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Overview: Vaginal Premarin is applied to the vagina to replace estrogen in that area to relieve dryness, discomfort, and pain during sex. Common side effects include headache, breast tenderness, and nausea. Serious side effects are rare but may include blood clots, certain cancers, and dementia. Talk to your health care provider right away about any unusual vaginal bleeding. Before using vaginal Premarin, tell your health care provider about any health conditions or medicines you are taking.

Uses

What is vaginal Premarin used for?

Vaginal Premarin (conjugated estrogens) is commonly used for the following.

Vaginal Premarin may also be used for other conditions as determined by your health care provider.

How does vaginal Premarin work (mechanism of action)?

Vaginal Premarin works by replacing the estrogen your body naturally produces, which decreases during menopause. When applied directly to the vagina, it restores estrogen levels in that area, helping to relieve symptoms like dryness and discomfort. 

How is vaginal Premarin supplied (dosage forms)?

Brands and other names

  • Premarin 

Dosage forms and strengths

  • 0.625 mg/gm vaginal cream

Premarin is also available in a form that is taken by mouth. See Premarin (conjugated estrogens) for more information. 

How should I store vaginal Premarin?

Vaginal Premarin should be stored at room temperature, between 68 F and 77 F (20 C and 25 C). It can be exposed to temperatures between 59 F and 86 F (15 C and 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place. 

Side Effects

What are the most common side effects of vaginal Premarin?

The most common side effects of vaginal Premarin are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Headache
  • Pelvic pain
  • Stomach pain, cramps, bloating, nausea, or vomiting
  • Breast pain or tenderness
  • Vaginal discharge, burning, irritation, itching, or yeast infection
  • Irregular vaginal bleeding or spotting
  • Hair loss
  • Fluid retention (see below)

There may be other side effects of vaginal Premarin that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of vaginal Premarin?

While less common, the most serious side effects of vaginal Premarin are described below, along with what to do if they happen.

Severe Allergic Reactions. Vaginal Premarin may cause allergic reactions, which can be serious. Stop using vaginal Premarin and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Blood Clots. Vaginal Premarin may cause a blood clot in your arteries or veins and could cause a stroke, heart attack, or venous thromboembolism (VTE), including a blood clot in the lungs (pulmonary embolism), in the back of your eye (retinal vein occlusion), or in your legs or arms (deep venous thrombosis). Stop using vaginal Premarin and get emergency help if you have any of the following signs of a blood clot.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech
  • Pain, swelling, or tenderness in your arm or leg
  • Vision loss
  • Bulging eyes
  • Double vision

Gallbladder Problems. Using vaginal Premarin can cause gallbladder problems, including cholecystitis and cholelithiasis (also known as gallstones). Call your health care provider right away if you have any of the following symptoms.

  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)
  • Fever
  • Pain in your upper stomach area
  • Clay-colored stool (poop)

Endometrial Cancer. You may be at a higher risk for cancer in the lining of your uterus (endometrial cancer) if you use vaginal Premarin. Call your health care provider right away if you have any abnormal vaginal bleeding.

Breast Cancer. You may be at a higher risk for breast cancer if you use vaginal Premarin. Call your health care provider right away if you have any of the following symptoms.

  • New lump in your breast or armpit
  • Changes in the size, shape, texture, or temperature of your breast
  • Nipple changes

Ovarian Cancer. You may be at a higher risk for cancer in your ovaries (ovarian cancer) if you use vaginal Premarin. Call your health care provider right away if you have any of the following symptoms.

  • Unusual vaginal discharge
  • Belly or back pain
  • Need to pee more often or urgently

Dementia. Vaginal Premarin may increase the risk of slowing of your brain function, especially if you are 65 or older. Tell your health care provider right away if you or your friends or family notice that you have any of the following.

  • Memory problems, such as asking the same question over and over
  • Confusion or disorientation
  • Trouble with complex but familiar tasks, such as cooking a meal or paying your bills
  • Personality changes, such as depression, agitation, paranoia, and mood swings

Increased Blood Sugar. Vaginal Premarin may increase your blood sugar levels. Talk to your health care provider about how to maintain healthy blood sugar levels.

Increased Blood Pressure (Hypertension). Vaginal Premarin may increase your blood pressure or make it worse if you have a history of high blood pressure. Call your health care provider if your blood pressure increases while using this medicine.

Fluid Retention (Edema). Vaginal Premarin can cause fluid retention, also called edema. Fluid retention can cause serious issues in people with certain conditions, such as heart failure or kidney problems. Call your health care provider right away if you have any of the following symptoms.

  • Chest pain
  • Irregular heartbeat
  • Shortness of breath
  • Stretched or shiny skin
  • Swollen body parts, such as the belly or ankles

Warnings & Precautions

Who should not use vaginal Premarin?

Allergies to Ingredients. People who are allergic to any of the following should not use vaginal Premarin.

  • Conjugated estrogens
  • Premarin
  • Any other medicine known as an estrogen
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in vaginal Premarin.

Unusual Vaginal Bleeding. Vaginal Premarin should not be used if you have bleeding from the uterus or vagina that is not part of the menstrual cycle or is abnormal. 

Cancer. Vaginal Premarin should not be used if you have, suspect, or had breast cancer or have a tumor or cancer that is sensitive to estrogen. These conditions could worsen if you use vaginal Premarin.

Blood Clots. Vaginal Premarin should not be used if you have or had blood clots, including a blood clot in the lungs (pulmonary embolism) or deep venous thrombosis (DVT). In addition, the medicine should not be used if you have a condition that makes your blood more prone to forming clots (thrombophilia). Vaginal Premarin can increase the risk of having a blood clot that could be dangerous, even life-threatening.

