This article reviews studies focusing on the removal performance of natural estrogens in municipal wastewater treatment plants (WWTPs). Key factors influencing removal include: sludge retention time (SRT), aeration, temperature, mixed liquor suspended solids (MLSS), and substrate concentration. Batch studies show that natural estrogens should biodegrade well; however, batch observations do not always agree with observations from full-scale municipal WWTPs. To explain this discrepancy, deconjugation kinetics of estrogen conjugates in lab-scale studies were examined and compared. Most estrogen conjugates with slow deconjugation rates are unlikely to be easily removed; others could be cleaved in WWTP settings. Nevertheless, some estrogens cleaved from their conjugates may be found in treated effluent, because deconjugation requires several hours or longer, and there is insufficient rest time for the biodegradation of the cleaved natural estrogens in the WWTP. Therefore, WWTP removals of natural estrogens are likely to be underestimated when estrogen conjugates are present in raw wastewater. This review suggests that biodeconjugation of estrogen conjugates should be enhanced to more effectively remove natural estrogens in WWTPs.