What are the recommendations for a 65-year-old female regarding ongoing use of Premarin (conjugated estrogens) and promethazine orally for postmenopausal symptoms?

From the Guidelines

For a 65-year-old female, continued use of Premarin (conjugated estrogens) for postmenopausal symptoms is generally not recommended beyond the shortest duration needed for symptom relief, ideally less than 5 years. The risks of hormone therapy increase with age, particularly cardiovascular risks and breast cancer risk, as noted in studies such as 1 and 1. If she has been using Premarin for many years, a gradual tapering approach should be considered rather than abrupt discontinuation.

Regarding promethazine, this is not a standard treatment for postmenopausal symptoms and should be reevaluated. If she's using it for hot flashes or sleep disturbances, safer alternatives exist. Non-hormonal options like SSRIs/SNRIs (such as paroxetine 7.5-10mg daily or venlafaxine 37.5-75mg daily), gabapentin (300mg at bedtime), or clonidine (0.1mg daily) may be more appropriate for managing vasomotor symptoms, as suggested by 1.

Some key points to consider:

• The use of hormone therapy for the primary prevention of chronic conditions in postmenopausal women is not recommended, as stated by 1 and 1.
• The risks associated with hormone therapy, such as cardiovascular disease and breast cancer, increase with age and duration of use, as discussed in 1 and 1.
• Alternative treatments and lifestyle modifications can help manage postmenopausal symptoms, including non-hormonal medications and changes to diet and exercise, as mentioned in 1 and 1.
• The decision to use hormone therapy should be individualized, taking into account the woman's specific health status, risk factors, and preferences, as emphasized by 1 and 1.

Given the potential risks and the availability of alternative treatments, it is recommended that the use of Premarin and promethazine be reevaluated and that safer alternatives be considered.

From the FDA Drug Label

Using estrogen-alone may increase your chance of getting dementia, based on a study of women 65 years of age or older The Women’s Health Initiative Study In the WHI estrogen-alone substudy (daily CE [0. 625 mg]-alone versus placebo), there was a higher relative risk of stroke in women greater than 65 years of age. The Women’s Health Initiative Memory Study In the WHIMS ancillary studies of postmenopausal women 65 to 79 years of age, there was an increased risk of developing probable dementia in women receiving estrogen-alone or estrogen plus progestin when compared to placebo.

A 65-year-old female using Premarin (conjugated estrogens) and promethazine orally for postmenopausal symptoms should be aware of the following key points:

• The use of estrogen-alone may increase the chance of getting dementia.
• There is a higher relative risk of stroke in women greater than 65 years of age.
• The risk of developing probable dementia is increased in women receiving estrogen-alone or estrogen plus progestin. It is essential for the patient to discuss these risks with her healthcare provider and weigh the benefits and risks of continuing treatment with Premarin 2, 2, 2.

From the Research

Recommendations for Ongoing Use of Premarin and Promethazine

• For a 65-year-old female, the ongoing use of Premarin (conjugated estrogens) and promethazine orally for postmenopausal symptoms should be carefully considered, taking into account the benefits and risks of hormone therapy 3.
• The study by 4 compared the efficacy and safety of Menorest and Premarin in the treatment of postmenopausal women, and found that both treatments were effective in reducing hot flushes and other menopausal symptoms.
• However, the use of hormone therapy, including Premarin, has been associated with safety and tolerability concerns, such as an increased risk of cardiovascular disease, venous thromboembolism, and breast cancer 5, 6.
• The American College of Obstetricians and Gynecologists recommends that hormone therapy be used at the lowest effective dose for the shortest duration necessary to alleviate symptoms 3.
• Alternative treatments, such as tissue-selective estrogen complexes (TSECs), may be considered for women who are at high risk for adverse effects or who have contraindications to traditional hormone therapy 5, 6.
• The study by 7 found that Menorest and Premarin were equally effective in reducing menopausal symptoms and preventing bone loss over a 1-year period.

Considerations for Long-Term Use

• Long-term use of Premarin and promethazine should be monitored closely for potential adverse effects, such as weight gain, breast tenderness, and vaginal bleeding 4, 7.
• Women should be informed about the potential risks and benefits of hormone therapy and alternative treatments, and should be involved in the decision-making process regarding their care 3.
• Regular follow-up appointments with a healthcare provider are necessary to assess the effectiveness of treatment and to monitor for potential adverse effects 6.

Alternative Treatment Options

• TSECs, such as the combination of bazedoxifene and conjugated estrogens, may be considered as an alternative to traditional hormone therapy for women who are at high risk for adverse effects or who have contraindications to traditional hormone therapy 5.
• Other alternative treatments, such as acupuncture and electroacupuncture, may also be considered for women who are experiencing menopausal symptoms 3.