Hormone Replacement Therapy for Menopausal Symptoms

Premarin is conjugated estrogens derived from pregnant mare urine. It’s used to treat menopausal symptoms (hot flashes, night sweats, vaginal dryness, mood changes), urogenital atrophy, osteoporosis prevention, and occasionally other conditions like certain cancers. It replaces estrogen that declines during menopause. Most commonly, women use it to manage menopausal symptom severity.

Age at Initiation: Starting HRT at 45-50 (typical menopausal age) is different from starting it at 35 or 65. Underwriters care about the age at which you started.

Duration of Use: 2-3 years of Premarin for menopausal symptoms is standard and has a modest risk. 10+ years of continuous Premarin is less common and draws more scrutiny.

Plan for Continuation: Is Premarin short-term to manage acute menopausal symptoms? Or long-term indefinite? Underwriters prefer short-term use for symptom management.

Personal/Family History of Breast Cancer: This is crucial. If you have a personal history of breast cancer, Premarin is contraindicated (shouldn’t be used). If you have a strong family history of early breast cancer, underwriters scrutinize HRT use more carefully.

History of Blood Clots or Stroke: If you have a personal history of deep vein thrombosis (DVT), pulmonary embolism (PE), or stroke, Premarin is contraindicated. If you have a family history of these conditions, that affects underwriting.

The Risk: HRT increases the risk of blood clots (DVT or PE) approximately 1.5-2x compared to non-users. In absolute terms, non-users have about 1-2 cases per 1,000 women per year; HRT users have about 2-4 cases per 1,000 women per year.

Important Context: The risk is higher with older formulations and oral estrogen. Newer formulations and transdermal delivery (patches) have lower VTE risk. Premarin (oral) carries a slightly higher VTE risk than some alternatives. Your risk is also higher if you have other clotting risk factors: family history of clots, smoking, obesity, prolonged immobility, or hereditary clotting disorders.

The Risk: HRT increases stroke risk approximately 1.3x compared to non-users. In absolute terms, non-users aged 50-59 have about 5 strokes per 1,000 women per year; HRT users have about 6.5 strokes per 1,000 women per year.

Important Context: Stroke risk increases with age, hypertension, smoking, and previous stroke history. Starting HRT closer to menopause (rather than much later) appears associated with lower stroke risk. The absolute increase in stroke risk is modest in healthy women without hypertension.

The Risk: Combined HRT (estrogen plus progestin) increases breast cancer risk approximately 1.25x compared to non-users. Estrogen-only HRT (like Premarin alone) carries lower or no increased breast cancer risk. With combined HRT, non-users aged 50-59 have about 30 breast cancers per 1,000 women over 5 years; combined HRT users have about 37-38 cases per 1,000 women over 5 years.

Important Context: Most breast cancer risk studies involve combined HRT (estrogen + progestin). Premarin used alone is estrogen-only, which has a lower breast cancer risk than combined therapy. Risk increases with longer duration of use and is higher in younger, leaner women (who have lower baseline breast cancer risk). Most research shows risk decreases after stopping HRT.

HRT carries real but modestly increased risks of blood clots, stroke, and breast cancer. These risks are relevant—they’re why underwriters evaluate HRT use carefully and why you should discuss them with your physician. BUT in absolute terms, for a healthy woman in her 50s without risk factors, using Premarin for 2-3 years for menopausal symptom relief, the actual increased risk is small. The health benefits of managing severe menopausal symptoms may outweigh the risks for many women. The decision to use HRT is individual and should be made with your doctor, considering your specific risks and symptoms.

1. Your Age and Age at HRT Start

If you’re 52 and started Premarin at 50 for hot flashes: standard underwriting. If you’re 42 and started Premarin at 40 for premature menopause, underwriters investigate more (premature menopause has different health implications). If you’re 68 and started Premarin at 50, still using it: underwriters want to know why you haven’t discontinued and will ask about your indication.

2. Duration of Premarin Use

Using Premarin for 2 years: standard. Using for 5 years: acceptable but noted. Using for 10+ years: Underwriters question the indication and timeline for discontinuation. Current medical consensus favors a limited duration (usually 3-5 years) for menopausal symptom management.

3. Indication for Premarin

Hot flashes, night sweats, vaginal dryness: standard indication. Osteoporosis prevention: acceptable. Atrophic vaginitis: acceptable. History of breast cancer: Premarin is contraindicated; you shouldn’t be taking it (if you are, that’s a serious red flag). Prostate cancer treatment: different underwriting (cancer-specific). Be clear about why you’re taking it.

