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Female sex hormones

Last updated: August 4, 2021

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Estrogen is a female sex hormone that is produced in the ovaries and, to a lesser degree, in the adrenal glands and adipose tissues. It is essential for the development of primary and secondary sex characteristics, as well as function of the reproductive organs. Estrogen also plays a role in several other processes, including bone metabolism and liver function. While ovarian insufficiency, aromatase deficiency, and hyperprolactinemia result in pathologically low estrogen levels, a decrease in estrogen is a normal feature of menopause. Possible symptoms of estrogen deficiency include menopausal symptoms, vaginal and endometrial atrophy, and osteoporosis. Increased estrogen levels may also have adverse effects, including gynecomastia, thrombosis, and an increased risk of breast and endometrial cancer. Progesterone is a female sex hormone produced by the corpus luteum in nonpregnant women and, in pregnant women, by the corpus luteum graviditatis until the 10th week of gestation, after which the placenta takes over production. Progesterone plays an important role in the preparation of the endometrium for implantation of a fertilized ovum and maintenance of pregnancy. Synthetic progesterone derivatives are called “progestins” and are used as contraceptives and are used in the treatment of conditions resulting from endometrial proliferation (e.g., endometriosis, endometrial cancer).

Overview of female sex hormones
Estrogen Progesterone
Production
Effects in uterus
Effects in cervix
  • ↑ Production of cervical mucus (facilitates entry of sperm)
  • ↓ Production of cervical mucus → thickening of cervical mucus (preventing the entry of sperm into the uterus)
Effects in other tissues
Effects of hyperproduction
Effects of hypoproduction
  • N/A

Ovarian estrogen synthesis

Estrogen synthesis primarily takes place in the ovarian granulosa cells.

See “Androgens” in "Adrenal gland."

Extra-ovarian estrogen synthesis [1]

Estrogen is also produced in other aromatase-containing tissues:

Estrogen types

There are three types of estrogen: estradiol, estrone, and estriol.

Obesity increases the risk of postmenopausal breast cancer. It is hypothesized that this is due to estrogen production in adipose tissue. [2]

Measurement of unconjugated estriol (uE3 or free estriol) is part of the prenatal screening for fetal anomalies (i.e., triple screen test and quad screen test). Decreased levels are associated with Down syndrome, Edward syndrome, molar pregnancy, and fetal demise.

Estrogen is a steroid hormone that promotes female sexual development and stimulates the growth and maturation of primary and secondary sex characteristics.

Genitalia/sex characteristics

Extragenital tissue [4][5]

Adverse effects of estrogen can arise from high levels secondary to increased endogenous production or medication (e.g., hormone replacement therapy during menopause):

Although estrogen is a risk factor for the development of some types of cancer, it reduces the risk of colon cancer.

High estrogen levels increase the risk of thrombosis.

Production

Effects

Genitalia/sex characteristics

Extragenital effects

Role in menstrual cycle

Clinical significance

Overview of reproductive system drugs
Drug class Examples Mechanism of action Indications Side effects
Selective estrogen receptor modulators (SERMs)
  • Tamoxifen
  • Hot flashes
  • Multiple simultaneous pregnancies
  • Visual disturbances [11]
Synthetic estrogens [12]
  • Ethinyl estradiol
  • Mestranol
  • Diethylstilbestrol (DES)
Aromatase inhibitors
  • Anastrozole
  • Letrozole
  • Exemestane
Androgen agonists
Antiandrogens
  • Steroid binding; achieved via nonsteroidal competitive inhibition at androgen receptors
  • Cyproterone
Anabolic steroids [12]
  • Methyltestosterone
  • Oxandrolone
  • Fluoxymesterone
Progestins [12]
Antiprogestins [12]
  • Mifepristone
  • Ulipristal

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