Is estradiol available as a drug?
Estradiol enantate
Estradiol enantate, sold under the brand names Perlutal and Topasel among others, is an estrogen medication which is used in hormonal birth control. It is formulated in combination with dihydroxyprogesterone acetophenide (DHPA; algestone acetophenide), a progestin, and is used as a combined injectable contraceptive. Estradiol enantate is not available alone. The medication is given by injection into muscle once a month.
Side effects of estradiol enantate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. The drug is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. Estradiol enantate is an estrogen ester and a long-lasting prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol enantate was first described by 1954, and was first studied in combination with DHPA as a combined injectable contraceptive in 1964. The combination was introduced for clinical use by the mid-1970s. Estradiol enantate is not available as a standalone medication (i.e., by itself without DHPA). The combination is available in Latin America and Hong Kong, and was also previously marketed in Spain and Portugal.
Pharmacokinetics of estradiol
When taken orally, about 95% of a dose of estradiol is metabolized in the intestines and liver into estrone and estrogen conjugates such as estrone sulfate, estrone glucuronide, and estradiol sulfate, among others, prior to entering the circulation. As a result, circulating estrone and estrogen conjugate levels are markedly elevated, in a highly unphysiological manner, with oral estradiol. Whereas the ratio of circulating estradiol to estrone is about 1:1 in premenopausal women and with transdermal estradiol, oral estradiol produces a ratio of about 1:5 on average and as high as 1:20 in some women. In addition, whereas levels of estradiol with menopausal replacement dosages of oral estradiol are in the range of the follicular phase of the normal menstrual cycle, levels of estrone resemble those during the first trimester of pregnancy. Moreover, whereas normal estrone sulfate levels are 10 to 25 times higher than those of estradiol and estrone in premenopausal women, levels of estrone sulfate with oral estradiol are an additional 10 to 20 times higher than normal premenopausal estrone sulfate levels. One study found that estrone sulfate levels were 200-fold higher than estradiol levels with 2 mg/day oral micronized estradiol or oral estradiol valerate, and estrone sulfate levels can reach up to nearly 1,000-fold higher concentrations than estradiol in some cases. In contrast to oral estradiol, due to the lack of the first pass, an excess in estrone and estrogen conjugate levels does not occur with transdermal estradiol or other parenteral estradiol routes.
Pharmacodynamics of estradiol
Lower dosages and concentrations of estradiol can also significantly suppress gonadotropin secretion and testosterone levels in men and transgender women. A retrospective study of oral estradiol monotherapy in transgender women found that dosages of 1 to 8 mg/day increased mean estradiol levels to about 50 to 150 pg/mL and suppressed mean testosterone levels to about 120 to 10 ng/dL. However, there was high interindividual variability in the estradiol and testosterone levels achieved, and testosterone levels were insufficiently suppressed in many even at 8 mg/day. In another study, a dosage of 1 mg/day oral micronized estradiol in healthy older men, which increased circulating estradiol levels by a relatively high amount of 6-fold (to 159 pg/mL), estrone levels by 15-fold (to 386 pg/mL), and SHBG levels by 17%, was found to suppress total testosterone levels by 27% (to 436 ng/dL) and free testosterone levels by 34% (to 11.8 ng/dL). A pharmacodynamic study of testosterone suppression by polyestradiol phosphate in men with prostate cancer found that estradiol levels of about 135 pg/mL (500 pmol/L) would decrease testosterone levels by 50% (from 430 ng/dL to 215 ng/dL), while estradiol levels of about 410 to 545 pg/mL (1500–2000 pmol/L) would decrease testosterone levels well into the castrate range to about 6 to 12 ng/dL (0.2–0.4 nmol/L).
Estrogen (medication)
Estrogens have contraceptive effects and are used in combination with progestins (synthetic progestogens) in birth control to prevent pregnancy in women. This is referred to as combined hormonal contraception. The contraceptive effects of estrogens are mediated by their antigonadotropic effects and hence by inhibition of ovulation. Most combined oral contraceptives contain ethinylestradiol or its prodrug mestranol as the estrogen component, but a few contain estradiol or estradiol valerate. Ethinylestradiol is generally used in oral contraceptives instead of estradiol because it has superior oral pharmacokinetics (higher bioavailability and less interindividual variability) and controls vaginal bleeding more effectively. This is due to its synthetic nature and its resistance to metabolism in certain tissues such as the intestines, liver, and uterus relative to estradiol. Besides oral contraceptives, other forms of combined hormonal contraception include contraceptive patches, contraceptive vaginal rings, and combined injectable contraceptives. Contraceptive patches and vaginal rings contain ethinylestradiol as the estrogen component, while combined injectable contraceptives contain estradiol or more typically an estradiol ester.
Pharmacokinetics of estradiol
Estradiol is available in the form of an aqueous suspension of 1.0 mg estradiol encapsulated in microspheres for use by intramuscular injection once a month under the brand name Juvenum E in Mexico. It achieves circulating estradiol levels of 163 pg/mL to 219 pg/mL in the first 3 to 12 hours following injection, which decrease to 42.4 to 65.7 pg/mL during the first 4 days post-injection and to 20 to 35 pg/mL after 8 days, with levels remaining in this range thereafter over 30 days. These estradiol levels are similar to the normal levels that occur during the early follicular phase of the menstrual cycle in premenopausal women (24 to 75 pg/mL). The elimination of the formulation follows three phases: a rapid phase in the first 2 days, a second phase during days 2 to 12 days with a biological half-life of 7.2 to 9.9 days, and a third phase in which estradiol levels remain elevated above baseline for up to 30 days.
Estriol (medication)
A variety of analogues of estriol are known, including both naturally occurring isomers and synthetic substituted derivatives and esters. 16β-Epiestriol (epiestriol), 17α-epiestriol, and 16β,17α-epiestriol are isomers of estriol that are endogenous weak estrogens. Mytatrienediol (16α-methyl-16β-epiestriol 3-methyl ether) is a synthetic derivative of 16β-epiestriol that was never marketed. Estriol acetate benzoate, estriol succinate, and estriol tripropionate are synthetic estriol esters that have been marketed for medical use, whereas estriol dihexanoate, estriol dipropionate, and estriol triacetate have not been introduced. Quinestradol is the 3-cyclopentyl ether of estriol and has also been marketed. Polyestriol phosphate, an ester of estriol in the form of a polymer, has been marketed previously as well. These esters, ethers, and polymers are prodrugs of estriol. Ethinylestriol and nilestriol are synthetic C17α ethynylated derivatives of estriol. Ethinylestriol has not been marketed, but nilestriol, which is the 3-cyclopentyl ether of ethinylestriol and a prodrug of it, has been.
Esterified estrogens
Esterified estrogens (EEs), sold under the brand names Estratab and Menest among others, is an estrogen medication which is used hormone therapy for menopausal symptoms and low sex hormone levels in women, to treat breast cancer in both women and men, and to treat prostate cancer in men. It is formulated alone or in combination with methyltestosterone. It is taken by mouth.
Side effects of EEs include nausea, breast tension, edema, and breakthrough bleeding among others. It is an estrogen, or an agonist of the estrogen receptors, the biological target of estrogens like estradiol. EEs are a prodrug mainly of estradiol and to a lesser extent of equilin.
EEs were introduced for medical use by 1970. They are available in only a few countries, such as Chile and the United States. They have also been marketed in Argentina and Switzerland in the past.
