Biologically important natural estrogens and progestins include estradiol, estrone, estriol, and progesterone. Estradiol-17$ is the most potent estrogen that is found naturally in women. Estrone is one-tenth as biologically active as estradiol, and estriol is the weakest of the three. Estriol is synthesized by the placenta and is excreted at high levels in the urine of pregnant women. Progesterone is the most important naturally occurring progestin.
The ovary is the major site of estrogen and progestin biosynthesis in nonpregnant premenopausal women. In pregnant women, the fetoplacental unit is the major source of estrogens and progestins. Peripheral sites of estrogen synthesis include the liver, kidney, brain, adipose tissue, skeletal muscle, and testes. Progesterone is secreted in small amounts by the testes and adrenal gland. The combined estrogen and progestin production by all of these peripheral sites amounts to 10% or less of ovarian synthesis in normal premenopausal women. In postmenopausal women, ovarian steroid synthesis declines and peripheral estrogen biosynthesis accounts for all estrogen produced, both in postmenopausal women and in males.
The naturally occurring estrogens and progestins are not orally active because they are rapidly metaboli-cally inactivated. The major site of estrogen and progestin metabolism is the liver. Both are subject to first-
pass metabolism. Metabolites are also formed in the gastrointestinal tract, brain, skin, and other steroid target tissues. Estrogens and progestins are primarily excreted in the urine. Estrone, estradiol, 2-methoxye-strone, and their respective glucuronide or sulfate conjugates are the most abundant estrogen urinary metabolites. Progesterone is excreted as pregnanediol or as a pregnanediol conjugate. A small fraction (10% or less) of the estrogen metabolites enter the bile, where they may undergo enterohepatic recirculation before elimination.
Plasma proteins bind estrogens and modulate estro-genic activity. More than 90% of estradiol in the bloodstream is protein bound, with sex hormone-binding globulin (SHBG) being the major serum estrogen-binding moiety. Estrogens that are bound to SHBG are biologically inactive because of their high binding affinity, while estrogens that are bound loosely to serum albumin are available for entry into tissues and are therefore biologically active. Progesterone in plasma is 89% protein bound. Progesterone binds with a relatively high affinity to the serum protein corticosteroid-binding globulin and also to albumin.
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