Premarin Vaginal Cream contains a mixture of estrogen hormones. Estrogen is a female sex hormone produced by the ovaries. Estrogen is necessary for many processes in the body. Conjugated estrogens are a mixture of estrogen hormones.

Premarin Vaginal Cream is used in the vagina to treat the vaginal symptoms of menopause such as dryness, burning, irritation, and painful sexual intercourse.

Premarin Vaginal may also be used for purposes not listed in this medication guide.

Do not use Premarin Vaginal Cream if you are pregnant.

You should not use Premarin Vaginal Cream if you have: undiagnosed vaginal bleeding, liver disease, a bleeding disorder, if you will be having major surgery, or if you have ever had a heart attack, a stroke, a blood clot, or cancer of the breast, uterus/cervix, or vagina.

Use Premarin Vaginal may increase your risk of developing a condition that may lead to uterine cancer. Report any unusual vaginal bleeding right away.

Using this medicine can increase your risk of blood clots, stroke, or heart attack, or cancer of the breast, uterus, or ovaries. Estrogen should not be used to prevent heart disease, stroke, or dementia.

Before taking this medicine

You should not use Premarin Vaginal Cream if you have:

• unusual vaginal bleeding that has not been checked by a doctor;

• liver disease;

• a history of heart attack, stroke, or blood clot;

• an increased risk of having blood clots due to a heart problem or a hereditary blood disorder; or

• a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina.

Do not use Premarin Vaginal if you are pregnant. Use effective birth control if you are not past menopause. Tell your doctor if you think you may be pregnant.

Premarin Vaginal Cream can weaken the latex of a condom, diaphragm, or cervical cap. Talk to your doctor about the best birth control methods to use.

Using Premarin Vaginal can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke.

Estrogen should not be used to prevent heart disease, stroke, or dementia, because this medicine may actually increase your risk of developing these conditions.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• a hysterectomy;

• heart disease;

• liver problems, or jaundice caused by pregnancy or taking hormones;

• kidney disease;

• gallbladder disease;

• asthma;

• epilepsy or other seizure disorder;

• migraines;

• lupus;

• endometriosis or uterine fibroid tumors;

• hereditary angioedema;

• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);

• a thyroid disorder; or

• high levels of calcium in your blood.

Use of Premarin Vaginal may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.

Estrogen lowers the hormone needed to produce breast milk and can slow breast milk production. Tell your doctor if you are breast-feeding.

This medicine is not approved for use by anyone younger than 18 years old.

Use Premarin Vaginal cream exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Conjugated estrogens may increase your risk of developing a condition that may lead to uterine cancer. Your doctor may prescribe a progestin to take while you are using Premarin Vaginal Cream, to help lower this risk. Report any unusual vaginal bleeding right away.

To apply Premarin Vaginal Cream, use only the vaginal applicator provided. After each use, take the applicator apart and clean it with mild soap and warm water. Do not use hot or boiling water.

Your doctor should check your progress on a regular basis to determine whether you should continue this treatment. Self-examine your breasts for lumps on a monthly basis, and have regular mammograms.

If you need major surgery or will be on long-term bed rest, you may need to stop using this medicine for a short time. Any doctor or surgeon who treats you should know that you are using vaginal Premarin Vaginal.

Store at room temperature away from moisture and heat.

You should not use Premarin Vaginal Cream if you have:

• unusual vaginal bleeding that has not been checked by a doctor;

• liver disease;

• a history of heart attack, stroke, or blood clot;

• an increased risk of having blood clots due to a heart problem or a hereditary blood disorder; or

• a history of hormone-related cancer, or cancer of the breast, uterus/cervix, or vagina.

Do not use Premarin Vaginal if you are pregnant. Use effective birth control if you are not past menopause. Tell your doctor if you think you may be pregnant.

Premarin Vaginal Cream can weaken the latex of a condom, diaphragm, or cervical cap. Talk to your doctor about the best birth control methods to use.

Using Premarin Vaginal can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, if you are overweight, or if you smoke.

Estrogen should not be used to prevent heart disease, stroke, or dementia, because this medicine may actually increase your risk of developing these conditions.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• a hysterectomy;

• heart disease;

• liver problems, or jaundice caused by pregnancy or taking hormones;

• kidney disease;

• gallbladder disease;

• asthma;

• epilepsy or other seizure disorder;

• migraines;

• lupus;

• endometriosis or uterine fibroid tumors;

• hereditary angioedema;

• porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);

• a thyroid disorder; or

• high levels of calcium in your blood.

Use of Premarin Vaginal may increase your risk of cancer of the breast, uterus, or ovaries. Talk with your doctor about this risk.

Estrogen lowers the hormone needed to produce breast milk and can slow breast milk production. Tell your doctor if you are breast-feeding.

This medicine is not approved for use by anyone younger than 18 years old.

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include drowsiness, vomiting, stomach pain, breast pain, or vaginal bleeding.

Avoid smoking. It can greatly increase your risk of blood clots, stroke, or heart attack while using Premarin Vaginal.

Get emergency medical help if you have signs of an allergic reaction to Premarin Vaginal: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• heart attack symptoms - chest pain or pressure, pain spreading to your jaw or shoulder, nausea, sweating;

• signs of a stroke - sudden numbness or weakness (especially on one side of the body), sudden severe headache, slurred speech, problems with vision or balance;

• signs of a blood clot - sudden vision loss, stabbing chest pain, feeling short of breath, coughing up blood, pain or warmth in one or both legs;

• swelling or tenderness in your stomach;

• jaundice (yellowing of the skin or eyes);

• memory problems, confusion, unusual behavior;

• unusual vaginal bleeding, pelvic pain;

• a lump in your breast; or

• high levels of calcium in your blood - nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, lack of energy.

Common Premarin Vaginal side effects may include:

• headache;

• pelvic pain;

• flushing (warmth, redness, or tingly feeling);

• breast pain; or

• vaginal itching or discharge, changes in your menstrual periods, breakthrough bleeding.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Sometimes it is not safe to use certain medications at the same time. Some drugs can affect your blood levels of other drugs you take, which may increase side effects or make the medications less effective.

Many drugs can interact with conjugated estrogens. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide. Tell your doctor about all your current medicines and any medicine you start or stop using.