Estetrol (medication)
Estetrol is metabolized slowly and minimally, and is not transformed into other estrogens such as estradiol, estrone, or estriol. This is related to the fact that estetrol is already an end-stage product of phase I estrogen metabolism in humans. The medication is conjugated via glucuronidation and to a lesser extent via sulfation. The biological half-life of estetrol is about 28 hours, with a range of 18 to 60 hours. The blood half-lives of estradiol and estriol, at about 1 to 2 hours and 20 minutes, respectively, are far shorter than that of estetrol, whereas the biological half-life of ethinylestradiol, at approximately 20 hours, is more similar to that of estetrol. Enterohepatic recirculation may occur with estetrol, similarly to other steroidal estrogens, although it has also been reported that estetrol does not seem to enter the enterohepatic circulation. Estetrol is excreted mostly or completely in urine, virtually entirely in the form of conjugates (unconjugated accounting for 0.2–0.7%). In one study, a median of 79.7% (range 61.1–99.0%) was recovered from urine; this was primarily as estetrol glucuronide (median 60.7%, range 47.6–77.2%), and, to a lesser extent, as estetrol sulfate (median 17.6%, range 13.2–22.1%).
Estriol (medication)
Estriol is available in oral tablet, vaginal cream, and vaginal suppository forms. It is also available over-the-counter or from compounding pharmacies in the form of topical creams. The medication is available both as estriol and in the form of estriol ester prodrugs such as estriol succinate, estriol acetate benzoate, and estriol tripropionate.
Estradiol (medication)
Synthetic derivatives of estradiol used as estrogens include ethinylestradiol, ethinylestradiol sulfonate, mestranol, methylestradiol, moxestrol, and quinestrol, all of which are 17α-substituted estradiol derivatives. Synthetic derivatives of estradiol used in scientific research include 8β-VE2 and 16α-LE2.
Pharmacokinetics of progesterone
Progesterone does not appear to be available pharmaceutically in the form of subcutaneous pellet implants. This is in contrast to estradiol and testosterone. Progesterone may be available in the form of subcutaneous pellet implants from some compounding pharmacies however. Such products are not regulated for quality or effectiveness however. Subcutaneous implantation of progesterone has been studied in animals. Although progesterone is not available for subcutaneous implantation as a pharmaceutical product, subcutaneous implants of progestins, such as etonogestrel (Implanon/Nexplanon) and levonorgestrel (Jadelle/Norplant), are available as pharmaceutical preparations. They are used specifically as a form of long-lasting hormonal birth control.
Pharmacokinetics of estradiol
A single 4 mg intramuscular injection of estradiol cypionate or estradiol valerate has been found to result in maximal plasma levels of estradiol of about 250 pg/mL and 390 pg/mL, respectively, with levels declining to 100 pg/mL (the baseline for estradiol cypionate) by 12 to 14 days. A single 2.5 mg intramuscular injection of estradiol benzoate in patients being administered a GnRH analogue (and hence having minimal baseline levels of estrogen) was found to result in serum estradiol levels of >400 pg/mL at 24 hours post-administration. The differences in the serum levels of estradiol achieved with these different estradiol esters may be explained by their different rates of absorption, as their durations and levels attained appear to be inversely proportional. For instance, estradiol benzoate, which has the shortest duration (4 to 5 days with a single intramuscular injection of 5 mg), produces the highest levels of estradiol, while estradiol cypionate, which has the longest duration (~11 days with 5 mg), produces the lowest levels of estradiol. Estradiol valerate was found to have a duration of 7 to 8 days after a single intramuscular injection of 5 mg.
Estradiol acetylsalicylate
Estradiol acetylsalicylate, or estradiol 3-acetylsalicylate, is a synthetic estrogen and estrogen ester – specifically, the C3 acetylsalicylic acid (aspirin) ester of estradiol – which was described in the late 1980s and was never marketed. In dogs, the oral bioavailability of estradiol acetylsalicylate was found to be 17-fold higher than that of unmodified estradiol. However, a subsequent study found that the oral bioavailability of estradiol and estradiol acetylsalicylate did not differ in rats (4.3% and 4.2%, respectively), suggestive of a major species difference.
Estriol
Although estriol is an efficacious agonist of the ERs, it is reported to have mixed agonist–antagonist (partial agonist) activity at the ER; on its own, it is weakly estrogenic, but in the presence estradiol, it is antiestrogenic. Given by subcutaneous injection in mice, estradiol is about 10-fold more potent than estrone and about 100-fold more potent than estriol. It is notable that unlike estriol, estrone can be metabolized into estradiol, and most of its potency "in vivo" is in fact actually due to conversion into estradiol.
Ethinylestradiol
Ethinylestradiol (EE) is an estrogen medication which is used widely in birth control pills in combination with progestins. It is also occasionally used as a component of menopausal hormone therapy for the treatment of menopausal symptoms in combination with progestins. In the past, EE was widely used alone for various indications such as the treatment of gynecological disorders and prostate cancer. It is usually taken by mouth.
The general side effects of EE include breast tenderness and enlargement, headache, fluid retention, and nausea among others. In men, EE can additionally cause breast development, feminization in general, hypogonadism, and sexual dysfunction. Rare but serious side effects include blood clots, liver damage, and cancer of the uterus.
EE is an estrogen, or an agonist of the estrogen receptors, the biological target of estrogens like estradiol. It is a synthetic derivative of estradiol, a natural estrogen, and differs from it in various ways. Compared to estradiol, EE has greatly improved bioavailability when taken by mouth, is more resistant to metabolism, and shows relatively increased effects in certain parts of the body like the liver and uterus. These differences make EE more favorable for use in birth control pills than estradiol, though also result in an increased risk of blood clots and certain other rare adverse effects.
EE was developed in the 1930s and was introduced for medical use in 1943. The drug started being used in birth control pills in the 1960s. Today, EE is found in almost all combined forms of birth control pills and is nearly the exclusive estrogen used for this purpose, making it one of if not the most widely used estrogens.
Estradiol cyclooctyl acetate
Estradiol cyclooctyl acetate (ECoA), or estradiol 17β-cyclooctylacetate, also known as estra-1,3,5(10)-triene-3,17β-diol 17β-cyclooctylacetate, is a synthetic, steroidal estrogen and an estrogen ester – specifically, the 17β-cyclooctylacetate ester of estradiol – which has been studied for use in hormone replacement therapy for ovariectomized women and as a hormonal contraceptive in combination with a progestin but was never marketed. It has greater oral bioavailability than does micronized estradiol due to absorption via the lymphatic system and hence partial bypassing of first-pass metabolism. It is approximately twice as potent as micronized estradiol orally and has a comparatively reduced impact on liver parameters such as changes in sex hormone-binding globulin production.
Estradiol acetate
"Estradiol acetate" is the generic name of the drug and its .
Levonorgestrel
Levonorgestrel is a hormonal medication which is used in a number of birth control methods. In pill form, sold under the brand name Plan B among others, it is useful within 120 hours as emergency birth control. It becomes less effective the longer after sex and only works before pregnancy has occurred. It is also combined with an estrogen to make combined oral birth control pills. Within an intrauterine device (IUD), sold as Mirena among others, it is effective for long-term prevention of pregnancy. An implantable form of levonorgestrel is also available in some countries.
Common side effects include nausea, breast tenderness, headaches, and increased, decreased, or irregular menstrual bleeding. When used as a form of emergency contraception, if pregnancy occurs, there is no evidence its use harms the baby. It is safe to use during breastfeeding. Birth control that contains levonorgestrel will not change the risk of sexually transmitted infections. It is a progestin and has effects similar to those of the hormone progesterone. It works mostly by preventing ovulation and closing off the cervix to prevent the passage of sperm.
