Estrogen ________ FSH release

Estrogen secretion reaches a peak just before midcycle, and at this point the granulosa cells begin to secrete progesterone. This stimulates brief surge in LH and FSH release that causes ________

Gonadotropins control the ovarian and endometrial cycles. The ovarian-endometrial cycle has been structured as a ___- day cycle

The ___________ phase (days 1 to 14) is characterized by rising levels of estrogen, thickening of the endometrium, and selection of the dominant "ovulatory" follicle

During the __________ phase (days 14 to 21), the corpus luteum produces estrogen and progesterone, which prepare the endometrium for implantation.

Natural Estrogen

• Major estrogen produced by the ovary

Natural Estrogen

• Some are produced in the ovary

• Produced in the liver from estradiol

• From peripheral tissues from androstenedione/ androgen

Natural Estrogen

• Produced in the liver from estradiol

• From peripheral tissues from androstenedione/ androgen

Synthetic Estrogen

• Ethinyl estradiol

• Quinesterol

• Mestranol

Synthetic Estrogen

• Dienestrol

• Diethylstilbestrol

• Benestrol

• Hexestrol

• Methestrol

• Methallenestril

• Chlorotranisene

Pharmacokinetics of Estrogen

• Only free __ is physiologically active

Metabolic & CV Effects of Estrogen

• _________ rate of bone resorption

Metabolic & CV Effects of Estrogen

• _________ adipose tissue production of leptin

Metabolic & CV Effects of Estrogen

• _________ LDL and total plasma cholesterol levels

Metabolic & CV Effects of Estrogen

• _________ hepatic oxidation of adipose tissue lipid to ketones and _________ synthesis of triglycerides

Blood Coagulation Effects of Estrogen

• _________ blood coagulability

Other Effects of Estrogen

• _______ synthesis of progesterone receptors

Clinical Uses of Estrogen

• Treatment of Primary ____________

Treatment of Primary Hypogonadism

• Initiation time: _______ years of age

• Stimulation of secondary sex characteristics and menses

• Stimulation of growth

• Prevent osteoporosis

• Avoiding psychological effects of the delayed puberty

Postmenopausal Hormonal Treatment

Risk of development of osteoporosis is highest in:

• Smokers who are _________

• Caucasian

• Inactive women with low calcium intake

• Strong family history

• Depression

Postmenopausal Hormonal Treatment

Cardiovascular effects following estrogen replacement

• ___ total cholesterol

• ↓ LDL cholesterol

• ↑ HDL cholesterol

• 50% reduction in myocardial infarction frequency

• As much as 40% reduction in fatal stroke frequency

Postmenopausal Hormonal Treatment

Estrogen monotherapy may cause increased risk of endometrial carcinoma

Other uses of Estrogen

• Ovulation suppression for treating intractable dysmenorrhea

• Ovarian suppression used to manage hirsutism and amenorrhea due to excessive ovarian androgen secretion

Other uses of Estrogen

• Stop excessive uterine bleeding caused by endometrial hyperplasia

• May stop blood loss (temporarily)

Adverse Effects of Estrogen Therapy

Adverse Effects of Estrogen Therapy

Contraindications to Estrogen Therapy