Premarin and Associated Medications

Premarin® is an estrogen replacement therapy (ERT) for women.  Premarin is similar to the medications Premphase and Prempro, all of which are manufactured by Wyeth Pharmaceuticals.  Estrogen replacement therapy is used to treat moderate to severe symptoms of menopause and osteoporosis.  Some symptoms of menopause include hot flashes, night sweats, and vaginal dryness.  Because of the often severe effects of menopause, these medications have become incredibly popular.  In 2001 alone, over twenty-two (22) million prescriptions for Prempro were written.

Premarin® is a vaginal cream that is usually prescribed for women who have had a hysterectomy.  In some cases the hysterectomy includes the removal of the ovaries, which causes the immediate loss of estrogen in the body.  Loss of estrogen can trigger symptoms of menopause, including vaginal dryness, atrophy, and reduced libido.  Premarin is prescribed to help restore vaginal tissue and pH levels (reducing the risk of infection), reduce other menopause-related symptoms, and increase libido.  Premarin is also prescribed to treat and prevent osteoporosis.

Premphase^® is similar in effect to Premarin, however, it is a hormone replacement therapy composed of both estrogen and progestin.  It is specifically indicated for moderate to severe vasomotor symptoms, including hot flashes, night sweats, and vaginal dryness.  These are symptomatic of menopause.  Additionally, Premphase is also prescribed to treat/prevent osteoporosis.  Premphase contains progestin because the danger of uterine lining overgrowth is much greater with estrogen therapy alone.  This overgrowth can result in cancer.  Therefore, Premphase is prescribed specifically for women who have not had a hysterectomy because of the reduced risk of uterine cancer.

Prempro™, a hormone replacement therapy composed of estrogens and progestin, is similar in effect to Premphase.  It is also prescribed specifically for women who have not had a hysterectomy. As with Premphase, Prempro is used to treat moderate to severe symptoms of menopause, vaginal dryness, and for the treatment/prevention of osteoporosis.

Understanding Hormone Replacement Therapy (HRT)

Hormone replacement therapy is descriptively named.  HRT replaces hormones that are no longer produced by a woman's ovaries.  This can occur as a result of either a medical problem or from the removal of the ovaries.  Estrogen and progesterone levels are affected in these circumstances.  HRT medications are used in these cases to 'replenish' the depleted hormones.  The goal is to bring the hormone levels in the human body back to a state of equilibrium or as close to that state as possible.  The hope is that the medical problem or side-effects of surgical removal of the ovaries and uterus will be minimized.

Risk of Hormone Replacement Therapy and with Premarin and Related Medications Use

Premarin®, Premphase^®, and Prempro™ use is not without side-effects. Estrogen, a component of these medications, increases the risk of uterine cancer. While Premarin contains only estrogen, Prempro and Premphase contain progestin.  The cancer risk is reduced with the addition of progesterone/progestin, a component of both Premphase^® and Prempro™.  To reduce the cancer risk associated with Premarin use a progestin can be administered simultaneously with Premarin.  Unfortunately progestin can cause blood sugar level abnormalities that may worsen a diabetic condition.  This is of concern with the use of Premphase, Prempro, and Premarin administered with progestin.

As previously stated, women who have had a hysterectomy (removal of the uterus) have no risk of uterine cancer.  Women who are prescribed Premarin should be extremely careful if they have not had a hysterectomy.  Women also should not use Premarin, or should be under close physician care, if they have a history of abnormal vaginal bleeding, abnormal blood clotting, cancer (breast or uterine), or heart disease.  Pregnant women should avoid Premarin use.  Women should also not take Prempro or Premphase if they have a history of liver disease or have had a stroke.  There are also side effects to the use of these medications which must be considered.

General detrimental side effects of Premarin/Prempro/Premphase use include:

• Abdominal pain
• Blood clots
• Blood sugar abnormality - may worsen a diabetic condition (only with Prempro and Premphase)
• Breast cancer, Increased risk of
• Coronary heart disease, Increased risk of
• Hair loss
• Headache
• Irregular vaginal bleeding
• Nausea
• Pulmonary embolism, Increased risk of
• Stroke, Increased risk of
• Tenderness of the breasts
• Vaginal irritation

Detrimental effects of the medication can begin appearing within 1 to 2 years.  Generally, the risk of breast cancer risk begins to increase in the third year of treatment.

