We made the following response to a comment on our Premarin 2019 Timeline and thought it might be worthwhile sharing with everyone as a post. We have altered it slightly to make the content clearer for this format.
Working as the Int’l Fund for Horses we are launching a social media campaign in Chinese and English in China. We originally thought that might not work. How many mature Chinese women are on social media?
Then we found out that most Chinese females 40 and under have learned to read and write English. So that’s why we will send our social media messages in both English and Chinese. That will reach the younger women who have English who can alert their female elders; and the 40+ women who do not have English.
We are also lucky because we have been able to get images of some of the Chinese versions of Premarin type drugs. This will help enormously on social media such as Twitter which relies heavily on visuals to catch attention.
The hugely disappointing part is that it appears the Chinese were either given, or have stolen/recreated Pfizer’s “recipe” for Premarin drugs and are manufacturing it themselves. Those drugs will be harder to identify but we have contacts who are trying to help us with that too.
The side effects will eventually show up making women question the use of these drugs.
Additionally, we have a British contact living and working in Hong Kong who is creating dual language posters warning of the dangers of these drugs listing them in their various Chinese names. We will try them out on bus shelters and train station platforms to start with. We have always had good outreach numbers at these type locations in other countries.
If you have ideas to share, or would like to help especially on social media such as Twitter, please use our contact form to get in touch with us.
FDA denies Pfizer Petition asking for new method of assessing Premarin generics
The FDA has denied a citizen petition from Pfizer calling on the agency to use the company’s method for assessing sameness in generics for its estrogen drug Premarin (conjugated “equine” estrogens).
Pfizer had appealed to the FDA to force sponsors of generics for Premarin to use the “Pfizer method” for assessing sameness rather than the method recommended in FDA draft guidance.
Pfizer claimed that the FDA’s December 2014 draft guidance for establishing sameness is “fundamentally flawed”. Additionally claiming that not only does it lack a critical level of sensitivity on API (Active Pharmaceutical Ingredient) steroidal composition, but also it does not account for all classes of components in the API or the non-steroidal components.
They maintained that guidance should instead use the “Pfizer Method” that the company developed at the FDA’s request and with their input, which permits a determination of sameness between a proposed generic for the company’s drug Premarin and the reference drug based upon the mixture as a whole, while allowing a comparison across all categories of components making up the API.
Bijuva launched for moderate to severe hot flashes in menopause
TherapeuticsMD announced the launch of Bijuva (estradiol and progesterone) capsules for use in women with a uterus for the treatment of moderate to severe vasomotor symptoms (hot flashes) due to menopause. It initially received approval from the Food and Drug Administration (FDA) in October 2018.
Bijuva is the first bio-identical hormone therapy that combines estradiol and progesterone in a single capsule. Compared with synthetic hormone products, the estradiol and progesterone found in Bijuva are structurally identical to the hormones naturally circulating in the woman’s body.
Bijvua carries a Boxed Warning regarding cardiovascular disorders, breast cancer, endometrial cancer, and probable dementia. Breast tenderness, headache, vaginal bleeding, vaginal discharge, and pelvic pain were the most common adverse reactions associated with Bijuva.
PMU Ranchers feel pinch as cuts announced
Pfizer Canada’s cuts to pregnant mares’ urine production will force four Manitoba ranches and one Saskatchewan ranch out of the industry.
The reduction affects three ranches in southwestern Manitoba, one in the Interlake region of Manitoba, and one in Saskatchewan. Of those five, three producers raised registered Quarter horses, one bred purebred Percherons, and one raised sport horses.
Pfizer has initiated a review of its inventory management and determined they are able to satisfy market demand by working with fewer ranchers.
The latest reduction leaves 19 producers still involved in PMU production in Manitoba and Saskatchewan, with most ranches located in southwestern Manitoba, four each in south-central Manitoba and southeastern Saskatchewan and one in the Interlake.
