a happy older couple

Q. My doctor recently prescribed Premarin Vaginal Cream. It has improved my life dramatically, reducing dryness and easing other symptoms of menopause. Are there any negative effects? Is it absorbed into my body?

A. Premarin Vaginal Cream contains conjugated estrogens just like Premarin pills. It has been approved by the FDA to correct vaginal dryness that leads to painful intercourse.


Over three decades ago there was evidence that vaginal estrogen cream (Premarin) could be absorbed rapidly and efficiently into the bloodstream (JAMA, Dec. 14, 1979). More recent studies have confirmed that estrogen in vaginal creams or tablets (Vagifem) is readily absorbed into the body (Annals of Oncology, April 2006; Menopause, Jan., 2009). There are concerns that vaginal exposure to estrogen might increase the risk of uterine or breast cancer in susceptible women.

Please discuss the benefits and risks with your physician. According to The Medical Letter on Drugs and Therapeutics, the long-term safety of vaginal estrogen creams remains unclear (Feb. 23, 2009).

The Estring also provides estrogen to the vaginal area to combat vaginal dryness but the dose is lower.


You can find out more about this and other ways to manage vaginal dryness in our Guide to Menopause. Many women find that lubricating with an edible oil such as almond, coconut or olive oil, is helpful. We are not aware of side effects so long as the woman is not allergic to the oil.

Others prefer water-based lubricants such as Sylk, containing a kiwi vine extract, especially for lubrication during sexual relations.

The FDA has approved a prescription medication, ospemifene (Osphena), to treat this problem. Rather than a vaginal cream or tablet, it is a pill to be taken by mouth. Although ospemifene is not estrogen, it does carry some of the same dangers. The manufacturer warns that there is a possibility that Osphena might increase the risk for endometrial cancer (cancer of the lining of the uterus) or strokes and blood clots deep within the veins. It recommends that women with breast cancer or liver impairment not take Osphena.

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  1. Stacey

    I also want to include on my previous information. I quit taking the RX after 3 weeks and I still have this horrifying and painful swelling. My Dr. seems to believe the Premarin should already be out of my system and he thinks the other meds I take are having a reaction among them, not Premarin. I also have taken these meds for over 4 years and no allergic reactions, until I started and stopped the Premarin.
    Does anyone know who I can contact regarding Premarin to clarify if I am allergic to this it or at least get their opinion about these side effects I am having? Only my headaches have eased off.

  2. Stacey

    My Dr. started me on Premarin cream. At first, I remembered to use it nightly. After about a 2 weeks, I would sometimes use it. The other times I would forget. I wld forget more than remember. About a month of using and not using I started getting continuous headaches that would not go away until I took Imitrex. Then, the swelling (edema) started in my ankles, feet, upper legs, and abdomen. My doctor prescribed me lasix for the swelling. No change at all on the swelling in those areas. I am in pain from all the swelling and weight gain. I was 140 lbs and now with the edema I weigh currently 180 lbs. I need to know if anyone has experienced this while taking this RX. I need help to get rid of this swelling and pain. Please HELP! Thanks you,

  3. sue
    United States

    If you use baby oil it makes the area nice and slick, won’t cause side affects, and does not make things sticky. We have used it for over10 years.

  4. Claudia
    Tyler tx

    I like the affect of the premarin cream. But the tube loses liquid gold. It is very hard to use and is not fair to me the consumer to have the cream keep coming out of the tube- even when you are not pushing it out. I think I lost half my tube this way.

  5. Robynne C
    Oxford, NY

    In answer to the question “are there negative effect,” YES,two big ones: Premarin causes breast cancer. Two, Premarin is made from PREgnant MARe urIN e. Thousands of mares are connected to urine-collection bags for ten months, the entire length of their pregnancy. They must stand 24 hours a day, cannot lay down or turn around until they deliver the foal, and then they are immediately bred again and the process starts over.

    This industry is so heinous and so cruel that the company, Wyeth, shut down their American barns and moved their operations to China. Even though there are synthetic estrogen formulas available, Wyeth continues to mistreat thousands upon thousands of horses each year, in spite of the well-known breast cancer danger, simply for profit.

    Please, ladies, please ask your doctors for the synthetic hormone. It’s safer for you, costs less, it’s more effective, and horses and their foals aren’t needlessly harmed.

