If lowering your estrogen dose makes you feel estrogen-deficient, then you might want to give some thought to adjusting both estrogen and progesterone to get them back into a better ratio (it's the ratio between the two, not just the plain amount of each, that determines how we feel on hrt). I found that when I got my progesterone right, I went on a peeing binge for several days, losing all sorts of water I didn't know I was carrying around with me.

Don't forget that changing a hormone dose can cause you to experience hot flashes even if you're going in the right direction--it's the change that's the culprit, not the dose. It's always a good idea to give yourself time to adjust before making more changes.

You should be able to find a middle ground that lets you sleep without turning you into a water balloon. Here's hoping you find that magic point with just a little more adjusting.

I just read your posts and Tanya, here I am like you just starting on HRT, 3 weeks ago.  I was postmeno at 43,  but since I didn't really let the hot flashes get to me and the anxiety I blamed on other things, I just let lie. Now after 3 years I had a bone scan test , both my  gyno and gp were both in favour of HRT. I'm not scared, just wary, after reading so much, but evidently there is an upside to this also, so I'm just watching and waiting ....

Up to now, all seems to be going well, although it's a very short time, the hot flashes have gone, they never bothered me too much really and the backache I had has also disappeared (maybe it's physcological) I take lorazepam for anxiety (it's not a brand name) for some time now and although it's not the best, it does the trick for me (I sleep like a log zzzzzzzz). I asked about weight gain and was told that if  I did have water retention, it would be just like Framboise said, and otherwise, the weight gain is minimum, practically nothing if you don't eat in excess and do regular excercise.  So I'm optimistic .....

Well now to you Framboise, I can see you are a professional in the area, so I hope you don't mind asking you about what I'm taking.  I can't really compare notes, because I live in Argentina and products licensed for Sth America  will possibly have different brand names, although they are from the Wyeth lab.  On the net, I've seen them, but I can't seem to find info on dosages.  I didn't know whether to use dermal patch, creams, or what, but I let my gyno take charge and I am taking:

Climaderm 7 patch, which according tothe formula liberates 50 mcg every 24 hrs and Cycrin - medroxiprogesterone acetate 2,5 gr. 10 days/month.

My gyno said that the dosage was relatively low, but I do imagine that it depends on the  estrogen level of each individual. I have read here on the boards that the ladies use excellent calcium supplements and soy products but what I'm not sure about is the difference between synthetic and natural hormones, it seems (in my ignorance) that although there are differences of opinion of which is better, they are all foreign substances if they are not produced by our own bodies.  That may be completely way off, and it's just an occurence.  

Framboise, thanks so much if you do get time to reply to this, even briefly :smile:

Love from a UK gal stranded in Buenos Aires.Barbara  (athenea)

Here, however, is my take on hormones. I use the term bioidentical for a specific reason: to indicate that the chemical structure of these hormones is absolutely identical to the ones our ovaries made. Once these molecules of bioidentical hormone are circulating in our bloodstream, our bodies cannot distinguish between the ones we took as hrt and the ones we made with our ovaries. They have the same actions and they are metabolized the same way. We may have some dose-related effects due to a huge bunch of them hitting our system at once as opposed to the ovaries dispensing them in variable amounts as our system actually needs them, the timing of our doses may interfere with the operation of other hormones and disrupt our normal circadian rhythms, and the ones we take may not fulfill all our needs, but that's the fault of the dosing failing to mimic the ovaries, not any chemical difference of the hrt itself.

Synthetics, on the other hand, are not chemically equivalent. Like soy and the phytoestrogens, (only more potent), they are able to fit some of the hormone receptors in our bodies, but not all of them. In some receptors, they "jam" the site and prevent the action of that site's function. In others, depending on their potency, they have the normal effects. In the case of Premarin, for example (which is "natural" in that it's developed from the urine of pregnant mares), the correspondance to our own estrogens is fairly strong. In the case of phytoestrogens, the corresponance is relatively weak. All hrt hormones are "natural" in terms of being refined from plant or animal materials, so a more useful functional distinction is the degree of congruance with our own hormones.