Pfizer’s Wyeth loses bid to duck hormone-therapy lawsuit
Pfizer Inc’s Wyeth unit must face a class action alleging that the drugmaker misled California women by downplaying risks including breast cancer associated with its hormone-replacement therapy products, a federal judge has ruled.
U.S. District Judge John Houston in San Diego on Monday ruled the plaintiffs presented sufficient evidence for a jury to decide whether Wyeth’s alleged misrepresentations caused women to buy Prempro, Premarin and Premphase.
New Book — Flash Count Diary: Menopause and the Vindication of Natural Life, by Darcy Steinke
“What orcas can teach humans about menopause and matriarchs” — A new book argues for a sea change in the way our culture views older women.
Her research unearthed a long history of dubious “cures,” from transfusions of dog’s blood to vinegar sponge baths to putting a magnet in your underpants. All of which, she says, seem a little less strange once you realize that the most popular hormone replacement treatment, Premarin, is made from the urine of pregnant horses. Source: Crosscut »
Hormone therapy during menopause raises breast cancer risk for years, study finds
New analysis adds to the evidence that many women who take hormone therapy during menopause are more likely to develop breast cancer — and remain at higher risk of cancer for more than a decade after they stop taking the drugs.
The study, in the Lancet, looked at data from dozens of studies, including long-term data on more than 100,000 women who developed breast cancer after menopause. The longer women took the medicine, the more likely they were to develop breast cancer. Experts say the findings could shape how women and their health care providers decide how to manage symptoms of menopause.
For years, research has suggested a potential link between MHT and an increased risk of breast cancer. But there wasn’t much information on whether that risk persisted, or how it differed based on the type of MHT a woman took. So, an international group of researchers pulled together data from dozens of studies — published and unpublished — to examine the issue more closely.
The researchers found that compared with women who never used MHT, women who did had a significantly higher risk of developing invasive breast cancer. Also, the longer women used MHT, the greater their risk of breast cancer.
Premarin sales figures continue to decline
The Premarin family of hormone replacement products was the 11th best seller in 2018 at $832 million, a decline of 14.8 percent. Sales in the first six months of 2019 were $361 million, 10 percent less than in same period of 2018.
Third quarter sales of Premarin (conjugated estrogens tablets, USP) family — $182 million, down 11%.
Data as of 12.31.19
About Premarin Horses
Premarin®, Prempro®, Premphase® and Duavee® are examples of the Premarin® family of drugs which are made with the the estrogen rich urine of pregnant mares.
In the ‘pregnant mare urine’ (PMU) industry, horses are repeatedly impregnated so their urine can be collected and made into hormone replacement products.
Some of the foals are rescued. Most, however, who can not be ‘repurposed’ in some way are sent to slaughter — seen as a byproduct of the industry much like male calves are in the dairy industry.
Alternatives to PMU Drugs
There are many alternatives to drugs made from the urine of pregnant mares.
Talk to your doctor. Visit your local pharmacy. There are prescription free over-the-counter treatments for hot flashes, vaginal dryness and other menopausal symptoms.
Another new study published September 12, 2017 in the Journal of the American Medical Society (JAMA) has made headlines claiming that HRT is not the villain it was once thought to be.
Per the investigators, a statistical review of the results of the damning 2002 WHI study showed that the women taking the hormones did not die earlier or have higher incidence of chronic illness than those taking a placebo.
In fact, to the contrary, this new study asserts that these women experienced a profusion of benefits as a result of taking the HRT – improving the quality of life, preventing osteoporosis, heart disease and Alzheimer’s, and of course a satisfying sex life among other advantages.
An author who penned an article in the Huffington Post by Erika Schwartz MD, self-described as a physician who is a hormones and prevention expert, even goes so far as to tout them as miracle drugs. Laughable at best.
“Hormones are great for you. You are better off with any kind of HRT (bioidentical estradiol, testosterone, conjugated equine estrogen, etc.) than nothing. The WHI study was a most horrific insult to women’s health in recent history. It hurt and still does millions of women. Women are suffering because money was more important than pure science and honest medical discourse.” 
