Premarin

Women considered to be at risk of developing fractures following the menopause include those who have had an early menopause, those with a family history of osteoporosis, those who have had recent prolonged corticosteroid therapy (eg prednisolone), those with a small thin frame, and smokers.

You can read more about the risks and benefits of HRT and other medicines for preventing osteoporosis in the factsheets about menopause and osteoporosis linked below.

What is it used for?

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- Hormone replacement therapy to relieve symptoms of the menopause
- Second-line option for preventing osteoporosis in postmenopausal women who are at high risk of fractures and cannot take other medicines licensed for preventing osteoporosis.

Warning!

- Women taking any form of HRT should have regular medical and gynaecological check-ups. Your need for continued HRT should be reviewed with your doctor at least once a year.
- It is important to be aware that all women using HRT have an increased risk of being diagnosed with breast cancer compared with women who don't use HRT. This risk needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. You should discuss these with your doctor before starting HRT. Women on HRT should have regular breast examinations and mammograms and should examine their own breasts regularly. Report any changes in your breasts to your doctor or nurse.
- It is important to be aware that women using HRT have a slightly increased risk of stroke and of blood clots forming in the veins (eg deep vein thrombosis/pulmonary embolism) compared with women who don't use HRT. The risk is higher if you have existing risk factors (eg personal or family history, smoking, obesity, certain blood disorders - see cautions below) and needs to be weighed against the personal benefits to you of taking HRT. There is more detailed information about the risks and benefits associated with HRT in the factsheet about the menopause linked above. Discuss these with your doctor before starting treatment.
- The risk of blood clots forming in the veins (thromboembolism) while taking HRT may be temporarily increased if you experience major trauma, have surgery, or are immobile for prolonged periods of time (this includes travelling for over five hours). For this reason, your doctor may recommend that you stop taking HRT for a period of time (usually four to six weeks) prior to any planned surgery, particularly abdominal surgery or orthopaedic surgery on the lower limbs, or if you are to be immobile for long periods.

Use with caution in

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- Close family history of breast cancer (eg mother, sister or grandmother has had the disease)
- History of benign breast lumps
- History of fibroids in the womb
- History of endometriosis
- History of overgrowth of the lining of the womb (endometrial hyperplasia)
- Personal or family history of blood clots in the veins (venous thromboembolism, eg deep vein thrombosis or pulmonary embolism)
- Blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome, factor V Leiden
- Women taking medicines to prevent blood clots (anticoagulants), eg warfarin
- Long-term inflammation of skin and some internal organs (systemic lupus erythematosus)
- Personal or family history of recurrent miscarriage
- Severe obesity
- Varicose veins
- Smokers
- History of high blood pressure
- Raised levels of fats called triglycerides in the blood
- History of liver disease, eg liver cancer
- Decreased kidney function
- Heart failure
- History of diabetes
- History of gallstones
- History of migraines or severe headaches
- History of epilepsy
- History of asthma
- History of an ear disorder that may cause hearing loss (otosclerosis)
- History of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of hormone preparations such as contraceptive pills (chloasma).

Not to be used in

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- Known, suspected, or past history of breast cancer
- Known or suspected cancer in which growth of the cancer is stimulated by oestrogen, eg cancer of the lining of the womb
- Untreated overgrowth of the lining of the womb (endometrial hyperplasia)
- Vaginal bleeding of unknown cause
- Women with a blood clot in a vein, eg in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism), or a past history of these conditions
- Women who have recently had a stroke caused by a blood clot
- Women who have recently had a heart attack
- Angina pectoris
- Active liver disease
- History of liver disease when liver function has not returned to normal
- Hereditary blood disorders known as porphyrias
- Pregnancy
- Breastfeeding
- Rare hereditary problems of galactose intolerance, fructose intolerance, the Lapp lactase deficiency, glucose-galactose malabsorption or sucrase-isomaltase insufficiency (Premarin tablets contain lactose and sucrose).

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

- This medicine should not be used by women who are pregnant or breastfeeding. You should stop taking this medicine and consult your doctor immediately if you get pregnant during treatment.
- A woman is considered fertile for two years after her last menstrual period if she is under 50, or for one year if over 50. HRT does not provide contraception for women who fall within this group. If you could get pregnant while taking this HRT, you should use a non-hormonal method of contraception (eg condoms or contraceptive foam). Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine.

- Breakthrough bleeding and spotting
- Breast pain, tenderness or enlargement
- Headache/migraine
- Gut disturbances, such as nausea, abdominal pain, bloating, flatulence, indigestion
- Leg cramps
- Fatigue
- Weight changes
- Vaginal thrush
- Depression
- Anxiety
- Dizziness
- Changes in sex drive
- Rise in blood pressure
- Gall bladder disease
- Swelling of the ankles due to to fluid retention (peripheral oedema)
- Skin reactions such as rash and itch
- Steepening of corneal curvature which may make contact lenses uncomfortable.
- Premenstrual-like symptoms
- Disturbance in liver function
- Irregular brown patches on the skin, usually of the face (chloasma)
- Blood clots in the blood vessels (eg, DVT, pulmonary embolism, heart attack, stroke - see warnings above)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer. . For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.