To a more specific degree the National Heart, Lung, and Blood Institute (NHLBI) researched the safety of Prempro™ use and determined that the medication is not safe when compared to the potential benefits.  The study, scheduled to last eight (8) years, was halted after only five (5) years.  The halting of research, based on harm to persons taking Prempro, underlies current discussions of the safety of hormone replacement therapy in general.  The NHLBI determined that the detrimental side effects of Prempro include:

• a 22 percent increase in total cardiovascular disease.
• a 26 percent increase in breast cancer.
• a 29 percent increase in heart attacks.
• a 37 percent reduction in cases of colorectal cancer.
• a 41 percent increase in strokes.
• a doubling of rates of venous thromboembolism (blood clots).

Beneficial side effects of Prempro use indicated by the National Heart, Lung, and Blood Institute (NHLBI) study include:

• no difference in total mortality (of all causes).
• a reduction in the risk of colorectal cancer.
• a 24 percent reduction in total fractures.
• a 33 percent reduction in hip fracture rates.

Use of Premarin®/Prempro™/Premphase® may lead to any number of the above detrimental effects.  These may occur due to incomplete consideration of one's medical history, lack of understanding of the nature of the medications, or negligence in relation to patient safety.

If you have been administered Premarin®/Prempro™/Premphase® and need assistance with an injury related to that use, please contact us for further contact us for further information.

LINKS	DESCRIPTION
Wyeth Pharmaceuticals	The manufacturer of Premarin.
Premarin® Product Site	Information about Premarin from Wyeth.
Information about Premarin, a conjugated estrogen	Information about Premarin from the Food and Drug Administration (FDA), including medical and clinical reviews.
Information about conjugated estrogens	General information from the FDA about the family of conjugated estrogens.
FDA Statement on Generic Premarin	Statement on the use of the generic form of Premarin
NLHBI Statement on Prempro Research Studies	The National Heart Lung and Blood Institute (NHLBI) Stops Trial of Estrogen Plus Progestin Due to Increased Breast Cancer Risk, Lack of Overall Benefit (part of the National Institutes of Health)
Medline from the National Institutes of Health(NIH)	Medline is provided by the National Institutes of Health, National Library of Medicine
Information on Premarin from Medline (Locate on List)	Information from Medline about Premarin.
Premarin MedMaster- Estrogen USP DI- Estrogens (Vaginal) USP DI- Estrogens (Systemic) Premarin Intravenous USP DI- Estrogens (Systemic) Premarin with Methyltestosterone USP DI- Androgens and Estrogens (Systemic) Premphase MedMaster- Estrogen and Progestin (Hormone Replacement Therapy USP DI- Conjugated Estrogens and Medroxyprogesterone For Ovarian Hormone Therapy (OHT) (Systemic) Prempro MedMaster- Estrogen and Progestin (Hormone Replacement Therapy) USP DI- Conjugated Estrogens and Medroxyprogesterone For Ovarian Hormone Therapy (OHT) (Systemic)	Information from Medline about Premarin and some related therapies/treatments. Information from Medline about Premarin and some related therapies/treatments. Information from Medline about Premarin and some related therapies/treatments. Information from Medline about Premarin and some related therapies/treatments.
InteliHealth - Premarin	Searchable directory from InteliHealth, an Aetna Company.
Researchers: HRT Risks Outweigh Benefits	News article discussing risks of HRT
Stop Taking Prempro, Doctors Warn	WebMD article discussing Prempro dangers.
Hormone Therapy Carries Serious Risks	Information about hormone therapy from ABCNews.
Government Halts Hormone Therapy Study	Information about government funding of hormone replacement therapy from ABCNews.
Due to risks, hormone trial halted	Information about the halting of hormone replacement therapy from MSNBC.
Are There Any Side Effects Of A Hysterectomy?	Are There Any Side Effects Of A Hysterectomy?