Levonorgestrel was discovered in 1963 and was introduced for medical use together with ethinylestradiol in 1970. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. The wholesale cost in the developing world costs between 0.23 and US$1.65 for the dose required for emergency birth control. In the United States it is over the counter for all ages.
Estetrol/drospirenone
Estetrol/drospirenone (E4/DRSP; tentative brand name Estelle; developmental code name FSN-013) is a combination of estetrol, an estrogen, and drospirenone, a progestin, which is under development by Estetra S.A. as a combined oral contraceptive for the prevention of pregnancy in women. It contains 15 mg estetrol and 3 mg drospirenone. As of 2018, it is in phase III clinical trials for this indication.
Cyclodiol
Cyclodiol (developmental code name ZK-115194; also known as 14α,17α-ethano-17β-estradiol) is a synthetic estrogen which was studied in the 1990s and was never marketed. It is a derivative of estradiol with a bridge between the C14α and C17α positions. Cyclodiol has 100% of the relative binding affinity of estradiol for the human ERα and similar transactivational capacity as estradiol at the receptor. It has comparable potency to estradiol when administered by subcutaneous injection. The drug shows genotoxicity similarly to estradiol. Cyclodiol showed an absolute bioavailability of 33 ± 19% and a terminal half-life of 28.7 hours in pharmacokinetic studies in women.
Estradiol benzoate/hydroxyprogesterone caproate
Estradiol benzoate/hydroxyprogesterone caproate (EB/OHPC), sold under the brand name Primosiston among others, is a combined estrogen and progestogen medication which is used to treat gynecological disorders and habitual abortion. It contains estradiol benzoate (EB), an estrogen, and hydroxyprogesterone caproate (OHPC), a progestin. The medication is given by injection into muscle.
Estetrol (medication)
Estetrol was discovered in 1965 by Egon Diczfalusy and coworkers at the Karolinska Institute in Stockholm, Sweden, via isolation from the urine of pregnant women. Basic research on estetrol was conducted from 1965 to 1984. It was established that estetrol is exclusively synthesized in the fetal liver and hence that it is a fetal estrogen. By 1984, estetrol was regarded as a weak estrogen; interest fell, and research was virtually abandoned. Subsequently a project at Pantarhei Bioscience was started to investigate estetrol with state-of-the-art technologies in 2001, with the sole reasoning that estetrol must have some biological role or function of importance as it would not be produced in such high quantities in the fetus otherwise. By 2008, estetrol was of major interest for potential clinical use, and development was in-progress. As of 2018, it is in mid- to late-stage clinical development for a variety of indications.https://adisinsight.springer.com/drugs/800034634 It was initially developed by Pantarhei Bioscience and Estetra SA (subsequently renamed Estetra SPRL), and is now being developed by Mithra Pharmaceuticals.
Estrogen (medication)
In 1938, British scientists obtained a patent on a newly formulated nonsteroidal estrogen, diethylstilbestrol (DES), that was cheaper and more powerful than the previously manufactured estrogens. Soon after, concerns over the side effects of DES were raised in scientific journals while the drug manufacturers came together to lobby for governmental approval of DES. It was only until 1941 when estrogen therapy was finally approved by the Food and Drug Administration (FDA) for the treatment of menopausal symptoms. Conjugated estrogens (brand name Premarin) was introduced in 1941 and succeeded Emmenin, the sales of which had begun to drop after 1940 due to competition from DES. Ethinylestradiol was synthesized in 1938 by Hans Herloff Inhoffen and Walter Hohlweg at Schering AG in Berlin and was approved by the in the on 25 June 1943 and marketed by Schering as Estinyl.
Estradiol monopropionate
Estradiol monopropionate (brand names Acrofollin, Agofollin, Akrofollin, Di-Ovahormon Depot, Follhormon, Ovocylin), also known as estradiol 17β-propionate or estradiol 17β-propanoate, as well as estra-1,3,5(10)-trien-3,17β-diol 17β-propionate, is a synthetic, steroidal estrogen and an estrogen ester – specifically, the C17β propionate ester of estradiol – which was first marketed in the late 1930s or early 1940s.
Pharmacokinetics of estradiol
The transformation of estradiol into estrone and estrogen conjugates is reversible, and these metabolites hence can be converted back into estradiol. About 15% of orally administered estradiol is transformed into estrone and 65% into estrone sulfate. About 5% of estrone and 1.4% of estrone sulfate can be converted back into estradiol. An additional 21% of estrone sulfate can be converted into estrone, whereas the transformation of estrone into estrone sulfate is approximately 54%. The interconversion between estradiol and estrone is mediated by 17β-hydroxysteroid dehydrogenases (17β-HSDs), whereas the conversion of estrone into estrone sulfate is mediated by estrogen sulfotransferases (ESTs) and the transformation of estrone sulfate into estrone by steroid sulfatase (STS). The metabolic clearance rates and hence blood half-lives of estrogen conjugates like estrone sulfate are far longer than those of estradiol and estrone. Estrogen conjugates, primarily estrone sulfate, serve as a large circulating reservoir for estradiol, and because of this, they function to greatly extend the biological half-life of oral estradiol. As such, the biological half-life of oral estradiol is a composite parameter that is dependent on interconversion between estradiol and estrogen conjugates, as well as on enterohepatic recirculation. Whereas the biological half-life of estradiol given by intravenous injection is only about 1 to 2 hours, the biological half-life of oral estradiol has a range of 13 to 20 hours due to the large and long-lasting pool of estrogen conjugates that is formed during first-pass metabolism and that serves to continuously replenish circulating estradiol levels.
Ethinylestradiol
EE is an estrogen similarly to natural estrogens like estradiol and conjugated estrogens (Premarin) and synthetic estrogens like diethylstilbestrol. It binds to and activates both isoforms of the estrogen receptor, ERα and ERβ. In one study, EE was found to have 233% and 38% of the affinity of estradiol for the ERα and ERβ, respectively. In another study, it was found to possess 194% and 151% of the affinity of estradiol for the ERα and ERβ, respectively. EE also appears to signal through the GPER, a membrane estrogen receptor, similarly to estradiol. Estrogens have antigonadotropic effects through activation of the ERα. As a contraceptive, EE acts in concert with a progestin to inhibit the mid-cycle surge in luteinizing hormone (LH) and follicle-stimulating hormone (FSH) via its antigonadotropic effects, thereby inhibiting folliculogenesis and preventing ovulation and hence the possibility of pregnancy.
Estradiol cypionate
Estradiol cypionate is and has been available as an oil solution for intramuscular injection provided in vials and ampoules at concentrations of 1, 3, and 5 mg/mL (and containing 5, 10, 15, 25, or 50 mg estradiol cypionate total). The 1 and 3 mg/mL concentrations (containing 5 and 15 mg estradiol cypionate total) have been discontinued in the United States, but the 5 mg/mL concentration (containing 25 mg estradiol cypionate total) remains available. Aside from estradiol cypionate, the only other injectable estrogen formulations that remain available in the United States are estradiol valerate (10 mg/mL, 20 mg/mL, and 40 mg/mL in oil) and conjugated estrogens (25 mg/vial in solution).
Estradiol cypionate
Estradiol cypionate is an estradiol ester, or a prodrug of estradiol. As such, it is an estrogen, or an agonist of the estrogen receptors. The affinity of estradiol valerate for the estrogen receptor has been reported to be 50 times less than that of estradiol, and estradiol valerate and estradiol cypionate have been found to possess similar affinity for the estrogen receptor. Both estradiol cypionate and estradiol valerate are rapidly cleaved into estradiol in the body, and estradiol valerate has been found to be unable to reach target tissues in any concentration of significance. As such, estradiol valerate is regarded as essentially inactive in terms of estrogenic effect itself, acting solely as a prodrug to estradiol, and estradiol cypionate is described as a prodrug of estradiol similarly. Estradiol cypionate is of about 46% higher molecular weight than estradiol due to the presence of its C17β cypionate ester. Because estradiol cypionate is a prodrug of estradiol, it is considered to be a natural and bioidentical form of estrogen.