How was money more important than science and honest medical discourse? If anything, the WHI resulted in huge losses in profits for Big Pharma, notably Wyeth, now a wholly owned subsidiary of pharmaceutical giant Pfizer.
Moreover, Wyeth was guilty of covering up the truth about HRT and its link to increased incidences of cancer, heart disease and other life-threatening ailments in pursuit of higher profits at the expense of women. A classic example was the use of ghostwriters hired by Wyeth for this very reason.
“The articles, published in medical journals between 1998 and 2005, emphasized the benefits and de-emphasized the risks of taking hormones to protect against maladies like aging skin, heart disease and dementia. That supposed medical consensus benefited Wyeth, the pharmaceutical company that paid a medical communications firm to draft the papers, as sales of its hormone drugs, called Premarin and Prempro, soared to nearly $2 billion in 2001.” 
In any case, the study: “Menopausal Hormone Therapy and Long- term All-cause and Cause Specific Mortality; The Women’s Health Initiative Randomized Trials” in its entirety is available here and a brief overview and summary of results can be found here.
The study was an observational follow-up of more than 27,000 postmenopausal women aged 50 to 79 years who were enrolled in the 2 WHI randomized clinical trials between 1993 and 1998 and followed up through December 31, 2014 – a cumulative total of 18 years.
These two trials — the original WHI study, and a second WHI study published two years later — found that taking estrogen plus progestin (Prempro) HRT increased a woman’s risk of heart disease and breast cancer while taking estrogen alone (Premarin) increased the risk of stroke, dementia, and other health dangers including endometrial cancer.
The new study published in JAMA on September 12, 2017 strongly supports the claim that hormone therapy with CEEs (conjugated equine estrogens) in combination with progesterone (e.g. PremPro) and CEEs alone (Premarin) are not associated with “all-cause” mortality. In other words, they are trying to convince women that HRT therapy is not harmful, will not kill you nor shorten your life – those women who took the drugs to alleviate the symptoms of menopause were no more likely to be dead after 18 years than those who didn’t.
“Among postmenopausal women, hormone therapy with CEE plus Progestin (PremPro) for a median of 5.6 years or with CEE alone Premarin for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.” 
Specifically, HRT taken for 5 to 7 years was not associated with risk of long-term “all-cause” mortality.
So they say.
Yet in the same breath, they continue to advise restrictions on its use based on the age of onset of menopause, the lowest dose possible, for the shortest duration possible, not to be taken with existing risk of cancer and heart disease, blah, blah, blah . . .
“Although these findings lend support to practice guidelines endorsing use of hormone therapy for recently menopausal women with moderate-to-severe symptoms, in the absence of contraindications, the attenuation of age differences with longer follow-up and potential health risks of treatment would not support use of hormone therapy for reducing chronic disease or mortality. Moreover, it is unclear whether benefits would outweigh risks with longer duration of treatment.” 
As with other prescription medications and the plethora of warnings, contraindications and precautions, how safe are these drugs, particularly given past studies other than the WHI trials have also shown them to be harbingers of heart disease, cancers and other maladies?
As a matter of fact, according to their analysis, the researchers found that there was indeed a “statistically significant” increase in breast cancer incidence in women who took the combination CEE and Progestin HRT (Prempro) – the same findings as the WHI and other independent studies of which there are many.
“Total cancer mortality did not differ significantly between intervention and placebo groups in either trial despite the increased incidence of breast cancer with CEE plus MPA34 and concerns about an increased risk of hormone-sensitive cancers with both regimens”. 
Yet this “critical finding” is obscured in the blanket statements in the many articles circulating the Internet that extol the benefits of HRT as a direct result of this study.
Sadly, often these warnings are not passed on to the unsuspecting patient and are glossed over, even by their physicians. One need only listen to the sweeping comments made by Erika Schwartz, MD, the hormone expert who authored the paper referred to above; “Principal Investigators of 2002 WHI Study Reverse Findings — HRT vindicated in new JAMA article”.
