by JANE ALLIN
Contrary to popular belief, the FDA has yet to approve any generic as a substitute for Premarin and its daughter products (i.e. Prempro, Premphase, Duavee).
Accordingly no prescription drugs used to treat menopausal symptoms, other than the Premarin family, contain pregnant mare’s urine.
However much confusion arises when the subject of HRT is broached, particularly in terms of the safety aspect of FDA-approved versions that are not derived from pregnant mare’s urine.
The vast majority of FDA-approved HRT prescription drugs are synthetic bioidenticals — hormones identical on a molecular level to endogenous hormones that are synthesized in the lab from natural plant sources.
These are not to be confused with the compounded bioidenticals, none of which are approved by the FDA.
Premarin and its derivatives are also synthetics but, of course, sourced from an animal by-product.
Apart from Brisdelle, the only non-hormonal FDA-approved HRT, the rest fall into three categories of hormone combinations as follows:
• Estrogen combinations (e.g. Estrace, Cenestin, Enjuvia, Menest)
• Estrogen/Progestin combinations (e.g. Activella)
• Estrogen/Androgen combinations (e.g. Menogen, Covaryx)
The estrogen combinations are intended as substitutes for Premarin and Duavee while the estrogen/progestin versions are proposed alternatives to Prempro and Premphase.
Estrogen/androgen replacement therapy primarily represents mainstay therapy for young women who have undergone a hysterectomy. See http://www.medscape.com/viewarticle/438357.
A good proportion of these drugs contain estradiol or esterified estrogens (non-equine) as the estrogen component (e.g. Estrace, Femtrace, Activella, Femhrt, Angeliq). However several have identical equine estrogens that are derived from plant-based sources versus pregnant mare’s urine.
That said, these drugs are not entirely identical nor are they exactly equivalent in constituents. Cenestin, Enjuvia, and Menest are three such HRTs included in this group.
Cenestin was originally developed as a generic for Premarin by Duramed/Barr but in 1997, the FDA refused to approve the abbreviated new drug applications from Duramed and Barr Laboratories for a generic version of Premarin.
The FDA’s rationale was quite straightforward. A synthetic generic version of Premarin could not be approved because the exact chemical composition of Premarin could not be fully identified. This has been a controversial topic for years, a topic The Horse Fund has visited in the past. See https://tuesdayshorse.wordpress.com/2014/11/14/the-quest-for-a-generic-premarin-a-bitter-pill-to-swallow/.
In any case, all three of these drugs – Cenestin, Enjuvia, and Menest – contain similar estrogen components that are found in Premarin and its derivatives.
Premarin however is a complex mixture of numerous hormonal components, of which only some of the estrogenic components are found in the plant-based synthetics.
The table below compares the ingredients of Premarin, Cenestin and Enjuvia. I was unable to locate the same information for Menest.
However the pharmacology is similar to the others and contains a mixture of esterified estrogenic substances, principally estrone, that are of the type excreted by pregnant mares (e.g. sodium estrone sulfate, sodium equilin sulfate).
|sodium estrone sulfate||Yes||Yes||Yes|
|sodium equilin sulfate||Yes||Yes||Yes|
|sodium 17 alpha-dihydroequilin sulfate||Yes||Yes||Yes|
|sodium 17 beta-dihydroequilin sulfate||Yes||Yes||Yes|
|sodium 17 alpha-betahydroequilenin sulfate||Yes||Yes||Yes|
|sodium 17 beta-betahydroequilenin sulfate||Yes||Yes||Yes|
|sodium 17 alpha-estradiol sulfate||Yes||Yes||Yes|
|sodium equilenin sulfate||Yes||Yes||Yes|
|sodium 17 beta-estradiol sulfate||Yes||Yes||Yes|
|sodium D8,9-dehydroestrone sulfate||Yes||No||Yes|
|5,7,9 (10) estratrien-3beta, 17 beta-diol||Yes||No||No|
|17 alpha-dihydro-delta, 8,9-dehydroestrone||Yes||No||No|
|17 beta-dihydro-delta, 8,9-dehydroestrone||Yes||No||No|
|5,7,9 (10) estratrien-3betal-ol-17-one||Yes||No||No|
|Prempro / Premphase||CEEs / Progestin||No||Expired||$5.77||$173|
|Brisdelle||SSRI (paroxetine)||No||Apr 2029||$5.74||$172|
|Duavee||CEEs / SERM (bazedoxifene)||No||Oct 2016||$4.77||$143|
|Angeliq||Estrogen / Progestin||No||Oct 2017||$4.31||$129|
|Cenestin||CEEs — plant based||No||Expired||$3.97||$119|
|Prefest||Estradiol / Progestin||No||March 2020||$3.37||$112|
|Enjuvia||CEEs — plant based||No||Feb 2021||$2.75||$83|
|Femtrace||Estradiol acetate||No||Dec 2021||$2.68||$80|
|Activella||Estradiol / Progestin||Yes||Expired||$2.06||$78|
|Menest||CEEs — plant based||No||Expired||$1.77||$53|
|Femhrt||Estrogen / Progestin||Yes||Expired||$1.32||$40|
Clearly, Pfizer is laughing all the way to the bank at the expense of women and horses alike.