Pharmacodynamics of estradiol
Estradiol is an estrogen, or an agonist of the nuclear estrogen receptors (ERs), the estrogen receptor alpha (ERα) and the estrogen receptor beta (ERβ). According to one study, the value of estradiol for the human ERα is 50 pM (0.05 nM) and for the human ERβ is 200 pM (0.2 nM). Estradiol is also an agonist of the membrane estrogen receptors (mERs), including the G protein-coupled estrogen receptor (GPER), G-coupled membrane estrogen receptor (G-mER), ER-X, and ERx. It is far more potent as an estrogen than are other natural and bioidentical estrogens like estrone and estriol. Given by subcutaneous injection in mice, estradiol is about 10-fold more potent than estrone and about 100-fold more potent than estriol.
Pharmacokinetics of estradiol
Estradiol has been assessed for use by rectal administration in a number of studies. Uses of estradiol by this route have included treatment of menopausal symptoms in postmenopausal women. Rectal administration of estradiol is described as qualitatively and quantitatively similar to vaginal administration of estradiol. The use of estradiol by the rectal route considerably bypasses the liver and hence the first-pass metabolism that occurs with oral estradiol, similarly to other parenteral routes of estradiol such as vaginal and transdermal administration. Irritation of the intestines does not usually occur with rectal estradiol. The use of estradiol by the rectal route is not well-accepted by all individuals, and due to its inconvenience, it has been said that rectal administration of estradiol has gained no practical clinical importance.
Estriol (medication)
Estetrol (E4), also known as 15α-hydroxyestriol, is a naturally occurring analogue of estriol with an additional hydroxyl group, at the C15α position. It is closely related to estriol and has similar but non-identical pharmacological properties. Like estriol, estetrol is a relatively weak and atypical estrogen. Estetrol is under development for potential clinical use for a variety of indications, such as menopausal hormone therapy and hormonal birth control.https://adisinsight.springer.com/drugs/800034634
Testosterone
Testosterone is included in the World Health Organization's list of essential medicines, which are the most important medications needed in a basic health system. It is available as a generic medication. The price depends on the form of testosterone used. It can be administered as a cream or transdermal patch that is applied to the skin, by injection into a muscle, as a tablet that is placed in the cheek, or by ingestion.
Estradiol benzoate
Estradiol benzoate is available in Europe and in other parts of the world. It was previously available for medical use in the United States, but is no longer marketed in this country. However, it is approved and marketed in the United States for veterinary use as a subdermal implant both alone and in combination with the androgen/anabolic steroid trenbolone acetate (brand names Celerin and Synovex, respectively). Outside of the United States, estradiol benzoate is also marketed in combination with progesterone for use as an intramuscular injection.
Estriol succinate
Estriol succinate, also known as estriol disuccinate or as estriol 16α,17β-di(hydrogen succinate), is a synthetic estrane steroid and a derivative of estriol. It is specifically the C16α and C17β disuccinate ester of estriol. The medication is provided both as estriol succinate and as estriol sodium succinate, the sodium salt. Other marketed estriol esters besides estriol succinate include estriol acetate benzoate and estriol tripropionate, whereas estriol dihexanoate, estriol dipropionate, and estriol triacetate are estriol esters that were never marketed. Quinestradol is an estriol ether and has also been marketed. Polyestriol phosphate is an ester of estriol in the form of a polymer, and was previously marketed.
Pharmacokinetics of estradiol
Transdermal estradiol is available in the forms of patches, gels, emulsions, and sprays. In the case of gels, emulsions, and sprays, the route is sometimes referred to as "topical" rather than as transdermal. Estradiol patches have an extended duration and are available for twice-weekly (3–4-day) and once-weekly (7-day) application, while gels, emulsions, and sprays are administered daily. There are two types of estradiol patches: reservoir patches, which have been described as first-generation patches, and matrix patches, which are considered to be improved second-generation patches. Reservoir patches were designed for twice-weekly application, while matrix patches have been produced for both twice-weekly and once-weekly application. Reservoir patches of estradiol (e.g., Estraderm) are mostly no longer used, with most estradiol patches available today being matrix patches (e.g., Alora, Climara, Esclim, Estradot, FemPatch, Menostar, Oesclim, Vivelle, and Vivelle-Dot). When estradiol is administered as a hydroalcoholic gel such as EstroGel, it dries within 2 to 5 minutes following application to the skin.
Pharmacokinetics of estradiol
Transdermal administration of estradiol via patch or gel produces an estradiol to estrone ratio of about 1:1. Estradiol patches delivering a daily dosage of 0.05 mg (50 µg) achieve mean estradiol and estrone levels of 30 to 65 pg/mL and 40 to 45 pg/mL, respectively, while a daily dosage of 0.1 mg (100 µg) attains respective mean levels of 50 to 90 pg/mL and 30 to 65 pg/mL of estradiol and estrone. Once daily application of 1.25 g topical gel containing 0.75 mg estradiol (brand name EstroGel) for 2 weeks was found to produce mean peak estradiol and estrone levels of 46.4 pg/mL and 64.2 pg/mL, respectively. The time-averaged levels of circulating estradiol and estrone with this formulation over the 24-hour dose interval were 28.3 pg/mL and 48.6 pg/mL, respectively. Levels of estradiol and estrone are stable and change relatively little over the course of the 24 hours following an application, indicating a long duration of action of this route. Steady-state levels of estradiol are achieved after 3 days of application. A higher dosage of estradiol gel containing 1.5 mg estradiol per daily application has been found to produce mean estradiol levels of 40 to 100 pg/mL and estrone levels of 90 pg/mL, while 3 mg per day has been found to result in respective mean estradiol and estrone levels of 60 to 140 pg/mL and 45 to 155 pg/mL. Topical estradiol at a dosage of 3 mg/day has been reported to be equipotent with 2 mg oral estradiol in terms of therapeutic effects and FSH suppression, as well as to produce similar estradiol levels. Following removal of an estradiol patch, circulating estradiol levels decrease to baseline within 24 hours.
Cloxestradiol acetate
Cloxestradiol acetate (brand name Genovul), also known as 17-(2,2,2-trichloroethoxy)estradiol "O","O"-diacetate, is a synthetic, steroidal estrogen derived from estradiol. It is the "O","O"-diacetate ester of cloxestradiol, which, in contrast to cloxestradiol acetate, was never marketed.
Estriol (medication)
Following its discovery in 1930, estriol was introduced for medical use as an oral tablet in the 1930s. Emmenin and Progynon were oral estrogens that contained estriol conjugates, primarily estriol glucuronide, and were introduced in the 1930s. They were the first orally active estrogen preparations to be introduced in medicine. Estriol continues to be used medically today, widely throughout the world and in a variety of different formulations and brand names.
Estradiol enantate/algestone acetophenide
Estradiol enantate/algestone acetophenide, also known as estradiol enantate/dihydroxyprogesterone acetophenide (E2-EN/DHPA) and sold under the brand names Perlutal and Topasel among others, is a form of combined injectable birth control which is used to prevent pregnancy. It contains estradiol enantate (E2-EN), an estrogen, and algestone acetophenide (dihydroxyprogesterone acetophenide; DHPA), a progestin. The medication is given once a month by injection into muscle.
