Premarin is an estrogen and contains a mixture of equine estrogens of natural origin (conjugated estrogens), which are similar to endogenous estrogens. In target tissues (organs of female urinary tract, breast and hypothalamus, pituitary) estrogens enter the cell and binding to nuclear estrogen receptors, regulate the synthesis of RNA and protein, causing metabolic effects.
The drug eases and relieves climacteric symptoms associated with estrogen deficiency: vasomotor disorders (including tides) and urogenital symptoms (atrophic vaginitis and atrophic urethritis).
Premarin postmenopausal osteoporosis prevents the development, decreases bone resorption, but does not stimulate bone formation.
The drug increases HDL, lowers LDL and total cholesterol, thereby reducing the risk of cardiovascular disease.
If you are using Premarin as replacement therapy in female hypogonadism or primary ovarian failure noted the appearance of secondary sexual characteristics in patients.
Premarin is used to treat conditions that occur in women during menopause and menopause.
– Vasomotor disorders of varying severity caused by estrogen deficiency (hot flashes, sweating);
– Atrophic vaginitis, atrophic urethritis;
– Prevention and treatment of osteoporosis caused by estrogen deficiency;
– Reduced risk of coronary heart disease and associated mortality in postmenopausal women;
– Gipoestrogenizm female (female hypogonadism or primary ovarian failure).
Dosage and administration
The drug may be appointed as a continuous or intermittent therapy (3 weeks – reception, a week – a break). With continuous therapy Premarin should be taken daily 1 time / day. For women who are postmenopausal treatment can be started at any time.
With vasomotor disturbances, atrophic vaginitis and atrophic urethritis appoint 0.625-1.25 mg / day.
Osteoporosis – to 625 micrograms daily.
When a female hypogonadism and primary ovarian dysfunction – 0.625-1.25 mg / day. The dose is adjusted depending on the severity of symptoms and the endometrium. Doses of 150 mg (used for girls) initiate the development of secondary sexual characteristics.
For the prevention of cardiovascular disease – 0.625-1.25 mg / day.
For patients older sets the minimum dose causing the effect.
– Proven breast cancer or a suspicion of it;
– Proven or suspected neoplasm on them;
– Bleeding from the genital organs of unknown origin;
– Acute thrombophlebitis and thromboembolism (an indication of the state data in a history related to prior use of estrogen);
– Proven or suspected pregnancy;
– Hypersensitivity to the drug.
Pregnancy and lactation
Premarin is contraindicated during pregnancy.
Keep in mind that estrogens are not effective for the treatment and prevention of threatening or habitual abortion.
If necessary, usage Premarin during lactation should decide on the termination of breastfeeding.
Experimental studies have shown that the usage of estrogen during pregnancy is associated with increased risk of birth defects, reproductive system in fetuses of female and male sex, increased risk of vaginal adenosis, squamous cell dysplasia of the cervix and vagina vaginal cancer.
Before starting therapy there should be carried out a full survey of the patient, including history taking, measurement of blood pressure, breast examination, abdominal and pelvic organs, performing vaginal smear smear.
With care prescribe the drug to patients with impaired liver function, renal, cardiovascular disease, migraines, asthma, epilepsy, porphyria, hypercalcemia, the risk of thrombosis.
The therapy by Premarin may increase the existing uterine leiomyoma.
Keep in mind that patients with an intact uterus, to reduce the risk of endometrial cancer or hyperplasia Premarin, should be prescribed in combination with progestogen (for 10-14-day course). In addition, you must inform the patient about the need to pass a yearly inspection of the gynecologist. If a patient with an intact uterus is not receiving therapy at the same time progestogen, the survey should also be regular (3-6 months) and must necessarily include endometrial biopsy.
Please note that use of estrogen at higher doses increases the risk of developing breast cancer. However, most studies found no significant correlation between the use of estrogen in normal doses used for replacement therapy and breast cancer.
In the application of Premarin increases the risk of thrombosis, thrombophlebitis and thromboembolism. In the event of complications estrogen therapy should be discontinued.
In the application of Premarin increases the risk of gallbladder disease.
Acceptance of Premarin should be discontinued at least 1 month before the planned surgery and during prolonged immobilization, in order to eliminate the risk of thromboembolism.
Premarin is not a contraceptive.
If you have abnormal vaginal bleeding you should take adequate diagnostic measures (including biopsy to exclude malignancy). If there is no reason to decrease the dose Premarin or intermittent appointment, estrogen therapy may lead to a sharp increase in triglyceride levels of blood plasma with the subsequent development of pancreatitis and other complications in patients with inherited defects in lipoprotein metabolism.
There is no reliable data on the effectiveness of estrogen in the nervous system disorders or depression, which can occur during menopause. It is therefore not recommended to prescribe Premarin for the treatment of these conditions.
The patient should be informed that the resumption of menses on the background of estrogen replacement therapy in postmenopausal women is not a sign of fertility.
It should be noted that the appointment of estrogen for older postmenopausal women with documented coronary heart disease, estrogen therapy does not reduce the overall risk of recurrent coronary heart disease. Therefore, the appointment of Premarin to these patients should be decided individually after evaluating the potential benefits and risks of estrogen therapy.
Results of experimental studies
In studies on laboratory animals there was found that prolonged continuous use of estrogen increases the incidence of carcinoma of the breast, cervix, vagina and liver.