  6. Kathy K

    Must I stay lying down for a period of time following use of this medication? I have not seen any information about this.

  7. Betty j.
    Worland WY

    I was wondering if the cream would cause bladder inflammation.

  8. Jane

    $280.00 I paid for small tube of Premarin! I squeezed it gently from the bottom and 3x more than the prescribed dose came flying out! This will not last 30 weeks at this rate….can I return it to the pharmacy?

    • Sheryl

      I’ve been using Premarin cream for over 5 years and have always had problems with extra cream coming out of the tube. I’ve tried various methods to prevent this from happening but have no luck.

      • Barbara

        I had the same problem with too much coming out of the tube. Also broke out in giant hives. No more Premarin for me. I have to find some other treatment.

  9. meg

    Thanks so much for your note, so very helpful!

  10. MKC

    seems like a lot to me, I was prescribed .5 gram a night for two weeks, then as needed…

  11. alex s.

    Yes, that seems like a lot. I was prescribed 1gm 2x week at first. Now I use every other week and achieve desired effects.

  12. Loretta

    Is it okay to take premarin pills and premarin cream?

  13. Holly

    Very concerned about this Premarin Cream. I wake up twice each night since I began 5-days ago.
    My pdoc directed to use 2grams each night for 14 days. Then use twice weekly.
    It feels like it’s too much; I want to cut this amount in half— does anyone else feel this way?

  14. BC

    Interesting…I have been using both the pills and cream for many years…yes, works for dryness…but I have had bouts with nausea, vomiting, abdominal pain and trying to get a handle on it…even had my gall bladder removed last year…when trying to analyze what I ate, etc…this last time…the light finally went off when I realized I had used the creme the last night before I got sick…since I have had all types of gastro tests…I am reaching at straws… It could have it been the Premarin all along?..interested in your findings…thanks BC

  15. MKC

    I’m sorry for your unpleasant beginning, I can only say that this was not my experience…I went from worst case possible to ‘normal’ after the first 2 weeks of daily use as prescribed…(then to use as needed)…
    Perhaps this is just a coincidence…?
    best wishes…

  16. alex segal

    Thank you for your thoughtful response. It was very well stated.

  17. Chris

    I was prescribed this earlier in the week and used it once. How common are yeast infections using this? Have discharge like an infection from one dose…..

  18. h

    I have been battling cancer since I was 11 and have been in menopause since I was 14. Was I suppose to go through my whole life without knowing the touch of an man? Did you only post on this page to try and make people feel bad for wanting to live their lives? Changing my diet will not make me produce more hormones. I knew this medicine was made out of horse urine before I used it but I don’t care I have suffered enough and I deserve happiness too. So next time you try to judge people, who’s situation you know nothing about, don’t. I am 26 married a deserve to be able to be with my husband without pain.

  19. Alex

    Thank you for your thoughtful response. It was very well stated.

  20. MKC

    In response to your response…in the research I did, I found out that they no longer use the abusive practices in the production of Premarin, that is outdated information. Additionally, whereas I am sure your intentions are well meant, they do come across as harsh and uninformed. As a 14 year practicing organic household and HUGE promoter/practicer of organic, humane etc… I know it is rash of you to think everything can be controlled with’ diet’, it can’t.
    I am a leukemia survivor (in the worst sense)…menapause was brought on prematurely in the hospital where i lived over 9 ½ months ‘dying’, making hard decisions and suffered many ill effects in the process of saving my life. I just had my 13th surgery in life-saving/body repair, and through God’s grace, I am very whole looking and acting (no-one could tell, I can not only walk again, not be on massive pain meds, but am able to remodel my house and serve others again) though I still suffer from side effects.
    Because I have been systematic and unrelenting in my purpose to NOT be a drain on family & society, I have worked VERY HARD to re-build my body…feeling that if I am to still ‘be here’, I am to be ‘useful’.
    …and you have it backwards, my ‘partner’ is my loving husband of 33 years who sacrificed GREATLY through the years of my illness, complications & recovery…it is my gift to him, not his requirement of me. We are too young to accept no option of physical intimacy…and it is not your place to ask us to do so.
    Maybe try to ‘read between the lines’ and understand you do not have the facts to everyone’s situation in a quick blog post before you go off ranting on animal cruelty and such… animal LOVERS that we are and long-time foster parents for the humane society and rescuer on every level, last I checked humans were as important, and in God’s eyes, more important that animals, bing made in His image. God DID give us the charge to take care of our animals (A righteous man careth for the needs of his animal….as well as giving man dominion to be in charge of and care for animals and the earth). Granted, man has done a poor job at large, but I as an individual have done MORE than my share, and continue to do so in ways this blog does not have space to outline.
    …Every-time I see a long expensive commercial to send money for animal shelters, good as that is, I think, ‘where are the commercials to foster and care for the ‘humans’, the abandoned children (we have taken in more than our share of those too)…
    …kindness & understanding, informing current information in a compassionate manner…that does more for the humane & organic movement than coming off as harsh and uninformed.
    Thank you for your time…and I am sure you have some very good responses to my post, but I do not wish to get into a battle of ethics, I just had a simple comment to begin with….