E2-EN/DHPA is used widely throughout Latin America, is also marketed in Hong Kong, and was previously available in Portugal and Spain as well but was discontinued in these countries.
Estrogen ester
Estrogen esters are used in hormone therapy, hormonal contraception, and high-dose estrogen therapy (e.g., for prostate cancer and breast cancer), among other indications. The first estrogen ester to be marketed was estradiol benzoate in 1936, which was followed by many more. One of the most widely used estradiol esters is estradiol valerate, which was first introduced in 1954. Other major estradiol esters that are or have been used in medicine include estradiol acetate, estradiol cypionate, estradiol dipropionate, estradiol enantate, estradiol undecylate, and polyestradiol phosphate (an estrogen ester polymer), as well as the nitrogen mustard alkylating antineoplastic agent estramustine phosphate (estradiol normustine phosphate).
Estradiol (medication)
Estrogens are involved in breast development and estradiol may be used as a form of hormonal breast enhancement to increase the size of the breasts. Both pseudopregnancy with a combination of high-dosage intramuscular estradiol valerate and hydroxyprogesterone caproate and polyestradiol phosphate monotherapy have been assessed for this purpose in clinical studies. However, acute or temporary breast enlargement is a well-known side effect of estrogens, and increases in breast size tend to regress or disappear entirely following discontinuation of treatment. Aside from in those without prior established breast development, evidence is lacking for long-term or sustained increases in breast size with estrogens.
Bioidentical hormone replacement therapy
The hormone estriol, produced during pregnancy, is frequently compounded into bioidentical preparations in the United States. While some think it to be a weaker estrogen, with a more limited period of effectiveness than estradiol, it has been demonstrated to be a stronger estrogen in certain ways. Though initial research in the 1970s suggested possible use, follow-up studies have failed to confirm this potential. Estriol is not found in any FDA-approved drug, and its safety and effectiveness as a hormone supplement is unknown.
Estradiol (medication)
Due to health risks observed with the combination of conjugated estrogens and medroxyprogesterone acetate in the Women’s Health Initiative (WHI) studies (see below), the United States Food and Drug Administration (FDA) label for Estrace (estradiol) advises that estrogens should be used in menopausal hormone therapy only for the shortest time possible and at the lowest effective dose. While the FDA states that is unknown if these risks generalize to estradiol (alone or in combination with progesterone or a progestin), it advises that in the absence of comparable data, the risks should be assumed to be similar. When used to treat menopausal symptoms, the FDA recommends that discontinuation of estradiol should be attempted every three to six months via a gradual dose taper.
Estradiol-containing birth control pill
Estradiol, mainly as esters including estradiol valerate, estradiol cypionate, and estradiol enanthate, is the exclusive estrogen used in combined injectable contraceptives.
Estradiol/estrone/estriol
Estradiol/estrone/estriol (brand name Hormonin) is a combination pharmaceutical medication produced by Shire which contains the estrogens estradiol (0.3 or 0.6 mg), estrone (0.7 or 1.4 mg), and estriol (0.135 or 0.27 mg) in a single oral tablet.
Birth control pill formulations
All contain an estrogen, ethinylestradiol or mestranol, in varying amounts, and one of a number of different progestogens. (Regarding the estrogen, the inactive 3-methyl ether of ethinylestradiol, which must be metabolized by the liver into the active ethinylestradiol; 50 µg of mestranol is equivalent to only 35 µg of ethinylestradiol and should not be used when high-dose [50 µg ethinylestradiol] estrogen pills are needed; mestranol was the estrogen used in the first oral contraceptive, Enovid). They are usually taken for 21 days with then a seven-day gap during which a withdrawal bleed (often, but incorrectly, referred to as a menstrual period) occurs. These differ in the amount of estrogen given, and whether they are monophasic (the same dose of estrogen and progestogen during each of the 21 days) or multiphasic (varying doses). The introduction of extended-cycle monophasic pills (i.e. Seasonale) has shown that the withdrawal bleeding intervals can be decreased.
Estradiol cypionate
Estradiol cypionate, sold under the brand name Depo-Estradiol among others, is an estrogen medication which is used in hormone therapy for menopausal symptoms and low estrogen levels in women, in hormone therapy for transgender women, and in hormonal birth control for women. It is given by injection into muscle once every 1 to 4 weeks.
Side effects of estradiol cypionate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. Estradiol cypionate is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. Estradiol cypionate is an estrogen ester and a long-lasting prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol cypionate was first described as well as introduced for medical use in 1952. Along with estradiol valerate, it is one of the most commonly used esters of estradiol. Estradiol cypionate has mostly been used in the United States, but is also marketed in a few other countries. It is not currently available as a generic medication in the United States.
Estradiol 3-saccharinylmethyl ether
Estradiol 3-saccharinylmethyl ether, or 3-"O"-(saccharinylmethyl)-17β-estradiol, is a synthetic estrogen and estrogen ether – specifically, the C3 saccharinylmethyl ether of estradiol – which was described in the mid-1990s and was never marketed. It is a prodrug of estradiol, and has been found to be 9-fold as potent as estradiol via the oral route in rats. Similarly, its bioavailability (16%) was 5-fold greater than that of estradiol via the oral route in rats, and the elimination half-life of estradiol released from the drug was 5- to 7-fold longer than that of regular estradiol. Conversely, when estradiol 3-saccharinylmethyl ether and estradiol were given intravenously in rats, there was no difference between them in terms of potency. "In vitro" studies revealed that saccarinylmethylestradiol is not hydrolyzed to estradiol enzymatically but rather is hydrolyzed chemically in biological media such as plasma, apparently dependent on the concentration of protein. Taken together, saccarinylmethylestradiol appears to be partially protected from first-pass metabolism in the liver and intestines with oral administration and shows greatly improved oral potency compared to estradiol.
EC508
EC508, also known as estradiol 17β-(1-(4-(aminosulfonyl)benzoyl)--proline), is an estrogen which is under development by Evestra for use in menopausal hormone therapy and as a hormonal contraceptive for the prevention of pregnancy in women. It is an orally active estrogen ester – specifically, a C17β sulfonamide–proline ester of the natural and bioidentical estrogen estradiol – and acts as a prodrug of estradiol in the body. However, unlike oral estradiol and conventional oral estradiol esters such as estradiol valerate, EC508 undergoes little or no first-pass metabolism, has high oral bioavailability, and does not have disproportionate estrogenic effects in the liver. As such, it has a variety of desirable advantages over oral estradiol, similarly to parenteral estradiol, but with the convenience of oral administration. EC508 is a candidate with the potential to replace not only estradiol in clinical practice, but also ethinylestradiol in oral contraceptives. Evestra intends to seek Investigational New Drug status for EC508 in the second quarter of 2018.
Methylestradiol
Methylestradiol, sold under the brand names Ginecosid, Ginecoside, Mediol, and Renodiol, is an estrogen medication which is used in the treatment of menopausal symptoms. It is formulated in combination with normethandrone, a progestin and androgen/anabolic steroid medication. Methylestradiol is taken by mouth.
Side effects of methylestradiol include nausea, breast tension, edema, and breakthrough bleeding among others. It is an estrogen, or an agonist of the estrogen receptors, the biological target of estrogens like estradiol.
Methylestradiol is or has been marketed in Brazil, Venezuela, and Indonesia. In addition to its use as a medication, methylestradiol has been studied for use as a radiopharmaceutical for the estrogen receptor.
