin vaginal cream used twice weekly can relieve pain during sex over a 12-week treatment period.

The cream contains a mixture of estrogen hormones that are applied deep into the affected area, usually the vagina. You should use this medication at the lowest effective dose and for the shortest treatment period possible.

Premarin vaginal helps in the treatment of vaginal dryness, irritation, pain during sex, and burning. However, you should always notify your doctor when you’re using this cream. Breastfeeding mothers may produce low breast milk when on this medication. Pregnant women shouldn’t use Premarin vaginal cream.

Precautions and Warnings

You should avoid using Premarin unnecessarily, especially for the long term and at high doses. Misuse will place you on the high end of getting a heart attack, blood clots in the legs and lungs, stroke, and breast cancer.

Other warnings and precautions you should take into account when using Premarin include the following;

  1. Estrogen doesn’t prevent cardiovascular complications like stroke, heart disease, or heart attacks- even when used with progestogen.
  2. If you’ve got high blood pressure, the medication may increase your blood pressure. Your doctor should give you directives on the right dosage for increased effectiveness of the medication, and whether you should be placed on special monitoring.
  3. Premarin-conjugated estrogen tablets may increase your triglyceride blood levels and result in increased cholesterol levels in your blood. So, you might be placed on special monitoring to avoid blood cholesterol spikes.
  4. The use of Premarin may cause dementia (memory loss) in women above the age of 65.
  5. Since estrogen affects your mood swings, it may lead to symptoms of depression. Notify your doctor as soon as you see signs of depression, including weight changes, lack of interest, and low concentration.
  6. Premarin may affect your fibroids, causing them to be large, painful, or tender.
  7. You’re at high odds of suffering from endometrial, ovarian, and breast cancer- when using estrogen replacement therapy. Though the use of estrogen with progestin decreases your chances of endometrial cancer, it doesn’t work for reducing breast cancer. As a result, you should commit to regular cancer screening.

Side Effects

Most, if not all, medications have side effects- some more serious than others. Contact your doctor when you notice any of the serious side effects of Premarin or when the common side effects become uncomfortable or prolonged.

Common Side Effects

Common side effects of Premarin include the following;

  • Weight changes
  • Breast tenderness
  • Bloating
  • Nausea and vomiting
  • An increase or decrease in your sexual drive

You should also be on the lookout for prolonged side effects. They may be an indication of a worsening health condition that needs immediate medical attention.

Rare Side Effects

Other rare side effects of Premarin that could lead to severe health conditions include the following;

  • Breast lumps
  • Mental changes like depression and forgetfulness
  • Continuous vomiting
  • Abnormal vaginal bleeding including blood spots and prolonged bleeding
  • Severe abdominal pain
  • Increased thirst and urination
  • Weakness on one side of your body, indicating cardiovascular complications
  • Yellowing of your eyes and skin
  • Serious allergic reactions like difficulty in breathing, skin rash, and itching of the tongue, throat, and face
  • Partial or complete blindness
  • Abnormal sweating
  • Swelling of the hands or feet
  • Chest pains
  • Slurred speech

Adverse Reactions

  • Cardiovascular Disorders
  • Malignant Neoplasms

Drug Interactions

Premarin reacts differently when used alongside other drugs. For instance, it may affect how birth control medicines function though it’s not a contraceptive. Therefore, you should notify your doctor if you’re on hormonal birth control medication for alternative medication.

Other drugs that may affect how well Premarin functions or that may need to be adjusted or changed completely for effectiveness include the following;

  • Thyroid replacement therapy
  • Antifungal medication like ketoconazole and itraconazole.
  • Grapefruit juice
  • HIV treatment medication like Dovato
  • Antibiotics and anti-infectives like erythromycin, rifampicin, and clarithromycin.
  • Medication containing St. John’s Wort.

You should notify your doctor if you’re using or planning to use the above-mentioned drugs with Premarin. Your healthcare provider will guide you on the appropriate dosage of Premarin to use and alternative medications you can use to avoid adverse side effects.

Strengths and Dosages

Premarin-conjugated tablets come in different strengths. The dosages may vary depending on your medical condition.

Your starting dosage will be 0.3 mg of Premarin. Your doctor should monitor its effectiveness before you advance to a stronger dosage. You may take the drug in a cycle of 25 days uninterrupted and relax for 5 days, each month. Or, you can take it daily. The 0.3 mg Premarin tablet is used for the effective treatment of vaginal atrophy due to menopause.

Remember to use progestogen every 10 to 14 days per month, if your uterus hasn’t been removed. It balances the effects of estrogen, averting the risk of uterine cancer.

You may also be prescribed a dosage of Premarin 0.625 mg or 1.25 mg daily to treat hypoestrogenism due to primary ovarian failure. The medication can be taken for three weeks with a one-week break from the meds.

Your doctor may also prescribe you the 0.45 mg or 0.9 mg tablet depending on the seriousness of your symptoms.

Here is a better breackdown;

  • 3 mg tablet-Green
  • 45 mg tablet- Blue
  • 625 mg tablet- Maroon
  • 9 mg tablet- White
  • 25 mg tablet- Yellow

When You Should Seek Help While Using Premarin?

If you or someone you know encounter any of the following symptoms while using Premarin, you should seek medical help immediately:

Allergic Reaction Signs

Wheezing, hives, and cheek, lip, tongue, or neck swelling may suggest an allergic reaction. Allergic reactions can be severe, so seek immediate medical attention.

Unusual Vaginal Bleeding

Please contact your doctor immediately if you experience unexpected vaginal bleeding or spotting while taking Premarin for vaginal symptoms like dryness or irritation. This helps rule out underlying issues.