4. Personal History of VTE, Stroke, or Breast Cancer

If you have ANY personal history of blood clots, stroke, or breast cancer, Premarin is generally contraindicated. You shouldn’t be taking it. If you are, that’s a major red flag for underwriters. If you have a personal history of these conditions and are not taking Premarin, underwriting is straightforward, no Premarin concern.

5. Family History of Breast Cancer or VTE

Family history alone doesn’t disqualify HRT, but it affects underwriting. If you have a strong family history of early breast cancer (mother or sister diagnosed before 50) or hereditary thrombophilia, underwriters note it and may increase rates slightly or request additional information.

6. Other Health Risk Factors

Smoking: increases stroke and VTE risk significantly. Being on Premarin + smoking is a serious combination. Hypertension: increases stroke risk on HRT. Obesity: increases VTE risk. These don’t automatically disqualify you from Premarin, but they increase underwriting scrutiny and may result in higher rates.

7. Combined vs. Estrogen-Only Therapy

Are you taking Premarin alone (estrogen-only) or Prempro (Premarin + medroxyprogesterone, combined therapy)? Combined therapy carries a higher breast cancer risk and slightly higher VTE risk than estrogen-only. Underwriters prefer estrogen-only if you’ve had a hysterectomy (women with an intact uterus typically need progestin to prevent endometrial cancer).

Prescription Information

When you started Premarin, current dose, and plan (temporary for menopausal symptoms, or indefinite), this comes from your prescription records automatically.

Your Physician’s Indication Statement

A simple note from your OB/GYN stating: “Ms. X has been diagnosed with menopausal symptoms, including [specific symptoms]. She is taking Premarin for symptom management. Prognosis is good, with a plan to discontinue in [timeframe] or [reason for ongoing use].” Basic but clear.

Your Breast Cancer Risk Assessment

A statement confirming: no personal history of breast cancer, and no family history. If you’ve had screening mammography recently, include that. If your physician has assessed you as low-risk for breast cancer, that’s helpful.

Your VTE and Stroke Risk Status

No personal history of blood clots or stroke. No family history of thrombophilia. Not a smoker or other VTE risk factors. If you have any of these, disclose them clearly to your physician before applying.

Overall Health Status

General health summary: blood pressure normal, no diabetes, no heart disease, active and feeling well, etc. Underwriters use this to contextualize the Premarin use—healthy woman on short-term HRT for menopausal symptoms? Standard risk. Multiple health conditions plus Premarin? Different assessment.

Be Clear About Your Indication

“I’ve been experiencing significant hot flashes and night sweats. I started Premarin at age 50 for menopausal symptom management. My plan is to discontinue in [timeframe] once symptoms resolve.” Clear, honest, complete.

Emphasize Timeline and Temporary Nature

If you’re planning to discontinue Premarin in the near future, say so. “I’ve been on Premarin for 2 years; symptoms are improving, and I plan to discontinue in 6-12 months.” This is what underwriters want to hear—temporary use for symptom management, not indefinite therapy.

Disclose Your Health Risk Factors Proactively

No personal history of breast cancer, blood clots, or stroke? Say so. If you have family history, smoking history, or hypertension, disclose those too. Underwriters will discover them anyway, and being upfront builds trust and prevents surprises.

Include Breast Cancer Screening History

If you’ve had a recent mammography with normal results, include that. “Normal mammogram [date].” This demonstrates proactive health management and low breast cancer risk in your current profile.

Emphasize Overall Good Health

If you’re generally healthy (normal blood pressure, no diabetes, active lifestyle, etc.), emphasize that. The Premarin is being used in the context of an otherwise healthy woman managing a specific menopausal symptom, not a person with multiple health problems.

Short-Term Premarin for Menopausal Symptoms (Healthy Woman)

Rate Impact: None to minimal. Standard rates apply. Example: A 52-year-old woman on Premarin for 2 years for hot flashes, otherwise healthy, receives the exact rate as someone not on HRT.

Long-Term Premarin Use (5+ Years)

Rate Impact: Minimal to moderate (0-15% above standard). Underwriters may apply a small increase if continuous HRT use continues beyond the typical duration for menopausal symptoms. But the increase is modest.

Premarin With Risk Factors Present

Rate Impact: 0-25% above standard. If you smoke, have hypertension, a family history of breast cancer, or an extended duration of HRT, underwriters may apply a modest rate increase. The increase reflects overall health risk, not just Premarin, but Premarin is part of the assessment.