Estriol (medication)
Estriol is an estrogen, or an agonist of the estrogen receptors, ERα and ERβ. It has been found to possess 11–14% and 18–21% of the relative binding affinities of estradiol for the human ERα and ERβ, respectively, while its relative transactivational capacities at these receptors were 11% and 17%, respectively. In addition to being a ligand of the classical nuclear ERs, estriol is an antagonist of the GPER, a membrane estrogen receptor, at high concentrations. This is in contrast to estradiol, which is an agonist of this receptor. Like other estrogens, estriol does not importantly interact with other steroid hormone receptors.
Estradiol undecylate
Estradiol undecylate, also known as estradiol undecanoate and formerly sold under the brand names Delestrec and Progynon Depot 100 among others, is an estrogen medication which has been used in the treatment of prostate cancer in men. It has also been used as a part of hormone therapy for transgender women. Although estradiol undecylate has been used in the past, it was discontinued and hence is no longer available. The medication has been given by injection into muscle usually once a month.
Side effects of estradiol undecylate in men include breast tenderness, breast development, feminization, sexual dysfunction, infertility, fluid retention, and cardiovascular issues. Estradiol undecylate is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. It is an estrogen ester and a very long-lasting prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen. An injection of estradiol undecylate has a duration of about 1 to 4 months.
Estradiol undecylate was discovered in 1954 and was introduced for medical use by 1956. It has been used in Europe as a parenteral estrogen to treat prostate cancer in men, although not as often as polyestradiol phosphate.
Estradiol-containing birth control pill
Combined birth control pills that contain natural estradiol or an estradiol ester (e.g., estradiol valerate) include:It is hypothesized that these contraceptives may pose less of a risk of blood clots than contraceptives containing ethinylestradiol, which is the conventional estrogen that is used in oral contraceptives, but this has yet to be proven. However, incidence of irregular vaginal bleeding may be higher with estradiol-containing contraceptives in relation to the fact that estradiol is a weaker estrogen than ethinylestradiol in the endometrium.
Diethylstilbestrol
Diethylstilbestrol (DES), also known as stilbestrol or stilboestrol, is an estrogen medication which is mostly no longer used. In the past, it was widely used for a variety of indications including pregnancy support for women with a history of recurrent miscarriage, hormone therapy for menopausal symptoms and estrogen deficiency in women, treatment of prostate cancer in men and breast cancer in women, and other uses. While most commonly taken by mouth, DES was available for use by other routes as well, for instance vaginal, topical, and by injection.
DES is an estrogen, or an agonist of the estrogen receptors, the biological target of estrogens like estradiol. It is a synthetic and nonsteroidal estrogen of the stilbestrol group, and differs from the natural estrogen estradiol in various ways. Compared to estradiol, DES has greatly improved bioavailability when taken by mouth, is more resistant to metabolism, and shows relatively increased effects in certain parts of the body like the liver and uterus. These differences result in DES having an increased risk of blood clots, cardiovascular issues, and certain other adverse effects.
DES was discovered in 1938. From about 1940 to 1971, the medication was given to pregnant women in the incorrect belief it would reduce the risk of pregnancy complications and losses. In 1971, DES was shown to cause clear cell carcinoma, a rare vaginal tumor, in girls and women who had been exposed to this medication "in utero". The United States Food and Drug Administration subsequently withdrew approval of DES as a treatment for pregnant women. Follow-up studies have indicated that DES also has the potential to cause a variety of significant adverse medical complications during the lifetimes of those exposed.
Pharmacokinetics of estradiol
Estradiol is well-absorbed regardless of route of administration. However, the bioavailability of estradiol differs substantially with different routes of administration. Oral estradiol has an average bioavailability of around 5%, requiring relatively high dosages of estradiol for effects. Conversely, transdermal estradiol has much higher potency, with a 20-fold lower dosage of transdermal estradiol being equivalent in potency to oral estradiol. Estradiol administered in the form of an ester by intramuscular or subcutaneous injection has complete bioavailability.
Estradiol benzoate
Estradiol benzoate, sold under the brand name Progynon-B among others, is a medication which is used in hormone therapy for menopausal symptoms and low estrogen levels in women, in hormone therapy for transgender women, and in the treatment of gynecological disorders. It is also used in the treatment of prostate cancer in men. Estradiol benzoate is used in veterinary medicine as well. When used clinically, the medication is given by injection into muscle usually two to three times per week.
Side effects of estradiol benzoate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. Estradiol benzoate is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. It is an estrogen ester and a prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol benzoate was discovered in 1933 and was introduced for medical use in 1936. It was the first estradiol ester to be discovered or marketed, and was one of the first estrogens to be introduced for medical use. Along with estradiol dipropionate, it was among the most widely used esters of estradiol for many years following its introduction. However, in the 1950s, longer-acting estradiol esters that necessitate less frequent injections, such as estradiol valerate and estradiol cypionate, were developed, and have since mostly superseded estradiol benzoate. Nonetheless, estradiol benzoate remains widely available throughout the world. It is no longer available for medical use in the United States.
Pharmacokinetics of estradiol
Vaginal estradiol is available in the forms of tablets, creams, inserts or suppositories, and rings. Vaginal estradiol tablets, creams, and inserts are usually administered once daily to twice weekly, whereas vaginal estradiol rings have a sustained action and are replaced once every 90 days. Vaginal estradiol can be used both as a systemic form of estradiol therapy, and at very low doses to selectively achieve a local vaginal effect without systemic effects, for instance in the treatment of menopausal symptoms such as vaginal atrophy and dryness.
Ethinylestradiol/segesterone acetate
Ethinylestradiol/segesterone acetate (EE/SGA), sold under the brand name Annovera, is a contraceptive vaginal ring and combined form of hormonal birth control which contains ethinylestradiol, an estrogen, and segesterone acetate, a progestin. It contains 17.4 mg ethinylestradiol and 103 mg segesterone acetate, releases an average of 13 μg ethinylestradiol and 0.15 mg segesterone acetate per day, and lasts for a duration of one year. The medication was developed by TherapeuticsMD and was approved for use in the United States on 10 August 2018.
Estrone (medication)
Estrone is an estrogen, specifically an agonist of the estrogen receptors ERα and ERβ. It is a far less potent estrogen than is estradiol, and as such is a relatively weak estrogen. Given by subcutaneous injection in mice, estradiol is about 10-fold more potent than estrone and about 100-fold more potent than estriol. According to one study, the relative binding affinities of estrone for the human ERα and ERβ were 4.0% and 3.5% of those estradiol, respectively, and the relative transactivational capacities of estrone at the ERα and ERβ were 2.6% and 4.3% of those of estradiol, respectively. In accordance, the estrogenic activity of estrone has been reported to be approximately 4% of that of estradiol. Because estrone can be transformed into estradiol, which is far more potent as an estrogen in comparison, most of the estrogenic potency of estrone "in vivo" is actually due to conversion into estradiol. As such, similarly to the case of estrone sulfate, estrone is considered to be a prodrug of estradiol. Some "in vitro" research has suggested that estrone might be able to partially antagonize the actions of estradiol, but this does not appear to be of clinical significance.
Bioidentical hormone replacement therapy
Estriol was part of the United States Pharmacopeia before FDA approval was needed for its use. Its approval was grandfathered in by the FDA until 2008 when the agency banned its use, stating that manufacturers of estriol would have to create a new application and estriol would be treated as a new drug. Its use is not approved by Health Canada; estriol is not available as a pharmaceutical preparation in Canada or the United States, but is a commonly prescribed conventional treatment in other countries and is available as a cream or vaginal suppository in the United Kingdom and the European Union. Estradiol is available as brand-name products in both oral and transdermal forms.
