Premarin (conjugated estrogens) is an estrogen-only treatment which can be used by itself or along with a progestin in hormone replacement therapy for women. The medication, with or without a progestin, helps reduce menopausal symptoms of hot flashes, dry an itchy skin, night sweats, vaginal dryness and so forth.

Premarin may also be used for:

• Prevention of osteoporosis
• Estrogen deficiency from other causes (such as ovarian failure or hysterectomy)
• Treatment for certain types of breast cancer (along with other medications) in men and women
• Treatment for prostate cancer (along with other medications) in men

Effective Use of Premarin

It's important to understand the difference between estrogen-only therapy and combination therapy, in which both estrogen and a progestin are taken. If a woman has a uterus, combination therapy should be utilized--failure to take a progestin during estrogen therapy may significantly increase a woman's risk of developing uterine cancer. Women who have had a hysterectomy do not need to take a progestin.

While Premarin is an estrogen-only treatment, it can be supplemented with progestin for combination therapy:

• Progestins may be purchased separately and taken in addition to Premarin.
• Combination products such as Prempro, which contains both estrogen and a progestin, will deliver both hormones at the same time.

Treatment with Premarin for menopausal symptoms may also vary somewhat according to the particular symptoms being experienced. If disruptive symptoms are vaginal only, Premarin cream may be preferable; it will reduce dryness and irritation with much less risk of side effects.

For most conditions Premarin is administered via tablet. In all cases the lowest effective dose should be used for the shortest amount of time. With the exception of use in certain cancer treatments, dosage and administration is surprisingly similar in all cases:

• Women are usually started on 0.3 mg per day.
• Dosage may be increased to 0.625 mg per day if 0.3 is insufficient.
• Younger women who have had a hysterectomy or ovarian failure may take up to 1.25 mg per day.
• Treatment is often cyclical; Premarin is taken for 3 weeks continuously with a 1 week break, or 25 days continuously with a 5 day break.

Hormone therapy may last a few months to decades. Women who enter menopause naturally typically take an estrogen supplement for under 5 years, while women who have a hysterectomy or otherwise stop producing estrogen while relatively young may undergo hormone replacement for much longer.

For the duration of treatment, doctor exams should take place periodically to ensure the hormone is working properly and to monitor for developing adverse effects. It is not unusual for dosage to be periodically adjusted.

Precautions & Side Effects

Hormone therapy is highly individual; women take estrogen supplements like Premarin for different reasons, at different ages, and for different lengths of time. All of these factors may influence the frequency and severity of side effects.

A general rule is that the younger a woman is when beginning hormone therapy, ideally 50 years or less, and the closer to menopause therapy is started, the lower the risk of adverse effects. Women who initiate therapy more than 5 years after menopause, or who who start treatment over 60 years of age, are more likely to experience serious side effects.

Most side effects are relatively mild, including cold-like symptoms, spotting, stomach upset, and so forth. These effects often disappear as treatment continues, and are not cause for concern unless severe.

Major side effects can be negative or positive, depending on when treatment was started and individual patient response:

• Reduced risk of osteoporosis
• Decreased risk of colon cancer
• Increased or decreased risk of heart disease
• Increased or decreased risk of dementia
• Increased or decreased risk of memory loss

The risk of blood clots and stroke is a concern in older women and women who start therapy years after menopause. In younger women there does not appear to be an increased risk, but neither is the risk decreased.

Women who have a family or personal history of breast cancer should never take estrogen without explicit doctor instruction and frequent medical exams.