Yes, Premarin is still on the market. The FDA-approved prescribing label was updated as recently as 2025, and the medication remains actively manufactured and prescribed in the United States. It is available as oral tablets and as a vaginal cream, both produced by Pfizer.
What Premarin Is Prescribed For
Premarin contains conjugated estrogens, a mixture of estrogens derived from the urine of pregnant mares (the name itself is short for “pregnant mares’ urine”). It has been on the market since 1942, making it one of the oldest hormone medications still in use.
The current FDA-approved uses include treatment of moderate to severe hot flashes and night sweats caused by menopause, treatment of vaginal dryness and irritation related to menopause, management of low estrogen due to certain medical conditions, and prevention of postmenopausal osteoporosis. It also carries approvals for palliative treatment of certain cancers, though those uses are far less common.
Available Forms and Strengths
Premarin tablets come in five strengths: 0.3 mg, 0.45 mg, 0.625 mg, 0.9 mg, and 1.25 mg. The vaginal cream contains 0.625 mg of conjugated estrogens per gram and is applied internally using a marked applicator that comes with the tube. For vaginal symptoms like dryness or discomfort, the cream is often preferred because it delivers estrogen locally with minimal absorption into the rest of the body.
A Generic Version Now Exists
For decades, Premarin had no generic equivalent. The FDA had difficulty approving one because the medication contains a complex mixture of estrogens that was hard to replicate exactly. That changed in October 2025, when the FDA approved a generic conjugated estrogens tablet made by Novast Labs, with marketing handled by Ingenus Pharmaceuticals. The generic is available in all five tablet strengths and is rated as therapeutically equivalent to the brand-name version.
This is significant for cost. Brand-name Premarin can be expensive without insurance. Pfizer offers a co-pay card for commercially insured patients that can bring the out-of-pocket cost down to as little as $25 per fill, with a maximum savings of $120 per prescription for the tablets and $250 for the vaginal cream. The card caps total annual savings at $1,440. A generic option will likely bring the baseline price down for patients paying out of pocket or those whose insurance formularies favor generics.
Why Some People Think It Was Discontinued
The confusion is understandable. Premarin’s reputation took a major hit in 2002, when results from the Women’s Health Initiative study linked hormone therapy to increased risks of blood clots, stroke, and breast cancer. Prescriptions dropped dramatically almost overnight, and some related products in the Premarin family were eventually pulled from the market. Prempro (Premarin combined with a progestogen) saw particularly sharp declines.
But Premarin itself was never discontinued. What changed was how it is prescribed. Doctors moved away from giving it routinely to all postmenopausal women and began using it more selectively, at the lowest effective dose, for the shortest time needed.
Current Guidelines on Hormone Therapy
Medical consensus has shifted considerably since the initial alarm of the early 2000s. Hormone therapy, including conjugated estrogens like Premarin, remains the most effective treatment for hot flashes in healthy postmenopausal women who are under 60 or within 10 years of menopause. It also effectively prevents menopause-related bone loss and reduces fracture risk during that same window.
The key principle is timing. Starting hormone therapy earlier in menopause provides the greatest benefit with the lowest risk. For women who still have a uterus, a progestogen must be added to estrogen therapy to protect against uterine lining overgrowth. Women who have had a hysterectomy can typically take estrogen alone.
Routine discontinuation at age 60 or 65 is no longer considered necessary. For women with low cardiovascular and breast cancer risk who continue to have symptoms, long-term use may be appropriate. Contraindications include unexplained vaginal bleeding, a history of estrogen-sensitive cancers, active blood clots, and liver or gallbladder disease.
The Animal Welfare Question
Because Premarin is derived from the urine of pregnant horses, it has long drawn criticism from animal welfare advocates. Pfizer works with equine ranches, primarily in Canada, where mares are kept during the later months of pregnancy and fitted with urine collection devices. The American Association of Equine Practitioners has reviewed the industry’s practices and concluded that, when ranches follow the recommended Code of Practice, the process “should not result in abuse, neglect or inhumane treatment of horses.”
Oversight includes herd health reviews by independent veterinarians and applied welfare research conducted at a dedicated facility called Linwood Equine Ranch, the only facility in the world specifically focused on the care of horses used in this industry. Programs also exist to market and place foals born as a byproduct of production. Still, the ethical concern is a reason some patients and prescribers prefer plant-derived or synthetic estrogen alternatives, which are widely available.
If the animal welfare issue matters to you, synthetic conjugated estrogens and bioidentical estradiol products (patches, gels, pills) treat the same menopausal symptoms without involving horses. These are worth discussing with a prescriber as a straightforward swap for most indications.