From the Research
For a 93-year-old woman, Premarin cream is typically prescribed at a low starting dose of 0.5 grams applied vaginally 1-3 times weekly, as this dose is associated with a lower risk of cardiovascular events and is more suitable for elderly patients due to age-related changes in metabolism and increased sensitivity to medications 1.
Key Considerations
- The standard applicator delivers 0.5 grams of cream containing 0.3 mg conjugated estrogens per application.
- Treatment should begin with the lowest effective dose and for the shortest duration needed to relieve symptoms.
- The cream should be applied at bedtime for best absorption and retention.
- Side effects to monitor include vaginal bleeding, breast tenderness, headaches, and potential increased risk of blood clots.
Rationale
- Vaginal estrogen use is associated with a lower risk of coronary heart disease and similar risk for myocardial infarction, stroke, and deep vein thrombosis/pulmonary embolism compared with nonuse 1.
- Elderly patients often require lower doses due to age-related changes in metabolism and increased sensitivity to medications.
- The benefit-to-risk ratio should be carefully considered, and the treatment should be coordinated with her healthcare provider who can adjust the dose based on her specific health conditions and response to therapy.
Additional Considerations
- Periodic evaluation of treatment, typically every 3-6 months, is necessary to determine if continued use is necessary.
- The use of vaginal estrogen therapy in elderly women is supported by studies, which show that it can be effective in relieving menopausal symptoms with a lower risk of cardiovascular events compared to oral estrogen therapy 2, 3.
- However, it is essential to weigh the benefits and risks of treatment and consider individual patient factors, such as medical history and current health status, when making treatment decisions.