Menopause affects every woman, and doctors have treated the symptoms of menopause for nearly 60 years with a drug called Premarin, which has become the third most prescribed drug in the world (just behind Tylenol), bringing its single maker over one billion dollars per year.
However, the production of this drug has cost the lives of over a million horses.

Several medically sound alternatives now exist which completely avoid this slaughter and cruelty and are safer for the women who take them. "The cruel manner in which Premarin is produced is outdated and no longer necessary," said Equine Advocates' president, Susan Wagner. "With numerous medically recognized alternative choices for effectively treating menopausal symptoms, including synthetic estrogens, women now have the opportunity to end a fifty-eight year catastrophe for horses."

A new drug called, CENESTIN, a form of synthetic conjugated estrogens, is now on the market and available to women to treat the symptoms of menopause. Produced by Duramed Pharmaceuticals in Ohio, CENESTIN may mean the beginning of the end of the use of horses to make estrogen replacement therapy drugs from pregnant mares' urine (PMU).

Duramed has launched an aggressive publicity campaign to inform the public and the medical community about CENESTIN, which has included colorful full-page ads in many women's magazines and medical journals.



Sadly, the Food and Drug Administration (FDA) did not approve CENESTIN as a synthetic/generic form of PREMARIN, even though this is what experts say it is. Because of that unfortunate, and what we also believe to be a heartless and highly political decision by the FDA, horses will continue to suffer and be slaughtered by the thousands every year. Nothing will change substantially until the public and the medical community become completely familiar with Cenestin and understand that finally a form or conjugated estrogens which is made completely from plants and free of unknown substances (which Premarin has), can be prescribed in place of drugs made from horse urine. It is the obligation of all of us in the equine and animal protection community to launch major public relations campaigns to educate the public and the medical community on the important point that the cruel and inhumane treatment of horses to produce drugs from PMU is no longer necessary and should be stopped. Then and only then will we begin to see an end to the suffering and the slaughter.



SECRETS, LIES & GREED


Since 1942, a drug called Premarin (pregnant mares' urine) has been prescribed by doctors to treat the symptoms of menopause in women. Premarin (conjugated estrogens) is extracted from the urine of pregnant mares (female horses). Produced by Wyeth-Ayerst, Premarin is the most widely prescribed drug in the United States. It is also used by many women in Israel. The active ingredient, pregnant mare's urine, is collected on farms in the United States and Canada under extremely inhumane circumstances. These docile animals spend most of their lives tethered until their health fails and they are slaughtered, as are most of their foals. Although more modern, non-animal based substitutes for the treatment of menopause and osteoporosis are widely available, this urine collection industry is expanding very quickly. Thousands of additional horses are committed to this punishing existence every year. Because so much of this drug is prescribed, its production requires the operation of around 700 "farms", in which around 80,000 horses live their entire lives penned in tiny stalls, unable to turn around or meaningfully lie down, deprived of water, repeatedly impregnated, and continuously connected to plumbing collecting that urine.

When they can no longer produce adequately, most are summarily slaughtered. Most of their offspring are either put in stalls or slaughtered. Over fifty-eight years of Premarin production, well over a million horses or perhaps millions of horses, have lived in cruelty and then been slaughtered. Only in the last twenty years has this dreadful secret become known at all.

Premarin is central to what is called "hormone replacement therapy" ("HRT"), although it replaces only estrogen, not progesterone or the other naturally occurring hormones whose levels drop after menopause. This makes any estrogen medically controversial.

Premarin is also controversial because the health risks to women of absorbing a substance made from equine waste may not be fully known. Further, Premarin is also said, even by its maker, to contain various unknown and unidentified substances.

All of these issues have been buried by Premarin's maker, Wyeth-Ayerst, a division of American Home Products, headquartered in Philadelphia, Pennsylvania, who have spent tremendous time and money to sell the notion that only Premarin can treat the symptoms of menopause. The practical monopoly Wyeth-Ayerst has achieved by avoiding these controversies and, at least so far, burying alternative medications brings Wyeth-Ayerst over $1 billion in revenues each year from sales of Premarin and other drugs (including Prempro, Premphase, and Prempac) made from pregnant mares' urine ("PMU").

As a whole new generation of women enters menopause, it is vital that they be allowed to make informed decisions about the drugs they should or should not take. This requires knowing what different drugs are available and, most specifically, how Premarin is produced.




Facts About Estrogen

Many gynecologists prescribe Premarin for women going through menopause; however, there are healthier, more humane alternatives. This drug is derived from very cruel treatment of horses.

Where Does Premarin Come From?

