Abstract. Endogenous estrogens exert an array of biological actions on women, many of which are mediated by the estrogen receptors (ERs) α and ß. Results from our recent studies suggest that the human ERα and ERß systems are differentially activated under different physiological conditions. In non-pregnant young women, the ERα system is preferentially activated over the ERß system, mainly by estrone (E1) and its major oxidative metabolite, 2-hydroxy-E1. These two estrogens are among the quantitatively major estrogens present in young women, and have approximately 4-fold preferential activity for ERα over ERß. During pregnancy, however, there is a preponderance of activation of ERß over ERα conferred by various pregnancy estrogens such as estriol and other D-ring derivatives of 17ß-estradiol (E2). These estrogens have an up to 18-fold preference for binding to ERß than for ERα, and some of them are produced in unusually large quantities. Given this new information, it is hypothesized that the estrogens ideal for female hormone replacement therapy (HRT) would be those which produce a hormonal condition mirroring that found in non-pregnant young women rather than in pregnant women. Endogenous estrogen derivatives, such as the sulfated conjugates of E1, may be among the ideal candidates for achieving this clinical purpose. In comparison, Premarin, the most commonly-used HRT containing a mixture of conjugated estrogens isolated from pregnant mare's urine, is less suitable because several of its estrogenic components can produce a strong preferential overstimulation of the human ERß signaling system. Contents 1. Introduction 2. Differences in the composition and quantity of endogenous estrogens produced in pregnant and non-pregnant women 3. Differences in the biological activity of pregnancy and non-pregnancy estrogens 4. Biological activity of estrogens contained in Premarin 5. Which estrogens are ideal for postmenopausal hormone replacement therapy? 6. Concluding remarks
IntroductionFemale hormone replacement therapy (HRT), also commonly called menopausal hormone therapy, is a hormonal treatment for peri-or post-menopausal women undertaken to reduce the discomfort and health problems associated with diminished circulating ovarian hormones (namely, estrogens and progesterone). HRT usually provides a low dose of an estrogen (or a mixture of estrogens), often in combination with a progestin. In the past few decades, the most commonly-used estrogen treatment for HRT has been Premarin, which consists of a mixture of mostly sulfated estrogens isolated from pregnant mare's urine. The hormonal activity of these conjugated estrogens in vivo results from their enzymatic hydrolysis and releases biologically active estrogens.Until a few years ago, the generally-held scientific belief was that 'an estrogen is an estrogen', i.e., that all estrogens exert similar pharmacological actions on the body. However, this dogmatic view has gradually changed over the past decade due, in large part, to the emergence of the following body of ...