Some vital information about menopause and estrogen replacement therapy...

Vital Information about Menopause
and Estrogen Replacement Therapy

"By switching from Premarin to another estrogen, women are personally empowered to change the lives of thousands of horses." -- Joan Saxton, M.D.

"After changing patients from Premarin to an alternative estrogen replacement therapy, I discovered all other alternatives to be comparable to Premarin in effectiveness." -- Robyn Marquez, CNP

Is estrogen replacement therapy important in relieving menopausal symptoms?

When a woman reaches her forties, her ovaries produce less estrogen, resulting in irregular menstrual periods. When her ovaries stop releasing eggs, they stop producing estrogen also. The estrogen level drops and her monthly menstrual periods end. Menopause or "change of life" has occurred -- the average age is 51.

Menopause is notorious for its symptoms -- sleep disturbances; impaired bladder control; vaginal dryness; mood swings; and "hot flashes" (sudden and intense episodes of heat and sweating). These symptoms are often relieved with holistic remedies or estrogen replacement therapy.

Menopausal symptoms, including hot flashes, rarely last longer than six months. In time, the body adjusts to lower estrogen levels.

Does menopause cause osteoporosis?

Bones are a living tissue constantly being rebuilt. As we grow older, new bones are built at a slower pace. When bone loss is greater than bone replacement, osteoporosis results. The bones become extremely fragile, especially at the wrist, spine, and hip.

Roughly 26 million Americans have osteoporosis, four out of five of them women. Women's bone loss accelerates during the earliest phase of menopause (premenopause) because of the loss of estrogen.

Estrogen therapy after menopause slows down bone loss; although it should be considered mainly by women who have the greatest risk of osteoporosis. Consult your physician.

Are estrogens completely safe?

In some cases, estrogen replacement therapy may increase the risk of uterine (endometrial) cancer. The lowest use which controls menopausal symptoms should be used. Lower doses of estrogen and concurrent use of another hormone, progesterone, will reduce the risk of uterine cancer. As with almost any medication, caution should be used.

When should estrogens be avoided?

Women should avoid taking estrogen replacements: if they are pregnant; if they have unusual vaginal bleeding; if they have had cancer; if they have any circulation problems; after childbirth or when breast-feeding.

Is Premarin the only choice?

Most doctors agree that Premarin is not the only estrogen replacement effective for preventing osteoporosis and treating the symptoms of menopause. These other estrogen drugs are derived from plants, and do not harm mares and foals. A number of herbal and dietary alternatives to estrogen may produce the same beneficial results.

Some doctors maintain that to help prevent osteoporosis, take an adequate amount of calcium your life long, either in your diet in calcium-rich foods, or by calcium supplements. Others suggest that a low-fat high-fiber vegan diet will help prevent onset of osteoporosis, heart disease, cancer, and some of the symptoms of menopause.

Are there holistic remedies for relieving menopausal symptoms?

Many menopausal symptoms can be relieved by diet and lifestyle changes. The hormones needed can be found in tofu, berries, soy bean, citrus fruits, and wild or Mexican yams.

Herb sources include dong quei, chaparral, damiana, licorice, black cohosh, motherwort, linoleic acid oils, and fennel.

Hot flashes may be alleviated by sleeping in a cool room, regular relaxation, and breathing exercises. A water-soluble lubricating cream (with or without estrogen) can alleviate vaginal dryness.

What other estrogen replacement products are available?

Only Premarin and PremPro (another Wyeth-Ayerst product that combines Premarin and progestin in one medication) are produced from equine (horse) estrogens. Many of the alternative estrogens available are priced comparable to Premarin.

Estraderm (estradiol transdermal system) is a clear plastic patch that releases small amounts of estradiol (hormone produced by ovaries) through the skin into the bloodstream.
Estrace (estradiol tablets) is derived from soybeans and Mexican yams.
Estratest is a combination of esterified (combined) estrogens and methyltestosterone, based on yam and soyplant and then synthesized to resemble human estrogen.
Estratab consists of esterified (combined) estrogens. Up to 15 percent of Estratab contains synthetic equine estrogens.
Ortho-est (estropipate tablets), derived from soybeans or Mexican yams, is identical to human estrone in its estrogen composition.
Ogen also consists of estropipate tablets and is identical to human estrone in its estrogen composition.
Fosomax is available for the treatment of osteoporosis. Fosomax is the first non-hormonal treatment option for post-menopausal women who cannot or will not take estrogen. Fosomax may also be effective in the prevention of osteoporosis but further research will be required prior to FDA approval of this medication for preventive use.
Miacalcin is a nasal spray for the treatment of post-menopausal osteoporosis. Miacalcin is a restorative drug and does not prevent osteoporosis.
Menest consists of esterified (combined) estrogens and is derived from Mexican yams.
Other alternative estrogens include Theelin and Progens.

