What is Premarin cream used for?

During menopause, estrogen and progesterone levels decline, causing symptoms such as hot flashes, night sweats, vaginal dryness (atrophic vaginitis), painful intercourse, mood changes, thinning hair, and weight gain.

Premarin vaginal cream (conjugated estrogens) is applied inside the vagina to treat menopausal vaginal symptoms. It restores local estrogen, relieving dryness, itching, inflammation, and pain during or after sex. It may also be used for low‑estrogen conditions in premenopausal women.

Benefits of Premarin cream

• Improves vaginal dryness and itching
• Reduces inflammation of vaginal tissues
• Alleviates pain during or after intercourse
• Restores vaginal pH and tissue thickness

Common side effects

• Abdominal pain and bloating
• Breast tenderness or pain
• Fatigue or lack of energy
• Depression or mood changes
• Nausea
• Chest or leg pain without shortness of breath
• Fluid retention
• Headache
• Vision changes
• Hair loss
• Vaginal discharge or yeast infection

Serious side effects

• Stroke (sudden headache, numbness, slurred speech, vision or balance problems)
• Heart attack (chest pain, shortness of breath, sweating)
• Dementia risk increase
• Blood clots (deep vein thrombosis or pulmonary embolism)
• Ovarian and breast cancer
• Gallbladder disease
• High blood sugar and blood pressure
• Liver problems
• Severe allergic reactions
• Uterine fibroid enlargement

Drug interactions

CYP3A4 inducers (St. John’s Wort, phenobarbital, carbamazepine, rifampin) may lower estrogen levels. CYP3A4 inhibitors (clarithromycin, itraconazole, ritonavir, grapefruit juice) may raise estrogen levels.

Who should not use Premarin cream?

• Unexplained vaginal bleeding
• Estrogen‑dependent cancer (uterine or breast)
• History of heart attack, stroke, or blood clots
• Liver disease or clotting disorders
• Allergy to any cream ingredient
• Pregnancy or planning pregnancy
• Breastfeeding (estrogen reduces milk supply)

Precautions

• Report unusual vaginal bleeding immediately
• Perform regular exams: blood pressure, pelvic exam, mammogram, Pap smear
• Monitor conditions worsened by estrogen: asthma, migraine, epilepsy, lupus, diabetes
• Adjust thyroid or anticoagulant therapy as needed

Dosing regimen

For vaginal atrophy: apply cream daily for 21 days, then off 7 days. For painful intercourse: apply twice weekly continuously or 21 days on/7 days off.

Missed dose

Apply as soon as remembered unless close to the next dose, then skip. Do not double apply.

Alternatives

• Over‑the‑counter vaginal lubricants and moisturizers
• Prescription estradiol cream (Estrace)
• Vaginal rings (Femring, Estring)
• Vaginal tablets (Vagifem, Imvexxy)

Related medications

• Estrace (estradiol)
• Premarin (oral conjugated estrogens)
• Prempro (estrogens + medroxyprogesterone)
• Enjuvia, Cenestin (synthetic conjugated estrogens)

Sources

• Premarin Prescribing Information. Pfizer. Accessed Jan 2025.
• Premarin Medication Guide. Pfizer. Accessed Jan 2025.
• Medscape: Premarin Vaginal Cream. Accessed 2025.
• Premarin FAQs. Pfizer. Accessed 2025.
• Prescribers’ Digital Reference: Premarin Cream. Accessed 2025.