Premarin (Conjugated Estrogens) Vaginal Cream

What is this medication for?

Premarin vaginal cream is a type of hormone replacement therapy (HRT) that contains estrogen (a female hormone). It is used to treat vaginal dryness, itching, burning in and around the vagina, and pain during sexual intercourse. These symptoms are typically caused by a decrease in the levels of estrogen in the body, which happens naturally after menopause (when your periods stop due to lower hormone levels). Topical estrogen works by replacing the estrogen in the body.

How should I take or use this medication?

• Do not stop using your medication without checking with your healthcare professional.
• Follow the instructions given by your healthcare professional.
• Before using the medication, wash your hands and vaginal area. Allow them to dry thoroughly.

Using the applicator provided:

• Remove the cap from tube.
• Screw the applicator onto the tube.
• Squeeze the tube to fill the applicator to the correct dose prescribed by your doctor. Use the marked points on the applicator as a guide.
• Unscrew the applicator from the tube.
• Lie on your back with knees drawn up and gently insert the applicator into the vagina.
• Press the plunger to release the cream.

To clean the applicator: Pull the plunger out from the barrel and wash with mild soap and water. Do not use hot water. Wash your hands thoroughly with soap and water.

For some patients, using the applicator can be uncomfortable, and hence they may prefer to apply the cream using their finger.

Using your finger:

• Remove the cap from the tube.
• Squeeze a small amount of cream onto your finger – approximately one fingertip unit (FTU), from the tip to the first crease of your index finger.
• Apply the cream inside and around the vagina.

Wash your hands thoroughly with soap and water.

What should I do if I forget to take or use this medication?

If you forget to apply the cream, use it as soon as you remember if it is within the same day. Skip the missed dose if it is almost time for your next dose. Do not use extra cream to make up for the missed dose. 

What precautions should I take when taking or using this medication?

Inform your healthcare professional if: 

• You are allergic to this medication or any of the other ingredients of this medication
• You are taking any other medications, including supplements, traditional medications and herbal remedies
• You have unexplained vaginal bleeding
• You have a history of or current medical conditions such as liver problems, stroke, heart disease, blood clots, migraine headaches, epilepsy (fits), diabetes mellitus, or cancer
• You are going for surgery or will be on bed rest

Regular check-ups with your doctor are important while using this medication.

What are some common side effects of this medication? ​

• Breast tenderness
• Headache
  • You may take Paracetamol to manage headaches. Do make sure that you are drinking enough water.
• Nausea, vomiting, bloating, and stomach cramps
  • You may consume smaller but more frequent meals, and avoid spicy, fatty food.
• Mild irritation or discomfort in the vaginal area
• Vaginal discharge

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following: 

• Swollen face/eyes/lips/tongue
• Difficulty in breathing
• Itchy skin rashes over your whole body

HRT increases a woman’s risk of developing blood clots and breast cancer. However, these are rare, and the doctor would have evaluated and weighed its benefits over risks before making the recommendation. Please discuss with your doctor if you have any concerns.

The symptoms of blood clot include one or more of the following: 

• Any unusual sudden cough, breathlessness or difficulty in breathing
• Severe pain in the chest which may reach the left arm
• Severe pain in the legs or swelling in either of your legs
• Weakness or numbness in any part of your body
• Change in your speech, including slurring of words
• Change in your senses of hearing, smell or taste
• Vision changes such as loss of vision/ blurred vision

It is also advisable to regularly check your breasts while you are on HRT.  If you notice any unusual changes, please see your doctor immediately. 

Other rare but serious side effects that you may or may not experience:

• Have unexpected, heavy or longer than usual menstrual bleeding
• Experience dark urine or light coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin. These may be signs of liver disease.
• Experience bothersome mood changes

If you experience any of these symptoms, you should stop your medication and see your healthcare professional immediately.

How should I store this medication?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children. 

How do I throw away this medication safely? ​

Pack this medication into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.

What else should I know about this medication? 

This cream may weaken latex condoms, diaphragms or cervical caps. These methods of birth control may not be reliable when used at the same time as Premarin vaginal cream.