Female sex hormones

Last updated: January 23, 2023

Summarytoggle arrow icon

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 clinical features 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).

Overviewtoggle arrow icon

Overview of female sex hormones
Estrogen Progesterone
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
  • N/A
Effects of hypoproduction

Estrogentoggle arrow icon

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.

Effectstoggle arrow icon

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 effectstoggle arrow icon

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.

Hyperestrogenismtoggle arrow icon

Hypoestrogenismtoggle arrow icon

Progesteronetoggle arrow icon



Genitalia/sex characteristics

Extragenital effects

Role in menstrual cycle

Clinical significance

Reproductive system drugstoggle arrow icon

Overview of reproductive system drugs
Drug class Examples Mechanism of action Indications Side effects
Selective estrogen receptor modulators (SERMs)
  • Tamoxifen
  • Clomiphene
Synthetic estrogens [12]
  • Ethinyl estradiol
  • Mestranol
  • Diethylstilbestrol (DES)
Aromatase inhibitors
  • Anastrozole
  • Letrozole
  • Exemestane
Androgen agonists
  • Cyproterone
Anabolic steroids [12]
  • Methyltestosterone
  • Oxandrolone
  • Fluoxymesterone
Progestins [12]
Antiprogestins [12]
  • Mifepristone
  • Ulipristal

Referencestoggle arrow icon

  1. Haas DM, Hathaway TJ, Ramsey PS. Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology. Cochrane Database of Systematic Reviews. 2019.doi: 10.1002/14651858.cd003511.pub5 . | Open in Read by QxMD
  2. HU R, HILAKIVI-CLARKE L, CLARKE R. Molecular mechanisms of tamoxifen-associated endometrial cancer (Review). Oncology Letters. 2015; 9 (4): p.1495-1501.doi: 10.3892/ol.2015.2962 . | Open in Read by QxMD
  3. Raloxifene. Updated: September 17, 2019. Accessed: September 18, 2019.
  4. Viola MI, Meyer D, Kruger T. Association between Clomiphene Citrate and Visual Disturbances with Special Emphasis on Central Retinal Vein Occlusion: A Review. Gynecol Obstet Invest. 2011; 71 (2): p.73-76.doi: 10.1159/000319497 . | Open in Read by QxMD
  5. Katzung B,Trevor A. Basic and Clinical Pharmacology. McGraw-Hill Education ; 2014
  6. Irene E. G. van Hellemond, MD, Sandra M. E. Geurts, Msc, PhD, and Vivianne C. G. Tjan-Heijnen, MD, PhD. Current Status of Extended Adjuvant Endocrine Therapy in Early Stage Breast Cancer. Current Treatment Options in Oncology. 2018.
  7. Hitisha K., Patel Teeru Bihani. Selective estrogen receptor modulators (SERMs) and selective estrogen receptor degraders (SERDs) in cancer treatment. Pharmacology & Therapeutics. 2018.
  8. Danazol. Updated: December 12, 2020. Accessed: August 25, 2020.
  9. Bork K, Bygum A, Hardt J. Benefits and risks of danazol in hereditary angioedema: a long-term survey of 118 patients. Annals of Allergy, Asthma & Immunology. 2008; 100 (2): p.153-161.doi: 10.1016/s1081-1206(10)60424-3 . | Open in Read by QxMD
  10. Procopio G, Guadalupi V, Giganti MO, et al. Low dose of ketoconazole in patients with prostate adenocarcinoma resistant to pharmacological castration. BJU Int. 2010; 108 (2): p.223-227.doi: 10.1111/j.1464-410x.2010.09825.x . | Open in Read by QxMD
  11. Katzung BG. Basic and Clinical Pharmacology 14th Edition. McGraw Hill Professional ; 2017
  12. Jadav SP, Parmar DM. Ulipristal acetate, a progesterone receptor modulator for emergency contraception. J Pharmacol Pharmacother. 2012; 3 (2): p.109-111.doi: 10.4103/0976-500X.95504 . | Open in Read by QxMD
  13. Barakat R, Oakley O, Kim H, Jin J, Ko CJ. Extra-gonadal sites of estrogen biosynthesis and function. BMB Rep.. 2016; 49 (9): p.488–496.doi: 10.5483/BMBRep.2016.49.9.141 . | Open in Read by QxMD
  14. Cleary MP, Grossmann ME. Obesity and breast cancer: the estrogen connection. Endocrinology. 2009; 150 (6): p.2537–2542.doi: 10.1210/en.2009-0070 . | Open in Read by QxMD
  15. Key TJ, Appleby PN, Reeves GK et al. Body mass index, serum sex hormones, and breast cancer risk in postmenopausal women. J Natl Cancer Inst. 2003; 95 (16): p.1218-1226.
  16. Björnsson ES. Hepatotoxicity by drugs: the most common implicated agents. Int J Mol Sci.. 2016; 17 (2): p.224.doi: 10.3390/ijms17020224 . | Open in Read by QxMD
  17. Gorodeski GI. Effects of menopause and estrogen on cervical epithelial permeability. J Clin Endocrinol Metab. 2000; 85 (7): p.2584-2595.doi: 10.1210/jcem.85.7.6671 . | Open in Read by QxMD
  18. Stachenfeld NS. Sex Hormone Effects on Body Fluid Regulation. Exerc Sport Sci Rev. . 2008; 36 (3): p.152–159.doi: 10.1097/JES.0b013e31817be928. . | Open in Read by QxMD
  19. Miller VM, Duckles SP. Vascular actions of estrogens: functional implications. Pharmacol Rev.. 2008; 60 (2): p.210–241.doi: 10.1124/pr.107.08002 . | Open in Read by QxMD
  20. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015

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