Desogestrel
Desogestrel is available widely throughout the world, including in the United States, Canada, the United Kingdom, Ireland, many other European countries, Australia, New Zealand, South Africa, Latin America, South, East, and Southeast Asia, and elsewhere in the world. In the United States, it is available only in combination with ethinylestradiol as a combined oral contraceptive; it is not available alone and is not approved for any other indications in this country.
Pharmacokinetics of estradiol
Estradiol has been studied and used by intranasal administration. It was available as a cyclodextrin-containing nasal spray under the brand name Aerodiol in some countries, although this specific product was discontinued in 2007. The product was administered once per day as one 150-μg spray in each nostril (300 μg/day total). Intranasal estradiol has pharmacokinetics similar to those of sublingual and intravenous administration of estradiol, including a sharp peak and then rapid decline in estradiol levels. Despite the relatively short duration of intranasal estradiol, it has similar effectiveness to other, longer-lasting routes of administration in terms of relief of menopausal symptoms like hot flashes.
Estriol (medication)
The bioavailability of estriol is markedly increased with vaginal administration compared to oral administration. The relative bioavailability of oral estriol was found to be about 10% of that of vaginal estriol. In accordance, a single dose of 8 mg oral estriol and of 0.5 mg vaginal estriol have been found to produce similar circulating concentrations of estriol. It has been said that 0.5 to 1 mg vaginal estriol may be equivalent in clinical effect to 8 to 12 mg oral estriol. The high bioavailability of vaginal estriol is due to rapid absorption and low metabolism in atrophic vaginal mucosa. Vaginal estriol at typical clinical dosages results both in high local concentrations of estriol in the vagina and in systemic action. Vaginal administration of low doses of 30 µg estriol and of higher doses of 0.5 and 1 mg estriol have been found to produce equivalent local effects in the vagina and improvement of vaginal symptoms, suggesting that a saturation of estrogenic effect of vaginal estriol has been reached in the vagina by a dose of only 30 µg estriol. In contrast to higher doses of vaginal estriol however, 30 µg/day estriol is not associated with systemic effects. Similarly, the use of 0.5 mg vaginal estriol twice a week instead of daily has been said to largely attenutate the systemic effects of estriol. Whereas oral estriol results in high levels of estriol conjugates which greatly exceed those of unconjugated estriol, vaginal estriol has been found to produce levels of unconjugated estriol and estriol conjugates that are similar.
Estradiol
In addition to its role as a natural hormone, estradiol is used as a medication, for instance in menopausal hormone therapy; for information on estradiol as a medication, see the estradiol (medication) article.
Pharmacokinetics of estradiol
In contrast to estradiol, estrone has very low activity as an estrogen. The affinities of estrone for the human ERs and its estrogenic activity have been reported to be approximately 3 to 4% of those of estradiol. In addition, unlike estradiol and estriol, estrone is not accumulated in target tissues. Because estrone can be transformed into estradiol, most of its activity "in vivo" is actually due to conversion into estradiol. In accordance, dosages of oral and transdermal estradiol that achieve similar levels of estradiol have been found, in spite of markedly elevated levels of estrone with oral estradiol but not with transdermal estradiol, to possess equivalent and non-significantly different potency in terms of clinical measures including suppression of LH and FSH levels, inhibition of bone resorption, and relief of menopausal symptoms such as hot flashes. In addition, estradiol levels were found to correlate with these effects, while estrone levels did not. These findings suggest that estrone contributes very little or not at all to the estrogenic potency of estradiol, while also not antagonizing the estrogenic activity of estradiol. This contradicts some "in vitro" research suggesting that estrone might be able to partially antagonize the actions of estradiol.
Estrone (medication)
Like estradiol, estrone has poor oral bioavailability. It has been said that, taken by mouth in non-micronized form, a dose of 25 mg estrone is approximately equivalent to 2.5 mg conjugated estrogens, 50 µg ethinylestradiol, or 1 mg diethylstilbestrol in terms of estrogenic potency. Due to its weak oral activity, estrone has been used parenterally instead, for instance by intramuscular injection or vaginal administration. The pharmacokinetics of vaginal estrone have been studied.
Segesterone acetate
A combination of SGA and the estrogen estradiol is under development in a transdermal gel formulation for use as a contraceptive in women by the Population Council in conjunction with Antares Pharma in the United States and Europe. As of December 2017, it is in phase III clinical trials for this indication. The medication has the tentative brand name NestraGel. A combination of SGA and the estrogen ethinylestradiol is under development in a vaginal ring formulation for use as a one-year contraceptive by the Population Council in multiple regions including Latin America, Europe, and Australia. It has completed phase III clinical trials and efforts are underway to pursue regulatory approval. It was approved in the United States in August 2018.
Dienestrol
Dienestrol (, ) (brand names Ortho Dienestrol, Dienoestrol, Dienoestrol Ortho, Sexadien, Denestrolin, Dienol, Dinovex, Follormon, Oestrodiene, Synestrol, numerous others), also known as dienoestrol (), is a synthetic nonsteroidal estrogen of the stilbestrol group which is or was used to treat menopausal symptoms in the United States and Europe. It has been studied for use by rectal administration in the treatment of prostate cancer in men as well. The medication was introduced in the U.S. in 1947 by Schering as Synestrol and in France in 1948 as Cycladiene. Dienestrol is a close analogue of diethylstilbestrol. It has approximately 223% and 404% of the affinity of estradiol at the ERα and ERβ, respectively.
Estradiol valerate
Estradiol valerate, sold under the brand names Delestrogen, Progynon Depot, and Progynova among others, is an estrogen medication which is used in hormone therapy for menopausal symptoms and low estrogen levels in women, in hormone therapy for transgender women, and in hormonal birth control for women. It is also used in the treatment of prostate cancer in men. The medication is taken by mouth or by injection into muscle once every 1 to 4 weeks.
Side effects of estradiol valerate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. Estradiol valerate is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. It is an estrogen ester and a prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol valerate was first described in 1940 and was introduced for medical use in 1954. Along with estradiol cypionate, it is one of the most widely used esters of estradiol. Estradiol valerate is used in the United States, Canada, Europe, and throughout much of the rest of the world. It is available as a generic medication.
Estradiol/progesterone
Estradiol/progesterone (E2/P4), sold under the brand names Bijuva and Juvenum, is a combined estrogen and progestogen medication which is used in the treatment of menopausal symptoms in postmenopausal women. It contains estradiol, an estrogen, and progesterone, a progestogen, and is available in both oral and intramucular formulations. E2/P4 differs from other estrogen–progestogen formulations in that the sex-hormonal agents used are bioidentical.
Estradiol (medication)
Estradiol is marketed under a large number of brand names throughout the world. Examples of major brand names in which estradiol has been marketed in include Climara, Climen, Dermestril, Divigel, Estrace, Natifa, Estraderm, Estraderm TTS, Estradot, Estreva, Estrimax, Estring, Estrofem, EstroGel, Evorel, Fem7 (or FemSeven), Imvexxy, Menorest, Oesclim, OestroGel, Sandrena, Systen, and Vagifem. Estradiol valerate is marketed mainly as Progynova and Progynon-Depot, while it is marketed as Delestrogen in the U.S. Estradiol cypionate is used mainly in the U.S. and is marketed under the brand name Depo-Estradiol. Estradiol acetate is available as Femtrace, Femring, and Menoring.
