R.M. Kellosalmi, B.Sc., M.D., L.M.C.C., physician and surgeon, Peachtree Medical Centre: "Premarin is the only estrogen containing materials from horses' urine, and most of the 10 known hormones in Premarin are not at all natural to the human female, being horse hormones that are chemically different from human hormones. No major clinical benefit has been accepted and proven for up to 8 of them. I prefer to know exactly what I am prescribing, Premarin contains a host of unknown ingredients that have not been identified. Any possible effects that could be caused by such ingredients are thus also unknown. The question has been raised as to whether Premarin would even pass if it were applying for FDA approval today, rather than 56 years ago. In those days, the regulations were far less stringent.
"Estrogen replacement drugs derived from plant-based natural sources are also purer and simpler drugs. Premarin is a complex blend of known and unknown estrogens, most of which are natural for the horse, but not for the human. Some of the plant-based estrogen products contain only the most active human type of estrogen. This is Estradiol, and these simple single entity estrogens have been passed with flying colors by the FDA for the treatment of menopausal symptoms, including hot flashes and osteoporosis. They are fully effective drugs, and certainly do not take a back seat to horse urine products.
"Formulating' or 'Compounding' pharmacies can also produce natural Estriol or Estriol-Estradiol combinations which have been suggested as minimizing the risks of cancers attributed to other estrogens. I feel very strongly that patients have a right to an informed choice, and that includes information which involves ethics, as in the PMU situation." Courtesy Equine Advocates, Inc., PREMARIN: Cycle of Cruelty pamphlet.
Don Sloan, M.D., F.A.C.O.G., board-certified gynecologist (excerpted from a 1997 letter to fellow gynecologists)
Courtesy Equine Advocates, Inc. PREMARIN: Cycle of Cruelty pamphlet.
"As a colleague and practitioner in our specialty over the past many years, I urge you to consider the use of medications other than Premarin for your patients in need of hormone/estrogen replacement therapy (HRT/ERT). It is well established and documented in the medical literature that the many synthetic estrogens readily available at the pharmacy will provide them with adequate coverage...Our patients are becoming more and more aware of Premarin's use of equine urine in its production. The validity of using another species' excretion for human use is being seriously questioned...Many reports from reliable sources both in Canada and the United States have described the deplorable living conditions these horses endure, all designed to create maximum urinary output...Such practices should disturb us as sensitive human beings in a profession devoted to the care and well-being of others."
Allan Warshowsky, M.D., F.A.C.O.G., board-certified obstetrician and gynecologist: "For many years, Premarin has been the major estrogen for hormone replacement therapy (HRT) in menopause. Most (but not all) of the studies [of HRT] have been based on Premarin. In my view and in the view of many other physicians, Premarin is responsible for a host of women's health problems including such frightening entities as breast and uterine cancer. Premarin has been given with another drug which many consider to be dangerous, medroxyprogesterone (as opposed to natural progesterone), which can add to the adverse health problems. There are many natural hormone alternatives made from soy or yam products which can be used instead of Premarin with equally beneficial results, but eliminating the negative effects. I choose to go with the natural hormones whenever possible." Courtesy Equine Advocates, Inc. PREMARIN: Cycle of Cruelty pamphlet.
Christian Northrup, M.D., 48 is the author of Women's Bodies, Women's Wisdom (Bantom Books, 1994) and assistant clinical professor of obstetrics and gynecology at the University of Vermont College of Medicine.
"When we talk about horomone replacement therapy, the whole world thinks we are talking about Premarin and menopause, but the truth is that there are several times during the life cycle when we might want to check hormone levels in our bodies and supplement with natural hormones." I used progesterone in cream form to see what it would do. I don't know if it actually worked because, I do so many things in combination. [Northrup consumes soy products, exercises regularly and takes natural progesterone as well as multivitaminis and minerals] that it's hard to attribute anything to that one particular cream. It does seem to work for many patients in my practice however.
