Estrogen Update: A Plant Based Alternative Cenestin, the latest estrogen alternative approved for menopause management by the Food and Drug Administration, is a plant based chemical copy of Premarin, the most prescribed drug in the United States. The manufacturer, Duramed, has also filed for FDA approval to test Cenestin with the progestin medroxy-progesterone acetate (MPA) to determine whether the combination is safe and effective. The Cenestin/MPA combination parallels Premphase, the Premarin/MPA combination. Identified as “synthetic conjugated estrogens,” Cenestin contains components chemically synthesized from plant material: a combination of nine estrogens for the relief of hot flashes, vaginal dryness, and other symptoms of menopause. Premarin, in contrast, is identified as “conjugated equine estrogens” and contains estrogens distilled from the urine of pregnant mares. Requests for approval as a generic form of Premarin have been denied because “the active ingredients have not been adequately defined,” according to the FDA. Premarin has been on the market for 56 years. At present, there is not enough information to determine whether the alternative estrogens on the market (including Estratab/Menest, Estrace, Ogen/Ortho-Est, and Estraderm/FemPatch) are biologically equivalent to Premarin. Unlike other prescription estrogens, however, Cenestin is not approved for the prevention or treatment of osteoporosis as studies have not lasted long enough to demonstrate the effects of the drug on bone density. Because each woman has a different amount of native estrogen, and because each woman metabolizes estrogen differently, the optimal dosage and combination of estrogens depend on the individual. It is also important to consider that all forms of estrogen used for menopause management (synthetic or otherwise, including topical and transdermal) may increase the risk of breast cancer.
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