Hi Koala,

I have used Vagifem in the past and now use Premarin cream. The Vagifem is a tiny little pill that is inserted and very little is systemically absorbed. However, with the Premarin cream there is more that is systemically absorbed. The way the ob/gyn and urogynecologist explained it is that it depends on how thin your tissues are. If very thin (have had that before), the Premarin cream CAN be rapidly absorbed UNTIL you have used it for awhile and as your tissues become more thick or rather plumped up as they put it. I have never had the acne problem but I would think it is very possible that the additional estrogen may be part of it. I think over time or as you continue to use it you will adjust. I should add that at first I was told to use 1 gram 3 times a week. Now it seems all I need is 1/2 a gram 2 to 3 times a week...sometimes even less than that. All in all and even though I said some is absorbed it is actually a lot less than any oral tablet or transdermal patch. I hope this helps a little.