WOMEN'S HEALTH and HORMONES
Re: Premarin, menopause, and exploiting of women and horses in this industry.
As you may have observed on the Readers Respond page, many women are unhappy not only with the equine welfare issues, but their medical treatment plans and uncertain of their choices. I've heard from women whose doctors become upset, and sarcastic with them when they want to go off Premarin and switch to a plant-based, synthetic or natural hormones. One woman wrote that when she requested an alternative to Premarin and complained of hot flashes, her doctor responded sarcastically "I can always give you a hysterectomy." She was appalled and said she verbally blasted him. Other women have had similar experiences when requesting an alternative to Premarin. Wyeth-Ayerst spends millions of dollars every year persuading doctors to think of Premarin as the estrogen replacement drug. Most doctors prescribe it as a matter of routine and do not inform women of the various alternatives such as: 17 B-estradiol, the exact estrogen women produce found in Estrace, from soybean and yam, available for 22 years, Estraderm patch, made from yam, available for 11 years, and Climara Patch, Vivelle patch, and Estring vaginal ring, made from yam and available for 2 years each. Some of these women have found a new doctor who is more open to discussing these alternatives to treat their individual needs and help them through what can be for some women a very difficult time.
In striking contrast to what I've heard about some women's bad experiences,
with their doctors, the following is one woman's good relationship with her doctor.
"My doctor has always discussed everything with me and he's a real straight
shooter. If he were not, I would have another doctor! I guess it's because
of my age, but I don't have trouble relating to professional people any
more. It helps to remember that the doctor works for me. Anyway, there is
no excuse for sarcasm." B.R.
{Ed. Note:} Women should keep this in mind when you have a doctor's appointment. You are paying for his/her services and should expect to be treated in a respectful manner and not brushed off when you tell your doctor about symptoms you are experiencing, especially when suggesting you think you may be going through menopause. Please check the letters on the (Readers Respond link) and you will see the truly appalling condescending, and insensitive ways some doctors treat their female patients.
We wouldn't accept this shabby treatment from any other professional we pay for their services. Remember, you are your own best advocate, and doctors are not god, much as we wish they could be sometimes.
This page will offer women a number of places they can turn to for help with answers to their questions. I am asking women to share their thoughts, suggestions, and regimens that have worked for them so that others may learn from their experiences.
NEWEST ALTERNATIVES TO PREMARIN
March 25, 1999 WASHINGTON (AP) - DURAMED PHARMACEUTICAL'S CENESTIN, a drug derived from a mix of estrogens from soy and yam plants has been approved by the FDA for the treatment of menopausal symptoms such as hot flashes and night sweats. Cenestin is the only other conjugated estrogen available, also lower priced and safer than Premarin because it doesn't have the many impurities that do more harm than good. Menopausal women already have a variety of different types of estrogen available to them, from pills to patches to creams, natural or synthetic. Duramed originally sought to sell Cenestin as a generic Premarin. Wyeth-Ayerst waged an intense battle to persuade the FDA to block generic competition, and through their Politics and Payoffs succeeded. After additional study of Cenestin, Duramed asked the FDA to approve it as a competing brand-name estrogen. Many estrogens sold also have FDA certification that they help prevent bone-destroying osteoporosis. Cincinnati-based Duramed has not finished its research to prove that Cenestin can help prevent bone-destroying osteoporosis, but plans to seek FDA approval of that additional benefit later this year. Cenestin is now available by prescription.
THE FIRST AND ONLY COMBINATION HORMONE PATCH - COMBIPATCH. Combipatch is a small (1-1/4") ultrathin combination hormone patch that relieves menopausal symptoms, Its advanced adhesive keeps the patch in place so you only change it twice a week. Bathe, shower - even exercise in the pool without giving it a second thought. Combipatch is indicated for menopausal women with an intact uterus. For more information, call 877-Combi-4-u (877-266-2448), ext. 107, or visit their web site at: www.combipatch.com.
MIAMI, FL -- May 10, 1999 -- NOVOGYNE PHARMACEUTICALS' VIVELLE-DOT(TM) (estradiol transdermal system), the world's smallest transdermal estrogen delivery system, has been launched in the United States for use in the treatment of the symptoms of menopause. Like the original Vivelle(R) (estradiol transdermal system), Vivelle-Dot is available in four dosage strengths (.0375, .05, .075 and .10 mg/day), and provides prescribing physicians with broad dosing flexibility. In the most commonly prescribed dosage strength (.05 mg/day), Vivelle-Dot is about the size and thickness of a postage stamp. By area, it is about one-third the size of Berlexís Climara(R) and about one-quarter the size of Novartisí Estraderm(R), the current U.S. market leaders. The new patch utilises Noven's proprietary Dot Matrix(TM) adhesive technology and delivers 17(beta)-estradiol through the skin and into the bloodstream. 17(beta)-estradiol is identical to a woman's own estrogen, unlike those estrogen therapies derived from equine sources.