Heart Attack or Stroke. Vaginal Premarin should not be used if you have or had a stroke or heart attack. Vaginal Premarin can increase the risk of having a heart attack or stroke that could be dangerous, even life-threatening.

Liver Problems. Vaginal Premarin should not be used if your liver is not working as well as it should be. If there is a concern about the health of your liver, your health care provider may do tests to see if it is working well enough to use this medicine.

Pregnancy. Do not use vaginal Premarin if you are pregnant or think you may be pregnant. If you become pregnant, contact your health care provider right away. See the Pregnancy section for more details

What should I know about vaginal Premarin before using it?

Do not use vaginal Premarin unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share vaginal Premarin with other people, even if they have the same condition as you. It may harm them.

Keep vaginal Premarin out of the reach of children.

Vaginal Premarin is inserted into the vagina. Make sure that you understand how to properly prepare and use vaginal Premarin. If you have any questions, talk to your health care provider or pharmacist.

Vaginal Premarin is not always used daily. Depending on your symptoms, your health care provider may have you use it for 21 days straight, then off for seven days, or for just two times a week. Consider using a calendar or app to help you remember when to use it next. 

Vaginal Premarin comes with a reusable applicator, which should be taken apart and washed with mild soap and warm water after each use. Do use hot or boiling water. 

Avoid using latex or rubber condoms, diaphragms, or cervical caps while using vaginal Premarin. The medicine can weaken these products, making them less effective. Talk to your health care provider about what you can use instead.

People who are 65 and older can be at greater risk of some side effects from vaginal Premarin. Talk to your health care provider about your risks if you are in this age group.

Make sure to keep all follow-up appointments with your health care provider. They will use these appointments to check if your dose or medicine needs to be changed. Estrogen-containing medicines should be used at the lowest possible dose for only as long as they are needed.

Perform monthly self-breast exams and have regular pelvic exams (female exam), breast exams (done by a health care provider), and mammograms (X-ray to look closely at breast tissue) before using vaginal Premarin and during treatment with it. Follow your health care provider’s recommendations for these.

Your health care provider may prescribe other hormonal medicines with vaginal Premarin. This is done in some cases to reduce cancer risk in people with a uterus. 

Vaginal Premarin may cause some laboratory tests to give a false reading, including thyroid function tests, certain hormone tests, and cholesterol blood tests. Talk to your health care provider if you have any concerns.

What should I tell my health care provider before using vaginal Premarin?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if vaginal Premarin is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Tobacco Use. Smoking and tobacco use can increase your risk of getting heart disease, which increases your risk of having a heart attack, stroke, or blood clots. Tell your health care provider if you use any tobacco products before starting vaginal Premarin. 

Contact Lenses. Vaginal Premarin may make it hard to wear contact lenses. Tell your health care provider if you become sensitive or intolerant to wearing them while using vaginal Premarin.

Upcoming Surgery or Bed Rest. You may be at an increased risk for some side effects of vaginal Premarin if you do not move around normally for an extended period of time. Tell your health care provider if you have any upcoming surgeries or need to be on bed rest. Your health care provider can tell you if or when you need to stop using vaginal Premarin.

High Triglyceride Levels. If you have high triglyceride levels, vaginal Premarin may increase your triglyceride levels even further. Very high triglyceride levels can lead to inflammation of the pancreas, which is called pancreatitis. Tell your health care provider if you have high triglyceride levels.

Uterine Fibroids. If you have benign tumors (fibroids) in your uterus, vaginal Premarin may cause them to get bigger. Some fibroids are small and cause no symptoms, while others may grow and cause problems. Talk to your health care provider if you have any of the following symptoms.

  • Heavy, long, painful periods
  • Pain in the lower belly or back
  • Painful sex
  • Peeing often 
  • Discomfort in the rectum

Pregnancy. Vaginal Premarin should not be used during pregnancy. Tell your health care provider if you are pregnant, think you may be pregnant, or plan to become pregnant. If you become pregnant while using vaginal Premarin, stop using it right away and contact your health care provider.

Breastfeeding. Vaginal Premarin can pass into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should stop breastfeeding or stop vaginal Premarin.

How can I get more information about vaginal Premarin?

For more information about vaginal Premarin, you can visit the drugmaker’s website at www.premarinvaginalcream.com or call them at 800-879-3477.

Interactions

Does vaginal Premarin interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice while using vaginal Premarin can increase the level of estrogens in your body. Talk to your health care provider if you eat grapefruit or drink grapefruit juice. 

It is unknown if drinking alcohol will affect vaginal Premarin.

Does vaginal Premarin interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using vaginal Premarin.

  • St. John’s wort, which is a supplement that may be used for depression
  • Phenobarbital, which is a medicine that may be used for seizures
  • Carbamazepine (Carbatrol, Tegretol, and others), which is a medicine commonly used to treat seizures or nerve pain
  • Rifampin (Rifadin), which is a medicine commonly used to treat an infection called tuberculosis
  • Clarithromycin or erythromycin (Ery-Tab and others), which are medicines used for bacterial infections
  • Itraconazole (Sporanox, Tolsura) or ketoconazole, which are medicines used for fungal infections
  • Ritonavir (Norvir), which is a medicine commonly used to treat HIV 

Some other medicines may alter the blood levels of vaginal Premarin. Tell your health care provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with vaginal Premarin. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much vaginal Premarin?

If you or someone else has used too much vaginal Premarin, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of vaginal Premarin?

If you miss a dose, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only use the next dose. Do not use double or extra doses.