Alert your doctor not to prescribe Premarin for menopausal symptoms

For every 150 women who stop taking Premarin, one mare is spared from the “pee line” and seven “byproduct” foals are not be slaughtered for their meat.

We are not spiritually unconnected from the drugs we take, or from the pain and suffering that goes into their making.”

— Alice Walker

“We crush ’em and recycle ’em . . . just like aluminum cans.”

— Pat Houde, equine feed lot manager, regarding Premarin foals and mares

The Int’l Fund for Horses is working to end the use of medications derived from conjugated equine estrogen (CEE), or pregnant mare’s urine.

Mares, foals and women are all at risk. The mares and foals cannot speak for themselves, but women can, and should, for the horses and for themselves.

We ask that women please prepare the following letter and send it to their physicians.

If you are a woman not experiencing menopausal symptoms, please edit the letter to fit your circumstances (omit the last paragraph and end with a thank you).

Both men and women should share this with the horse lovers and women in their lives.

Thank you for getting involved!

Download Word Document of Letter Here

Thin Gray Line

[Insert Date]

Dr. [Insert Name]
[Insert Address]
[Insert City, State, Zip]

Dear Dr. [Insert Name]

Re: Hormone Replacement Therapy Drugs for Treatment of Menopausal Symptoms
Premarin®, Prempro® and Aprela (awaiting approval)

Please Refuse to Prescribe these Drugs

As a concerned and knowledgeable patient regarding the use of the conjugated equine estrogen produced drugs Premarin® and Prempro®, I encourage you to stop prescribing these medications for relief of menopausal symptoms. Premarin® and other such HRT compounds are derived from the high concentration of estrogen in pregnant mare’s urine (PMU). Not only is the collection practice inhumane but the risks imparted by these drugs to unsuspecting women are objectionable and unnecessary. Many believe that the risks far outweigh any benefits offered given that these particular medications are recognized by the United Nations as potent carcinogens.

The Horses

Life for PMU mares is merciless; repeatedly impregnated for up to as many as 20 years, they spend 6 months of their 11-month pregnancy confined to stalls so small they have difficulty turning around or lying down. During this time, they are permanently connected to cumbersome rubber urine collection bags that chafe their flanks, cause infections and severely limit movement. Water intake is routinely restricted to concentrate the amount of estrogen in their urine causing life-threatening renal and liver problems. Equally disturbing is the fate of the foals – the “by-products” of the industry. Most are sold at auction to “kill buyers” and ultimately end up at the slaughterhouse.

The Women

Nationwide studies (e.g. NIH’s Women’s Health Initiative) have been published that clearly corroborate the link between HRT, cancer, heart disease, stroke and dementia. Women who take these drugs face significantly increased risks of: invasive breast cancer (26%), heart disease (29%), strokes (41%), blood clots to the lungs and legs (50%), ovarian cancer (60%), impaired cognitive function, dementia and Alzheimer’s, asthma, lung cancer, malignant melanoma, and reduced insulin resistance, among others. Most importantly, when these medications are stopped, a woman’s risk returns to the same level as those who have never used these therapies.

The Culprits

Noteworthy are the on-going lawsuits against Wyeth (now a Division of Pfizer), the manufacturer of the Premarin® family of drugs. Juries and Judges alike have shown that Wyeth failed to adequately warn consumers about the risks associated with these drugs and that they purposefully hid the risk of breast cancer and other diseases. Moreover, evidence has confirmed that Wyeth employed ghostwriters to write medical reports related to HRT and paid physicians to sign off as the authors. Not only did the articles overstate the benefits of HRT, but they diminished the serious risks associated with the drugs.

The Alternatives

I believe there are safer and more humane alternatives available. However, as always, before trying these alternative remedies, I would like to discuss these options with you.


[Insert Patient Name]
[Insert Patient Ref Id# if applicable]
[Insert Patient Address]
[Insert Patient City, State, Zip]
[Insert Patient Telephone No.]