Not only does she recommend all forms of HRT to her patients, as well as making the ridiculous statement that women are suffering because money was more important than science when in fact, money had nothing to do with it — sales of Premarin and its derivatives plunged after the results were released — she has this little rant to add:
“Now oddly media coverage hasn’t really done this report justice. It has been casually covered as a ray of hope but not as the wake-up call it MUST be. While in 2002 the media frenzy killed HRT, the JAMA report was interpreted as light reassurance for HRT. That’s just not right. There is no doubt here. HORMONES DO NOT HARM WOMEN, the medical establishment dogma does.” 
The researchers themselves have underscored the limitations of the study, caution the interpretation of the results and warn that cause-specific mortality analyses should be considered exploratory. If that isn’t from the horse’s mouth what is?
So, what to make of this? What prompted these original researchers to revisit this 25 years after the fact? To right a perceived wrong in the hope that the whole debacle of the HRT debate goes away once and for all? To help lessen the stigma so that there will be a resurgence of sales of the Premarin family of drugs?
Your guess is as good as mine, but I am betting it has everything to do with Pfizer’s bottom line.
There is no reason to think that a new study is right and all the previous studies are wrong. But if they are profit driven this is exactly what the drug companies want people to believe.
Class Action Lawsuits
And what about all those class-action lawsuits? Are they suddenly moot? These were massive suits involving thousands and thousands of women, some surviving and others dying. If these drugs don’t cause cancer why on earth did Wyeth/Pfizer lose these lawsuits, many of which were unlawful death suits? Do people really think that companies such as Wyeth and Pfizer have no leverage? Money talks.
The science is there but it seems that there is always some new study funded by these mammoth pharmaceutical companies to cast doubt on the findings if they are not in support of pushing their drugs that make lucrative profits — money before patient safety. In fact, for this study, Pfizer was paid for consultancy and review activities.
Conflict of interest? You be the judge.
As Peter Gotzsche M.D., Director of The Nordic Cochrane Centre and author of “Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Health Care” points out:
“Much of what the drug industry does fulfills the criteria for organized crime in US law,” Dr. Gotzsche said in a recent interview. “And they behave in many ways like the mafia does, they corrupt everyone they can corrupt, they have bought every type of person, even including ministers of health in some countries . . . The drug industry buys the professors first, then chiefs of departments, then other chief physicians and so on, they don’t buy junior doctors.” 
Lies, Damn Lies and Statistics
The approach to this study is not new and similar studies have been made in the past — for example, one in 2013:
One of the key points is that in these studies the results of the WHI are broken down by age groups, rather than individuals treated as a single cohort. The other principal factor is that the statistical analysis used in both the current and 2013 study was hypothesis testing (statistical significance) using “P values”. And in each case, the conclusions were the same — HRT is safe (with some restrictions).
While this age-stratified analysis is a good approach, what of the actual statistical method used to arrive at the conclusions?
Without going into detail about hypothesis testing and the use of “P values” to predict the significance of an event, this statistical method and its applicability to medical research has been shown repeatedly that conclusions based on calculating “P values” are frequently false. Just as statistical significance does not always mean a result is real, lack of statistical significance (which they are using in this study) does not mean that there is no effect.
In fact, observant experts have been pointing out serious flaws in standard statistical testing for decades. In recent years, the depth of the problem has become more apparent and better documented, yet the medical community continues to employ these methods simply because these methods have been embedded in the scientific process. In effect, it is not just medical research, but all research fields, that often draw erroneous conclusions.
Even the researchers warn of caution when interpreting these results:
“Finally, the nominal P values presented here should be interpreted cautiously, as multiple outcomes and subgroups were examined. Thus, cause-specific mortality analyses should be considered exploratory.” 
And yet, this new study is being promoted as leading-edge “feel-good” news for menopausal women across the globe via social media without recognition of the caveats associated with the results. Reckless endangerment at its best.
Yes, ladies, you can breathe a sigh of relief. Or not.
