Prempak-C

Prempak C is a form of hormone replacement therapy (HRT) containing estrogens and norgestrel. It is used to treat some of the effects of the menopause. If you would like to purchase HRT, simply complete a 2 minute online consultation and our UK registered doctors will review your answers, before issuing a prescription if appropriate. Our NHS registered pharmacy will dispense and dispatch your medicine in discreet packaging.

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Strength Quantity Price
1.25mg120 tablets24.99
625mcg120 tablets24.99
Prices exclude a prescription fee. Find out more

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About

What is Prempak-C?

Prempak-C is a type of hormone replacement therapy (HRT) used to treat the symptoms of menopause, including osteoporosis. It contains conjugated oestrogens and norgestrel, a synthetic form of progesterone, and helps relieve symptoms such as hot flushes and night sweats, mood swings, vaginal dryness and irregular periods.

How does Prempak-C work?

Prempak-C contains two different types of tablet, once containing conjugated oestrogens and the other containing norgestrel, a synthetic form of the naturally occurring hormone progesterone. As women approach menopause, their ovaries begin to produce less oestrogen, resulting in symptoms such as hot flushes and night sweats, mood swings, vaginal dryness and irregular periods.

Ingredients

Active ingredients

The active ingredients of Prempak-C are conjugated oestrogens and norgestrel.

Inactive ingredients

The inactive ingredients of Prempak-C are lactose monohydrate, sucrose, methylcellulose, magnesium stearate, glyceryl monooleate, macrogol, carnauba wax, calcium sulfate anhydrous, microcrystalline cellulose, shellac, titanium dioxide (E171), stearic acid, purified water, ethanol, n-butyl alcohol, propylene glycol (E1520), ammonia solution, ethyl acetate, iron oxide black (E172), erythrosine (E127), sunset yellow (E110), indigo carmine (E132), povidone, sodium benzoate, quinoline yellow (E104), starch, talc, calcium carbonate, and bleached wax.

Dosage

How to use Prempak-C

Starting with the tablet marked ‘day 1’, swallow each day’s tablet or tablets whole with a glass of water at the same time each day. Do not crush or split the tablets, as this may reduce the effectiveness of the tablets. Each pack is marked with a calendar of the days of the week to help you remember to take your pill each day. You will experience a simulated period, or ‘withdrawal bleed’ once a month, usually at the beginning of each pack. If you forget to take a dose, take it as soon as you remember, unless it is time for your next dose. In this case, just carry on as normal, and never take a double dose to make up for a missed one. Missing more than 1 tablet in a row may result in a withdrawal bleed.

Remember that Prempak-C is not a contraceptive. If it is less than 12 months since your last natural period, or if you are under 50 years of age, you may still need to use additional mens of contraception to prevent pregnancy. Speak to a doctor for advice.  

Prempak-C dosage

The usual dose is 1 x oestrogen tablet each day for the first 16 days of the cycle. Start the pack with the tablet marked ‘day 1’ to help you remember. On days 17 to 28, take 1 x oestrogen tablet AND 1 x norgestrel tablet. When you finish the 28-day pack, start the next pack the following day without leaving a gap.

Side Effects

Prempak-C side effects

Like all medicines, Prempak-C can cause side effects in some patients. The following are reported slightly more often in women using HRT compared to women not using HRT:

  • Breast cancer
  • Endometrial hyperplasia or endometrial cancer
  • Ovarian cancer
  • Blood clots in the veins of the legs or lungs (venous thromboembolism)
  • Heart disease
  • Stroke
  • Probable memory loss if started over the age of 65

Other side effects are usually mild and tend to get better in time. The following common side effects may affect up to 1 in 10 women:

  • Breakthrough bleeding, vaginal inflammation, period pain
  • Breast tenderness or pain, swollen nipples, nipple discharge
  • Depression
  • Muscle or joint pain, leg cramps
  • Weight change
  • Changes to your triglyceride levels

Uncommon side effects, affecting up to 1 in 100 women, include:

  • Changes in menstrual flow, vaginal discharge
  • Thrush
  • Nausea, bloating, abdominal pain
  • Headaches, migraines
  • Blood clots in the veins
  • Dizziness
  • Change in mood, anxiety
  • Increased or decreased libido
  • Visible swelling of the face or ankles
  • Itchiness, acne
  • Difficulty wearing contact lenses
  • Gallbladder disease, such as gallstones
  • Hair loss

The following rare side effects may affect up to 1 in 1 000 women:

  • Vomiting
  • Changes in breast tissue, milky secretion from the breast
  • Irritability
  • Increase in hair growth
  • An intolerance to glucose
  • Worsening of asthma
  • Increased size of fibroids
  • Ovarian cancer
  • Worsening of epilepsy
  • Heart attack, stroke
  • Inflammation of the veins just under the skin
  • Inflammation of the pancreas
  • Various skin disorders, including discolouration of the skin (chloasma), painful reddish skin nodules (erythema nodosum) and a rash with target-shaped reddening or sores (erythema multiforme)

