Premarin Vaginal Cream 0.625 mg (Conjugated Estrogens CREAM) 0.625 MG

Conjugated oestrogens applied vaginally treat the tissue changes that follow the loss of oestrogen at menopause.

• Atrophic vaginitis: treats thinning, dryness, and inflammation of the vaginal lining after menopause.
• Kraurosis vulvae: treats shrinkage and dryness of the vulval tissue.
• Moderate to severe dyspareunia: relieves painful intercourse caused by menopausal vulvar and vaginal atrophy.
• Local rather than systemic therapy: delivers oestrogen directly to the affected tissue, though some is absorbed into the bloodstream.
• Short-term use at the lowest effective dose: treatment is reviewed regularly and continued only as long as needed.

• Conjugated oestrogens replace the hormone the ovaries stop producing at menopause. Oestrogen binds receptors in the cells lining the vagina and vulva, switching on the genes that maintain tissue thickness, blood supply, elasticity, and natural lubrication, and that keep the vaginal pH acidic. After menopause these tissues thin and dry. Applying oestrogen locally restores the lining and relieves dryness, irritation, and pain, though a proportion is still absorbed into the bloodstream.

Report any unexpected vaginal bleeding straight away, since this needs investigation rather than observation.

Common Side Effects

• Vaginal irritation or discharge: local burning, itching, or discharge at the application site.
• Headache and breast tenderness: reflecting absorbed oestrogen.
• Abdominal or pelvic discomfort: cramping or bloating during treatment.
• Back pain and mood changes: reported during oestrogen therapy.

Serious or Rare Side Effects

• Endometrial cancer: the risk rises in women with a uterus using oestrogen without a progestogen; report any abnormal vaginal bleeding at once.
• Cardiovascular events: stroke and deep vein thrombosis were increased in the Women’s Health Initiative; seek emergency care for chest pain, breathlessness, weakness, or leg swelling.
• Breast cancer and probable dementia: risk increased in trial populations; dementia risk was seen in women aged 65 and over, and standard breast screening should continue.

Oestrogen therapy carries boxed warnings, so treatment is individualised, monitored, and kept to the shortest effective course.

• Investigate abnormal bleeding: rule out malignancy before and during treatment in any woman with undiagnosed or recurring vaginal bleeding.
• Consider adding a progestogen: women who still have a uterus need this considered to reduce the risk of endometrial cancer.
• Do not use to prevent heart disease or dementia: oestrogen therapy is not indicated for either purpose.
• Use the lowest effective dose for the shortest time: review the need for continued treatment at regular intervals.
• Avoid in a history of hormone-sensitive cancer or clots: assess carefully in breast or endometrial cancer, stroke, or venous thromboembolism.
• Store as directed on the pack: keep at room temperature away from heat, and use the calibrated applicator supplied.

Review the full medicine list, as several drug classes change how oestrogen is processed.

Major Interactions (Avoid)

• Strong CYP3A4 inducers (rifampicin, carbamazepine, St John’s wort): these lower oestrogen levels and can reduce the treatment effect.
• Anastrozole and other aromatase inhibitors in breast cancer: added oestrogen works against the treatment, so the combination should be avoided.

Moderate Interactions (Monitor Closely)

• Strong CYP3A4 inhibitors (ketoconazole, grapefruit juice): these raise oestrogen levels and may increase side effects.
• Thyroid replacement therapy: oestrogen raises thyroid-binding globulin, so thyroid function needs monitoring and the dose may need adjusting.
• Anticoagulants and corticosteroids: oestrogen can alter their effect, so monitor clotting and clinical response.