Short answer: For atrophic vaginitis and kraurosis vulvae, the Premarin Vaginal Cream label gives 0.5 to 2 g in the vagina daily for 21 days, then 7 days off, usually starting at 0.5 g. For painful intercourse from menopause it gives 0.5 g either twice weekly (for example Monday and Thursday) or daily for 21 days then 7 days off. Each gram holds 0.625 mg conjugated estrogens.
This is what the FDA label says. Follow your prescriber. Your prescriber may use a different dose or pace than the label's standard schedule.
What Premarin Vaginal Cream is approved for: Premarin Vaginal Cream is a mixture of estrogens placed in the vagina with an applicator. It is approved to treat atrophic vaginitis and kraurosis vulvae (thinning and drying of vaginal and vulvar tissue), and to treat moderate to severe dyspareunia (painful intercourse), a symptom of vulvar and vaginal atrophy due to menopause (sections 1.1, 1.2). The label notes that some of the estrogen is absorbed into the body (section 5.1).
Source
PREMARIN (conjugated estrogens) vaginal cream, prescribing information and Patient Information. Wyeth Pharmaceuticals (Pfizer). DailyMed, version published June 2, 2025. DailyMed setid 96609623-528e-4aba-cabe-7254aed816d5
The cream is placed in the vagina with the plastic applicator, which is marked in 0.5 g steps up to 2 g (sections 2, 3).
The Patient Information steps: screw the applicator onto the tube, squeeze cream into the barrel to the prescribed mark, lie on the back with knees drawn up, insert the applicator deeply and press the plunger. The applicator is washed with mild soap and warm water, not boiled or put in hot water.
Each tube holds 30 g (1.06 oz). It is stored at 20° to 25°C (68° to 77°F) (section 16).
The table below is the label's schedule, from the Dosage and Administration section. Numbers are copied exactly; the section is in brackets.
| Use | Dose | Schedule |
|---|---|---|
| Atrophic vaginitis and kraurosis vulvae | 0.5 to 2 g intravaginally; generally start at 0.5 g | Daily for 21 days, then off for 7 days |
| Moderate to severe dyspareunia from menopause (cyclic) | 0.5 g intravaginally | Daily for 21 days, then off for 7 days |
| Moderate to severe dyspareunia from menopause (twice weekly) | 0.5 g intravaginally | Twice weekly, for example Monday and Thursday, continuously |
Dose changes between 0.5 g and 2 g may be made based on individual response.
When estrogen is prescribed for a postmenopausal woman with a uterus, a progestin should generally also be considered to reduce the risk of endometrial cancer. A woman without a uterus does not need one, though some with past endometriosis may.
Estrogen is used at the lowest effective dose for the shortest duration consistent with treatment goals and risks, with periodic re-evaluation of whether treatment is still needed.
If feasible, estrogens are stopped at least 4 to 6 weeks before surgery linked to a higher risk of blood clots, or during long immobilization.
Dose and the need for treatment are talked over regularly, for example every 3 to 6 months.
The Premarin Vaginal Cream label gives no missed-dose instruction. Neither the prescribing information nor the Patient Information says what to do if a dose is missed. Ask your prescriber what to do.
In Dose Track you set up Premarin Vaginal Cream as a protocol with the dose and schedule your prescriber gave you. A protocol can hold dose steps, each with its own dose and length in days or weeks, so a step-up plan like the one on the label can be entered once and the app moves to the next step on its own. Reminders follow the schedule, and every dose is logged with the date and time, so you can see which step you are on and when your last dose was. The app follows what you enter; it does not choose or change a dose.
This page is what the FDA label says, in plain words. It is not medical advice. Follow your prescriber, and ask them or your pharmacist about anything here.