Premarin

Try Premarin to reduce menopausal discomfort

Premarin is a type of hormone replacement therapy (HRT) containing conjugated oestrogens. These offset the body’s decline of natural oestrogen levels and relieve menopausal symptoms.

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Strength Quantity Price Stock
300mcg84 tablets£21.99In Stock
625mcg84 tablets£21.99In Stock
1.25mg84£21.99In Stock
Prices exclude a prescription fee. This treatment requires a quick online consultation,
which a doctor will review to determine if a prescription is appropriate.

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Information

Dr Samantha Miller

Reviewed by Dr Samantha Miller MB ChB
(2017, University of Glasgow)
GMC number: 7561464

Information last reviewed 07/06/2021

About

What is Premarin?

Premarin is a type of hormone replacement therapy (HRT) containing a mixture of hormones known as conjugated oestrogens. It works by supplementing the body’s natural oestrogen levels to relieve the symptoms of menopause and prevent the onset of osteoporosis. 

How does Premarin work?

During menopause, the amount of oestrogen produced by a woman’s ovaries decreases, resulting in symptoms such as mood swings, hot flushes and night sweats, vaginal dryness and a weakening of the bones known as osteoporosis. Premarin contains a mixture of hormones known as conjugated oestrogens and works by supplementing the body’s natural oestrogen levels, relieving the symptoms of menopause and helping to prevent osteoporosis. 

Oestrogen supplementation also stimulates the growth of the womb lining which, if left to build up, can lead to endometrial hyperplasia (excessive growth of the womb lining), endometrial cancer or endometriosis (growth of the womb lining outside of the womb). Therefore, Premarin is only suitable for use in women who have had a hysterectomy, or who have a Mirena coil (IUS) fitted, which provides a flow of progesterone to counteract excessive growth of the womb lining.

Ingredients

Active ingredients

The active ingredient in Premarin is a mixture of hormones called conjugated oestrogens.

The conjugated oestrogens in Premarin are primarily the sulfate esters of estrone, equilin sulfates, 17a-estradiol and 17b-estradiol.

Premarin is available in three doses:
Premarin 0.3mg (green tablets) contains 0.3mg of conjugated oestrogens.
Premarin 0.625mg (maroon tablets) contains 0.625mg of conjugated oestrogens.
Premarin 1.25mg (yellow tablets) contains 1.25mg of conjugated oestrogens

Inactive ingredients

The inactive ingredients in Premarin are lactose monohydrate, titanium dioxide (E171), propylene glycol (E1520), hypromellose, microcrystalline cellulose, magnesium stearate, hypromellose, sucrose, hydroxypropyl cellulose, macrogol, carnauba wax, edible ink and coating.

Premarin 0.3mg (green tablets) also contain quinoline yellow (E104), and indigo carmine (E132).

Premarin 0.625mg (maroon tablets) also contain red aluminium lake (E129) and indigo carmine  (E132).

Premarin 1.25mg (yellow tablets) also contain iron oxide black (E172), quinoline yellow (E104) and sunset yellow (E110).

Dosage

How to use Premarin?

You should always take Premarin as recommended by a doctor or pharmacist.

If you are not already taking an alternative form of HRT, you can start Premarin at any time. If you are already taking another form of HRT, finish the pack and start the pack of Premarin without leaving a break. 

Take one tablet a day at the same time each day. Try and make this a part of your routine to help you remember – for example, take your daily tablet when you brush your teeth in the morning. 

When you finish a pack, start the next pack on the following day without taking a break.
If you forget to take a tablet, take it as soon as you remember, then continue to take the rest of the pack as usual. Do not take a double dose to make up for a missed dose. Women who have not had a hysterectomy may experience some light bleeding or spotting in this instance, but this is nothing to worry about.

Premarin dosage

Premarin comes in three different doses: 0.3mg conjugated oestrogens, 0.65mg conjugated oestrogens and 1.25mg conjugated oestrogens. A doctor will usually prescribe the lowest dose which controls your symptoms. The recommended starting dose for menopausal symptoms is 0.3mg per day. The 0.65mg and 1.25mg doses are suitable for the prevention of osteoporosis.

Side Effects

Premarin side effects

Like all medications, some people may experience side effects when taking this medication. Reported side effects include:

  • Changes in vaginal bleeding such as spotting or breakthrough bleeding
  • Changes in vaginal discharge
  • Pelvic pain
  • Vulvovaginal thrush
  • Breast changes such as tenderness, enlargement, swelling and nipple discharge
  • Abdominal pain or bloating
  • Nausea or vomiting
  • Headaches, including migraines
  • Dizziness
  • Changes in mood, anxiety, depression or irritability
  • Joint pain or leg cramps
  • Increase or decrease in sex drive
  • Visible swelling of the face or ankles
  • Rash, itchiness, acne, or dark/red patches on the skin
  • Changes in hair growth (loss or increase)
  • Minor changes to the eye such as difficulty tolerating contact lenses
  • Changes in weight
  • Changes in triglyceride (fat) levels in the blood
  • Intolerance to glucose
  • Memory loss
  • A worsening of chorea (a neurological disorder characterised by involuntary movements of the body)
  • Worsening of asthma
  • Worsening of hypocalcemia
  • Gallbladder disease or jaundice
  • Growth of benign meningioma
  • Inflammation of the colon, which may be characterised as pain in the lower left side of the abdomen and/or bloody diarrhoea
  • Signs of angioedema, characterised by generalised swelling in parts of the body.

Speak to your doctor for advice if you are worried about any side effects of this medication.

