Premarin

Premarin is a hormone replacement therapy (HRT) to help with the symptoms of menopause. It contains the hormone oestrogen, as during the menopause, oestrogen levels in the blood drop as women stop having periods. This drop can cause some unpleasant symptoms such as hot flushes, lower sex drive, vaginal dryness, mood swings and difficulty sleeping. Many women cope with these symptoms on their own, but when they are severe, HRT can help to ease them by balancing the levels of oestrogen, so you can get back to enjoying life. Premarin contains only oestrogen.

Menopause is a natural reaction in the body when the ovaries stop producing eggs. During child-bearing years, the ovaries produce the hormone oestrogen, and as they stop working, the levels of oestrogen in the blood drop. This does not happen suddenly overnight and indeed can take anything from six months to 13 years. Sadly, those who experience unpleasant symptoms during the menopause may suffer from them for some time.

Menopause usually happens sometime between the ages of 45 and 55 – in the UK, the average age is 51. It can happen much earlier however, and this is known as premature menopause which can occur at any age, with no clear explanation why. Sometimes it can be caused by surgery to remove the ovaries, but in other cases, it is simply unexplained.

There are three stages of menopause:

• Peri-menopause: the time when periods become less frequent and lighter, which lasts on average four years;
• Menopause: after the last period, with the average age in the UK being 51;
• Post-menopause: menopause ends one full year after the last period but it usually takes two to five years for symptoms to stop.

The drop in oestrogen levels can leave women more susceptible to certain types of disease such as osteoporosis, which is why it is critical to take care of your health during the menopause, stay active, eat a healthy and varied diet, lose any excess weight, stop smoking and limit your alcohol intake.

The changes in your hormones during all of these various stages of menopause can cause some unpleasant symptoms including:

• Hot flushes;
• Vaginal dryness
• Lower sex drive;
• Night sweats;
• Difficulty sleeping;
• Headaches;
• Anxiety;
• Mood changes;
• Palpitations;
• Joint pain or stiffness;
• Frequent urinary tract infections;
• Reduced muscle mass;
• Weak bones or osteoporosis.

There are plenty of things you can do at home to help ease the symptoms of menopause, for example maintaining an active, healthy lifestyle. Regular exercise (30 minutes of moderate exercise five times a week) can help you to sleep better and improve your mood. Pelvic floor exercise can help with bladder control as you strengthen the muscles required. If you are suffering from hot flushes, take steps to help prevent these such as avoiding possible triggers: spicy foods, caffeine, alcohol etc. Try to keep as cool as possible and dress in layers so you can remove some clothing if you start to feel too warm.

If you are not coping well, you may wish to speak to a doctor about medical treatments. The main treatment for menopause is HRT, which restores the normal levels of oestrogen and progesterone in your blood. There are other remedies such as complementary and herbal medicines or bioidentical hormone therapy, but it is unclear how effective or safe these are, as they are not tested in the same way as conventional medicines. You can also look at topical treatments for vaginal dryness or cognitive behavioural therapy to help with low mood.

HRT comes in different guises – either a combination of oestrogen and progesterone, or just oestrogen. Getting the right type can be a process of trial and error. HRT also comes in different forms: tables, patches, vaginal creams, gels, pessaries and rings. Not all HRT treatments are taken the same way: some are taken continuously while others alter along with your menstrual cycle. One option you can consider is Premarin, an HRT which contains only oestrogen. See below for more information.

Premarin is a hormone replacement therapy (HRT) to help with the symptoms of menopause. It contains the hormone oestrogen, as during the menopause, oestrogen levels in the blood drop as women stop having periods. This drop can cause some unpleasant symptoms such as hot flushes, lower sex drive, vaginal dryness, mood swings and difficulty sleeping. Many women cope with these symptoms on their own, but when they are severe, HRT can help to ease them by balancing the levels of oestrogen, so you can get back to enjoying life. Premarin contains only oestrogen.

Premarin is prescribed for women going through the menopause who are experiencing severe symptoms. Premarin is usually only prescribed to women who no longer have a womb as it contains only oestrogen. However, women who have not had their womb removed can still be prescribed Premarin. There may be circumstances where it is prescribed alongside another treatment which contain progesterone.

Premarin tablets are used to combat moderate to severe hot flushes, treat menopausal changes in and around the vagina and to ward off osteoporosis. Premarin can also be used to treat conditions where a woman’s ovaries do not produce enough oestrogen naturally and to treat the symptoms of certain cancers in both men and women.

With any medication, you should always follow the instructions given to you by your doctor or pharmacist. Premarin comes in tablet form and should be swallowed whole. If you crush or split the tablet, it may affect the way Premarin works. You can take Premarin with or without food.

The usual dose to treat menopausal symptoms is one Premarin tablet a day. There are different doses available and you should take the lowest dose to control your symptoms. The lowest dose is 0.3 mg and this should be your starting dose the first time you take Premarin tablets. If after time this does not seem to control your symptoms, you may need a larger dose.