“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.” 
In truth, the best solution to determine the safety of HRT on the health of menopausal women would be to repeat the experiment without the flaws that existed in the original WHI studies. Unfortunately, often studies are too complicated, lengthy or expensive to repeat.
Or, as in this case perhaps, the drug company does not want to pursue a wholly comprehensive study as it will further affect sales if found to negatively impact the health of patients, just as it did originally – why take the time and money if only to find that HRT does in fact cause heart disease, cancer and the like.
That is both a financial risk and a precarious risk where damning results could leave a stain on the brand name and negatively affect profits if the results are published. However, drug companies publish only a fraction of the studies they fund — the ones that promote their drugs. Unwanted results are not published.
Sadly, doctors must rely on academic peer-reviewed medical journals to learn about prescription drugs and pass these findings onto their patients in the way of prescription medications. What choice do they have?
“Pharmaceutical companies know this and have worked hard to sway the leadership. Now the question comes up if we can trust the data that the leadership relies on. One wonders how deep the deception goes. In fact, the heavy influence of pharmaceutical dollars inspired the former editor-in-chief of the New England Journal of Medicine, Dr. Marcia Angell, to conclude, “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.” 
In the News
It is always tempting for journalists and scientists alike to report a finding that is contrary to popular belief. This is no exception.
For years after the damning result of the WHI study, and to this day forward, HRT has been a controversial subject. When a study emerges that defies previous findings, often the magnitude of the effect is overstated and the less likely the research findings are to be true.
Then there is the enticing phrase “Contrary to previous scientific belief . . .”.
“Ordinarily, “contrary to previous belief” should be a warning flag that the result being reported is likely to be wrong. Instead it is usually a green light to go with the story. So the general criteria of newsworthiness—a first report, in a hot field, producing findings contrary to previous belief—seem designed specifically to select the scientific papers most likely to be bogus.” 
Add to this, the HRT media campaigns by Pfizer and others that underplay the dangers of cancer and heart disease. These types of studies that shine a positive light on the use of HRT to control symptoms of menopause clearly add more arsenal to their strategy. Billions are spent on direct-to-consumer ads promoting drugs that Big Pharma say are intended to raise awareness of treatment options.
The truth is, direct-to-consumer advertising is used to drive choice rather than inform it – the ‘driving’ typically in the direction of expensive brand-name drugs. 
The only two countries in the world that allow direct-to-consumer advertising are the U.S. and New Zealand.
Survey’s carried out in both countries have shown that when a patient asks for a specific drug their family physician is likely to prescribe that drug over others such as generics or alternatives, for example.
But it is more insidious than this since the ugly truth is that doctors are being enticed by pharmaceutical companies to prescribe their drugs.
In a gullible nation that has been brainwashed by Big Pharma, and their physicians who receive 95% of their information from this very source, there is little difficulty persuading the masses that drugs are the answer to any “condition” although many of these so-called illnesses are treatable by lifestyle changes or, in effect, are not diseases at all. 
Such is the case for the ubiquitous Premarin family of drugs.
So, I leave you with this.
“The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful.” – Arnold Seymour Relman (1923-2014), Harvard Professor of Medicine and former Editor-in-Chief of the New England Medical Journal 
The Women’s Health Initiative (WHI) was initiated by the U.S. National Institutes of Health (NIH) in 1991. The Women’s Health Initiative, which consisted of three clinical trials (CT) and an observational study (OS), was conducted to address major health issues causing morbidity and mortality in postmenopausal women.
Further reading on the use of “P values” and other sources of statistical error:
October is National Breast Cancer Month. What better opportunity to remind women of the dangers posed by the use of HRT and the inherent cruelty foisted upon the innocent mares and their foals by the PMU industry?
Despite advances in medical technology over the years, Pfizer continues to promote their conjugated equine estrogen drugs (e.g. Premarin, Prempro, Duavee) based on antiquated science – science that has since been proven to be flawed.
