• Vulvovaginal atrophy:
    • Initially intravaginally 0.5-2g OD *2/52 OR PO 0.3-1.25mg OD *3/52, off *1/52, repeat
      • Taper dose gradually to maintain dose
      • Consider adding progestin for 10-14 days/4 week cycle if intact uterus
  • Moderate-severe dyspareunia; treats symptoms of vulvar and vaginal atrophy due to menopause:
    • 5g intravaginally twice/week OR 0.3-1.25mg*3/52, off 1 week, repeat OR
    • Dosing is cyclic i.e. 4 weeks on, 1 week off
  • Post-menopausal osteoporosis prevention:
    • PO 0.3-0.625mg OD *3/52, off *1/52, repeat
      • Consider adding progestin for 10-14 days/4 week cycle if intact uterus
  • Hypoestrogenism associated with hypogonadism:
    • PO 0.3-1.25mg OD *3/52, off *1/52, repeat
      • Consider adding progestin for 10-14 days/4 week cycle if intact uterus
      • Reasses treatment in 3-6 months
  • Palliative treatment in metastatic breast cancer:
    • PO 10mg TDS *3/12
  • Palliative treatment in advanced prostrate cancer:
    • PO 12.5-2.5mg TDS
  • Fusion of labis in children (Off-label):
    • >1 month: Apply BD for up to 6 weeks
  • Cream:
    • 0.625mg/g
  • Tablet:
    • 0.3mg
    • 0.625mg
    • 1.25mg
  • In postmenopausal women with a uterus, a progestin should also be considered to reduce risk of endometrial cancer
  • Women without a uterus do not need a progestin unless they have a history of endometriosis
  • The plastic applicator is calibrated in 0.5g increments to a maximum of 2g

Estrogen derivative

It binds to estrogen receptors, developing and maintaining female sex characteristics and reproductive systems

  • Vaginal bleeding
  • Vaginal spotting
  • Abdominal cramps
  • Abdominal distension
  • Nausea
  • Vomiting
  • Breast changes
  • Breast pain
  • Cervical secretion changes
  • Headache
  • Migraine
  • Pain
  • Asthenia
  • Fluid retention
  • Elevated BP
  • Mood changes
  • Vulvovaginal candidiasis
  • Glucose intolerance
  • Weight changes
  • Libido changes
  • Contact lens intolerance
  • Vision changes
  • Rash
  • Melasma
  • Chloasma
  • Alopecia
  • Hirsutism
  • Acne
  • Breast development (vaginal cream form in peds patients)
  • Hypersensitivity to class/components
  • Hepatic disease or impairment
  • Undiagnosed vaginal bleeding
  • Breast cancer or history
  • Estrogen-dependent cancer or history
  • Venous thromboembolism or history
  • Arterial thromboembolism within 12 months
  • Protein C deficiency
  • Protein S deficiency
  • Thrombophilic disorder
  • Pregnancy

WARNING

  • Using conjugated estrogens in combination with medroxyprogesterone increases risk of invasive breast cancer
  • Estrogens with progestins increased risks of myocardial infarction (MI), stroke, invasive breast cancer, pulmonary embolism (PE) and deep vein thrombosis (DVT) in postmenopausal women
  • Estrogens increase risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens

None restricted

                          Drug Status

Availability Prescription only
Pregnancy Category X
Breastfeeding Contraindicated
Schedule Not controlled
BRAND NAME STRENGTH FORMULATION PACK SIZE MANUFACTURER DISTRIBUTOR
Premarin 0.3mg Tablet 28’s Pfizer Labs Pfizer Labs
Premarin 0.625mg Tablet 28’s Pfizer Labs Pfizer Labs
Premarin 1.25mg Tablet 28’s Pfizer Labs Pfizer Labs
Premarin V 0.625mg/g Cream 14g Pfizer Labs Pfizer Labs