Risk of cancer of the uterine lining
Premarin contains estrogen. If you still have your uterus, taking estrogen without a progestogen can cause the uterine lining to become too thick. This condition is called endometrial hyperplasia, and it may increase the risk of endometrial cancer.
Your healthcare provider may prescribe a progestogen along with Premarin to help protect the uterine lining. However, adding a progestogen has its own possible risks, so your treatment must be based on your individual medical history.
Tell your healthcare provider promptly if you experience unusual vaginal bleeding or spotting. This is especially important if you have already gone through menopause.
Unusual bleeding may include:
- Bleeding or spotting after menopause
- Bleeding between menstrual periods
- Bleeding that is heavier or lasts longer than expected
- Bleeding that returns after being absent
Unusual vaginal bleeding does not always mean that you have cancer. However, your healthcare provider should investigate the cause. Tests may include a pelvic examination, ultrasound, or a sample of tissue from the uterine lining.
Skin darkening and melasma
Premarin may cause dark or blotchy patches to appear on the face or other areas of the skin. This condition is called melasma or chloasma.
Melasma commonly develops on the cheeks, forehead, upper lip, or nose. Sunlight and ultraviolet light can make the patches darker or more noticeable.
To help protect your skin:
- Limit prolonged exposure to direct sunlight.
- Avoid tanning beds and sunlamps.
- Wear a hat and protective clothing outdoors.
- Use a broad-spectrum sunscreen.
- Reapply sunscreen as directed, especially after swimming or sweating.
Skin darkening is usually not dangerous, but it may not disappear completely after treatment ends. Speak with your healthcare provider if the changes are severe, bothersome, or accompanied by other unusual skin symptoms.
Smoking and nicotine use
Smoking while taking estrogen may further increase your risk of serious heart and blood vessel problems. These may include blood clots, stroke, heart attack, and high blood pressure.
The risk may be greater if you are older than 35 or have other risk factors, such as:
A personal or family history of blood clots
- High blood pressure
- High cholesterol
- Diabetes
- Obesity
- Migraine with aura
- Limited mobility
- Previous stroke or heart attack
Tell your healthcare provider if you smoke cigarettes, vape nicotine, or use other nicotine products. They can explain your individual risks and help you find support to stop smoking.
Premarin does not prevent heart disease
Do not use Premarin to prevent heart disease, a heart attack, or a stroke. Hormone therapy has not been shown to protect against these conditions.
Studies of postmenopausal women found that estrogen taken alone increased the risks of stroke and deep vein thrombosis. A deep vein thrombosis is a blood clot that usually develops in a deep vein in the leg. The clot can travel to the lungs and cause a pulmonary embolism, which can be life-threatening.
Estrogen combined with a progestogen has also been associated with increased risks of heart attack, stroke, blood clots, and breast cancer. The exact level of risk varies according to factors such as your age, health, dose, and length of treatment.
Seek immediate medical attention if you develop possible symptoms of a blood clot, heart attack, or stroke, including:
- Pain, redness, warmth, or swelling in one leg
- Sudden chest pain
- Sudden shortness of breath
- Coughing up blood
- A sudden severe headache
- Sudden difficulty speaking or understanding speech
- Sudden weakness or numbness, especially on one side of the body
- Sudden vision loss or changes in vision
- Fainting or severe dizziness
Premarin does not prevent dementia
Do not use Premarin to prevent memory loss, cognitive decline, or dementia.
Studies found a higher risk of probable dementia in women aged 65 and older who took estrogen alone. Estrogen combined with a progestogen was also associated with a higher risk of probable dementia in women aged 65 and older.
It is not known whether these findings apply in the same way to younger postmenopausal women. However, Premarin should not be prescribed specifically to protect memory or prevent dementia.
Use the lowest effective dose
Hormone therapy should be individualized. Your healthcare provider will consider your symptoms, age, medical history, risk factors, and treatment goals before prescribing Premarin.
Premarin should generally be used at the lowest dose that controls your symptoms and for the shortest period appropriate for your needs. However, some patients may need longer treatment after discussing the benefits and risks with their healthcare provider.
Attend regular follow-up appointments. Your healthcare provider may review your blood pressure, breast health, vaginal bleeding, treatment response, and ongoing need for hormone therapy.
Do not increase your dose, stop treatment, or add a progestogen without speaking with your healthcare provider.
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