Now, before you write off all synthetics as "bad," let me mention a couple important points to do with metabolism of hormones. When your body breaks its own (or bioidentical) hormones down, the chemical stages they go through are progressively weaker and weaker until they are eliminated from the system. Some synthetics (Premarin is the poster child for this) degrade into stronger and stronger metabolites. Your body does't have a "system" to remove these metabolites--they are foreign chemicals. Some of them pass harmlessly out of your body. Others are believed to cause some of the many side effects associated with this particular hormone in some women. (Interestingly, not even the company that makes Premarin knows exactly what all is in it, and the FDA has charged them, in no uncertain terms, to figure that out.) Other synthetics, like soy and other food or herbal phytoestrogens, process out of the body as foods or are weak enough that we don't really see huge side effects from them. Some of those effects are worth remembering, however--such as the capacity of soy to bind thyroid hormone or the increase in blood clotting time caused by red clover. The fact that these are less-refined plants in no way means they are totally benign.

So why would a synthetic be useful to anyone other than the drug or neutraceutical company making a profit from its sale? Well, it's normal for the body to interconvert one hormone into another, depending on what you need for any given moment. This is the task of the adrenal glands. All of the ovarian hormones (estrogen, progesterone, testosterone) can be interconverted, and progesterone is the raw material for a number of other hormones--most notably, cortisol, the stress hormone. Now, if you are in menopause and more or less relying on hrt for your estrogen/progesterone supply to feel good, and then undergo a period of stress, your body is going to shift that progesterone into cortisol production. That, in turn, is going to affect the balance of a whole lot of other hormones...and the way you feel. Some women's bodies are particularly efficient at using one hormone to fulfill a shortage of another, such that they have a terrible time adjusting their hrt. For them, a synthetic that remains "locked in" to its intended use may actually be better at making sure that need is met. Or, for another example, look at testosterone use by a woman avoiding estrogen after having an estrogen-sensitive cancer. Bioidentical testosterone can be freely converted to estrogen; taking it is like taking estrogen when your body is "hungry" enough for estrogen to immediately shunt all the testosterone into estrogen production. Taking a synthetic testosterone may let you enjoy the benefits of testosterone without incurring the estrogen risks. In other words, there are a number of specific instances where the synthetics, just because they alter the normal metabolic destiny of the hrt we take in, have a preferred therapeutic effect.

Sorry to have run on so long on this: it's a complex subject but a fairly important one, I feel, in making personal hrt decisions. And it goes a little way into casting light on why there is so much variation in what works and what is best for each of us. That means that we and our doctors may have to look much more closely into our individual body's needs and why the "one size fits all" strategy just doesn't work in menopause.

So, to get back to your question, the "better" has to do with what your own body needs--it's not a simple value judgement than can be passed on any one hormone source in isolation. If you are in natural menopause and just need a little help, then a phytoestrogen plus a handful of nutrients (like calcium) and a good exercise and diet strategy might be all you need to sail gracefully and healthily into the post-reproductive (long) rest of your life. For those of us in surgical menopause or with specific health problems that alter our hormone needs or risks, the various forms of hrt in addition to the specific nutrients consumed by processing hrt (magnesium, zinc, B6, folate) and the specific dietary/nutrient/exercise measures appropriate to our time of life are probably needed. But "better" has to do with providing what your body needs, can metabolize, and does not have ill effects from, rather than any inherent quality in the various hormone sources themselves.

