Premarin is a brand-name conjugated estrogen medication used to treat menopausal symptoms like hot flashes and vaginal dryness, and to prevent osteoporosis after menopause.

Whether your doctor just mentioned Premarin or you're researching it on your own, this guide covers everything you need to know — what it is, what it's used for, how to take it, who should avoid it, and how much it costs in 2026.

What Is Premarin?

Premarin is a hormone replacement therapy (HRT) medication that contains conjugated estrogens — a mixture of estrogens derived from pregnant mares' urine (the name "Premarin" comes from pregnant mares' urine).

Here are the basics:

• Generic name: Conjugated Estrogens
• Drug class: Conjugated estrogens / Hormone replacement therapy
• Manufacturer: Pfizer (originally Wyeth-Ayerst)
• FDA approved: Yes — Premarin is one of the oldest and most studied HRT medications
• Controlled substance: No — Premarin is not a controlled substance

The first generic version of Premarin tablets was approved in November 2025 by Ingenus Pharmaceuticals, available in all five tablet strengths (0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, and 1.25 mg).

What Is Premarin Used For?

Premarin is FDA-approved for several conditions:

Menopause Symptoms

• Hot flashes (vasomotor symptoms) — the most common reason Premarin is prescribed
• Vaginal dryness, itching, and burning (vulvar and vaginal atrophy)

Osteoporosis Prevention

Premarin helps prevent bone loss in postmenopausal women. It's typically considered when other medications aren't appropriate.

Other Approved Uses

• Treatment of low estrogen levels due to hypogonadism, castration, or primary ovarian insufficiency
• Palliation of breast cancer in certain patients with metastatic disease
• Palliation of advanced prostate cancer
• Abnormal uterine bleeding due to hormonal imbalance (injection form)

Off-Label Uses

Some doctors prescribe Premarin off-label for gender-affirming hormone therapy in transgender women and for managing certain urinary incontinence symptoms.

How Is Premarin Taken?

Premarin comes in three forms:

Oral Tablets

• Strengths: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, 1.25 mg
• How to take: One tablet daily, with or without food, at the same time each day
• Typical dose: 0.3 mg to 1.25 mg daily, depending on symptoms

Vaginal Cream

• Strength: 0.625 mg per gram
• How to use: Applied intravaginally using the provided applicator
• Typical dose: 0.5 g to 2 g, usually on a cyclic schedule (21 days on, 7 days off)

Injection

• Strength: 25 mg vial
• How used: Administered by a healthcare provider, typically for acute uterine bleeding

The general guidance: use the lowest effective dose for the shortest duration needed. Your doctor will start you on a low dose and adjust based on how you respond.

Who Should Not Take Premarin?

Premarin is not safe for everyone. You should not take Premarin if you have:

• Undiagnosed abnormal vaginal bleeding
• Known or suspected breast cancer (or a history of it)
• Known or suspected estrogen-dependent tumors
• Active blood clots (deep vein thrombosis or pulmonary embolism) or a history of them
• Recent stroke or heart attack
• Liver disease or dysfunction
• Known protein C, protein S, or antithrombin deficiency (blood clotting disorders)
• Known or suspected pregnancy (Category X — can cause birth defects)
• Allergy to conjugated estrogens or any ingredient in Premarin

Important: If you still have your uterus, you must take a progestin along with Premarin to reduce the risk of endometrial cancer. Your doctor will prescribe one — common options include Provera (Medroxyprogesterone) or the combination pill Prempro.

For a full list of side effects and warnings, see our guide on Premarin side effects. For interactions with other medications, see Premarin drug interactions.

How Much Does Premarin Cost?

Without insurance, Premarin is expensive:

• Oral tablets (0.625 mg, 30-day supply): $215 to $285
• Oral tablets (1.25 mg, 100 tablets): Up to $717
• Vaginal cream: $250 to $400 per tube
• Injection: Approximately $411 per vial

Ways to Save

• Pfizer Premarin Savings Card: Pay as little as $25–$30/month for tablets or $25–$35 for cream (commercial insurance required; not valid for Medicare/Medicaid)
• Generic Conjugated Estrogens: The first generic was approved in November 2025 and is expected to cost significantly less than brand-name Premarin
• Pfizer RxPathways: Free or discounted Premarin for uninsured/underinsured patients — call 1-844-989-7284 or visit pfizerrxpathways.com
• Discount cards: GoodRx, SingleCare, and other coupon tools can reduce your out-of-pocket cost

For a full breakdown, read our guide on how to save money on Premarin.

Insurance Coverage

Most insurance plans cover Premarin, typically on Tier 2 or Tier 3. Some plans may require prior authorization or ask you to try generic Estradiol first (step therapy). Medicare Part D generally covers Premarin.

Final Thoughts

Premarin has been around for decades and remains one of the most widely prescribed HRT medications. It's effective for treating menopause symptoms and preventing osteoporosis, but it's not without risks — especially with long-term use.

The most important things to remember:

• Use the lowest dose that works for you
• Take a progestin with it if you have a uterus
• Talk to your doctor about your personal risk factors
• Don't stay on it longer than necessary

If you're ready to fill your prescription, use Medfinder to find Premarin in stock near you. And if cost is a concern, check out our savings guide.