The Animal Cruelty and Danger Behind the ERT Drug Premarin

One of the most widely and longest prescribed drugs in the U.S. is Premarin®, named after pregnant mare's urine, its chief ingredient. Premarin®, which has been produced for some fifty years, is the only ERT (estrogen replacement therapy) drug made with estrogen from an animal. Other drugs are synthetic or plant-derived. If you're a menopausal woman contemplating estrogen therapy, I hope you'll consider your other choices after reading this.

The story behind Premarin® is ugly and tragic. There are 50,000 mares in North Dakota, Minnesota and western Canada who are impregnated and then tethered in cramped stalls (3.5-5 feet wide by 8 feet long) so that their urine, which contains estrogen, can be collected to make Premarin®. The mares are trapped in this prison barely able to move for six months, fitted with cumbersome rubber urine collection bags, and often denied adequate water in order to increase the estrogen concentration. Grooming and hoof trimming is minimal to nonexistent, and mares are often denied adequate water, reportedly to increase the concentration of estrogens in the urine. The mares are kept pregnant so that they produce estrogen-rich urine for as much of their lives as possible. Within days of giving birth, they are re-impregnated. A few months later, the foals of these mares are taken away from them and they're put back on the "pee line". Most of the foals-"byprods", as the industry callously calls them-are sold to "kill buyers", fattened, and then slaughtered; they're generally dead by four months old. The meat is sent to markets in Europe and Asia for human consumption. A few foals are kept for stud or to replace worn-out mares. The mares, in turn, are eventually auctioned off to butchers when they've outgrown their economic usefulness.

Conditions on PMU farms are terrible. Some of the problems found by the WSPA (World Society for the Protection of Animals) and the USDA (United States Department of Agriculture) on PMU farms were mares with untreated wounds and illnesses (respiratory, renal and liver problems), dehydrated mares fighting with each other over their meager water allotment, and mares so tightly tethered in their stalls that they could never lie down. The American Association of Equine Practitioners observed, in addition, many lower limb deformities caused by confinement and lack of exercise and chafed flanks caused by the collection bags.

Is a woman prescribed Premarin® at least guaranteed a pure product with consistent ingredients, considering all the animal suffering involved? The answer is no. Many physicians have their doubts about using animal waste in a drug for humans, particularly since the amount of estradiol (one of the active ingredients) can vary widely from batch to batch. The truth is that the estrogen in synthetic and plant-derived drugs is closer to human estrogen than that from pregnant mares. In addition, the type of estrogen found in Premarin® has been strongly linked to breast cancer.

Synthetic and organic plant-based conjugated estrogen alternatives to Premarin® include Climara (from beets and yams); Estrace (yams and soybeans); Estratab (soy); Ogen (vegetable sources); Provera (soy); Estraderm (sweet potato); and Ortho-Est (yams), as well as Estrovirus, Tace, Estinyl, Menest,Ortho, Dienestrol, and Cenestin. But often, just proper diet and regular exercise are all that is needed to keep the symptoms of menopause at bay: a low-fat, vegetarian diet with lots of fiber and soy products, yams, berries, and citrus, and avoidance of caffeine, sugar, and alcohol is the ideal. Too much animal protein leaches calcium from the bones and can lead to osteoporosis.

Wyeth-Ayerst, the company that produces Premarin®, has blocked attempts to classify any of the alternatives a generic form of Premarin®. That's a shame, because it would save hospitals, managed care groups, and Medicare some $300 million a year if a specific generic alternative to Premarin® were approved.