In fact, the findings of the WHI study was listed as one of the top ten medical advances of the decade in an article published in 2009; “The Top 10 Medical Advances of the Decade: From genome to hormones, doctors pick the top medical advances of the decade.” 
“And then the world changed, the National Heart Lung and Blood Institute, which was sponsoring a placebo-controlled trial of hormone replacement therapy in more than 161,000 healthy women, announced that it was shutting down the study because HRT increased the risk of heart attack, stroke, blood clots, and breast cancer.
It was the “oops” heard round the world.” 
Why are these drugs still here 14 years after the fact? Why haven’t the FDA and other drug agencies around the world pulled these from the market?
Time and again the antagonistic effects of conjugated equine estrogens have proven to be potent carcinogens that give rise to a variety of cancers and other life-threatening diseases, breast cancer included.
The FDA and other governing bodies such as the European Commission in the EU continue to endorse these drugs as safe therapies for women of menopausal and post-menopausal age despite the unequivocal dire warnings on the packaging cautioning women of substantial risks that should, in any dutiful context, prevent these drugs from being marketed.
And not to forget the pitiful existence of the mares and their by-products – the innocent foals born into a precarious world where their fate is sealed if there are no takers. Now of course, this malevolent industry has moved across the globe to countries where animal welfare is decidedly worse than the loathsome state of affairs in North America.
But there are of course options – alternatives to the use of drugs containing equine-derived hormones. The Horse Fund has compiled a list of such options (see http://horsefund.org/pmu-alternatives-to-cee-drugs.php) as well as the safety aspects of FDA-approved prescription versions of HRT that are not derived from pregnant mare’s urine. 
One natural alternative that crops up (pun intended) on occasion, yet is not mentioned in either of these articles, is “rhubarb”.
Rhubarb is said to be a very “old” plant, meaning that documented knowledge of the plant goes back as far as 2,700 years in China. The roots were said to have medicinal value and were a prized commodity for treating a variety of ailments. 
In many cultures, herbs and foods that contain so-called phytoestrogens have been used to treat symptoms of climacteric complaints – that is, complaints associated with the transition between premenopause, perimenopause and early postmenopausal stages. Examples include black cohosh, soy and red clover; rhubarb is also classified as a phytoestrogen.
Phytoestrogens are known to have distinct actions on what are known as estrogen receptors (ERs) which are activated by the hormone estrogen. As an example, estrogen receptors are over-expressed in around 70% of breast cancer cases, referred to as “ER-positive”, which can lead to proliferation of mammary cells. Moreover, estrogen metabolism creates genotoxic waste – chemical agents that damage the genetic information within a cell causing mutations which may lead to cancer.
There is growing evidence that phytoestrogens could have a protective effect on the initiation or progression of breast cancer by inhibiting pathways important for cell growth and proliferation. The characterized mode of phytoestrogen action is estrogen receptor (ER) binding which effectively blocks estrogen from binding to the ER and reduces the risk of cell propagation. Their metabolic actions are much more complicated than this simple explanation and the science behind their effectiveness is challenging to address. 
Essentially this is what a SERM’s (Selective Estrogen Receptor Modulator) function is.
Several reports have indicated that experimental data supports the theory that ERr from the rhubarb plant and/or its constituents do in fact exhibit(s) SERM-like properties. 
SERMs block the effects of estrogen in the breast tissue, for example, as well as other tissues in the body that have estrogen receptors (e.g. bones, uterus). Recall that the bazedoxifene component of Duavee is a SERM, although it is not naturally derived, nor has it been officially approved by the FDA as a stand alone drug.
Several scholarly articles can be found online that describe the efficacy and safety profile of rhubarb extracts in the treatment of menopausal symptoms such as hot flashes, sweating, sleep disturbances, and mood swings.
In each of these, a pill containing the extract (ERr) significantly reduced vasomotor and other menopausal symptoms. ERr was first introduced to treat menopausal symptoms in 1993 and has had no severe adverse effects reported with its use.