Blood Clot Warning Signs

Using Premarin may raise your chance of developing blood clots. Blood clots may be announced by some of the following symptoms:

  • An unexpectedly bad headache
  • Chest discomfort or pain
  • Breathing difficulty
  • Leg swelling, warmth, or discomfort
  • Vision changes, such as sudden blindness

Chest Discomfort or Pain

It may indicate a cardiac condition if you feel pain or discomfort in your chest, particularly if it spreads to your arm, neck, jaw, or back. Seek immediate medical attention.

Liver Issues

If you have liver symptoms including jaundice, dark urine, persistent nausea or vomiting, or intense stomach or abdominal pain, see a doctor immediately.

Breast Changes

Report any breast tissue changes to your doctor as Premarin may cause them. Some of these include breast pain, nipple discharge, and lumps.


The appropriate usage, storage, overdose, and missed dosage of Premarin may vary according to the formulation (oral or vaginal), your doctor’s instructions, or the pharmaceutical label. Read your medication’s product information and follow your doctor’s advice. Here are some general guidelines:

Dosage and Formulation

Follow your doctor’s instructions for taking Premarin strictly. Depending on your medical condition and the Premarin formulation (oral pills or vaginal cream), the dosage and method of administration may change. Pay close attention to their prescriptions and recommendations.

 Oral tablets

Premarin pills are often swallowed whole. You can take them with or without food, but it can be easier for you to remember if you take them at the same time every day.

Vaginal cream

Applying Premarin vaginal cream will require you to use the provided applicator to place it inside the vagina. For proper dosage and application, refer to the instructions that come with the medication.


Most medicines come with storage instructions written on the product box. Please make sure you read, understand, and adhere to the storage instructions. Alternatively, you can consult your doctor for storage advice.

Just like most medicinal drugs, Premarin ought to typically be kept at room temperature, free from light and moisture.


Find emergency medical help right away if you think you or someone else may have taken too much Premarin.

For users of vaginal cream, overdose symptoms may include nausea, vomiting, and vaginal bleeding.

Missed Dose

Premarin missed doses should be taken as soon as you remember unless it is almost time for your next dose. Avoid double-dosing to make up for a missed dose. Ask your doctor or pharmacist for advice if you have any concerns about what to do if you miss a dose.

Please note that these are just broad guidelines and your Premarin prescription may differ. It, therefore, is important to follow your doctor’s advice and prescription instructions.

If you have questions about your medication, how to take it, or side effects, ask your doctor or pharmacist. They can give you individualized advice and guarantee that you are using Premarin safely and effectively.

Who Shouldn’t Use Premarin?

Premarin, like many drugs, is not for everyone. Your doctor will consider your health history, current condition, and risk factors before prescribing Premarin. People who should not use Premarin include:

  • Allergic: Avoid Premarin if you have allergies to it or any of its ingredients.
  • Pregnant Women: Avoid using Premarin during pregnancy as it could harm the fetus.
  • Blood Clots: Due to an increased clotting risk, anyone with a history of blood clots should exercise caution.
  • Liver Issues: For those with severe liver illness, it is recommended that you seek your doctor’s advice or find Premarin alternatives.
  • Hypertension: If your blood pressure is not well-controlled, stay away from it.
  • Vaginal Bleeding: Seek evaluation if you experience unexplained vaginal bleeding.
  • Endometriosis/Fibroids: If you have endometriosis or fibroids, talk to your healthcare professional about the risks.

Cost of Premarin?

Premarin prices vary depending on region, dosage, insurance, and brand name or generic drug. Generally, Premarin can be quite expensive. A supply of 100 Premarin oral tablets 0.3 mg costs $715, but this can vary by drugstore.

These prices are for cash-paying consumers and may not apply to insurance holders. Insurance plans may cover this drug differently.

If you feel these prices are on the high end,  MyRx Outlet offers a substantially less alternative for purchasing your prescription Premarin.

Are There Alternatives?

Premarin (conjugated estrogens) has alternatives for hormone replacement therapy. Discussing your needs with your doctor is essential to choosing the right Hormone Replacement Therapy (HRT) or alternative treatment. Your doctor will assess your medical history, symptoms, and hormone therapy risks before recommending it. Follow your doctor’s advice before choosing a drug or treatment.

You can choose an option based on your health, medical history, and preferences. Common Premarin alternatives include:

  1. Other Estrogen Medications: Estrogen drugs include estradiol (Estrace, Vivelle), which is chemically identical to ovarian estrogen.
  2. Combination Hormone Therapy: Estrogen in combination with synthetic progestin may be recommended. To lower uterine cancer risk from estrogen therapy, progestin is used to form combination hormone therapy widely used in non-hysterectomy women.
  3. Low-Dose Hormone Therapy: To manage your symptoms and reduce risks, your doctor may prescribe the lowest estrogen dose.
  4. Non-Hormonal Therapies: Depending on your Hormone Replacement Therapy (HRT) needs, non-hormonal therapy may be provided. Without hormones, over-the-counter moisturizers and lubricants alleviate vaginal dryness and atrophic vaginitis.
  5. Bioidentical Hormones: Some people use bioidentical hormone therapy, which employs hormones chemically identical to those produced by the body. Bioidentical hormones’ safety and efficacy vary, so consult your doctor before trying them.
  6. Lifestyle changes: Lifestyle changes like eating well, exercising, and controlling stress can lessen menopausal-like hot flashes without HRT.

IMPORTANT NOTE: The information provided here is for educational purposes only and is not intended to serve as medical advice, diagnosis, or treatment recommendations. It should not be taken as an endorsement of any specific medication or treatment. Individual health conditions and responses to treatment can vary greatly; therefore, this information should not be seen as a guarantee of safety, suitability, or effectiveness for any particular individual. Always consult with a healthcare professional for personalized medical advice and before making any decisions regarding your health or treatment plans.

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