  21. NM

    For all of you worried about the side effects of Premarin you should do a web search for premarin mares. You’ll find that the drug is made from horse urine obtained from mares that are kept pregnant year round with a tube in them to constantly extract the urine. Most of their male babies are sent to auctions where they are shipped to Canada or Mexico to be killed or they are just killed outright at birth. The mares are sent to kill auctions when they will no longer accept pregnancy immediately after giving birth. They are kept tied up for 23 hours a day to give this urine to you.
    Is having sex worth the abuse of all of these animals? Does your bed partner know you use horse urine on your private parts? Did you know?
    A simple change in diet can help with vaginal dryness when going through menopause without
    worrying about the side effects on you and the animals from which your drugs were obtained.

    • Just Me
      Midwest Lady

      My Lord!
      This is NOT just about having sex!
      I’m in my fifties, haven’t had sex in six years.
      The PAIN from dryness, horrible itching, bleeding, etc. all around and all over my labia is the ONLY reason my doc prescribed Premarin. I was far more than miserable. I cannot imagine having the problems I did have AND trying to have intercourse too. No way!! I love animals. I am bothered somewhat as to ALL the details. However, how many millions of women should suffer for lack of HORSE URINE??

      • Racheal

        Add to that all the bladder infections caused by lack of hormones to the list!

  22. CAF

    I had the same problem. It must be a flaw in the tube. Even when I try to not squeeze the tube, after I pull the applicator away the cream still pours out and is lost. Does anyone else have any suggestions on how to handle this.

    • New 2 Premarin

      My doctor said that many folks have a hard time with the applicator. Using and cleaning are both difficult. His remedy was to use about as much cream as you would use toothpaste, place it on your finger and apply liberally as deep as you can reach.

      Of course – wash hands after!

      He said I should expect noticeable results within a week.

      I’ve been cautious to try it yet, but after reading the helpful posts on this site, I may finally give it a try.

    • Ginny
      United States

      I don’t think it is a “flaw” in the tube at all! I am sure the manufacturers of this cream are aware of the problem. Why should they bother to fix it? The more that is wasted, the more refills, so the more exorbitant profits the drug company can make.

    • lori

      When I squeeze the tube to do it ever so gently to get the amount I want in the tube, but should it keep coming out, I have another applicator tube cleaned and ready to catch the remainder that comes out and wrap it with syran for the next time I need it. I have lost very little of the cream this way. Hope that helps.

    • gametime

      Put a cap quickly on the end of the tube. Have a piece of saran wrap ready to place firmly over the end of the tube. Put you finger on the end of the tube to stop any excess from coming out until the cream stabilizes again.

    • Jree

      You would think that a better tube would be introduced. What I have tried to do is to slowly squeeze the bottom of the tube and then allow it to self fill the applicator. The key to this is patience. As you see that the cream is nearing the desired amount, be ready to slide the applicator across the opening and then to quickly replace the top. This should help cut down on the wastefulness of the product.

