Estrogen loss due to menopause causes changes in the vaginal tissue, which result in an increase in vaginal pH2,5,6
PREMARIN Vaginal Cream Important Safety Information
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There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens. Adding a progestin to estrogen therapy has been shown to reduce the risk of endometrial hyperplasia, which may be a precursor to endometrial cancer. Adequate diagnostic measures, including directed or random endometrial sampling when indicated, should be undertaken to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding.
Estrogens with or without progestins should not be used for the prevention of cardiovascular disease or dementia.
The Women’s Health Initiative (WHI) estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis (DVT) in postmenopausal women (50 to 79 years of age) during 7.1 years of treatment with daily oral conjugated estrogens (CE) [0.625 mg], relative to placebo.
The WHI Memory Study (WHIMS) estrogen-alone ancillary study of WHI reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 5.2 years of treatment with daily CE (0.625 mg) alone, relative to placebo. It is unknown whether this finding applies to younger postmenopausal women.
In the absence of comparable data, these risks should be assumed to be similar for other doses of CE and other dosage forms of estrogens.
Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.
The WHI estrogen plus progestin substudy reported increased risks of DVT, pulmonary embolism, stroke and myocardial infarction in postmenopausal women (50 to 79 years of age) during 5.6 years of treatment with daily oral CE (0.625 mg) combined with medroxyprogesterone acetate (MPA) [2.5 mg], relative to placebo.
The WHIMS estrogen plus progestin ancillary study of the WHI, reported an increased risk of developing probable dementia in postmenopausal women 65 years of age or older during 4 years of treatment with daily CE (0.625 mg) combined with MPA (2.5 mg), relative to placebo. It is unknown whether this finding applies to younger postmenopausal women.
The WHI estrogen plus progestin substudy also demonstrated an increased risk of invasive breast cancer.
In the absence of comparable data, these risks should be assumed to be similar for other doses of CE and MPA, and other combinations and dosage forms of estrogens and progestins.
PREMARIN Vaginal Cream therapy should not be used in women with any of the following conditions: undiagnosed abnormal genital bleeding; known, suspected, or a history of breast cancer; known or suspected estrogen-dependent neoplasia; active deep vein thrombosis, pulmonary embolism or a history of these conditions; active arterial thromboembolic disease (for example, stroke, and myocardial infarction), or a history of these conditions; known liver dysfunction or disease; known thrombophilic disorders; known or suspected pregnancy.
In a prospective, randomized, placebo-controlled, double-blind study, the most common adverse reactions (≥5%) were headache, infection, abdominal pain, back pain, accidental injury, and vaginitis.
PREMARIN Vaginal Cream is indicated for the treatment of atrophic vaginitis and kraurosis vulvae and for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy, due to menopause.Please see Full Prescribing and Patient Information, including boxed warning.
References: 1. Bachmann G, Bouchard C, Hoppe D, et al. Efficacy and safety of low-dose regimens of conjugated estrogens cream administered vaginally. Menopause. 2009;16(4):719-727. 2. Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Phys. 2000;61(10):3090-3096. 3. Data on file, Pfizer Inc. 4. Dorr MB, Nelson AL, Mayer P, et al. Plasma estrogen concentrations after oral and vaginal estrogen administration in women with atrophic vaginitis. Fertil Steril. 2010;94(6):2365-2368. 5. Lynch C. Vaginal estrogen therapy for the treatment of atrophic vaginitis. J Women's Health. 2009;18(10):1595-1606. 6. Pandit L, Ouslander J. Postmenopausal vaginal atrophy and atrophic vaginitis. Am J Med Sci. 1997;314(4):228-231. 7. Wyeth Pharmaceuticals Inc. REVEAL: Revealing Vaginal Effects At mid-Life: surveys of postmenopausal women and health care professionals who treat postmenopausal women. REVEAL Website. Published May 2009. Accessed August 24, 2010.