Premarin is derived from pregnant mare's urine, obtained by impregnating a mare, fitting her with a rubber collection cup joined to a hose, and forcing her to stand for over 5 months on a concrete floor in stalls so small she cannot take more than one step, turn around, or lie down properly. After her foal is born, she is allowed out to pasture with it for only up to 5 months, after which time she is reimpregnated, separated from her baby, and returned to the estrogen production line. Sometimes, to increase profits, the mare's urine is concentrated by water restriction, potentially leading to disease in the animals which could be transmitted to humans. There is also some evidence that the equine estrogen contained in Premarin may cause cancer.

What Are the Alternatives to Premarin?

There are several equally effective drugs derived from plants like soybeans and Mexican yams, including:
Estrace
Ogen
Orthoest

When smaller amounts of estrogen are needed, natural estrogenic substances (plant-derived estrogen-like chemicals called phytoestrogens consisting of lignans and isoflavones) should be considered. These compounds are 1/400 as potent as estrogen itself and serve to balance estrogen levels. If estrogen levels are low, ingestion of these foods can result in an increase in overall estrogen activity. If estrogen levels are high — as in some cases of PMS — they can bind to estrogen receptor sites and decrease estrogenic activity. In either case, they can balance estrogenic activity and protect against the cancer-producing effects of either natural or animal/synthetic estrogen. These compounds can also lower cholesterol.

Foods containing these substances include:
Soybean Products (soy milk; soy burgers and hot dogs; tofu; tempeh; soy nuts and beans; soy flour; miso)
Split Peas
Whole Wheat
Rye
Oats
Barley
Chickpeas
Sesame Seeds
Pomegranates
Apples
Spinach
Flaxseeds
Lima Beans
Alfalfa Sprouts

One combination would include flaxseed cereal and soy milk (1 bowl) for breakfast and 4 oz. tofu at another meal.

Some supplements that can stimulate estrogen production by the ovaries include:
Flaxseed Oil
Licorice Root
Unicorn Root
False Unicorn Root
Black Cohosh
Fennel
Evening Primrose Oil
Vitamin E (400 U)
Dong Quai

A recent study in the American Journal of Epidemiology from the Cancer Research Center in Hawaii showed that women whose diets are rich in soy foods are less than half as likely to develop uterine cancer. Ask your gynecologist about raloxifene, a new drug that is not an estrogen but acts on estrogen receptors to increase bone density without increasing cancer risk (New England Journal of Medicine 337:1641, 1997).



Should Every Menopausal Woman Take Estrogen?

Estrogen deficiency may occur during or after menopause, and estrogen excess or imbalance may cause PMS. There are instances, therefore, when the amount of estrogen activity in the body should be increased, decreased, or balanced. This should be discussed with your gynecologist.

Estrogen supplementation should be considered with caution in women with:

History of breast cancer
Liver disease
Thrombosis
Hypertension
Fibrocystic breasts
Elevated cholesterol
Migraine headaches
Endometriosis
A 1997 review published in Lancet (350:1047) of 51 studies in 21 countries shows a 35% increased risk of breast cancer in women who have used hormones for 5 years or longer. Estrogen can also increase uterine cancer risk (Lancet 349:458, 1997).

Estrogen may have the following side effects:
Headache
Nausea
Anxiety
Insomnia


What You Can Do

Learn more about Premarin and Estrogen Replacement Therapy
Discuss alternatives with your doctor
Discuss alternatives with your friends
Try a vegan diet
Boycott Wyeth-Ayerst
Note: The vitamin company Solgar has been bought by Wyeth-Ayerst. If you have been buying Solgar vitamins, please find an alternative.





CYCLE OF CRUELTY

Premarin is produced at Ayerst Organics in Brandon, Manitoba, Canada. Brandon is known as the "PMU capital of the world." Urine extracted from the mares on about 700 PMU "farms" in Canada and the United States is shipped to the processing plant in Brandon. The company sets the quotas, sets the price, and picks the PMU producers, as farmers compete to obtain contracts with "Wyeth" to set up PMU farms. The company also runs a "research" facility in Carberry, Manitoba (near Brandon) which is operated like a working PMU farm. Security there is tight as the "work" and experiments are kept strictly confidential.

For six to seven months of their eleven-month pregnancies, an estimated 80,000 mares are confined to tiny stalls where, contrary to Wyeth-Ayerst's explicit statement, they cannot turn around, groom themselves, or lie down comfortably. They are harnessed in with urine collection pouches fitted over their urethras designed to collect the precious urine. The urine then travels through hoses that lead to plastic containers on the ground in front of each stall where PMU farmers empty them when full for collection and shipment to Ayerst Organics.

