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My doctor wants me to take Premarin, but I understand it’s made from horse urine. Is this true?

The estrogen-replacement drug Premarin, prescribed to menopausal women, is made from horse urine; in fact, the drug’s name is short for PREgnant MARes’ urINe. About 750,000 mares are impregnated each year for the sole purpose of collecting their estrogen-rich urine. Tied in small stalls, unable to move either backwards, forwards, or sideways or lie down comfortably, they stand with sacks strapped to their groins for months on end. In order to make the urine more concentrated, their water intake is restricted, so the horses are constantly thirsty. The foals are considered “byproducts,” and most are fattened up, slaughtered, and sold for horsemeat or turned into dog food.

Fortunately, humane alternatives to Premarin are available. Cenestin, manufactured by Duramed Pharmaceuticals, is used to treat menopausal symptoms such as hot flashes and night sweats. Duramed is currently conducting clinical trials to prove Cenestin’s effectiveness at preventing osteoporosis, as well. Like Premarin, Cenestin contains a complex mixture of conjugated estrogens that are slowly released into the body. But unlike Premarin, Cenestin is derived from plant sources—soybeans and yams—not horse urine. Recent studies linking Premarin to an increased risk of breast cancer serve as an additional reason to consider the switch.

Be aware that there is evidence that mammography screening is less accurate in women who use hormone replacement therapy. The same activities important for health at other times in our lives can help alleviate many of the common symptoms of menopause. Switching to a low-fat vegetarian diet, exercising, quitting smoking, and reducing stress could eliminate some women’s need for drugs in the first place.