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. norma
    wichita, ks

    I have vaginal/vulva pain. The Premarin cream the dr. gave me I hate. It hurts to get into vagina and does not seem to help. Is estridiol ok for helping the pain I am going through?

    • Terry Graedon

      Are you asking about estradiol cream or tablets?

  2. Diane
    San Diego, CA

    As far as filling the tube, I just squeeze a little and let the tube fill the rest up to the line. I have not lost any of the cream because I don’t squeeze until I hit the line, I just squeeze a little and let it slowly fill up on it’s own. That being said, whoever stated they should use the toothpaste tube, that would definitely be a better solution!

  3. Helen

    I use the premarin cream twice a week, works well. Yes the tube was an issue because it ooozed the cream out, but i found a solution to pull back the ointment back in the tube each time by pressing on the side of the tube. It works and now i dont looze any of the medication. So i press in the middle from the bottom to push it out and immediately after I press on the sides slowly to pull it back, take some practice, but i made it work. Good luck. Sorry I didnt have any of the bad side effects from this products and Im on it for 4 years.

  4. Nelly

    I used the cream for 8 days. Felt pain, dryness and swelling in Vaginal area trying to insert the syringe with the Premarin creme on the 7th day of use. Tried again on the eighth day and it hurt too much couldn’t even insert the tube felt too swollen. Made an appointment to see the doctor did a pap and said everything looked fine and lab came back normal. Have not used the product for two weeks still feel swollen and dryness with pain. Do people ever feel doctors do not understand their patients concerns and fears of using unknown hormones. When you can read all the negative side affects of medications or hormones. It is so hard now a days to trust your physicians.

    • Sharon

      Yes, Neely. I got really swollen. Been off it for almost 3 weeks and it’s not subsiding. Do you remember how long until that went away?

  5. Melody Silva

    Had total host three months ago . my doc said use a drop . the size of. a blueberry twice a week doesn’t take much to be executive .

  6. Lisa

    Well I’m 45. 5’4″ and weigh 110lbs. My Dr yesterday prescribed me something but it cost 325$ not covered by ins.. So today they called my Dr and he prescribed this premarin.. It was 13$ with ins… But this says to do 1.5 daily for 3 weeks on and 1 week off for dryness… Now the other expensive stuff sounded better. Twice a week for 2 weeks. And he said that would help with urin leakage and hot flashes. This premarij mentions nothing about that. Not sure what to do. I’m just starting menopause

  7. Sheila

    Everyone should call 800-582-1002 to complain about the product design. I see my money being wasted every time I see the excess cream keep coming out the tube and no way to stop the flow.

  8. LaurieinCT
    Milford, CT

    Hi, I was prescribed the Premarin cream today for mild discomfort and burning when I urinate. I am post-menopausal, aged 55. The symptoms only began approx 4 mos ago.

    After reading all these comments I told my Dr. I’d like to hold off. As it is, I have long been against hormone replacement therapies because my former physician talked to me about cancer links. I got talked into using the cream today and I realize it’s safer than the pill, but I also see a lot of risks.

    I write about science and know that all it takes is the next study to reveal with the studies to date might not show. As long as I am only about a .05 on the discomfort scale, this isn’t worth it for me now, is it?


  9. Carol

    I started having lower abdominal pain and swelling 3 days after starting the cream. I found a non hormonal product, formulated by an MD, that has great reviews. I am planning to try it. Has anyone used http://www.NeuEve.com

  10. Marnie

    I am taking Premarin for 2 weeks straight and then I am to continue with half a dose, twice a week. On day 5, I experienced mild discomfort, and bloating reminiscent of when I had my period (I am 63). I wonder if this is just an adjustment to the meds and whether or not the long time users found that such side effects eventually disappear.

  11. Claire

    I want to know who thinks that 2 applicators per tube is fair? The process is messy and for me, somewhat embarrassing. I hate having to clean the used applicator at the end of a long day and I don’t really think that I can disinfect them in my bathroom. Other vaginal medications include 1 applicator per application and those meds are no where near as expensive. Every women should complain!

  12. Rebecca

    Does anyone know the smallest dose of Premarin I can get away with? I thought my doctor said .05 but when I filled the script, it says 2 grams. It gives me mild menstral cramps. I also have to take progesterone pills first 5 days of the month. I don’t want to call the doctors office again because receptionists are kinda rude. They make you feel stupid for asking.

    • Julie

      Rebecca, my MD prescribed 0.5 g twice a week as a maintenance dose. She did say that some women find they can cut it to 0.5 g once a week depending on the results they get from it. I have reduced the twice weekly dose to once weekly to see if I can get by with the bare minimum and so far that dose is providing decent symptom relief. Sorry your MD’s office staff is not more helpful, that is very frustrating! I would still try to clarify with your MD what dose is recommended for you.

      • Lisa
        Binghamton, NY

        Julie, we do not have to tolerate rude behavior. You should report directly to your doctor the rudeness. They are supposed to be there to help patients. If the Dr does not assist w this problem, find another Dr. 😊

  13. Susan M.

    Has anyone had very obvious weight gain in belly specifically? I just read this can be a side effect- I have been beating myself up over my unhappy shape for a year now- my diet is very healthy… So upset if I go off Premarin I’ll have the ‘other issue ‘ back…
    Also just refilled the ridiculous price tube so can’t trash it.

