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Before initiating or reinstituting HRTa complete personal and family medical history should be takenPhysicalincluding pelvic and breastexamination should be guided by this and by the contraindications and warnings for useDuring treatmentperiodic check-ups are recommended of a frequency and nature adapted to the individual womenWomen should be advised what changes in their breasts should be reported to their doctor or nurseseeBreast CancerbelowInvestigationsincluding appropriate imaging toolse.gmammographyshould be carried out in accordance with currently accepted screening practicesmodified to the clinical needs of the individual.

No studies on the effect of ability to drive or use machines have been performed.

Avoid smokingIt can greatly increase your risk of blood clotsstrokeor heart attack while using conjugated estrogens.

The effect of hepatic impairment on the pharmacokinetics of PREMARIN Vaginal Cream has not been studied.

Generallywhen estrogen is prescribed for a postmenopausal woman with a uterusa progestin should also be considered to reduce the risk of endometrial cancer.

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