When I start to go through menopause myself, I'll do what I tell my patients to do; get yearly salivary hormone level tests to monitor my hormones. Then, if my results show that any levels are low and I'm having symptoms, I will supplement with natural hormones that my body can use to create hormonal balance. If I decide to use estrogen, I'll start with a skin cream for instant feedback. Creams are absorbed into the body faster than pills, and you feel the effects sooner.
I won't take anything that's not exactly like the hormones made by my own body. That makes no sense to me at all, especially taking hormones made from pregnant mare's urine."
If you isolate 17-beta-estradiol from the body and manufacture the exact same molecule in a laboratory, then the body doesn't know the difference. You simply need to replace a hormone with exactly what the body is missing. Let's replace hormones the same way we replace thyroid - according to the individual's levels. That's the way it is done with natural hormones.
If I decide to prescribe hormones to a patient, I usually work with a formulary pharmacy to tailor the prescription. Natural estrogens are made from plant sources. I like the practice of the pharmacist preparing medications from scratch, which harkens back to the original roots of medicine. There are also many herbal remedies that work well for menopause such as black cohosh, licorice root and the Chinese herbs rehmannia, ginseng and dong quai. It can't hurt to eat soy and other phytoestrogens too, because to some extent they act like hormones in the body. Exercise is particularly important because it increases a woman's bone density, maintains her cardiovascular fitness and helps to improve her mood. I personally do aerobics and strength training at least five times a week for these very reasons. Courtesty Living Fit Magazine, March 1998.
Susan Love, M.D., 49, is one of the best-known experts in women's health care. She is the author of Dr. Susan Love's Breast Book Addison-Wesley, 1995) and Dr. Susan Love's Hormone Book (Random House, 1997), director of the Santa Barbara Breast Cancer Institute and adjunct professor of surgery at the University of California, Los Angeles. Dr. Love says "There are two reasons to take HRT. One is symptom relief: About a third of women have symptoms for which they need to take something. The second is disease prevention, which can mean taking hormones for 30 or 40 years. I would never do the latter. Using anything that long which carries the risk of causing a potentially fatal disease (breast cancer) is crazy when there are risk-free alternatives. It also assumes that researchers are not going to figure out other ways to prevent heart disease and osteoporosis, which is unlikely. I would much rather exercise and eat a reasonable diet.
I am 49 and have experienced some hot flashes for the past year and a half. It's possible [because perimenopause can take two or three years] that I will have horrible symptoms in the next year and decide to take HRT to tide me over, but you take it for three to five years and taper off. The symptoms of menopause are not from low estrogen. In fact, there is some good data that shows they usually stop when you have your last period; they are really from puberty in reverse - variations in hormones."
Some of Dr. Love's natural regimens to treat the symptoms of menopause include: regular weight bearing exercises and stretching consisting of 1/2 hour daily aerobics and 1/2 hour lifting weights and stretching. She also uses a new cookbook by Nina Shandler's "Menopause Naturally (Villard 1997). It has many delicious soy and tofu recipes, and Dr. Love also cooks with soy and adds nonfat soy milk to her cereal. Courtesy Living Fit Magazine, March 1998)
Exclusive New Book Excerpt - Natural Hormone Replacement Reduces Cancer Risk, from NATURAL HORMONE REPLACEMENT THERAPY FOR WOMEN OVER 45 by Jonathan V. Wright, M.D. and John Morgenthaler
Despite the overwhelming clinical and marketing success of Premarin and other forms of patentable "estrogen", there has been, almost from the start, a disturbing undercurrent of doubt about the safety of conventional "estrogen" replacement therapy. That doubt can be summed up in one word: cancer. The increased risk of endometrial cancer from "ERT" is largely eliminated when women take a patentable "progestin" or natural progesterone along with their "estrogen" (making it "HRT"), but the risk of breast cancer remains highly controversial. Scores of large, sophisticated, expensive studies have been done over the years to try to answer one key question: Does replacement horse estrogen cause human breast cancer? (I'm NOT making this up!) You, I, and any reasonable high school science student would want to know if replacement human estrogen causes human breast cancer. But then, you, I, and reasonable high school students don't own patents and make huge amounts of money selling horse estrogen.) Despite all the time and money thrown at (some might say, wasted on) the problem of "HRT" and human breast cancer, the answer still remains elusive. There's no direct proof HRT causes breast cancer, but at the same time, it's not possible to say that it doesn't. In the face of this uncertainty, though, three facts remain indisputable:
In nearly all the large scale studies that have examined the relationship between estrogen replacement and cancer, the "estrogens" used have been estrone + equilin (Premarin), estradiol, or ethinyl estradiol. The results of many studies in laboratory animals and cell cultures have confirmed that estrone, equilin, estradiol, and ethinyl estradiol can all cause cancer in endometrial and breast tissue. Some researchers think estriol - the major component of human estrogen - has virtually no propensity to cause cancer, and that it reduces the carcinogenic activity of other estrogens and other carcinogenic chemicals in breast tissue. Others, especially those working with estriol in "unnatural" ways in experimental animals, believe estriol may have carcinogenic potential. No large studies have been done in a human population to examine the possible risk of cancer associated with estriol (or triple estrogen, the combination of estriol, estradiol, and estrone in their natural proportions). However, a large amount of clinical and laboratory evidence dating back to the mid-1960s has been collected that addresses the issue of estriol and cancer. This research strongly suggests that estriol has less cancer-causing potential than estrone, equilin, estradiol, and ethinyl estradiol, and that estriol may actually inhibit the carcinogenic activity of these other "estrogens."
In a letter to the New York Times Dr. Phillip Warner, an Orinda, CA gynecologist with 30 years experience and Director of the Menopause Clinic of Northern California states "prescribing premarin for estrogen deficiency has evolved as a 'Pavlovian response without any thought to individual treatment.'" Warner continues, "The notion that a substance derived from horse urine is "natural" to the human female is simply a tribute to 50 years of successful advertising." Warner stated at a press conference in Fargo, N. Dakota, "Premarin is no longer the most appropriate technology - if we were starting from scratch today to replace the human hormone (that women lose at menopause), we would not be looking to the horse," said Warner. Premarin is helpful, certainly, but it is no longer the most useful (hormone-replacement drug)." Warner said confining horses in order to produce urine for Premarin (which he said he stopped prescribing five years ago) is an outmoded practice, given the artificial alternatives available on the market." Peggy Larson a Vermont-based veterinary law consultant also present at the press conference in Fargo said "the PMU industry is "an abomination." "(The confinement operations) are inhumane treatment for an animal designed for movement and endurance, and the whole process needs to be done away with."
Virginia Reath, registered Physicians' Assistant in Gynecology
"I like to prescribe naturally-occurring estrogens, such as Estradiol and Tri-Est, a combination of Estriol, Estradiol, and Estrone derived from natural sources [which can be produced at a formulating or compounding pharmacy]. I tend not to prescribe Premarin to my patients. There are options to Premarin and patients have the right to know what they are. Medical practioners should be informed and able to offer different options to women. I don't think we compromise anything by not prescribing Premarin." Courtesy Equine Advocates, Inc. PREMARIN: Cycle of Cruelty pamphlet.
The Physicians Committee for Responsible Medicine reports in their Spring 1994 newsletter, Good Medicine: "A synthetic estrogen works as well as, if not better than Premarin. The synthetic is closer to a human female's estrogen than is a mare's estrogen. Also the synthetic may have a more consistent potency than animal's derivatives. Plant-based estriol may be even better (than Premarin,) apparently causing no increased cancer risk." Many doctors agree. See the 1996 article in The Journal of Medical Ethics by Dr. Dennis Cox of Cambridge University Medical School. He considers objections to the mistreatment of horses including slaughtering of the majority of foals and concludes that plant-derived estrogen (estriol) is "an effective, economical and acceptable alternative to equine estrogen".
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