Combined HRT (Prempro) vs. Estrogen-Only (Premarin)

Combined HRT carries a higher breast cancer risk than estrogen-only. If you’re on Prempro (estrogen + progestin), rates may be slightly higher than if you were on estrogen-only. But the difference is typically minimal unless the duration is very long.

1. Disclose Premarin on the Application

When asked about current medications, include Premarin with the indication (menopausal symptoms, osteoporosis, etc.). Don’t try to omit it—it will show up in prescription records. Transparency from the start builds credibility.

2. Include Your Discontinuation Plan

If you plan to discontinue Premarin, say when and why. “Plan to discontinue in 6 months once menopausal symptoms resolve” is an excellent context. If you’re unsure: “Will discuss with physician about discontinuation timeline” is acceptable.

3. Get Your Physician’s Confirmation

Ask your OB/GYN to provide a brief note: “Ms. X has menopausal symptoms, is being treated with Premarin, and has no contraindications to this therapy (no personal history of breast cancer, blood clots, or stroke).” This is protective documentation.

4. Disclose Risk Factors Proactively

Smoking, hypertension, and a strong family history of breast cancer? Disclose these upfront. Underwriters will find them anyway, and being transparent prevents them from discovering information you omitted.

5. Apply with Standard Carriers

You don’t need specialty insurance. Premarin users apply with standard carriers. No special underwriting needed unless you have significant health complications or risk factors.

6. If Possible, Wait Until Discontinuation

If your symptoms are resolving and your physician agrees, you can discontinue Premarin, waiting 3-6 months after stopping before applying can simplify underwriting. Application becomes: “I was on Premarin for menopausal symptoms, completely resolved, no ongoing use.” Cleanest scenario.

Will Premarin result in a rate increase?

Direct answer: No, not for short-term appropriate use.

Short-term Premarin for menopausal symptoms in a healthy woman results in standard rates. Long-term use (5+ years) or use with other risk factors may result in a modest rate increase (0-15%), but Premarin itself doesn’t drive significant rate increases.

Will I be declined because I’m taking Premarin?

Direct answer: No, not typically.

Premarin use alone doesn’t result in a decline. You could be declined if you have contraindications to HRT (personal history of breast cancer, blood clots, stroke) OR if you’re taking Premarin despite these contraindications. But appropriate Premarin use in an appropriate candidate results in approval.

What if I have a family history of breast cancer?

Direct answer: Family history alone doesn’t disqualify you, but increases scrutiny.

If your mother or sister had breast cancer after 50, it’s noted but not disqualifying. If diagnosed before 50 or multiple family members are affected, underwriters scrutinize more carefully. But you can still be approved—the assessment just includes family history as one factor. Work with your physician about whether Premarin is still appropriate given your family history.

What if I’m taking Premarin long-term?

Direct answer: Underwriters will question it, but won’t automatically decline.

Long-term continuous Premarin (5+ years) is less common and less supported by medical evidence for menopausal symptoms. Underwriters will ask: Why are you still on it? Is discontinuation planned? This doesn’t result in decline, but may result in slightly higher rates or requests for physician clarification. Be prepared to explain your need for continued therapy.

Should I quit Premarin to get life insurance?

Direct answer: No. Discuss with your physician first.

You don’t need to discontinue Premarin just to get life insurance. If it’s helping manage menopausal symptoms, discuss the insurance question with your doctor. Your health is more important than slightly lower insurance rates. If your symptoms are controlled and your physician agrees that discontinuation is appropriate, waiting 3-6 months after stopping before applying can streamline underwriting. But don’t stop medication just for insurance purposes.

Do I have to disclose Premarin?

Direct answer: Yes, absolutely.

Premarin will appear on your prescription records. Insurance companies verify medication lists automatically. Concealing Premarin use is fraud and results in denial or cancellation if discovered. Complete honesty is essential and legally required.

What about Prempro (combined HRT) vs. Premarin (estrogen-only)?

Direct answer: Estrogen-only is preferred; combined carries slightly higher breast cancer risk.

Premarin (estrogen-only) carries a lower breast cancer risk than Prempro (estrogen + progestin). If you’ve had a hysterectomy, estrogen-only is standard. If you have an intact uterus, progestin is usually added to prevent endometrial cancer. Underwriters prefer estrogen-only if medically appropriate, but combined HRT isn’t disqualifying.

Can I apply with any carrier, or do I need specialty insurance?

Direct answer: Any standard carrier works.

You don’t need specialty insurance for Premarin. Apply with standard carriers. Unless you have significant health complications or serious risk factors, no special underwriting is required.