• Estrogens – estradiol.
• Progestins - progesterone.
• The estrogens mainly promote proliferation and
growth of specific cells in the body that are
responsible for the development of most
secondary sexual characteristics of the
• The progestins function mainly to prepare the
uterus for pregnancy and the breasts for
• In the normal nonpregnant female, estrogens are secreted
in significant quantities only by the ovaries, although minute
amounts are also secreted by the adrenal cortices.
• During pregnancy, tremendous quantities of estrogens are
also secreted by the placenta.
• b-estradiol, estrone and estriol
• Small amounts of estrone – most formed in the peripheral
tissues from androgens and by ovarian thecal cells.
• Estriol - weak estrogen - oxidative product - liver.
• The estrogenic potency of b-estradiol is 12 times that of
estrone and 80 times that of estriol.
• Progesterone & 17- α – hydroxyprogesterone
• In the normal nonpregnant female, progesterone is secreted in
significant amounts only during the latter half of each ovarian cycle,
when it is secreted by the corpus luteum.
• large amounts of progesterone are also secreted by the placenta
during pregnancy, especially after the fourth month of gestation.
• Steroids – cholesterol
• Synthesis - progesterone and the testosterone - during the follicular
phase of the ovarian cycle - almost all the testosterone and much of
the progesterone are converted into estrogens by the granulosa
• During the luteal phase - large secretion of progesterone
• 1/5th testosterone
• Transported in the blood bound mainly with plasma albumin
and with specific estrogen and progesterone binding
• Liver conjugates the estrogens to form glucuronides and
sulfates and about 1/5th of these conjugated products is
excreted in the bile; most of the remainder is excreted in the
• liver converts the potent estrogens - estradiol and estrone impotent estriol.
• Therefore, diminished liver function increases the activity of
estrogens in the body, sometimes causing hyperestrinism.
• Progesterone – pregnanediol - urine
• Cellular proliferation and growth of the tissues of the sex
organs and other tissues related to reproduction.
• Puberty - The ovaries, fallopian tubes, uterus, and vagina
all increase several times in size.
• The external genitalia enlarge, with deposition of fat in the
mons pubis and labia majora and enlargement of the
• estrogens change the vaginal epithelium from a cuboidal
into a stratified type, which is considerably more resistant
to trauma and infection
• Vaginal infection in children
• Uterus: size + marked proliferation of the endometrial stroma
and greatly increased development of the endometrial
glands, which will later aid in providing nutrition to the
implanted ovum - the muscle becomes more active and
excitable - The "estrogen dominated" uterus is also more
sensitive to oxytocin.
• Fallopian tube: glandular tissues proliferate - number of
ciliated epithelial cells increase - activity of the cilia
enhanced - cilia always beat toward the uterus, which
helps propel the fertilized ovum in that direction.
• Breasts: development of the stromal tissues of the breasts growth of an extensive ductile system - deposition of fat in
the breasts - pigmentation of the areolas.
• lobules and alveoli - progesterone and prolactin
• Skeleton: Estrogens inhibit osteoclastic activity in the
bones and therefore stimulate bone growth - uniting of
the epiphyses with the shafts of the long bones – much
stronger effect – growth stops earlier – female eunuch
• Osteoporosis in Old Age – after menopause – no
estrogen - increased osteoclastic activity in the bones decreased bone matrix - decreased deposition of
bone calcium and phosphate.
• Weak bones – vertebra # - prophylactic estrogen
• Protein deposition – less potent than testosterone
• BMR & Fat deposition - ↑ BMR but only 1/3rd - deposition of
increased quantities of fat in the subcutaneous tissues –
breasts - buttocks and thighs - body fat % greater.
• Hair distribution – pubic & axillary – more role of adrenal
• Skin – soft & smooth but thick – more vascular - ↑ warmth
– greater bleeding - to make sebaceous gland secretions
more fluid and inhibit formation of comedones
("blackheads") and acne.
• Electrolyte balance – Na & water retention – body fluid
retention during pregnancy
• Estrogens have a significant plasma cholesterol - lowering action
and they rapidly produce vasodilation by increasing the local
production of NO.
• These actions inhibit atherogenesis and contribute to the low
incidence of myocardial infarction and other complications of
atherosclerotic vascular disease in premenopausal women.
• estrogen treatment in postmenopausal women - Large doses of
orally active estrogens promote thrombosis - they reach the liver in
high concentrations in the portal blood and alter hepatic
production of clotting factors - CA Breast, CA Uterus
• "tailor-made" estrogens that have the bone and cardiovascular
effects of estradiol but lack its growth-stimulating effects on the
uterus and breast - tamoxifen and raloxifene
• MOA – nuclear receptor
• Uterus – promote secretory changes in the uterine
endometrium during the latter half of the monthly
female sexual cycle, thus preparing the uterus for
implantation of the fertilized ovum.
• decreases the frequency and intensity of uterine
contractions - to prevent expulsion of the
implanted ovum - mifepristone + PGs for abortion
• Fallopian Tubes - increased secretion by the
mucosal lining - nutrition of the fertilized, dividing
ovum before implantation
• Breasts - development of the lobules and alveoli - alveolar
cells to proliferate, enlarge, and become secretory in
nature – milk only after prolactin
• Relaxin - corpus luteum, uterus, placenta, and mammary
glands - During pregnancy, it relaxes the pubic symphysis
and other pelvic joints and softens and dilates the uterine
cervix. It also inhibits uterine contractions.