In an article published in Menopause in 2006 “Efficacy and safety of a special extract of Rheum rhaponticum (ERr 731 – trade name Phytoestrol N) in perimenopausal women with climacteric complaints: a 12-week randomized, double-blind, placebo-controlled trial.” Authored by Heger et al, the effectiveness of the rhubarb extract ERr 731 to treat menopausal symptoms was validated by a multicenter, prospective, randomized, double-blind, placebo-controlled, clinical trial on 109 women with climacteric complaints receiving either a daily dose of 4 mg of ERr 731 or a placebo. 
The primary outcome criterion for the efficacy of ERr 731 was the change of the Menopause Rating Scale II (MRS II) total score compared to the placebo after 12 weeks. The MRS II is a health-related quality of life developed in the early 1990’s that measures the severity of age-/menopausal-related complaints by rating a profile of 11 different symptoms. 
These symptoms include; hot flashes/flushes, heart discomfort, sleep problems, depressive mood, irritability, anxiety, physical and mental exhaustion, sexual problems, bladder problems, dryness of vagina and joint and muscular discomfort. 
Additionally, the MRS II score was accompanied by secondary outcome criteria which included physical examinations to assess the safety of ERr 731 (e.g. vaginal smear, pap smear, transvaginal ultrasound, endometrial biopsy, breast palpitation, body weight).
The treatment outcome after the intake of ERr 731 or placebo for 12 weeks was assessed by both the investigators and participants according to the Integrative Medicine Outcome Scale (IMOS) – a 4-point (investigator) and 5-point (patient) verbal rating scale ( complete recovery (patient-only), major improvement, moderate change, no change, and deterioration). Results are shown in the figure below.
More detailed results, including the MRS II scores, are shown in the paper. 
Clearly the rhubarb ERr 731 extract is effective in significantly reducing symptomatic climacteric complaints when compared to the placebo.
Throughout the trial no abnormalities in breast tissue were observed which support those of long-term treatment with ERr 731 in everyday practice.
Moreover, women who took the ERr 731 experienced no vaginal bleeding and spotting which are common side effects due to an estrogen-dependent stimulation of the endometrium, nor was there any evidence of endometrial hyperplasia in the treated women.
Neither clinical nor experimental results detected any adverse effects of ERr 731 (e.g. uterine and endometrial growth and proliferation) which suggests that ERr 731 exerts SERM-like activites.
Overall, the trial results show that ERr 731 is a highly effective, well-tolerated, and safe herbal medicinal product in the treatment of climacteric complaints in the transition through the various stages of menopause as an alternative to traditional HRT. 
The demand for safe and effective estrogen-free medications is ever-increasing given the risks associated with conventional HRT, particularly those derived from conjugated equine estrogens.
In the end what matters most is that women become informed from a health and risk perspective with the realization that there is no need for PMU farming operations, whether that be here in North America or on the fledgling farms in lands far away.
PFIZER MARCHES ON
Unfortunately Pfizer, and now their counterparts in foreign jurisdictions, continue to deceitfully market these drugs as the panacea to every woman’s natural menopausal transition.
Sadly, those farms in China, India and other places where they may exist, are, in general, without the same level of oversight from advocates of animal welfare, unlike here in North America where the plight of animals, whether that be livestock or the use of animals for other human profit, such as the PMU horses, has an ever-increasing base of concerned citizens.
Foremost because the industry outside of North America is, relatively speaking, new, secondly because animal welfare issues appear to be less front and center and last, but not least, because many people in these countries are likely unaware of the risks associated with these drugs derived from pregnant mare’s urine.
This of course is changing as time progresses.
At one point North America, and the EU for example, were in the same position. It took decades for the truth to surface and yet Pfizer still manages to market these drugs, considered carcinogens, to physicians and their patients alike without moral compass from all perspectives – horse or human.
After all, to Big Pharma it is all about corporate welfare and shareholder satisfaction no matter what the cost.
Save a horse – go out and eat some rhubarb, just don’t eat the leaves.