Price Comparison Chart

From a May 1999 survey of pharmacies nationwide by HorseAid listing the average cost per day reported to maintain a prescribed regiman (although prices* vary widely according to region and retail source).

PLANT BASED
Drug Name	Route	Years	FDA Approved for	Strength	Cost/Day*
Alora	Transdermal	6	Menopausal syndrome	0.05 mg 0.075 mg 0.1 mg	$0.72 0.72 0.72
Cenestin	Oral	6	Menopausal syndrome	0.625 mg 0.9 mg	N.A.
Climara	Transdermal	6	Menopausal syndrome	0.05 mg 0.75 mg 0.1 mg	0.72 0.72 0.72
Estrace	Oral Vaginal	26 16	Menopausal syndrome Osteoporosis Vaginal atrophy	0.5 mg 1.0 mg 2.0 mg 0.1% cream	0.31 0.38 0.56 1.61
Estroderm	Transdermal	16	Menopausal syndrome Osteoporosis	0.05 mg 0.1 mg	0.72 0.80
Estratab	Oral	26	Menopausal Syndrome Osteoporosis	0.3 mg 0.625 mg 1.25 mg 2.5 mg	0.32 0.32 0.32 0.32
Estring	Vaginal Ring	6	Vaginal Atrophy	5-10 mg
FemPatch	Transdermal	6	Menopausal syndrome	0.05 mg 0.1 mg	0.72 0.72
Menest	Oral	26	Menopausal Syndrome	0.3 mg 0.625 mg 1.25 mg 2.5 mg	0.32 0.32 0.32 0.32
Ogen	Oral	46	Menopausal Syndrome Osteoporosis	0.625 mg 1.25	0.58 0.77
Ortho-est	Oral	8	Menopausal Syndrome	0.625 mg 1.25 mg	0.58 0.77
Vivelle	Transdermal	6	Menopausal Syndrome	0.037 mg 0.05 0.75 0.1	0.72 0.72 0.72 0.72
ANIMAL BASED (equine)
Premarin	Oral	62	Menopausal Syndrome Osteoporosis	0.3 mg 0.625 mg 0.9 mg 1.25 mg 2.5 mg	0.37 0.37 0.37 0.37 0.37
ESTROGEN / PROGESTERONE COMBINATIONS (Prempro & Premphase are animal based; equine)
CombiPatch	Transdermal	6	Menopausal Syndrome	0.05 mg estradiol 0.14 mg norethindrone	0.72
Prempro	Oral	10	Menopausal Syndrome Osteoporosis	0.625 mg premarin 2.5 mg cycrin continous	0.73
Premphase	Oral	10	Menopausal Syndrome Osteoporosis	0.625 mg premarin 5 mg cycrin sequential	0.73
ESTROGEN / ANDROGEN COMBINATIONS
Estratest	Oral	10	Menopausal Syndrome Osteoporosis	1.25/2.5 mg	0.90
Estratest HS	Oral	10	Menopausal Syndrome Osteoporosis	0.625/1.25 mg	0.74

Is estrogen replacement therapy right for you?

Before deciding for or against estrogen replacement therapy, discuss it with your doctor. Some alternatives to Premarin may not be right for you -- you might be allergic to some medications, or they may not deliver the precise estrogen therapy you need. Not every estrogen drug is approved for every use discussed on this page.

Restorative and Alternative Therapies

A recent and welcome trend across the country is the opening of menopause centers that help women with hormonal and mid-life complaints.

To enhance health, natural therapies such as Chinese medicine, acupuncture, herbs, homeopathy, supplements, vitamins, and natural progesterone are used. Consultations may be offered as well as treatment plans.

An important focus is on education. Many centers feature classes (day and evening) on menopause and osteoporosis, and teach women how to use alternative medical therapies to deal with the discomfort they might be experiencing.

Menopause support groups are popular, offering women the opportunity to share their stories, difficulties, and successes; books and other resources they've discovered; sympathetic practitioners who helped them; mineral-rich recipes and other supplements that have helped relieve their discomfort.

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