{Ed. Note:} Premarin contains the following equine estrogens - estrone sulfate (53-61%), equilin sulfate (23-30%) equilenin, 17 a-dihydroequilin, 17 a-estradiol, 17 a-dihydroequilenin and numerous other horse estrogens? Not one of these ingredients are ever found in a woman. Premarin also contains numerous unidentified substances which also have unknown side-effects. Premarin has more of an effect on the liver than non-horse estrogens do. Equine estrogens are many times more potent than a woman's estrogen and may be the cause of many unpleasant and sometimes life-threatening side effects many women are experiencing. Although two of the equine estrogens do metabolize into estradiol and estrone in a woman's body, the levels of the equilin estrogens in Premarin are many times higher than women's bodies' normal levels of estradiol or estrone. What are these long-term side effects? Wyeth-Ayerst hasn't made that known.
Disappointing results of the 4 year Heart and Estrogen/Progestin
Replacement Study (HERS) Research Group:
Hopkins: Hormone Therapy and Cardiac Risk, August 24, 1998
BALTIMORE (Johns Hopkins) - There are good reasons for older
women to begin hormone replacement therapy. But for now at
least, reducing the risk for a future heart attack does not
appear to be among them.
Results are in from one of the largest studies of hormone replacement therapy ever conducted. More than 2,700 women with heart disease were studied at 18 different medical centers around the country, including Johns Hopkins. Hopkins cardiologist Dr. Roger Blumenthal was a principal investigator in the study. He says doctors expected to find that a pill combining estrogen and progestin (PremPro) would help lower the risk for a heart attack in women who had already developed heart disease.
"To our surprise, we found that overall, during the 4 year period of the trial, there was no beneficial effect to the hormone therapy," explains Blumenthal. "What is very interesting is that within the first year of the trial there seemed to be an adverse effect of the hormones."
In other words, hormone therapy appeared to raise the risk of a heart attack in these women for the first year, then decrease by the fourth year leaving "no overall benefit. In addition, there was a three-fold increase in venous thromboembolic events (blood clots in the legs and lungs) and a significant increase in gallbladder disease in the user group. Researchers plan on further study to try to get to the bottom of it.
{Ed. Note: Dr. Judith Reichmann, The Today Show's resident M.D.,
said on August 19, 1998, "There was a 50% increase in heart attacks during
the first year for women who were on PremPro (who participated in this study),
but that women should continue to take PremPro.??? Other surprising findings
revealed that although the 'good' cholesterol (HDL) increased by 10 per cent
and the 'bad' cholesterol (LDL) decreased by 10 per cent, this change had
virtually no protective effect. The HERS Study did not provide findings
regarding HRT and breast cancer. However, in June of 1998, an extensive
review of previous studies by Graham Colditz in the Journal of the National
Cancer Institute concluded that HRT substantially increases the risk of
breast cancer. Unsurprisingly, the study does not mention how the other
estrogen products, Estrace, Ogen, etc., (with progesterone) would do, since the
study was funded by Premarin's manufacturer, Wyeth-Ayerst. }
The HERS report
The FDA has not approved any form of HRT for the prevention of heart disease because the studies conducted to date have been observational only and do not measure up to the standards typically used to prove a drug is effective.
On customizing your HRT needs, women can have their hormone levels checked either saliva (no need for a doctor; it can be done through pharmacies like Madison Women's Pharmacy, (Ph. number listed below) or blood tests ordered by their doctors, in order to tailor their treatment plans exactly to their own needs. They can also have their risk of osteoporosis checked through urine tests. Doctors mostly shrug off such approaches, saying that "it depends on how you feel" (e.g., whether the drug regimen stops your hot flashes, moodiness, etc.). The upshot is that you the patient can waste of lot of time and energy trying this or that. This is of course nonsense, and doctors wouldn't do this for any other kind of condition where they could do tests. Dr. Vliet, Gillian Ford and Dr. Lee and others certainly test and so should all doctors. They will if women insist on it before taking anything!
Regarding hormone levels, I recommend reading "Restoring Balance," a booklet by Marla Ahlgrimm and John Kells, order from Impakt Communications, 1-800-477-2995 (@$9.95) or 1-888-2229 in Canada, and also Dr. Vliet's discussion in her book, SCREAMING TO BE HEARD, is very good.
Women's Health Access Newsletter by Women's Health America and Madison Pharmacy Associates founder Marla Ahlgrimm, Ph.D. is very helpful. Call 1-800-222-4767 (National Women's Health Hotline) for information. Website Madison Pharmacy number is 1-800-225-8025, at 429 Gammon Place, Madison, WI, where trained RNs are on duty every day to answer questions.