Very rarely (1 in 10 000 cases), women may experience:

  • Jaundice (yellowing of the skin and whites of the eyes)
  • A worsening of chorea
  • A worsening of hypocalcaemia
  • Blurred vision or loss of vision
  • Worsening or porphyria
  • Growth of benign liver tumours

Contraindications

Do NOT take Prempak-C if:

  • You are allergic to conjugated oestrogens, norgestrel, or any of the other ingredients of this medication
  • You have or have ever had breast cancer, or are suspected of having breast cancer
  • You have or are suspected of having an oestrogen-sensitive cancer, such as endometrial cancer or ovarian cancer
  • You have ever had a blood clot in a vein, such as in the legs (deep vein thrombosis) or the lungs (pulmonary embolism)
  • You have ever had a blood clotting disorder, such as protein C, protein S, or antithrombin deficiency
  • You have recently had a disease caused by blood clots in the arteries, such as heart attack, stroke or angina
  • You have  rare blood problem called porphyria
  • You have any unexplained vaginal bleeding
  • You have endometrial hyperplasia that is not being treated
  • You have or have previously had liver disease
  • You are pregnant or breastfeeding

Before taking Prempak-C, speak to your doctor if you have ever had any of the following problems:

  • Fibroids inside your womb
  • Endometriosis or a history of endometrial hyperplasia
  • Increased risk of developing blood clots
  • Increased risk of developing an oestrogen-sensitive cancer
  • High blood pressure
  • Heart disease
  • A liver disorder
  • Kidney disease
  • Fluid retention due to kidney or cardiac problems
  • Diabetes
  • Gallbladder disease or gallstones
  • Migraines or severe headaches
  • Systemic lupus erythematosus (SLE)
  • Epilepsy
  • Asthma
  • Otosclerosis
  • Hypocalcaemia
  • A high level of triglycerides in the blood

Drug interactions

Before taking Prempak-C, tell your doctor or pharmacist if you are taking any other medicines, including those purchased over the counter without a prescription. In particular, tell your doctor if you are taking any of the following medicines, which may alter the effectiveness of Prempak-C:

  • An anticonvulsant for epilepsy, such as phenobarbital, phenytoin, or carbamazepine
  • An anti-infective used to treat tuberculosis (rifampicin, rifabutin) or HIV infection (nevirapine, efavirenz, ritonavir, nelfinavir)
  • A herbal preparation such as St. John’s wort
  • Metyrapone, usually used to treat Cushing’s syndrome
  • Aminoglutethimide, usually used to treat cancer or Cushing’s syndrome

Treatment Options

Alternatives to HRT

HRT is the most accessible and effective treatment for the symptoms of menopause, and and be accessed on prescription through the NHS and online at Dr Felix. Some women may choose to try herbal supplements and remedies for relieving symptoms such as hot flushes and mood swings, although their effectiveness is unknown. Make sure to speak to a doctor or pharmacist about the contents and effectiveness of herbal remedies before trying them.

Prempak-C vs other types of HRT

There are several different types of HRT available in the UK, and a doctor will be able to help you find the one which is best for you. Like Prempak-C, Trisequens, Kliovance, Climesse, Elleste Duet and Elleste Duet Conti contain both an oestrogen and a progesterone supplement and are therefore suitable for women who have not had a hysterectomy, or who do not have an intrauterine system (IUS), or mirena coil, fitted. While, Kliovance, Climesse and Elleste Duet Conti are continuous HRTs, Prempak-C, Trisequens and Elleste Duet cause a monthly bleed, and are therefore better suited to women who have experienced a natural period within the last 12 months. Tibolone (brand name Livial) is a synthetic steroid which mimics the actions of oestrogen and progesterone in the body, but is only suitable for women who have not had a natural period in the last 12 months.

Women who have had a hysterectomy or who have an IUS supplying them with progesterone are able to take oestrogen-only HRT. These can be taken orally (Elleste Solo, Premarin) or applied to the skin as transdermal patches (Elleste Solo MX80, Elleste Solo MX40, Evorel).

Lifestyle changes to improve menopause

Alongside HRT, a few simple lifestyle changes can help you to manage the symptoms of menopause. The impact of hot flushes can be reduced by cutting down on caffeine, alcohol and spicy foods, and by quitting smoking. Exercise regularly and try to increase your intake of vitamin D to help keep your bones strong and healthy. For those experiencing vaginal dryness, a range of moisturisers and lubricants can be purchased from any pharmacy with help from a pharmacist.

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