If you are comfortable on your present hrt, then that can be taken to indicate that it is fulfilling your needs. It is certainly something to revisit on a regular (every few years) basis even so, as our hormone needs decline somewhat with age and the lower the dose we take, the lower our risk exposure is (so long as we don't dip below the level that conveys, for us, the beneficial effects).  On the other hand, if the idea of the synthetic progestagen (generic term for all progesterone-like hormones) you are taking fails to please you, you can always try out a bioidentical knowing that you can go back to this one if it doesn't work out for you. The estradiol in your Climaderm is already bioidentical. Both of the doses you are taking are the lowest of the dose range offered by those particular versions, although lower doses are available with other forms. Bottom line: listen to your body and be guided by what it tells you.

Thank you so very, very much for going to so much trouble to answer me in so much detail, it  must have consumed a lot of your valuable time. although I do think this will be of interest not only to me but to all women considering HRT. I am now going to print this, so I can study all you have told me.

You have still not convinced me that you're not a professional on the subject!!! Congratulations. Just reading over, it seems that you have explained exactly what I need to know. I could have spent hours on internet and not have found the same explicit answers.

Framboise, thankyou once again and I  hope you have an excellent weekend.

Very best regards, Barbara

Sometimes, knowing what has changed allows us to identify that factor and thus have an idea which way we need to adjust. Sometimes we have to go on the symptoms, even though they can be ambiguous. Journaling is an excellent tool, btw, in figuring out how things have changed, and in reading back you can recognize factors and trends that may escape you in day to day life.

All of that said, if looking at how your life and your body might have changed don't provide a clue, there are several ways to approach the question. It seems reasonable that if symptoms aren't there when you aren't taking something and appear when you do, then perhaps the amount you are taking is in excess of your body's needs at that moment. A reduction in dose, while slower to show up in effects, can be "safer" in terms of creating bad side effects. So that might be worthwhile exploring (at least conceptually and in discussion with your doctor--please understand that I can't give you specific advice, but merely concepts and directions to explore).

I have to say, though, that this is complicated by the fact that premarin stays in the system a long time and contains many hormones, so that switching from it to another, simpler (in this case, a bioidentical estrogen) hrt can be confusing for a time (how long? it seems to relate to how long you took it and seems to be weeks to months).  You also don't mention whether you took a progestagen (some form of synthetic or bioidentical progesterone). Since estrogen works in direct relationship with progesterone, changing your estrogen from one type and dose route to another will possibly impact your progestagen dose/need as well. Often, "headaches, more twitches, buzzing" relate as much to the progestagen dose as the estrogen, so you cannot treat the estrogen as a single, independent entity. And yes, I know, this makes it really confusing. *sigh*

On the other hand, it would also be plausible, if you have no life changes to pin this on, that your needs have increased over time as your ovarian output declined, and now you need to take over more of your body's hormone needs with the hrt. Just based on your age, this is something to consider. So it could be (dizzy yet?) that what you need is a higher rather than lower dose. A trial of that one would yield an answer faster than lowering your dose, but  runs the risk of making just those symptoms you are describing worse if it doesn't make them better (for as long as you took it; it should drop off again if you stop, quickly).

Hormone testing is inexact and unfulfilling, in that there is no test that really paints a good picture of what is going on in our body over time. If you are totally baffled, however, as to whether you are starving or surfeited, getting estrogen and progesterone levels drawn might give you at least a general signpost of the direction in which to look for answers. You can't look for a magic number and say "yes! thisis where I must be to feel good!" but you can say whether or not you are above or below the median for "acceptable" hormone levels. Unless, of course, you come out at the norm and are once again thrown back on experimentation.

Sorry to overwhelm you with inexact answers, but I'm trying to give you a handle on a way to approach the problem since the answers you finally develop will have to be your own. Listening to your body is fine, but sometimes what you hear is like listening to the ocean in a shell: you hear the surf but you don't know whether the tide is coming in or going out. And then all you can do is wade in and see.

Good luck--and let us know what you decide and how it works, okay? Each person who charts their journey helps fill in the map for the rest of us.

