Premarin
Conjugated estrogens are used for treating the symptoms of menopause including hot flashes, vaginal dryness, and vaginal atrophy. They also are used as therapy when the body does not produce enough estrogen due to castration, ovarian failure or underdevelopment of hormone-secreting organs (hypogonadism). Conjugated estrogens also may be beneficial in treating advanced prostate and breast cancer. Although estrogens are approved for treating osteoporosis, other drugs usually are prescribed for this purpose.
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Direction
Tablets: 0.3, 0.45, 0.625, 0.9, and 1.25 mg. To minimize side effects, the lowest effective oral dose of conjugated estrogens is used. The usual starting dose for treating symptoms associated with menopause and for preventing postmenopausal osteoporosis is 0.3 mg/day. The dose should be increased based on the response of patients' symptoms.
Hypogonadism is treated with doses of 0.3 mg or 0.625 daily with a cyclical interval of three weeks on treatment followed by one week off treatment. The dose for women who have been castrated or have ovarian failure is 1.25 mg daily in a cyclical interval of three weeks on treatment and one week off treatment. (In reality, most women take estrogens continuously since during the week off treatment, symptoms return because of the lack of estrogen.) For treatment of breast cancer the recommended dose is 10 mg daily for three months.
Side Effect
The most common side effects of conjugated estrogens are headache, nausea, back pain, joint pain and vaginal bleeding. Patients may also experience vaginal spotting, loss of periods or excessively prolonged periods, breast pain, breast enlargement and an increase or decrease in sexual drive. Effects of estrogen on the skin include rash, and melasma (tan or brown patches) that may develop on the forehead, cheeks, or temples and may persist even after estrogens are stopped. In the eyes, conjugated estrogens may cause an increase in the curvature of the cornea, and patients with contact lenses may develop intolerance to their lenses.
There is an increased risk of cholesterol gallstones among men and women taking estrogens. Estrogens can inhibit the flow of bile from the liver (cholestasis) and uncommonly cause jaundice.
Precaution
There are no restrictions on food, beverages, or activity while taking conjugated estrogens unless your doctor directs otherwise. Estrogens should not be given to pregnant women due to the risk of harm to the fetus. Estrogens are secreted in breast milk and cause unpredictable effects in the infant. They should not be taken by women who are breast-feeding.