Thin Gray Line

Download Word Document of Alternatives Here

For more information on the PMU industry, please read the iFH Fact Sheet >>

Read articles about Premarin and the horses on Tuesday’s Horse >>

Thank you, Jane, for your stellar work and leading our Team in this effort.

35 thoughts on “Alert your doctor not to prescribe Premarin for menopausal symptoms”

  1. I was prescribed Premarin in the UK after a hysterectomy. I was in the dark to any problems, until my right leg started losing its form on my thigh. I was referred to a specialist at Bristol hospital. She invited several students to join in the examination on my leg. I was told that I had LYPODYSTROPHY. I had read an article that Michael Jackson (now deceased) was taking a medication to keep his weight down which came from PREGNANT Mare’s urine. I stopped taking PREMARIN and my leg eventually returned to normal! It had been banned in France when we moved here in 2004!!


  2. I would like to see a list of which hormone replacements contain the urine of doctor tells me my medication doesn’t.i take femeston.i think a list of the actual hormones which are directly linked would make the awareness higher and have a bigger impact on our choices.lisa


    1. In North America the only products that contain “real” pregnant mare’s urine are the Pfizer Premarin brand of producst (Premarin, Prempro, Duavee, etc.). Despite the fact that the Premarin patent has expired, Pfizer/Wyeth have won all of their court cases against any drug company that has tried to reproduce Premarin using mare’s urine.
      Companies that have attempted to market generic versions of Premarin® have encountered FDA regulatory problems, as opposed to patenting problems. The two main lines of reasoning cited by the FDA for its prior refusals to approve generic versions of Premarin® have related to characterization and bioequivalence.

      Premarin® is a mix of conjugated estrogens and other steroidal and non-steroidal ingredients isolated from the urine of pregnant mares. When Premarin was first approved in 1942, it was known to contain estrone and equilin, with additional estrogens in smaller amounts (which, at the time, were regarded as trace impurities). In fact, the original 0.625 mg tablet strength was controlled using a colorimetric assay, and the estrogenic potency was established with a now-defunct rat bioassay using estrone (sodium estrone sulfate) as the reference standard.

      The FDA initially permitted conjugated estrogens containing estrone and equilin to be marketed as generic versions of Premarin. However, by the mid-1980s, the FDA concluded that it was no longer clear that estrone and equilin were the only active ingredients in Premarin. Moreover, the FDA began to recognize Premarin as a modified release dosage form, which called into question the bioequivalence of the generic conjugated estrogens on the market. Thus, in 1991, the FDA withdrew approval for all of the then-existing generic conjugated estrogens, and there has not been a generic version of Premarin since then.

      P.S. The FDA has approved for marketing conjugated-estrogen drug products similar to Premarin, but which are not generic versions of Premarin in the strict legal sense (i.e., not approved under Section 505(j) of the FFDCA, as codified by 21 U.S.C. § 355(j)). For example, in March 1999, the FDA approved Cenestin, a blend of nine synthetic estrogenic substances developed by Duramed Pharmaceuticals Inc. (now Teva Women’s Health) which was specifically developed to mimic Premarin’s® modified-release characteristics by using a tablet that controls the release rate of the estrogen and prevents the estrogen from disintegrating through contact with excess water during storage.

      There is no “generic” available – no matter what anyone may tell you – and all of the other HRT products are derived from other sources (e.g. plants). Of course there is a thriving market in China where horse urine is used to produce HRT, but not here.
      “Premarin is a brand-only medication, and a 30-day supply can cost well over $200. Currently, there is no generic for Premarin, and there may never be.”


  3. This is an urgent message to stop prescribing
    Pregnant mare’s urine (Premarin) to women.
    It is not only horrifying for the horses and death to the foals but dangerous for the women and
    known to cause cancer.
    Thank you!
    Kathleen Johnson


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