You may indeed find that testing is useful in trying to find out where you are right now--but bear in mind that a test is only a snapshot of where you are at that moment. If your problem seems to be cyclical, you may need to take more than one measurement to accuarately map the progression of your levels through your cycle.  And you would need to be either on or fully off the hrt in order to get an accurate reading--taking samples while you are in transition is even less useful as an indication of where you are.

Still, there are hrt choices that are much easier on the system than the (very synthetic, and for that reason, a difficult one for many women) premphase. The progestin in that one is a long way from real bioidentical progesterone, and your reaction to one does not predict your reaction to the other.

Withdrawing over a few months and then listening to your body again to see which symptoms call out for intervention (and which health issues need to be addressed for longterm maintenance--never forget that aspect) might be a reasonable approach to the situation.

If your doctor isn't comfortable with hrt variations, you might want to consider a repreductive endocrinologist, if one is available, or at least a compounding pharmacist to work with your doctor on balancing any future hormones you might take.

It does sound as though it's time to re-evaluate your hrt strategy and maybe look for something that works better in your system. But going slow, letting some of what you have now clear your system, and looking at other choices is more likely to yield better results than something abrupt (however tempting).

And yeah, you're right: "baffling" is hrt on a good day...on a bad day, I wouldn't want to subject anyone else to my indelicate opinions of hormones!

That said, I can offer two thoughts. First of all, did you know that progesterone and xanax occupy the same receptors in the brain? If xanax works for you, then bioidentical progesterone might be what your body is looking for.

Secondly, there are various resources out there (including at this site) that list the various hrts, and some of them distinguish between bioidentical and synthetic. Message me if you are having trouble finding them--but a google search should return you quite a few. But for personalized guidance, I really would urge you to work with a compounding pharmacist. Even if you decide not to go with the compounds, they can give you good suggestions on the proprietary hrts as well. And they could provide the help you need right now in bridging between one doctor and the next, not to mention coping with the "clueless" problem. Don't forget that this site has a lot of transcripts by Pete Hueseman of College Pharmacy, with an email link.

Hang in there--it's confusing, but you'll get there. It just takes time and some work to find the best answers for your body.

I noticed you also posted on the Prempro topic....so you'll understand where I'm coming from!!

HRT,  can really mess up the system!! My story as told on the other topic....took years of tials and errors...etc.,etc.When I had my emotional/mental meltdown....it was sooooo bad the doc told me I HAD to stop the Prempro immediately , (Cold Turkey)

I had no choice.....I was literally bedridden...in a serious manic state:o:oHere in Canada, our choices are limited as far as HRT are concerned...such as  Bio-Identical compounded types!I had a long talk with my gyn...and he said, I may not be able to take the Bio-indentical without problems either, due to the severity of my meltdown!!

I had tried herbs, which I found, I was allergic to...sooo...as the result I won't dabble in HRT of any kind again....that's me!!

When I went off cold turkey....the withdrawals, were fierce...but NOT worse than the situation I was already in!!My main problem was anxiety/panic attacks...insomnia, including nightmares.  I had the shakes...had headaches, etc.....for at least six weeks!!

Since I did choose NOT to try other types of hormones....the only thing that helped me gain control till the withdrawals were over was, Xanax!!I took one tab, 3 times a day for 60 days...then, I was able to stop, without any problems!!!!!

Now I realize some people may have problems with Xanax....but I credit this little pill for helping me restore my sanity!! I believe med's like these have their place, as long as one doesn't abuse them.....and follows the doctors instruction to the letter!!

I can't say it was a breeze for me....but it was better, than nothing 'till the hormones left my system!!

Whether my story helped or not, I don't know!! Your situation may be different....but I thought I would just share it, for you to consider!! It is rough going cold turkey....if you don't have to...it would be better to wean!! However, if your doctor told you to stop NOW....only you can tell if it warrants a serious enough of a problem to do so!! Your doctor might know best??!!

Anyhow....I really wish you all the best and hope you find a better alternative!!  Perhaps the Bio-Indentical Compounds is your answer??!!

