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Precautions and Warnings With Conjugated Estrogens Vaginal Cream

Specific Precautions and Warnings With Conjugated Estrogens Vaginal Cream

Warnings and precautions to be aware of prior to using conjugated estrogens vaginal cream include the following:
  • It is important to understand that even though conjugated estrogens vaginal cream is applied vaginally, the hormones in the cream are absorbed into the bloodstream. This means that any of the risks associated with oral estrogen hormone replacement therapy also apply to conjugated estrogens vaginal cream.
  • Studies have shown that estrogen hormone replacement therapy increases the risk of stroke and blood clots in the legs. Before you use the cream, your healthcare provider should make sure you are appropriately treated for any risk factors for blood clots or heart disease, such as high blood pressure, high cholesterol, diabetes, obesity, or smoking.
  • When possible, conjugated estrogens vaginal cream should be stopped four to six weeks before many surgeries in order to help prevent blood clots.
  • Estrogen drugs may increase the risk of breast cancer. Proper screening and monitoring as determined by your healthcare provider, such as yearly mammograms and monthly self breast exams, are recommended.
  • Let your healthcare provider know if you have abnormal vaginal bleeding (such as heavy bleeding or bleeding between periods) while using conjugated estrogens vaginal cream, as this may be a sign of precancerous or cancerous changes in the uterus. Your healthcare provider can perform the necessary tests to rule out cancer. Of course, if you have had a hysterectomy, you are not at risk for uterine cancer.
  • Estrogen drugs seem to increase the risk of dementia. In no case should conjugated estrogens vaginal cream be used to prevent or treat dementia (it is not effective for this use).
  • Women who take estrogens have an increased risk for gallbladder disease.
  • Let your healthcare provider know right away if you notice any vision changes. This can signal a blood clot in the retina, a possible side effect of conjugated estrogens vaginal cream.
  • Conjugated estrogens vaginal cream can cause high blood pressure (hypertension) or high triglycerides in some women. Your healthcare provider should monitor you for these problems.
  • If you have had jaundice (yellowing of the whites of the eyes or skin) due to estrogens or pregnancy, conjugated estrogens vaginal cream could cause similar problems to recur. If this happens, your healthcare provider will probably advise you to stop using conjugated estrogens vaginal cream.
  • If you have an underactive thyroid (hypothyroidism), conjugated estrogens vaginal cream may increase your body's requirement for thyroid hormones. Your healthcare provider should monitor you and adjust the dose of your thyroid medications as necessary.
  • Conjugated estrogens vaginal cream can cause fluid retention. This can cause problems for people with congestive heart failure (CHF) or kidney problems.
  • Conjugated estrogens vaginal cream should be used with caution in people who have low calcium levels in the blood (known medically as hypocalcemia).
  • It is not clear if conjugated estrogens vaginal cream increases the risk of ovarian cancer. Some studies have shown an increased risk, while others have not.
  • The cream can make endometriosis symptoms worse.
  • Conjugated estrogens vaginal cream can interact with a number of different medications (see Drug Interactions With Conjugated Estrogens Vaginal Cream).
  • The cream should not be used during pregnancy (see Premarin Vaginal Cream and Pregnancy).
  • Conjugated estrogens vaginal cream does pass through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to using the cream(see Premarin Vaginal Cream and Breastfeeding).
Last reviewed by: Kristi Monson, PharmD
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