  23. MC

    …I assume because it is ‘absorbed’ and the tissue is connected…it can easily transfer the benefits internally…

  24. Darline C.

    I purchased this prescription, which was 90 gms. Was suppose to be a 50 day supply. I was to use it 2 times a week for 1 month then 1 time a week from there out. When the tube was opened and the cream poured out before I could get the applicator on, then after the applicator was taken off it still poured out. I only got 6 applications out of this tube. My insurance would not pay for another so soon. I contacted Pfizer and at first they were going to replace the spent tube, via pharmacy, then decided to refund for the rx. Didn’t do me any good, because out of pocket would have been over 200.00. I still haven’t received the paperwork to get the rx refunded and has been 2 weeks. Not a good way to dispense the cream. I had the doctor put me on a low dose of estrogen and it has helped.

  25. JB

    I was started on premarin cream nightly for one month and then 2 times a week thereafter. Have been using it 2 and a half months now. Definitely helped with dryness problem, but have had LOTS of nausea in the first month and now end up nauseated and throwing up the day after each bi-weekly application. Just put the pattern together in this last week. Called the doctor’s office and they said they’re very doubtful it’s the premarin…. to go see my primary care for reflux or something. Anyone have this side effect? Really still believe it’s the premarin. Going to stop it for a week or so and see if nausea abates.

  26. p tharp

    I use a small dab of topical premarin twice a week inside my vagina to top a tumor from getting any larger. What, if any, side effects are there?

  27. mvan

    FMH…I am a 66 year old female and up until last august was on .065 premarin pills – since 1995. It was a 20 year mark and the docs thought since I had rectal cancer I should not take it anymore although the doctors I saw in the group were torn on this. Some felt it was okay and others not since I had a full hysterectomy they had mixed opinions. So I went off, first cold turkey (not good) and then weaned down. I didn’t notice any change right away but within a few months became irritable, had frequent UTI’s and yeast infections, dryness and so many other issues. I did not connect it to the hormones until I realized wait, what changed over the last few months or so and voila that was the only change that was made.
    I finally asked today after visiting my gynecologist with a severe UTI and yeast infection (itching) if I could have vaginal cream instead as I heard the pills are not as safe. I honestly think that if this med makes us feel better and live a fuller life, what harm can it do if we go to the doctor, have our regular checkups and mammograms and such and are monitored? I’m very diligent about this. I would talk to your doctor and be honest about your quality of life and you feel better on it. When I talked to my doctor she asked me what I thought, patch, pill or cream and I told her what I had read and felt the cream would be the safest. She agreed. Now I’m just going to wait a few days until this stuff kicks in again. I so miss it. Be well. mvan

  28. MC

    I am a 44 year old female who has had breast cancer in 2011. Had a mastectomy, chemo, radiation, more chemo and lastly had a chemically induced menopause (zoloadex) because of my her2 status. Because of the menopause side effects I sometimes feel that I would be better off dead than go through the awful symptoms of menopause. The absolute worst was the vaginal dryness, infections all the time. Very painful intercourse and the 24 hour discomfort.
    I have explained these symptoms to both my oncologist and my gynae explaining that I am avoiding sex altogether and this is now affecting my marriage and to date neither have recommended the use of Premarin Cream. They suggest MI use a water base gel or even vaseline but both of these have done absolutely nothing for me. Out of desperation I googled for help, and this is where I got the idea of Prevarin cream. I explained my condition to my pharmacist and he didn’t seem to have a problem giving it to me. But then I read the enclosed leaflet and now I am really scared. What do I do?

  29. B.T.

    I had the same problems with the dryness and was going to stop having intercourse altogether. Recently went to get a second opinion and was told that KY is ok to put on the men but women should be using Replens. HUGE difference! I don’t believe you are supposed to use Premarin as a lubricant as it can cause problems for your man.

  30. alex s

    I think the same thing happens to a lot of us at this age, it’s the drop off in hormones. It happened to me. I wasn’t opposed, I just lost desire. I was already a long time premarin user, but premarin does not provide significant blood levels of hormones.
    I do take a hormone replacement pill, estradiol and progesterone. When I talked with my gynecologist about the lack of desire issue, he added a modest dose of testosterone and DHEA to my prescription. It took a long time to take effect (11 months like I said it was a modest amount) but when it did I became a responsive partner once again. My husband always notices when the hormone pill bottle gets low so I guess he appreciates my taking it!
    You have to get it from a compounding pharmacy. Talk to your GYN. Good luck!

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