Alternatives to Premarin and Prempro

As a follow up to iFH’s patient-to-doctor letter regarding the Premarin family of drugs and the horrors they inflict on both horses and women alike, we have compiled a list of alternatives that may be safer, effective and humane.

We encourage you to go online to further acquaint yourself with the effectiveness and safety of these compounds; there is a wealth of information out there, but beware of false claims and err on the side of caution.

And, as always, please inform your doctor if you plan to use these as treatments for the relief of menopausal symptoms since some may have seriously adverse side-effects.


Lifestyle Changes

Probably the simplest and most natural approach to the treatment of menopause is to adopt a healthy lifestyle in regard to diet, exercise and stress management. Not only will this help alleviate symptoms but the benefits will ensure that you remain healthy now and in the future.

  1. Nutrition: It should go without saying, avoid refined and processed foods, choose more whole foods, fresh fruit, vegetables and complex carbohydrates. Avoid high fat dairy products and meats and supplement these items with healthy fats such as olive oil, nuts, seeds and lean cuts of meat or fish. Additionally, practice portion control and avoid empty calorie foods.
  2. Exercise: Exercise is vital to keeping symptoms in check. Exercise directly affects hormonal activities in the body by raising the level of endorphins, for example, to maintain emotional stability and suppress anxiety. Moreover, the benefits are unsurpassed: maintenance of muscle and joint strength, increased metabolism, reduced weight, improved cardiovascular health, increased cognitive function, maintenance of bone integrity, and the list goes on.
  3. Stress Management: It is a well known fact that stress induces more severe hot flashes. There are many stress-reduction techniques available to manage the burden of everyday anxiety – rest, relaxation, varied leisure activities, and most importantly self-affirming thoughts to maintain self-image and confidence.

Bio-identical Hormones

Bio-identical hormones are synthesized in the lab from plant sources and as the term implies are pharmaceuticals that closely mimic natural hormones produced in the body since they possess the same molecular structure. There are many indications that bio-identical hormones pose far less risk for the human species than conventional therapies such as Premarin.

Dietary Phytoestrogens

Dietary phytoestrogens are naturally occurring substances (e.g. Isoflavins) found in fruits, vegetables, and whole grains such as soybeans, alfalfa sprouts, and oilseeds (such as flaxseed). There is some evidence that they have a weak estrogen-like effect that may reduce the intensity and frequency of hot flashes.
Eating natural foods that contain these compounds is safe but there are also non-prescription supplements on the market for which there is no long-term safety data.

Natural Hormones

  1. Estriol: Can be used to treat hot flashes and other symptoms and helps in maintaining bone density. However, two studies have recently shown that estriol causes stimulation endometrial cells.
  2. Natural Progesterone: There is some evidence that natural progesterone is useful in the treatment of hot flashes but no evidence that it benefits bone density. Examples include: topical progesterone creams and oral progestins.
  3. DHEA:  Dehydroepiandrosterone (DHEA) is an estrogen precursor meaning it is converted to estrogen and possibly some testosterone in the body. This may or may not increase levels of estrogen in the body naturally.

Prescription Drugs

There is also convincing evidence that some prescription drugs such as SSRIs, SNRIs, Gabapentin and Clonadine, which are not licensed for treating menopausal symptoms do in fact alleviate hot flashes and night sweats. These are powerful drugs yet in severe cases some doctors may be willing to prescribe one of these treatments, with the patient’s consent.

Herbal Medicines

Herbal medicines are readily available however caution is advised since they can contain powerful ingredients that may contraindicate other prescription drugs and/or may have adverse effects on certain individuals.

Some examples include: Black Cohosh for hot flashes and sweating, Kava to reduce anxiety, Ginko to decrease the risk of onset of dementia and St. John’s Wort as an anti-depressant. No substantiated medical studies are available for these medicines and most do not have to comply with the stringent safety, quality and manufacturing regulations that govern conventional medicines.

In the News

As time progresses many women – and doctors – are looking for safer and more humane alternatives to conventional HRT. Recently in the news a non-hormonal supplement called Amberen, manufactured by Lunada Biomedical, has been touted as the next cure-all for relief of menopausal symptoms. Claiming to have a double-blind, placebo-controlled clinical study to back its effectiveness, it contains 100% natural ingredients, all on the FDA’s approved Generally Recognized As Safe (GRAS) list. Only time will tell as to the authenticity.

Consult Your Doctor

In any case, it is important to separate fact from fiction and be astutely aware of the consequences of clinically unproven medications. Apart from the unmistakable benefits of lifestyle changes, before considering any of the alternatives listed please consult your doctor.



— Alternatives to Premarin and Prempro in Word

— Patient to Doctor Letter

— Articles on Premarin Horses

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