From the Guidelines
Premarin should be used with caution and only when the benefits outweigh the risks, as it may increase the risk of stroke, pulmonary embolism, and invasive breast cancer, particularly in postmenopausal women with a uterus 1. When considering Premarin for the treatment of menopausal symptoms, it is essential to weigh the potential benefits against the risks. The medication is a form of conjugated estrogens, which can be effective in alleviating hot flashes, vaginal dryness, and preventing osteoporosis. However, the use of Premarin, particularly in combination with progestin, has been associated with an increased risk of stroke, pulmonary embolism, and invasive breast cancer, as evident from the Women's Health Initiative (WHI) study 1.
Some key points to consider when prescribing Premarin include:
- The lowest effective dose should be used for the shortest duration necessary to manage symptoms
- Women with an intact uterus should also take a progestin medication to reduce the risk of endometrial cancer
- Premarin is contraindicated in women with a history of breast cancer, estrogen-dependent tumors, undiagnosed vaginal bleeding, blood clotting disorders, or liver disease
- Regular follow-up appointments with a healthcare provider are necessary to monitor for potential risks and benefits of continued therapy
Alternative treatments, such as transdermal estrogen formulations, may be preferred due to lower rates of venous thromboembolism (VTE) and stroke 1. Additionally, local hormonal treatments, such as vaginal estrogen preparations, can be effective for managing vaginal dryness and have been shown to be safe in survivors of hormone-dependent cancers 1. Ultimately, the decision to use Premarin should be individualized based on a woman's specific risks and benefits, and alternative treatments should be considered when possible.
From the FDA Drug Label
PATIENT INFORMATION PREMARIN® (conjugated estrogens tablets, USP) What is PREMARIN used for? PREMARIN is used after menopause to: Reduce moderate to severe hot flashes Treat menopausal changes in and around the vagina Help reduce your chances of getting osteoporosis (thin weak bones)
Premarin is used to treat moderate to severe hot flashes, menopausal changes in and around the vagina, and to help reduce the chances of getting osteoporosis in postmenopausal women 2.
- Key uses of Premarin include:
- Reducing hot flashes
- Treating menopausal changes in and around the vagina
- Helping to reduce the risk of osteoporosis It is also used to treat certain conditions in women before menopause if their ovaries do not make enough estrogen naturally, and to ease symptoms of certain cancers that have spread through the body, in men and women 2.
From the Research
Premarin Overview
- Premarin is a complex of conjugated equine estrogens used as hormone replacement therapy in women 3
- The name Premarin was coined from pregnant mare urine, from which the estrogen complex was isolated 3
- Although the complete composition of Premarin and its active components remains undisclosed or unknown, it contains a mixture of 10 estrogens 3
Pharmacotherapeutic Options for Menopausal Symptoms
- Hormone therapy (HT) is the most efficient therapy for managing vasomotor symptoms and related disturbances 4
- Estrogens and progestogens, androgens, tibolone, the tissue-selective estrogen complex (TSEC), and selective estrogen receptor modulators (SERMs) are options for HT 4
- Non-hormonal options include selective serotonin reuptake inhibitors (SSRIs), selective noradrenergic reuptake inhibitors (SNRIs), and GABA-analogue drugs 4
Menopausal Hormone Therapy and Estrogen
- Menopause is a universal experience for midlife women, associated with a decline in endogenous estrogen 5
- Estrogen therapy is the most effective means to address vasomotor symptoms, sleep disruption, mood disorders, and osteoporosis 5
- Refinement of knowledge of risks and benefits facilitates patient selection and counseling for estrogen therapy 5
Conjugated Estrogens/Bazedoxifene for Menopausal Symptoms
- Conjugated estrogens/bazedoxifene (CE/BZA) is a menopausal hormone therapy that combines a selective estrogen receptor modulator with conjugated estrogens 6, 7
- CE/BZA reduces hot flush frequency and severity, prevents bone loss, and improves vaginal maturation index and ease of lubrication 6, 7
- CE/BZA has a favorable tolerability profile, with no increases in uterine bleeding or breast tenderness, and has positive effects on metabolic parameters and quality of life 6, 7