There are few drugs in modern history that have stimulated greater controversy than Premarin. Since its Food and Drug Administration approval in the early 1940s, more than 30 billion doses have been dispensed. The estrogens in this hormone replacement therapy (HRT) are made from purified pregnant mare's urine.
By the 1960s, Premarin was widely prescribed to ease menopausal symptoms. Not only was it used to eliminate hot flashes and night sweats, doctors prescribed it to calm anxiety, slow the aging process and help women stay "Feminine Forever." That was the name of a popular book written by physician Robert A. Wilson in 1966.
Since then, Premarin has been praised and vilified by doctors, patients and consumer advocates. Even 40 years later, the controversy rages on. Epidemiologists continue to argue about the risks and benefits of HRT. The experiences of individual women often get lost in the clamor.
Some women, like this one, strongly favor the drug: "I had a complete hysterectomy in 1974 due to endometriosis, a very painful disease involving my uterus and ovaries. I took Premarin but did not take progestin since I had no uterus. I have heard that progestin is what may increase the risk of cancer for women taking estrogen.
"Nothing terrible has happened to me all these years on Premarin. At 79, I'm healthy and play tennis and golf regularly."
Another woman had a serious side effect, but still opts for Premarin: "After I had a hysterectomy, I was put on a high dose of Premarin for menopausal symptoms. I stayed on it for 30 years. Two years ago, I was diagnosed with early breast cancer. I had a lumpectomy and seven weeks of radiation. The cancer has not returned.
"Would I do it again? You bet! Surgery and radiation are a small price to pay for 30 years of health and happiness."
Here is a different perspective: "In the mid-1980s, my doctor talked me into taking estrogen for night sweats and lack of sleep. In 1998, after taking estrogen all that time and getting annual mammograms for 12 years, I was diagnosed with early stage breast cancer.
"I needed a lumpectomy and five weeks of radiation. The first thing I was told was to stop taking estrogen. Not long after that, the uproar started over HRT, and many women stopped taking it. After 12 years, I was breast cancer waiting to happen. I took it that long because I was told it was good for my bones.
"In 2006, I found out I had uterine cancer. I'd had symptoms for only a few weeks before they performed a hysterectomy. The doctor said the cancer was about to break through the lining of the uterus. I guess I was lucky. Again, I needed five weeks of radiation. This time it was much harder.
"I have to wonder if any of this would have happened had I never agreed to take the estrogen. I guess I'll never know."
Proving that HRT was responsible for a particular woman's cancer is very difficult. The stories of these three women demonstrate why individual preferences must be part of the prescribing decisions. Weighing benefits and risks based on objective information is critical to that process.