Those women who are able to tolerate Premarin can go on taking it for years--well past the five-year mark that most studies consider a critical period--all the while harboring the worry that if they go off it, the chassis will start to break down and various parts will begin to fail or fall off. These women face a difficult dilemma: If the drug they are using seems to be working, it's hard to consider a change. But ignoring the potential for harm can be dangerous to your health.

To add another complication, Premarin and its sister drugs are now being advertised as necessary to ward off osteoporosis and heart disease, opening up a whole new marketing strategy to sell these drugs to you for long-term use. When they were first put on the market, the primary emphasis was on short-term treatment of temporary symptoms, but by advocating use of these drugs for long-term use as prevention against heart disease and osteoporosis, a whole new element of danger and confusion has been added.

The Profit Motive
Why haven't the makers of standard HRT drugs sought out safer alternatives? In the case of Premarin, 940 million dollars and growing is the answer. Premarin is the number-one best-selling drug in the country.(4) Why haven't American pharmaceutical companies strongly marketed these safer bio-identical plant-derived hormone products? Simple. They can't be patented, which means that no single company can corner the market. And since research money will flow only to those projects that will provide a drug company with so-called protected profit, "natural" will always lose to "synthetic" in the pharmaceutical world.

Since the late 1800s, U.S. law has allowed medicines to be patented only if they are not natural substances. If, for example, a pharmaceutical company decides to market a natural substance, another competing company could ride on its coattails and dilute its profitability, hence the notion of creating drugs with protected profit. Many natural substances are changed into patentable drugs simply by changing a few molecules of the natural substance. The decision to do this is often not driven by the desire for a better drug, but rather for one that is different enough to obtain a patent.

But what seems a tiny change in the molecular structure of a substance can make a huge difference in its effect on your body. Adding or subtracting a few hydrogen atoms and a few double bonds in the biochemical structure of estrogen or testosterone is the difference between a male and a female! In the case of Provera, which is a molecularly altered version of natural progesterone, side effects can result because the body doesn't recognize the substance as completely biologically identical to one in your body.

Fortunately, switching to the plant-derived bio-identical hormones can be done with relative ease. A woman taking Premarin can have an equivalent dose worked out for her by a pharmacist, and she can immediately start taking the plant-derived hormones.

How "Estrogen" Got Politicized
Unfortunately, and for many of the wrong reasons, not supplementing estrogen has become a political cause for some women.

Betty Friedan has taken a strong position against women using HRT. She is also quoted as saying, "I may have had a hot flash, one hot flash, while I was giving a major speech in the middle of the seventies,"(5) implying that women who took anything for menopause were sissies, and dismissing the significance of the menopausal passage altogether.