The urine pouches and the manner by which they are attached to the mares' bodies can cause infections of their vulvas and chafing of their legs, and makes it practically impossible for them to lie down. They are also tied by their necks to prevent them from turning around. These mares get little or no exercise, with some of them actually standing in that position for the entire six to seven months. Due to the nature of their confinement on the "pee lines", the mares are denied the opportunity to assume all of their natural postures. When sleeping, the mares are unable to enjoy the fully relaxed position of lateral recumbency (lying stretched out on their sides). Instead, they must sleep standing up or lying down in the more cramped position of sternal recumbency (lying on their chest with legs tucked up). There is no official government regulation for the treatment of PMU mares, only a "Code of Practice" written by Wyeth-Ayerst for the PMU farmers to follow.

The mares are commonly fed and watered on a time-release basis. They are deliberately deprived of water so that the estrogen is as concentrated as possible. Mares are given minimal amounts of water 17 or 18 times a day. They can be seen trying to drink out of empty water bowls and are in such anticipation of each allotment that they continue to try to drink long after the water is gone. They also exhibit stressful and anxious behavior when they know the water is coming. Liver and kidney disease are common in these mares, as is swelling of the legs.




IT'S A HORRIBLE LIFE

In general, most horses live well into their twenties and thirties, but not PMU mares. The ones who are considered to be "good producers" can stand on the "pee lines" for as long as twelve to fourteen years before being scrapped at the slaughter auctions for meat. The same fate is a common occurrence for most of the mares who don't become impregnated. In the spring, when they give birth and their estrogen levels are down, the mares are allowed out in the fields again...but not for long. They are soon impregnated again and placed back on the "pee lines." Life for the mares on the PMU farms is so hard that one-fourth of them are replaced each year, even though typical life expectancy for the draft breeds used on most of these farms is twenty years or more.





BABY HORSE MASSACRE

A majority of the mares on Canadian PMU farms give birth on "community pastures," which are on public land. Many of the foals born to the 52,000-plus mares in Canada die soon after birth, unable to survive the harsh conditions of the prairies. The surviving colts are considered to be byproducts and the majority of them are sold for slaughter. Most of the fillies are either slaughtered or kept to replace the worn-out mares on the PMU farms.




Most of the foals are sold at auctions in the fall, at which time they are between two and three months old. They can regularly be observed trying to nurse off each other. The colts are sold by lot where almost all are bought by "killer buyers" (middlemen for the slaughterhouses) and feedlot operators who fatten them up before shipping them to slaughter plants in Canada and the United States. There they are butchered and their meat is then exported to Europe and Japan as a delicacy (with certain cuts selling for $25 per pound) for human consumption.

The fright and terror in these foals is apparent as they are herded through the sales arenas and then on to cramped trailers with canes and electric cattle prods. Some of them are loaded on to the backs of pickup trucks. Injuries are common, but veterinary care is virtually non-existent at these auctions. Young, frail horses are often loaded together with large, heavy horses with no one present to stop the cruel and inhumane treatment during the loading process.


THE HORROR STORIES


Mares who are no longer productive and stallions who are used up are also sold at slaughter auctions for meat. One Canadian investigator told us, "One of the saddest things I ever saw was an old, used-up Belgium mare being sold for meat at one of the auctions. She had a cheap halter on that was embedded in her head. Her owner wanted the halter back after she was sold to the killers so he ripped it off and she had this gaping hole in her head. She stood there shaking and bleeding profusely and nobody did anything to help her."


CONFESSIONS OF AN EX-PREMARIN FARM WORKER


"He (Frank _____, a PMU producer) does have horses right now that are wounded from the winter, but as he said, you cannot prove he did it. He told me that this is the reason why he has his PMU farms so far away from everything...

"He does not usually give worm shots or any other shots for that matter. Eventually the animals get very sick...some cannot stand or eat and become very weak and need to lie down. This is when he takes the (front end) loader and beats on them either causing them to abort or krippling [sic] them and worst of all killing them. Six or seven were killed in this way...

"He will also kripple [sic] a horse that he finds he can't work behind. The horse jumps because he spooks it and Frank will then beat it until it cannot stand well. Frank _____ came out and shot an older but healthy horse...with a .22 calibre rifle twice. He did not have any more bullets. And the horse did not go down. He had a black knife, the kind you push the blade up. The knife's end was broken so it was only an inch and a half long. He began slashing the neck of the horse over and over. It stood bleeding. He then went to the house, brought out a shotgun. Shot it three more times...

"There was a thoroughbred, its stall was too small. So when he cleaned the barn with loader and bucket, he would bash her legs. The horse was bashed up so bad that puss [sic] and blood was dripping. They were the size of watermelons...I took her out of the barn. I gave her a few shots. I bought things to get ride of the outer infection. I brought the swelling down. I showed the vet the day she came to look at the thoroughbred. The leg was only hurt at the time and she said the horse was finished. I fixed that leg and was working on the other.

"Frank didn't like this at all. I used to feed her oats outside away from the others. She was too weak to fight. Frank didn't like this either. He took the tractor and chased her around until her legs ripped in half. He left her to bleed to death..."