Keep me posted as to how things go for you and take care!!

(((((((((Hugs from a Canadian Gal))))))))               Nancy (aka Snowy)

Buttercup

I'm not an expert...and I haven't had hysterectomy....but I know of a gal, (who's had a hyster)...and favors a bio-identical estrogen rather than Premarin!! She takes....Estrace 2mg, ( 1mg. in the morning and 1mg at bedtime)!  Plus, with this she takes Prometrium 100=200 mg. at bedtime, (a bio-identical progesterone).She claims, she needs it to balance out the estrogen,  and to protect the breasts!!It has also helped her with the anxiety attacks and insomnia!!

Like I said....I'm no expert...but perhaps someone else can come on board and add to what I just posted...who is better qualified to suggest a possible alternative to help you out!!

Premarin...makes me nervous...whether, a hysterectomy or not has been involved!!  It sounds like you're having much the same concerns that I had at one time!!

It's my opinion only...but I think the bio-identical compound route would be safer for you...with the proper balanced estradiol and prometrium!!

Hope that helped a little....maybe gave you something to think about:)

Take care and Godspeed;)

(((((((((Hugs from Snowy)))))))))                    Nancy

I'm not sure such a thing as a "hormone expert" exists (or we wouldn't all be in the dark stumbling around like this!), but I've had a hyst and researched hormones quite a bit looking for my own balance and looking to see how others have achieved it.

I too was started on estrogen-alone for that old saw of an excuse "no uterus--don't need progesterone." Well, that's just flat outdated. We now know there are bazillions of progesterone receptors all over the body and taking progesterone affects many other hormones and systems. When I took estrogen by itself, I didn't seem to have any middle ground between too much, by some symtoms, and too little by others. Among other things, insomnia (not hot flash wake-ups, but the caffeine-like too-wired-to-sleep) was wearing me down. It took a couple weeks after starting (a tiny bit) of progesterone cream before I felt better, but since then, it's been a no-going-back situation. I've tweaked up and down over time as I've refined my balance and responded to other things going on in my life (getting sick or high stress levels require another 5 mg a day for me to stay balanced, for example), but I can clearly feel that I am much healthier and more...resiliant, have less of an on-the-edge-of-disaster sort of feeling now that I'm taking both hormones. For me, it's been pretty important. And I know a lot...a LOT...of women who have had hysts who have found a similar sort of thing.

When I started it, I bought a decent brand of otc cream, to try it out. Once it was clear I wanted to use it over the long term (and when you've got no uterus you use it continuously, not cycling as women with uteruses tend to), I went to my doc and asked for a prescription. She didn't think I needed it, but when I asked her what harm it would do and pointed out that I felt better taking it, she gave in and wrote the prescription.

BTW--I have heard of some women who are sensitive to either the up-curve or the down curve of the patches. Sometimes a slightly lower dose plus progesterone works; others find that they do better on daily doses of estrogen creams to avoid that problem. A good compounding pharmacist might be someone to talk to at this point--they can be excellent at guiding you through these sorts of dosing problems.

Best of luck with it--it can be a confusing and frustrating process, but all I can say is that when you start to get close, how much better you feel will astonish you. And if you're that close now, you can get there.

Thanks guys for the feedback, I don't know what I'd do without this board. Framboise,so basically what you are saying is if you had a hysterectomy we can without harm take progesterone. I can just get OTC. Is it a cream? What is the difference between OTC one and the prescribed one? Sometimes I feel like I might be taking too much estrogen and of course not balancing it out with the progesterone might be causing alot of the problems. I know it is confusing, all the material out there including the doctors, say NO uterus, don't need progesterone. I am going to try it, I guess go easy at first is the best advice..My doctor is on holidays now, but I am sure she will try to tell me it is not necessary. But perhaps the OTC will work fine.Thanks again, feel better knowing a little more...