Madison Pharmacy and Bajamar Pharmacy in St. Louis both supply a long list of compounds for patients directly when possible and to doctors. They also provide the saliva test kits for Aeron LifeCycles for testing estradiol, progesterone, testosterone, DHEA, melatonin and cortisol levels. They can also fax lists of doctors who use their products in your area. That may not mean the doctors named understand bioidentical (natural) hormone replacement optimally, but if they are using these or other compounding pharmacies, it's a start.
Health and Science Research Institute in Crawfordville, Fl offers an OsteoCheck urine test kit for checking a woman's risk of osteoporosis.
The Women's International Pharmacy with two locations: Madison, Wisconsin and Sun City West, Arizona. Women's International Pharmacy is dedicated to educating women and men about hormone related disorders. They provide free educational information packets on hormonal disorders that encourage patients to become active and involved participants in managing their health care and will provide a list of doctors that prescribe natural hormones. Women's International Pharmacy, upon physician request, specializes in individually compounded natural hormone prescriptions that may include, but are not limited to, progesterone, estrogens, testosterone, coenzyme Q-10, pregnenolone and DHEA. Their toll free number: 1-800-279-5708. E-mail: info@wipws.com Website.
Transitions for Health, tel. 1-800-888-6814, also has a good website, click here
Dr. Elizabeth Lee Vliet, founder and medical directorHER Place: Health Enhancement and Renewal for Women, Inc.
2700 Tibbets Drive, Suite 100
Bedord, TX 76022
817-355-8008
fax: 817-355-8010
Her book, SCREAMING TO BE HEARD: HORMONAL CONNECTIONS WOMEN SUSPECT AND DOCTORS MAY IGNORE (Evans, 1995) is a must read and describes her center as:
"An integrated, wellness/preventive-medicine-oriented program for mid-life women as well as women of other ages experiencing hormonally-aggravated health concerns: PMS, menstrual migraines, fibromyalgia, pelvic pain, chronic fatigue, bladder disorders, menopause, osteoporosis, depression/anxiety syndromes, post-partum depression. Comprehensive evaluation and individualized "health plan" includes blood chemistries with hormone profiles, bone density testing, resting metabolic assesments, cardiac stress test, excercise and nutrition evaluations, physical exams, mammography, ultrasonography, psychological profile, and specialized gynecology consultations/procedures when needed.
On site seminars, workshops, and discussion groups on a variety of women's health topics are offered, along with continuing education courses for health professionals. This consultation program emphasizes early identification of health risks, the woman as leader of her health team, and a written take-home health plan to use in working with her own physician and other health practitioners...recommendations are highly individualized to the needs of each women using natural hormone preparations. Dr. Vliet's book also gives a list of doctors and other centers that specialize in hormonal problems in an appendix.
Learn more at Dr. Vliet's web page: HER PLACEDr. Vliet's friend and colleague Gillian Ford also has a treatment center for women around the country based in San Francisco. Her number is 916-772-1681. Gillian Ford's book, LISTENING TO YOUR HORMONES, and Dr. Christiane Northrup's OUR BODIES, OUR WISDOM, are also very valuable.
Please visit these web sites for additional information concerning Women's Health and Hormones.
FEMININE & AFFLICTED - How it Is, How it Was, How it Could Be by Dr. Betty Kamen, Ph.D.Alternatives to Hormone Replacement Therapy
Natural Hormone Replacement Therapy Reduces Cancer Risk - Exclusive New Book Exerpt
Life Extension Foundation: How To Prevent Breast Cancer: Estrogen Replacement Therapy - What's a Woman To Do?
Natural Progesterone FAQs If Natural Progesterone is so wonderful, why isn't it used by my doctor?
Doctor's Guide to Medical and other News - Soy Phytoestrogens prevent stroke as much as Premarin.
Scientists Suggest More Soy in the Diet. Soy offers potential benefits for women who can't take estrogen. In monkey studies, soy and Premarin were about equal in reductions in total cholesterol," while soy was better ...
Power Surge: A Warm and Caring Community for Women at Midlife.
A World Community helping women and their families
CNN - Estrogen therapy may affect mammograms, study says - May 15, 1996
Low B Vitamin Levels Linked To Increased Heart Disease, Stroke Risk
Empowering Women in Medicine Excluding Women - Endangering Women, Medical Research is Sex-Biased
Menopause Matters Homepage We seek to empower women to make conscious decisions about health
The HERS report - During an average follow-up of 4.1 years, treatment with oral congugated equine estrogen plus medroxyprogesterone (Prempro) did not reduce the overall rate of CHD (coronary heart disease) events in postmenopausal women w/established coronary disease. Treatment did increase the rate of thromboembolic events and gallbladder disease.
