Premarin Side Effects
Generic name: conjugated estrogens
Medically reviewed by Drugs.com. Last updated on Feb 11, 2025.
Note: This document provides detailed information about Premarin Side Effects associated with conjugated estrogens. Some dosage forms listed on this page may not apply specifically to the brand name Premarin.
Applies to conjugated estrogens: oral tablet.
Other dosage forms:
Important warnings
This medicine can cause some serious health issues
Oral route (tablet)
Endometrial Cancer, Cardiovascular Disorders, Breast Cancer and Probable Dementia. Estrogen-Alone Therapy. There is an increased risk of endometrial cancer in a woman with a uterus who uses unopposed estrogens.Estrogen-alone therapy should not be used for the prevention of cardiovascular disease or dementia.Women's Health Initiative estrogen-alone substudy reported increased risks of stroke and deep vein thrombosis.The Women’s Health Initiative Memory Study estrogen-alone ancillary study of Women’s Health Initiative reported an increased risk of probable dementia in postmenopausal women 65 years of age and older.Estrogen Plus Progestin Therapy. Estrogen plus progestin therapy should not be used for the prevention of cardiovascular disease or dementia.The Women’s Health Initiative estrogen plus progestin substudy reported increased risks of stroke, DVT, pulmonary embolism, and myocardial infarction.The Women’s Health Initiative estrogen plus progestin substudy reported increased risks of invasive breast cancer.The Women’s Health Initiative Memory Study estrogen plus progestin ancillary study of Women’s Health Initiative reported an increased risk of probable dementia in postmenopausal women 65 years of age and older.
Precautions
It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly and does not cause unwanted effects. Pelvic exam, breast exam, and mammogram (breast x-ray) may be needed to check for unwanted effects, unless your doctor tells you otherwise.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.
Using large doses of this medicine over a long period of time may increase your risk of heart attack, stroke, blood clots, dementia, breast cancer, or uterine cancer. Talk with your doctor about this risk. If you still have your uterus (womb), ask your doctor if you should also use a progestin medicine.
Your risk of heart disease or stroke from this medicine is higher if you smoke. Your risk is also increased if you have diabetes or high cholesterol, or if you are overweight. Talk with your doctor about ways to stop smoking. Keep your diabetes under control. Ask your doctor about diet and exercise to control your weight and blood cholesterol level.
Tell the medical doctor or dentist in charge that you are using this medicine before any kind of surgery (including dental surgery) or emergency treatment. Your doctor will decide whether you should continue using this medicine.
Using this medicine alone may increase your risk of getting cancer of the uterus (womb). Check with your doctor right away if you have unusual vaginal bleeding while you are using this medicine.
Stop using this medicine and check with your doctor immediately if severe headache or sudden loss of vision or any other change in vision occurs while you are using this medicine. Your doctor may want you to have your eyes checked by an ophthalmologist (eye doctor).
This medicine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, mouth, or throat while you are using this medicine.
Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
Serious side effects of Premarin
Along with its needed effects, conjugated estrogens (the active ingredient contained in Premarin) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking conjugated estrogens:
More common side effects
- heavy non-menstrual vaginal bleeding
Less common side effects
- body aches or pain
- chills
- cough
- difficulty with breathing
- ear congestion
- fever
- headache
- loss of voice
- nasal congestion
- runny nose
- sneezing
- sore throat
- unusual tiredness or weakness
Incidence not known
- abdominal or stomach pain and tenderness
- acid or sour stomach
- anxiety
- backache
- belching
- bloody stools
- blurred vision
- breast tenderness, enlargement, pain, or discharge
- change in vaginal discharge
- change in vision
- changes in skin color
- chest pain or discomfort
- clay-colored stools
- clear or bloody discharge from the nipple
- confusion
- constipation
- dark urine
- diarrhea
- difficulty with speaking
- dimpling of the breast skin
- dizziness or lightheadedness
- double vision
- fainting
- fast heartbeat
- full or bloated feeling or pressure in the stomach
- headache, severe and throbbing
- heartburn
- hives
- hoarseness
- inability to move the arms, legs, or facial muscles
- inability to speak
- indigestion
- inverted nipple
- irritation
- itching
- joint pain, stiffness, or swelling
- loss of appetite
- lump in the breast or under the arm
- migraine headache
- nausea
- pain or discomfort in the arms, jaw, back, or neck
- pain or feeling of pressure in the pelvis
- pain, redness, or swelling in the arm or leg
- pain, tenderness, or swelling of the foot or leg
- painful or tender cysts in the breasts
- pains in the stomach, side, or abdomen, possibly radiating to the back
- persistent crusting or scaling of the nipple
- poor insight and judgment
- problems with memory or speech
- rash
- rectal bleeding
- redness of the skin
- redness or swelling of the breast
- shortness of breath
- slow speech
- sore on the skin of the breast that does not heal
- stomach discomfort or upset
- sudden shortness of breath or troubled breathing
- sweating
- swelling of the abdominal or stomach area
- swelling of the eyelids, face, lips, hands, or feet
- tightness in the chest
- trouble recognizing objects
- trouble thinking and planning
- trouble walking
- troubled breathing or swallowing
- unpleasant breath odor
- vaginal bleeding
- vomiting
- vomiting of blood
- wheezing
- yellow eyes or skin
Other side effects of Premarin
Some side effects of conjugated estrogens may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common side effects
- back pain
- excess air or gas in the stomach or intestines
- itching of the vagina or genital area
- lack or loss of strength
- pain during sexual intercourse
- passing gas
- thick, white vaginal discharge with no odor or with a mild odor
Less common side effects
- increased clear or white vaginal discharge
- leg cramps
Incidence not known
- blistering, peeling, or loosening of the skin
- cramps
- decreased interest in sexual intercourse
- diarrhea
- difficulty with moving
- heavy bleeding
- hives or welts
- inability to have or keep an erection
- increased hair growth, especially on the face
- increased in sexual ability, desire, drive, or performance
- increased interest in sexual intercourse
- irritability
- itching of the vagina or outside genitals
- joint or muscle pain
- loss in sexual ability, desire, drive, or performance
- loss of scalp hair
- mental depression
- mood changes
- muscle stiffness
- pain
- pain during sexual intercourse
- pain in the ankles or knees
- painful, red lumps under the skin, mostly on the legs
- patchy brown or dark brown discoloration of the skin
- rash
- red, irritated eyes
- sores, ulcers, or white spots in the mouth or on the lips
- swelling of the breasts or breast soreness in both females and males
- thick, white curd-like vaginal discharge without odor or with mild odor
- unexpected or excess milk flow from the breasts
- weight changes
For healthcare professionals
Applies to conjugated estrogens: injectable powder for injection, oral tablet, vaginal cream.
Cardiovascular adverse events
- Common (1% to 10%): Hypertension, palpitation, vasodilation
- Rare (less than 0.1%): Stroke
- Postmarketing reports: Deep and superficial venous thrombosis, pulmonary embolism, thrombophlebitis, myocardial infarction, stroke[Ref]
HRT is associated with a 1.3 to 3-fold increased relative risk of developing VTE, i.e., deep vein thrombosis or pulmonary embolism. This event is more likely to occur in the first year of using HRT.
The use of estrogen-only and estrogen-progestin therapy is associated with an up to 1.5 fold increased relative risk of ischemic stroke.