Below is a list of the various dosages available for Premarin tablets, with each strength colour-coded to help you recognise it easily:

• 0.3 mg: green Premarin tablet;
• 0.45 mg: blue Premarin tablet;
• 0.625 mg: maroon Premarin tablet;
• 0.9 mg: white Premarin tablet;
• 1.25 mg: yellow Premarin tablet.

Take your Premarin tablet at the same time every day. Unlike certain HRTs, there are no tablet-free days when taking Premarin.

If you are not already taking another kind of HRT or you are taking an HRT that does not give you a monthly bleed, you can start your course of Premarin tablets at any time. If you are already taking an HRT that gives you a monthly bleed, you will need to wait until you finish the course of the treatment you are already on and start with Premarin the day after. For osteoporosis, the recommended dose is 0.625 mg a day, but you may be prescribed up to 1.25 mg a day. If you forget to take a Premarin tablet, take the missed tablet as soon as possible but do not take a double dose. If you miss a Premarin tablet, you may experience light bleeding. If you do take a double dose, you may feel sick or have tender breasts and be dizzy, but it is unlikely to cause any serious harm.

As with all medicines, Premarin tablets can cause some side effects, although of course not everyone taking Premarin will get them.

These include:

• Headaches;
• Nausea and vomiting;
• Breast pain;
• Irregular bleeding or spotting;
• Stomach cramps;
• Fluid retention;
• Hair loss;
• Joint pain;
• Changes to your libido;
• Weight changes;
• Vaginal yeast infection;
• Rashes and itching;
• Dizziness.

These side effects should improve with time.

More serious side effects include:

• Increased problems with asthma;
• High blood pressure;
• High blood sugar;
• Liver problems;
• Fibroids;
• Severe allergic reaction.

Some diseases are reported more often in women using HRT compared to those who are not, including:

• Breast cancer;
• Abnormal growth or cancer of the lining of the womb;
• Ovarian cancer;
• Blood clots in the leg veins or lungs;
• Memory loss (dementia);
• Heart disease;
• Stroke.

If any of your side effects are serious or hard to cope with, discuss your treatment with your doctor.

Do not take Premarin tablets if you:

• Are allergic to conjugated oestrogens or any of the other ingredients listed on the pack;
• Have ever had breast cancer or cancer of the lining of the womb;
• Have excessive thickening of the lining of the womb;
• Have unexplained vaginal bleeding;
• Have ever had blood clots on the leg veins or lungs;
• Have angina;
• Have had a stroke
• Have or have had liver disease;
• Are pregnant or breastfeeding.

If you have ever had any of the following, you should talk to your doctor before taking Premarin tablets as they might exacerbate or cause a recurrence of the condition, requiring more frequent check-ups:

• Fibroids
• Growth of womb lining outside your womb or excessive growth in the lining of the womb;
• High blood pressure;
• Kidney disease;
• Fluid retention;
• Gall bladder disease;
• Severe headaches;
• Epilepsy;
• Asthma;
• Low blood calcium levels;
• High levels of fat in your blood;
• A disease which affects your immune system.

Premarin tablets contain the colouring agent E111 (sunset yellow) which can cause allergic reactions.

Always discuss any other medication you are taking with your doctor, including herbal medicines or supplements as some of these may prevent Premarin tablets from working effectively or vice versa. It is particularly important you mention any of the following:

• Anticonvulsants (used for epilepsy);
• Anti-infective (used to treat tuberculosis);
• Antibiotics or antifungal medicines;
• St. John’s Wort or other similar herbal remedies;
• Metyrapone;
• Cimetidine (used for stomach ulcers);
• Dexamethasone.

Drinking grapefruit juice may also affect the way Premarin tablets work.

You can buy Premarin tablets from pharmacies nationwide, including online and supermarket pharmacies.

Premarin is a prescription-only medication, and as such you will need a consultation with a doctor in order to get a prescription for Premarin. This could be your family doctor or any other doctor who will go through a checklist with you to make sure the treatment is the right choice for you and your symptoms. You cannot buy Premarin tablets over the counter without a prescription.

Brazier, Yvette What you need to know about HRT (May 2017) Retrieved from https://www.medicalnewstoday.com/articles/181726.php

Irani, Shirin Consultant Gynaecologist Menopause (2019) Retrieved from https://www.bupa.co.uk/health- information/womens-health/menopause

NHS UK Hormone Replacement Therapy (July 2016) Retrieved from https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/

NHS UK Menopause Treatment (August 2018) Retrieved from https://www.nhs.uk/conditions/menopause/treatment/

Pfizer Pharmaceuticals Premarin (September 2018) Retrieved from http://labeling.pfizer.com/showlabeling.aspx?id=131#PI

Pfizer pharmaceuticals Premarin Package Leaflet (September 2016) Retrieved from https://www.medicines.org.uk/emc/files/pil.2900.pdf