Buttercup

The other main difference is that otc is unregulated--you don't know what you're getting, actually, nor how fresh it is, etc. There are reputable brands, but it can be hard to tell. Aeron Labs had a testing program and verified content of creams, but they haven't released new test results in a couple of years. What you need to look for is USP progesterone--not wild yam, which can't be converted to progesterone in the body, although it can in the lab. Some creams are called wild yam that contain progesterone and vice versa, so you have to read carefully.

Third peril is that some creams have whole bunches of other stuff in them that may or may not be helpful and may even cause problems. Rx creams, of course, are nothing but the progesterone and the vehicle. I know that I've seen slightly different (and in a few otc cases, significantly different) responses to different creams, and have had friends have similar experiences.

I'm not totally dissing otc here--it's convenient and if it's all you can get, it may be better than nothing. I don't have health insurance, so it was cost effective to try out a few tubes to see how I felt about it before shelling out $80 to stand there, make my case, and watch the doc write the prescription.

Doctors who are up to date on this stuff don't have as much problem with progesterone as those who spend all their time practicing and get their continuing education from drug reps and trips to the Caribbean.  A lot of the stuff you can find on the internet that goes the "no uterus/no progesterone" direction is either old or is backlash against John Lee's popularization of its use. Whether or not it is the right choice for you (which you have to decide for yourself, of course), there are many many women who have had hysts who use it and swear by it. Myself, I've done both, and won't go back to estrogen alone.

Just want to say here, I find your posts very informative!! I have also checked your web-site....and just love it!!I haven't had a hyster...but I have a couple of  friends who did...(one recently)...who could sure benefit with what you have to say!! One is in denial...say's, "There's no way I'm going to have trouble with menopause now that I've lost it all!" She had a total!! *Sigh* She a tuffy...doesn't have a 'puter...but when she's ready to ask certain questions, I be there to help her...."where ever I can!!"

The other friend just lost her ovaries....a couple of months ago,(cancer)!! *Sigh*Both are in their early 50's!!  Both are angry and (like I said) denial!!

Again...appreciate your contribution....Thank you!!!

(((((((((Hugs from a Canadian Chick)))))))                            Nancy

I've seen a lot that denial, and there's really no good answer to it other than to wait for women to realize that sometimes attitude just isn't enough. The whole hyst process itself is fraught with the most basic of self-image problems--on top of the magniude of the problem that requires such radical surgery and then the physical challenges of recovering well from the procedure itself--and I think it is one that is too oversold as "no big deal and this will fix all your problems." To go through all of that and then get hit with the uncertainties and frustrations of trying to balance hrt, and it's no wonder, no wonder at all, that so many women initially just balk at taking on one more monumental task. And the depression and mood instability and sleep deprivation that can come from the hormonal loss don't foster rational thought, either.

Your friends are lucky that you're standing by ready to help.

To repeat, for those who may not have seen it on the other boards:

Hot Flash Drug Recalled

Millions of doses of Premarin are recalled by manufacturer

By Colette BouchezHealthScoutNews Reporter

THURSDAY, Aug. 16 (HealthScoutNews) --

In the third recall since the beginning of the year, the maker of one of the most popular brands of estrogen replacement therapy said late yesterday that more than 10 million pills are being pulled off wholesalers' shelves. Add that to recalls in January and April, and the total of pills taken off the market is more than 500 million doses. Premarin, made by American Home Products, is apparently shy of meeting Food and Drug Administration (FDA) standards in regard to dissolution -- which is the criteria that measures how uniformly or evenly a drug dissolves in your body. If it dissolves too quickly or too slowly, your body won't get the correct dose of the medicine. Premarin, derived from purified horse urine, is taken by 10 million women every day.