    • Julie
      North Carolina

      Regarding belly bloat – YES. Very upsetting to walk around appearing 4 months pregnant all the time. I, too, maintain a healthy weight and diet so this is very disturbing; but the alternative of the vaginal burning/discomfort is worse! I’m trying to back down to the least possible dose once a week until I see my MD again. Also – regarding the people who have trouble with the cream continuing to flow out of tube after filling applicator – here is what I have found works: Press the tube from bottom VERY slowly to desired fill line. When filled, gently squeeze the bottom of the tube (empty section) from the SIDES just below where the level of the cream in the tube is. This serves to suck the cream back into the tube a little bit. I agree it is very annoying that this expensive medication wants to gush out and result in waste. Poor product design.

  14. anniess
    Martins burg, WV

    They made the tube smaller, and increased price 300% since I have been taking it, about seven years.

    It is over $300 a tube now.

    I doubt the tube has 30 grams. I use needle-nosed pliers to squeeze every possible drop from tube when near the end, yet still get only 22 doses from the tube.

    Tube is poorly designed and product sometimes keeps on coming out by itself.
    I take off the cap, put the tube cap on on it’s side near the edge of my tall dresser ready to recap, fill the syringe right in front of it, then quickly pick up the cap and replace it quickly jam it on the tube. Otherwise, I would waste grams of the stuff.

    What a rip off! Who do I complain to?

  15. Laneil

    I have been taking this medication vaginally for the past 5 months with no improvement. My insurance does not pay for it…$250 per tube. I also feel like I’m wasting medication in the tube and left in applicator. It also just “falls” out of me the next day. I feel like a guinea pig! I’m going to stop use, change doctors and go with an over the counter inserted lube.

    • Marilyn

      I have been using this product for 6-7 years and EVERY single tube I have ever had oozes a considerable amount of product after I have squeezed the cream into the applicator. I have complained to Pfizer and they act as if they have never heard of this and blame it on a faulty tube even though I continued to remind them that this has been every single tube over the course of several years.

      Finally last week I was talking to my Gynecologist and he suggested we go the route of using a compounding pharmacy. VOILA! Not only am I saying Good Riddance to Pfizer and its very expensive product, which for some reason is never covered by insurance, I have a new product which even without being covered by insurance was only $30 for a 3-4 month supply (as opposed to $130 using Pfizer’s faulty and wasteful tubes).

      Here is Pfizer’s Complaints Department # 1-800-582-1002. You have to ask for someone to call you back. Good Luck. FYI: I was on the phone for one hour with them and to no avail. They just said they would report that I received a defective tube. They completely ignored the fact that I said every single tube was defective. I also noted that they might consider talking to the toothpaste folks as toothpaste doesn’t seem to have this problem!!!!!

      • Edna

        What did your doctor write for the compounding pharmacy to make that is similar to Premarin? I really can not afford the cost of the script, and insurance does not cover it. Thanks

      • Rebecca

        I wish there was a like button for all these posts.

  16. Robin

    My doctor just prescribed this cream. I have been using it for 4 days now, 1/2g daily for 2 weeks, then twice a week thereafter. Today I have had sudden sharp pains in the very low abdomen area, towards one side. I am 56 and went through menopause 10 years ago so I do not have a period. But the pain reminds me of when I did get periods, I would sometimes have sudden “take my breath away” pain for a few seconds. This seems similar. I can certainly put up with it for the benefits just as long as it’s a side effect and not going to lead to something more serious. If I call the office, I am sure I will be told to stop using it but I am wondering when my body gets used to it, the pain will disappear? Anyone else experience this?

    • Peg

      Just wondering if your cramping went away, and how long did it take? My cramping started on day 7 of Estrace cream for dryness and frequent urination. Still have all my parts , and uterus feels just like menstrual cramps of 10 years ago

    • Suzanne

      I have the same pain. It ruins my day!

  17. Bonstern

    Just started using a today.. I have dysplasia in my vagina. I had a total hysterectomy about 7 yrs ago.. I’m 50 now.. pap smears are still required even though you don’t have a uterus… that’s how they found the dysplasia.

    • Ms. Patty

      I recently moved and talked to my new doctor about painful intercourse. I had been told before I moved that I needed a pap test before the doctor would prescribe something for me. I am 57 and had a hysterectomy but kept my ovaries more than 20 years ago. You can not imagine how shocked I was when this new doctor wrote me a prescription for this cream and told me because I had a hysterectomy because of wicked bleeding and pain that I do not need to have any more pap tests.

      When I questioned him about it, he said that I have no uterus or cervix which is what they scrape for cells to check for cancer of the uterus or cervix which I no longer have. I came home after picking up what I hope will renew my sex life and looked into what he told me and found he was telling me the truth. Here is an article about it. Doctors often charge for tests that we do not need. http://www.webmd.com/cancer/cervical-cancer/news/20130102/pap-often-not-needed

  18. E

    The applicator and medicine tube are so poorly designed. Cream is lost in the applicator as all of it doesn’t come out. Cream continues to come out of the tube even when you are not pushing the tube. You are wasting plenty of the cream, many of my friends have complained and The manufacturer needs to correct this. One tube is supposed to be a 90 day supply with the waste involved I always run short. My insurance company will not dispense more than one tube as a 90 day supply. Really a consumer rip off!

    • Rebecca

      I have same problem. Medicine is expensive n much is wasted! It keeps coming out of tube even when ur not even holding it at end!!!

      • Valerie
        Cary, nc

        I feel sure it is intentionally designed this way. I have the same problem….cream continues coming out of tube even when not pushing on the tube. Pharmaceutical companies find all sorts of ways to increase profits.

      • M

        The medicine keep coming out after you stop squeezing & the tube is removed so instead of going till 0.5gm go till 0.45 and leave the coming out medicine to go into the tube making sure you get the accurate reading.

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