OnHealth: Estrogen, Bones, Breast Cancer The New England Journal of Medicine
OnHealth: Hormone Therapy - When and For How Long? From the publishers of The New England Journal of Medicine
CNN - Studies: "Some women will gain over 3 years of life," said lead researcher Dr. Nananda F. Col of New England medical Center," and some will lose on the order of several months." - Apr. 9, 1997
Premarin: Cure or Curse?
CALCIUM and OSTEOPOROSIS How Much Is Enough?
THE OSTEOPOROSIS CENTER
OSTEOPOROSIS and Related Bone Diseases Natural Rescource Center
OBGYN.NET Alternatives to Hysterectomy
Sapient Health Network - Welcome to Women's Health Place
What is complementary/alternative medicine? Here you'll find a current listing of ACAM physicians searchable by city, state, and area code; chelation therapy and books on sale for complementary/alternative medicine; links to other relevant websites.
Welcome to Preventive Medicine Research Institute
Infoseek Health Channel: Menopause
Great News for Women and The Men Who Love Them - Women's Health Matters
After I had been in practice about 20 years, I had more and more people who had osteoporosis. In 1976 and 1978, it became apparent to everybody in medicine that estrogen therapy....
Estrogen Replacement Therapy - Save money with femScript - 0gen is an all natural plant derivative containing 100% estrone, which closely resembles the body's own estrogen. On the market 40 + years.
Estradiol Vaginal Ring
Nutrition Science News - March 1998
I WOULD STRONGLY RECOMMEND THAT WOMEN who have had problems with their doctors and hormone-related treatments consider contacting the American College of Obstetricians and Gynecologists. Only when women--the patients, the consumers--demand that their doctors stop using Premarin and other non-bioidentical hormones and request hormone level testing to customize their treatment plans, using better, less harmful drugs will they change! ACOG's website.
Women can protest the continued use of Premarin in the major studies at NIH's Women's Health Initiative and other labs around the country, instead of the bioidentical and readily available, and far better alternatives, e.g. estradiol, biodentical (natural) progesterone and (natural) testosterone, as bad science, and more than likely more bad medicine. WHI's website If you feel that it is wrong for Premarin, and Premarin only to be used in the Women's Health Initiative studies around the country (involving 164,000 women), then you can write, call or e-mail NIH to express your objections.
NIH thus describes it: "Sponsored by the National Institutes of Health, the WHI is a 15-year (began in 1993 and will end in 2008) nationwide clinical study that will investigate heart disease, osteoporosis, and breast and colon cancers in 63,000 women ages 50 to 79. Long-term, well-designed studies such as the Women's Health Initiative should be able to answer many of the lingering questions about the true effects of HRT."
Remember that these government-funded PEPI studies, which the WHI began in 1993, are using Premarin in trials involving 164,000 women. Unfortunately, Premarin is most probably the wrong medicine to be tested, or at least the studies' results risk being skewed. The consequences of these trials are potentially vast for women who can expect to be further urged to take Premarin rather than safer and better alternatives. Since these trials won't show anything other than estrogen, in this case Premarin alone, helping cholesterol levels and bone mass, not how alternatives might be an improvement over that.
In other words, testing Premarin against itself in all the protocols except the placebo is like testing a Viagra in all scenarios, instead of looking to see how one drug genuinely compares to all others for the problem in question.
Without using bioidentical or natural alternatives such as estradiol and estriol to level the playing field, the WHI studies are rigging the results in advance--in favor of Premarin. Why?
Wyeth of course donated the Premarin being used by NIH and elsewhere. See Dr. Jonathan Wright's discussion of the NIH PEPI study in his book Natural Hormone Replacement, pp.76-80 for the full implications of this taxpayer-funded folly.
For further information on studies and outcomes regarding women's health issues, here are more resources, courtesy of the NIH website:
The Women's Health Initiative (WHI) has a toll-free telephone number that women can call to obtain more information about the study and the location of the nearest participating facility. The toll-free number is 1-800-54-WOMEN (1-800-549-6636). The WHI Program Office address is: Room 6A09, Federal Building, 9000 Rockville Pike, Bethesda, MD 20892-9110. Information about the WHI
Also, from the NIH website:"The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) coordinates the Osteoporosis and Related Bone Diseases National Resource Center, which has printed material about osteoporosis. The National Resource Center address is: Suite 500, 1150 17th Street NW., Washington, DC 20036. The toll-free telephone number is: 1-800-624-BONE (1-800-624-2663) and 1-202-466-4315 for callers with TTY equipment. Information about osteoporosis.
"The National Institute on Aging (NIA) Information Center offers printed material about menopause, osteoporosis, heart disease, and stroke. The NIA Information Center address is: P.O. Box 8057, Gaithersburg, MD 20898-8057; the toll-free telephone number is: 1-800-222-2225, and 1-800-222-4225 for callers with TTY equipment. A variety of NIA materials.