© The Horse Fund
• Print friendly version of this report (pdf, 7 pp)
Menopause is not a disease. It is a natural change in hormones that takes place when women begin to move past their childbearing years.
Hot flashes may occur and make you uncomfortable during that time. Last I heard hot flashes caused by menopause most likely will never kill you.
Last class action lawsuit I saw demonstrates that drugs made with horse pee such as Premarin, Prempro, Premphase and its latest incarnation — DUAVEE — can cause cancer. The World Health Organization has been saying this for a long while. Drugs made with conjugated equine estrogens are known carcinogens.
Premarin Cream ads peddle the idea to menopausal woman that they are too dried up to enjoy sex. Really?
If women are old enough to have symptoms of menopause, surely they are old enough to know what lube is and how to use it.
SOUND THE ALERT!
Let us know when and where you see advertisements for Premarin, Premarin Cream, Duavee (or Duavive in the EU) by completing the form below.
If aired on television, we must know which show you were watching please and the time. When we contact television stations their staff do not want to look it up. Let’s make it as easy for them as we can so they will co-operate.
Here’s the form. Fill in the revelant bits. Click submit when you are ready. Your information will be sent directly to our inbox. Thank you!
What are we doing with this information? We are getting these ads off the air and out of magazines by alerting advertisers to the nature of these products.
Oprah (I thought she had retired or something) ignores all requests and still advertising Premarin Cream. I guess she doesn’t care. And she’s a horse owner too.
Our Facebook page is active again. See https://www.facebook.com/HorseFund. Please feel free to post this information there.
— Learn more about the horses and foals who abused by this obnoxious industry at Premstoppers »
Cross-posted from The Coast Reporter »
By CHRISTINE WOOD
CANADA — The class action lawsuit launched by a Sechelt woman against Wyeth Canada Inc. for selling hormone replacement therapy drugs linked to breast cancer is now settled and a $13.65 million payment has been awarded by the B.C. Supreme Court.
A large portion of that settlement, about 43 per cent, will go to legal counsel for the plaintiffs in the class action suit. The approximately 1,100 plaintiffs themselves will split what’s remaining based on medical costs incurred to date and the ability to prove they took the hormone replacement drug Premarin or Premplus between 1977 and 2003.
Sechelt resident Dianna Stanway, who launched the class action suit, said this week that while the payout may be minimal in the end for the many women involved, she was “satisfied with whatever they can get us.”
“As long as everybody knows it can cause cancer. That was the main object of the court case, because people didn’t know it did at the time but now they do,” Stanway said.
“I’m quite pleased with the outcome of it all.”
Stanway started the class action suit in 2004 after taking the drug Premarin and subsequently being diagnosed with ductal and lobular breast cancer. Continue reading »
What this article does not mention is that Premarin and its sister drugs are made with the urine of pregnant mares.
The pharmaceutical industry now commonly refers to the estrogen component in Premarin drugs (including its latest Duavee) as conjugated estrogens conveniently omitting equine which indicates the true identity and alarming nature of these products. There is a hint in the name of the drug itself — pregnant mare’s urine.
The $13M payout is chump change to pharma giant Pfizer, who acquired Wyeth in a merger in 2009 and continues to make billions of dollars from the sales of these types of products.
And all those commercials you see for Premarin cream? Yessiree. Same drug. Same company. Same conjugated equine estrogens. Same horror for the horses.
Please note that the image of the PMU farm on this page was not filed with the cited report.