PREMARIN AND WOMEN'S HEALTH


"Women are not horses," said one of numerous medical practitioners interviewed by Equine Advocates regarding the health issues associated with Premarin, all of whom conclude that the risks may outweigh the benefits of taking this questionable drug.

Here's more of what some of them had to say:

R. M. Kellosalmi, B.Sc., M.D., L.M.C.C., physician and surgeon, Peachtree Medical Centre:

"I prefer to know exactly what I am prescribing," said Dr. Kellosalmi. "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 some 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 need to 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."

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."

Don Sloan, M.D., F.A.C.O.G., board certified gynecologist
(excerpted from a 1997 letter to fellow gynecologists)

"As a colleague and practitioner in our specialty over the past many years, I urge you to consider the use of medication 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."

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 practitioners should be informed and able to offer different options to women. I don't think we compromise anything by not prescribing Premarin."


POLITICS VERSUS SCIENCE


The approval by the Food and Drug Administration (FDA) of a synthetic/generic form of conjugated estrogens would virtually end the cruelty and save money for millions of women. Both Barr Labs of Pomona, New York and Duramed Pharmaceuticals of Cincinnati, Ohio have produced synthetic/generic forms of Premarin, but the FDA has not approved either. According to the Boston Globe, "It is impossible to predict when a generic, vegetable-synthetic copy of Premarin will be approved by the FDA. Wyeth-Ayerst, grossing a billion dollars a year from Premarin, has the financial incentive to block a generic substitute and has the scientific and legal consultants to do the job."

According to the Washington Post, "Wyeth-Ayerst has played Washington hardball, lining up support from women in Congress and women's organizations. The pitch to the FDA has been that the generics don't contain delta 8,9 dehydroestrone sulfate, an ingredient of Premarin that the FDA has repeatedly found to be an impurity and not a required component of any generic...Nevertheless, Wyeth-Ayerst, which holds the patent on delta 8,9, has been saying both in a citizens petition filed with the FDA and in its public relations campaign that it may be a key ingredient and that the FDA should require it to be included in any generic version."

This is only one of Wyeth-Ayerst's attempt to spin up a wall of pseudo-technology to block generics. In 1991, they persuaded the FDA to withdraw its approval of generics because they were absorbed into the blood faster than Premarin and, according to Wyeth-Ayerst, this faster absorption could increase cancer incidence. FDA took this step and called for lengthy studies of the issue even though Wyeth-Ayerst was selling a fast-absorption version of Premarin in Canada.

Meanwhile, Duramed and Barr went ahead and addressed the absorption issue and were, in 1995, given reason by the FDA to expect approval, but pressure on the FDA from members of Congress and several women's organizations, all of which have received significant amounts of money from Wyeth-Ayerst, led to the delta 8,9 debacle. An internal FDA document from May 1997 is the latest to cite this substance as an impurity and names at least 25 more impurities of unknown medical properties found in Premarin.

Something other than science or medicine appears to be keeping the FDA from approving generic alternatives to Premarin.



THE GOOD NEWS IS...

There are numerous alternatives to Premarin, including synthetic estrogens and changes in diet and lifestyle which can be at least equally effective in treating menopausal symptoms without involving cruelty.


ALTERNATIVE ESTROGENS: Vegetable-derived Estrace is the second most prescribed estrogen therapy drug. There are others including Orthoest, Ogen, Estradiol, Estriol, Estrone, Estrovis, Estropipate, and the Estraderm and Climara patches, and others, all of which are considered to be effective for hormone replacement therapy. Ask your doctor to go over the choices with you.

OTHER HORMONES: Estrogen is not the only hormone produced by pre-menopausal women's bodies, and therapies including progesterone and other naturally occurring hormones in addition to estrogens appear, in some cases, to offer better mitigation of symptoms with less risk than estrogen-only therapy.

RALOXIFENE: Produced by Eli Lilly, this new drug increases bone density and, unlike Premarin, involves no risk of breast cancer or cancer of the womb (uterine cancer). It also appears to protect the heart.

DIET: "There is no Japanese word for hot flashes," writes physician and author Dr. Neal Barnard. In his book Eat Right, Live Longer, he says, "Diet is a great contributor [to hot flashes]. It has long been known that menopause is much easier for Asian women than for most Westerners," referring to the low-fat, tofu and rice-based diets of many Asian women.

PHYTOESTROGENS: Foods including flaxseed, soy milk, and tofu contain naturally occurring estrogens known as "phytoestrogens." Books like Estrogen: The Natural Way by Nina Shandler and Dr. Susan Love's Hormone Book, encourage diets high in phytoestrogens. Shandler's book also includes recipes for adding foods with phytoestrogens to meals.