The risk of hemorrhagic stroke is not increased during use of HRT. This relative risk is not dependent on age or on duration of use, but as the baseline risk is strongly age-dependent, the overall risk of stroke in women who use HRT will increase with age.[Ref]
Dermatologic
- Common (1% to 10%): Acne, alopecia, hirsutism, pruritus, rash, skin discoloration, sweating, fungal dermatitis
- Postmarketing reports: Chloasma or melasma (may persist when drug is discontinued), erythema multiforme, erythema nodosum, loss of scalp hair[Ref]
Gastrointestinal
- Common (1% to 10%): Constipation, diarrhea, dyspepsia, eructation, flatulence, nausea
- Uncommon (0.1% to 1%): Bloating, abdominal pain
- Postmarketing reports: Vomiting, abdominal discomfort, abdominal distension[Ref]
Genitourinary
- Common (1% to 10%): Pelvic pain, breast disorder, breast enlargement, breast neoplasm, breast pain, cervix disorder, dysmenorrhea, endometrial disorder, endometrial hyperplasia, leukorrhea, metrorrhagia, urinary tract infection, uterine fibroids enlarged, uterine spasm, abnormal uterine bleeding (breakthrough bleeding/spotting), vaginal dryness, vaginal hemorrhage, vaginal moniliasis, vaginitis
- Uncommon (0.1% to 1%): Vaginal candidiasis, changes in menstrual flow, changes in cervical ectropion and secretion
- Postmarketing reports: Increases in seize of uterine leiomyomata, change in cervical secretion, ovarian cancer, endometrial cancer, breast tenderness, breast discharge, galactorrhea, fibrocystic breast changes, breast cancer, gynecomastia in males[Ref]
Metabolic
- Common (1% to 10%): Hyperlipidemia, weight gain, increased appetite
- Very rare (less than 0.01%): Hypocalcemia
- Postmarketing reports: Increase or decrease in weight, glucose intolerance, aggravation of porphyria, increased triglycerides[Ref]
Musculoskeletal
- Common (1% to 10%): Back pain, arthralgia, leg cramps, myalgia, muscle spasm[Ref]
Nervous system
- Common (1% to 10%): Headache, dizziness, paresthesia, migraine, hypertonia, insomnia, nervousness
- Very rare (less than 0.01%): Exacerbation of chorea
- Postmarketing reports: Exacerbation of epilepsy, dementia[Ref]
Other
- Common (1% to 10%): Accidental injury, asthenia, chills, flu syndrome, pain, edema, peripheral edema, generalized edema, moniliasis
- Postmarketing reports: Irritability[Ref]
Psychiatric
- Common (1% to 10%): Depression, emotional liabilities, anxiety
- Uncommon (0.1% to 1%): Changes in libido, mood disturbances[Ref]
Respiratory
- Common (1% to 10%): Chest pain, bronchitis, increased cough, pharyngitis, rhinitis, sinusitis, upper respiratory tract infection
- Postmarketing reports: Exacerbation of asthma[Ref]
Hepatic
- Uncommon (0.1% to 1%): Gallbladder disease
- Postmarketing reports: Cholestatic jaundice, pancreatitis, enlargement of hepatic hemangiomas, ischemic colitis[Ref]
Hypersensitivity
- Uncommon (0.1% to 1%): Hypersensitivity
- Rare (less than 0.1%): Anaphylactic/anaphylactoid reactions including urticaria and angioedema[Ref]
Ocular
- Uncommon (0.1% to 1%): Intolerance to contact lenses, steepening of corneal curvature
- Postmarketing reports: Retinal vascular thrombosis[Ref]
Oncologic
- Rare (0.01% to 0.1%): Breast cancer, ovarian cancer, fibrocystic breast changes, growth potentiation of benign meningioma.
- Very rare (less than 0.01%): Endometrial cancer, enlargement of hepatic hemangiomas[Ref]
Breast cancer:
An up to 2-fold increased risk of having breast cancer diagnosed is reported in women taking combined estrogen-progestin therapy for more than 5 years.
Any increased risk in users of estrogen-only therapy is substantially lower than that seen in users of estrogen-progestin combinations. The level of risk is dependent on the duration of use.
Endometrial Cancer:
Endometrial cancer risk is about 5 in every 1000 women with a uterus not using HRT.
In women with a uterus, use of estrogen-only HRT is not recommended because it increases the risk of endometrial cancer.
Depending on the duration of estrogen-only use and estrogen dose, the increase in risk of endometrial cancer varied from between 5 and 55 extra cases diagnosed in every 1000 women between the ages of 50 and 65.
Adding a progestin to estrogen-only therapy for at least 12 days per cycle can prevent this increased risk. In the Million Women Study the use of five years of combined HRT did not increase risk of endometrial cancer.
Ovarian cancer:
Long-term use of estrogen-only and combined estrogen-progestin HRT has been associated with a slightly increased risk of ovarian cancer. In the Million Women Study 5 years of HRT resulted in 1 extra case per 2500 users.[Ref]
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Premarin side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.