Contraindications

Always consult a doctor before starting this medication. You should NOT take Premarin if you:

  • Are allergic to any of the ingredients in this medication
  • Have, have had or are suspected of having breast cancer
  • Have, have had or are suspected of having an oestrogen-sensitive cancer
  • Have unexplained vaginal bleeding
  • Have endometrial hyperplasia (excessive thickening of the womb lining) that is not being treated
  • Have ever had a venous thrombosis (blood clot in the vein)
  • Have or have recently had angina, a heart attack, or any other disease caused by blood clots in the arteries
  • Have or have ever had liver disease
  • Have porphyria 
  • Are pregnant or breastfeeding

Before taking Premarin, you should inform your doctor and go for regular check-ups if you have ever had any of the following:

  • Fibroids inside your womb
  • Endometriosis (growth of the womb lining outside of the womb) or endometrial hyperplasia (excessive growth of the womb lining)
  • Increased risk of developing blood clots
  • Increased risk of developing oestrogen-sensitive cancer
  • High blood pressure
  • Heart disease
  • A liver disorder
  • Kidney disease
  • Fluid retention due to cardiac or kidney problems
  • Diabetes
  • Gallbladder disease or gallstones
  • Migraines or severe headaches
  • Systemic lupus erythematosus (SLE), a disease of the immune system
  • Epilepsy
  • Asthma
  • Otosclerosis (a disease affecting the eardrum and hearing
  • Hypocalcaemia (low blood calcium levels)
  • A high level of triglycerides (fat) in your blood

Drug interactions

Before taking Premarin, tell your doctor if you are taking any other medication, including those bought over the counter without a prescription. In particular, tell your doctor if you are taking any of the following:

  • Epilepsy medication such as phenobarbital, phenytoin and carbamazepine
  • Tuberculosis medication such as rifampicin and rifabutin
  • HIV medication such as nevirapine, efavirenz, ritonavir and nelfinavir
  • Antibiotics or antifungal medications such as erythromycin, clarithromycin, ketoconazole, itraconazole
  • Medication containing St John’s wort
  • Metyrapone
  • Cimetidine
  • Dexamethasone

Treatment Options

Alternatives to HRT

HRT is the most accessible and effective treatment for the symptoms of menopause. It can be accessed on prescription through Dr Felix. Herbal supplements are another popular choice for relieving symptoms such as hot flushes and mood swings, although their effectiveness is unknown. It is important to speak to a doctor or pharmacist about the contents and effects of herbal supplements before trying them.

Premarin cream vs. tablets

Premarin cream has been discontinued in the UK, however other vaginal creams are available such as estriol cream or its branded form, Ovestin. These creams are applied topically to the vaginal area and while they contain oestrogen, they only help relieve symptoms of menopause local to the vaginal area, such as vaginal dryness. Vaginal oestrogen creams can affect condoms, so it’s important to use an alternative form of contraception while you’re using it.

Premarin vs. other types of HRT

HRT is available in many different forms and brands, and your doctor will be able to help you choose which is right for you. Premarin is an oestrogen-only type of HRT and is therefore only suitable for use in women who have had a hysterectomy, have a Mirena coil (IUS) fitted, or who are regularly taking a progestogen supplement. Elleste Solo is another form of oestrogen-only HRT available from Dr Felix and is available in tablet (Elleste Solo) or patch form (Elleste Solo MX80, Elleste Solo MX40). Evorel patches are also available.

Women who still have a womb and who do not have a Mirena IUS will require a form of HRT containing both an oestrogen and a progestogen, such as Climesse, Elleste Duet, Elleste Duet Conti and Kliovance. Elleste Duet is suitable for women going through menopause who have had a natural period in the past 12 months and allows for a monthly bleed at the end of each pack. 

If you only experience vaginal symptoms such as dryness, a locally acting vaginal oestrogen such as Ovestin or Vagifem may be more appropriate, which provides relief from troublesome vaginal symptoms, without the risks and side effects of a tablet or patch.

Alternatively, tibolone (brand name Livial) is a synthetic steroid that mimics the actions of oestrogen and progesterone in the body and is thought to carry a slightly lower risk of breast cancer.

Lifestyle changes to improve menopause symptoms

Making a few simple lifestyle changes can help you to manage the symptoms of menopause, as well as increasing the effectiveness of HRT. Cutting down on caffeine, alcohol and spicy food can help reduce the impact of hot flushes, as can quitting smoking. To keep your bones healthy and strong, exercise regularly and increase your intake of vitamin D, which is vital in the production of calcium. For those experiencing vaginal dryness, a range of moisturisers and lubricants can be purchased from any pharmacy with the advice of a pharmacist.

Q&A

Will Premarin help with hot flushes?

Hot flushes are one of the most common symptoms of menopause which, for some women, can be unbearable. Experts believe they are caused by the drop in oestrogen levels, which causes the hypothalamus (the part of the brain which regulates body temperature) to detect too much heat. The hypothalamus then signals the heart rate to rise and blood vessels to dilate in order to dissipate the heat, resulting in a feeling of overwhelming heat and sweats.

By supplementing the body’s natural oestrogen levels, Premarin prevents oestrogen levels from falling and effectively prevents hot flushes.

Will Premarin improve my libido?

A drop in oestrogen levels can cause some women to lose their sex drive. The symptoms of menopause are different for everyone, but supplementing oestrogen may aid in boosting your libido.

Is Premarin suitable for vegans?

Premarin contains conjugated oestrogens, some of which are from the urine of pregnant horses. While Premarin doesn’t contain any meat or tissue from animals, some people who follow a vegan or vegetarian diet may prefer to use an alternative form of HRT which does not contain equine products such as Elleste Solo or Evorel.

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