Premarin, while it's been well studied, and it's been a good drug over the years, comes from horses' urine -- and because it is animal based, we don't know exactly what's in it other than the main ingredient, and you can't tell the horses what to pee, says Dr. Alan Altman, assistant clinical professor of obstetrics and gynecology and reproductive biology at Harvard Medical School. (Power Surge guest and Ask The Doctor)

As a result, says Altman, each time Wyeth-Ayerst, the manufacturer, makes Premarin, it's a little bit different from the time before, so, sometimes a woman gets too much [estrogen], sometimes too little, and sometimes the right amount. Other hormone replacement products, such as plant-derived Cenestin, a synthetic estrogen made by Cincinnati, Ohio-based Duramed Pharmaceuticals, Inc., don't have that problem, says Altman, because each and every pill is structurally identical. Because new drug manufacturing technologies allow for better-controlled dissolution, older drugs like Premarin -- on the market for more than 58 years -- can find it difficult to meet current standards. Which is one reason they can be recalled. The [government] specifications [for dissolution] were amended in May 1998 and [some] Premarin manufactured after May has not met the new specifications.

It's important to note that the product didn't change -- the specifications changed, says Audrey Ashby, spokeswoman for Wyeth, the division of American Home Products that makes and distributes Premarin. And, in fact, even if formulations do differ from batch to batch, not all medical experts see it as a problem. Generally, the variations remain within such a strict level of acceptance, the difference from batch to batch is so small it's not really an issue, says Dr. Rogerio Lobo, chief of OB/Gyn at Columbia-Presbyterian Medical Center in New York City. When a batch does exceed the normal acceptable levels, says Lobo, it is unlikely to make it to the consumer. I believe any woman who is currently taking Premarin should feel extremely confidant in continuing to take it without hesitation -- this is a quality control issue not a medical issue, and I don't think these recalls represent any major health or medical problems, says Lobo. No one has reported any ill effects from taking any of the recalled drug. The current recall, which was done at the wholesale level, involves one lot of 896 bottles and one lot of 1,174 bottles. Each bottle contains 5,000 tablets. The grand total of pills pulled off wholesalers' shelves: a whopping 10 million-plus pills, all in the dosage strength of 1.25 milligrams, a mid-strength dose of the five the company makes. This current recall follows two others -- one in January, and a second in April of 2001 -- all for the same dissolution issue. According to FDA reports, more than 100,000 bottles of 5,000 pills -- a total of some 500 million doses of Premarin -- have been voluntarily recalled at the wholesale level, for dissolution problems since the start of this year. While the focus of the current recall is wholesalers, some of the now-recalled pills could be sitting on the consumer's bathroom shelf. Indeed, because the dissolution problems were discovered in batches of older pills -- stashes routinely held by drug manufacturers in the event that safety testing becomes necessary -- the company has no way of knowing how many of the previously shipped pills from the same batch made it to the drugstore, and ultimately into women's hands.

Still, they insist there is no need for worry or alarm Women should be reassured that the product they have is not subject to the recall and even if they have Premarin tablets from these lots, they contain the proper estrogen dose and will provide them with all the proven benefits, says Ashby. The company has declined to release lot numbers, saying only that the products consumers have are safe and do not need to be returned. Premarin is is used primarily to treat symptoms of menopause including hot flashes and night sweats. It is also approved for the prevention of osteoporosis, a bone thinning disorder related to a lack of estrogen. Although it has been sold since 1942 without a patent, there is no generic version of the drug. The reason, says Altman, is that nobody really knows what's in it. Even the people who make Premarin don't know exactly what's in the formula, he says.

Indeed, in 1997 the FDA declared the active ingredients of Premarin cannot be definitively identified…[so] a generic version cannot be approved. Manufactured from what American Home Products call a complex blend of natural estrogens, which includes urine taken from pregnant mares, Premarin has also become a rallying point for animal rights activists. What To Do To learn more about natural alternatives to hormone replacement therapy, visit The North American Menopause Society, found here. To learn more about the symptoms of menopause and the variety of drugs available for hormone replacement therapy visit The National Institute on Aging found here. Copyright © 2001 HealthScout News, Inc.