• In nonpregnant women, relaxin is found in the corpus luteum
and the endometrium during the secretory phase of the
menstrual cycle. Its function in nonpregnant women is
• Fertile Period - The ovum remains viable and capable of
being fertilized after it is expelled - not longer than 24 hours sperm must be available soon after ovulation if fertilization is
to take place.
• A few sperm can remain fertile in the female reproductive
tract for up to 5 days - for fertilization to take place,
intercourse must occur sometime between 4 and 5 days
before ovulation up to a few hours after ovulation - about 4
to 5 days.
• Rhythm (calendar, safe period, natural) Method of
Contraception - to avoid intercourse near the time of
ovulation - difficulty is predicting the exact time of ovulation
- avoidance of intercourse for 4 days before the calculated
day of ovulation and 3 days afterward – only if regular
• 21, 28, 40 day cycle; shortest – 18 and longest – 11 (10 to 21)
• Barrier – mechanical – female condom, diaphragm & cervical caps
• Displacements – cervicitis – irritation
• Barrier – chemical – spermicidal – ricinoleic acid – nonoxynol 9 –
• Foam tablets, pastes, creams, jellies, vaginal sponge (TODAY)
• Combined – mechanical + chemical
• Chemical – OC Pills – Mala N (21) – Mala D (28)
• MOA – prevent ovulation, implantation & make cervical secretion
• administration of either estrogen or progesterone, if given in
appropriate quantities during the first half of the monthly cycle,
can inhibit ovulation.
• Prevention of the preovulatory surge of LH secretion by the
pituitary gland, which is essential in causing ovulation.
• immediately before the surge occurs, there is probably a sudden
depression of estrogen secretion by the ovarian follicles, and this
might be the necessary signal that causes the subsequent
feedback effect on the anterior pituitary that leads to the LH
• The administration of sex hormones (estrogens or progesterone)
could prevent the initial ovarian hormonal depression that might
be the initiating signal for ovulation.
• too much of either hormone can cause abnormal menstrual
• synthetic progestins in place of progesterone, especially the 19norsteroids, along with small amounts of synthetic estrogens
• the natural hormones (oral) are almost entirely destroyed by the
liver within a short time after they are absorbed from the
gastrointestinal tract into the portal circulation
• synthetic estrogens - ethinyl estradiol, mestranol.
norethindrone, norethynodrel, ethynodiol, norgestrel.
• First 21 days – stopped – menstruation – withdrawal bleeding
• Women are given large doses of estrogens for 4-6 days to prevent
conception after coitus during the fertile period (postcoital or
• 2 OCP immediately + 2 OCP after 12 hours
• Indications – emergency like rape, contraceptive failure or
• I pill, unwanted 72
• MOA - pregnancy is prevented by interference with implantation of
the fertilized ovum rather than changes in GnRH secretion +
hypermotility of uterus
• Minipill – micropill – P only pill – daily for entire cycle – make
cervical mucosa thick & ↓ motility of fallopian tubes
IUD & IMPLANTS
• Intrauterine implantation of pieces of metal or plastic (intrauterine
devices, IUDs) - to prevent sperms from fertilizing ova.
• Lippes loop – plastic – S shaped – nylon tail - barium sulphate
• Copper - T appear to exert a spermatocidal effect – prevent
implantation by evoking aseptic inflammation - most common
• Adv. – safe, effective, reversible, easily removed, long term
• Disadv. – heavy bleeding, come out, ectopic pregnancy
• Hormonal IUDs that slowly release progesterone or synthetic
progestins have the additional effect of thickening cervical mucus so
that entry of sperms into the uterus is impeded – infections
• Levonorgestrel skin implant – 5 years – amenorrhea
• Injectables, vaginal rings – adv. Not to remember – disadv. Sterility,
• Abnormal ovaries – thick capsule - cyst
• Tests - to analyze the urine for a surge in pregnanediol,
the end product of progesterone metabolism, during
the latter half of the sexual cycle; the lack of this
substance indicates failure of ovulation
• Body temp. chart - Secretion of progesterone during
the latter half of the cycle raises the body temperature
about 0.5°F, with the temperature rise coming abruptly
at the time of ovulation.
• Human chorionic gonadotropin, a hormone that is
extracted from the human placenta has almost the same
effects as LH and is therefore a powerful stimulator of
• excess use of this hormone can cause ovulation from
many follicles simultaneously; this results in multiple
births, an effect that has caused as many as eight babies
(mostly stillborn) to be born to mothers treated for
infertility with this hormone.
• Endometriosis – endometrial tissue grows and even
menstruates in the pelvic cavity surrounding the
uterus, fallopian tubes, and ovaries – fibrosis – ovum cant
be released – tube blockage.
• Salpingitis -gonococcal infection - inflammation of the
fallopian tubes; this causes fibrosis in the tubes, thereby
• secretion of abnormal mucus by the uterine cervix
• at the time of ovulation, estrogen causes the secretion
of mucus with special characteristics that allow rapid
mobility of sperm into the uterus and actually guide the
sperm up along mucous “threads.”
• low-grade infection or inflammation, or abnormal
hormonal stimulation of the cervix can lead to a
viscous mucous plug that prevents fertilization.