Estriol (medication)
Estriol is a far less potent estrogen than is estradiol, and is a relatively weak and atypical estrogen. Given by subcutaneous injection in mice, estradiol is about 10-fold more potent than estrone and about 100-fold more potent than estriol. In most tissues, such as the liver and endometrium, estriol is weakly estrogenic, but in the vaginal epithelium, it produces pronounced and full estrogenic responses. The medication has been found to reduce hot flashes, improve vaginal atrophy, reverse the postmenopausal decline in skin thickness and collagen content, suppress gonadotropin secretion, and produce proliferation of breast epithelium. Conversely, estriol does not consistently affect bone resorption or fracture risk, does not increase breast density or the risk of breast cancer, and, at oral dosages of 2 to 4 mg/day, does not affect liver proteins, lipid metabolism, or hemostatic parameters. Additionally, vaginal estriol does not appear to produce endometrial proliferation or increase the risk of endometrial hyperplasia, and some studies have found this to be the case for oral estriol as well. On the other hand, it appears that estriol may be able to stimulate the growth of active breast cancer. Via the oral route, estriol has approximately 30% of the potency of estradiol on hot flashes relief and suppression of follicle-stimulating hormone secretion and about 20% of the potency of estradiol on stimulation of liver production of high-density lipoprotein (HDL) cholesterol. In relation to its differing effects, estriol can be considered a safer estrogen than estradiol.
List of estrogens available in the United States
This is a complete list of estrogens and formulations that are approved by the and available in the United States. Estrogens are used as hormonal contraceptives, in hormone replacement therapy, and in the treatment of gynecological disorders.Atypical (dual estrogen and nitrogen mustard alkylating antineoplastic):Oral estradiol valerate (except in combination with dienogest as an oral contraceptive) is not available in the U.S. and is used primarily in Europe.
Estradiol acetate
Estradiol acetate is a synthetic estrane steroid and the C3 acetate ester of estradiol. It is also known as estradiol 3-acetate or as estra-1,3,5(10)-triene-3,17β-diol 3-acetate. Another common ester of estradiol in use for oral administration is estradiol valerate, which is a C17β ester of estradiol.
Estrone (medication)
Clinical research has confirmed the nature of estrone as an inactive prodrug of estradiol. With oral administration of estradiol, the ratio of estradiol levels to estrone levels is about 5 times higher on average than under normal physiological circumstances in premenopausal women and with parenteral (non-oral) routes of estradiol. Oral administration of menopausal replacement dosages of estradiol results in low, follicular phase levels of estradiol, whereas estrone levels resemble the high levels seen during the first trimester of pregnancy. In spite of markedly elevated levels of estrone with oral estradiol but not with transdermal estradiol, clinical studies have shown that dosages of oral and transdermal estradiol achieving similar levels of estradiol possess equivalent and non-significantly different potency in terms of measures including suppression of luteinizing hormone and follicle-stimulating hormone levels, inhibition of bone resorption, and relief of menopausal symptoms such as hot flashes. In addition, estradiol levels were found to correlate with these effects, while estrone levels did not. These findings confirm that estrone has very low estrogenic activity, and also indicate that estrone does not diminish the estrogenic activity of estradiol. This contradicts some "in vitro" research suggesting that estrone might be able to partially antagonize the actions of estradiol.
Estradiol/megestrol acetate
Estradiol/megestrol acetate (E2/MGA), sold under the brand names Mego-E and Chinese injectable No. 2, is a form of combined injectable birth control which is used in the People's Republic of China. It contains 3.5 mg estradiol (E2), an estrogen, and 25 mg megestrol acetate (MGA), a progestin. It is a microcrystalline aqueous suspension with a defined particle size range. The medication is given once per month by injection into muscle.
Mestranol
Mestranol, also known as ethinylestradiol 3-methyl ether (EEME) or as 17α-ethynyl-3-methoxyestra-1,3,5(10)-trien-17β-ol, is a synthetic estrane steroid and a derivative of estradiol. It is specifically a derivative of ethinylestradiol (17α-ethynylestradiol) with a methyl ether at the C3 position.
Pharmacokinetics of estradiol
Estradiol can be taken sublingually instead of orally. Non-micronized estradiol is insoluble in water, but micronized estradiol is rapidly absorbed by the sublingual route. All oral estradiol tablets are micronized, as estradiol is not absorbed efficiently in the gastrointestinal tract otherwise. The absorption of sublingual estradiol can be attributed to the rich vascularization under the tongue. With administration of an oral estradiol tablet sublingually, complete dissolution of the tablet occurs within a few minutes and circulating levels of estradiol begin to rise within 5 minutes. Maximal levels of estradiol occur after 30 to 60 minutes of administration. After this, estradiol levels drop steeply within 4 hours, and this is followed by a more gradual decline in levels of estradiol and a return to baseline concentrations by 24 hours. The rapid rise and steep fall of estradiol levels with sublingual administration of estradiol is analogous to the case of intravenous injection and intranasal administration of the hormone.
Estrogen ester
An estrogen ester is an ester of an estrogen, most typically of estradiol but also of other estrogens such as estrone, estriol, and even nonsteroidal estrogens like diethylstilbestrol. Esterification renders estradiol into a prodrug of estradiol with increased resistance to first-pass metabolism, slightly improving its oral bioavailability. In addition, estrogen esters have increased lipophilicity, which results in a longer duration when given by intramuscular or subcutaneous injection due to the formation of a long-lasting local depot in muscle and fat. Conversely, this is not the case with intravenous injection or oral administration. Estrogen esters are rapidly hydrolyzed into their parent estrogen by esterases once they have been released from the depot. Because estradiol esters are prodrugs of estradiol, they are considered to be natural and bioidentical forms of estrogen.
Ethylestrenol
Ethylestrenol, also known as ethyloestrenol or ethylnandrol and sold under the brand names Maxibolin and Orabolin among others, is an androgen and anabolic steroid (AAS) medication which has been used in the past for a variety of indications such as to promote weight gain and to treat anemia and osteoporosis but has been discontinued for use in humans. It is still available for veterinary use in Australia and New Zealand however. It is taken by mouth.
Side effects of ethylestrenol include symptoms of masculinization like acne, increased hair growth, voice changes, and increased sexual desire. It can also cause liver damage. The drug is a synthetic androgen and anabolic steroid and hence is an agonist of the androgen receptor (AR), the biological target of androgens like testosterone and dihydrotestosterone (DHT). It has strong anabolic effects relative to its androgenic effects. The drug also has strong progestogenic effects. Ethylestrenol is a prodrug of norethandrolone.
Ethylestrenol was first described in 1959 and was introduced for medical use in 1961. In addition to its medical use, ethylestrenol has been used to improve physique and performance. However, it is described as a very weak muscle-builder compared to other AAS and in relation to this has not been commonly used for such purposes. The drug is a controlled substance in many countries and so non-medical use is generally illicit.
Estradiol phosphate
Estradiol phosphate, or estradiol 17β-phosphate, also known as estra-1,3,5(10)-triene-3,17β-diol 17β-(dihydrogen phosphate), is an estrogen which was never marketed. It is an estrogen ester, specifically an ester of estradiol with phosphoric acid, and acts as a prodrug of estradiol in the body. It is rapidly cleaved by phosphatase enzymes into estradiol upon administration. Estradiol phosphate is contained within the chemical structures of two other estradiol esters, polyestradiol phosphate (a polymer of estradiol phosphate) and estramustine phosphate (estradiol 3-normustine 17β-phosphate), both of which have been marketed for the treatment of prostate cancer.
Ethinylestradiol
EE has been marketed as a standalone oral drug under the brand names "Esteed", "Estinyl", "Feminone", "Lynoral", "Menolyn", "Novestrol", "Palonyl", "Spanestrin", and "Ylestrol" among others, although most or all of these formulations are now discontinued. It is marketed under a very large number of brand names throughout the world in combination with progestins for use as an oral contraceptive. In addition, EE is marketed in the in combination with norelgestromin under the brand names "Ortho Evra" and "Xulane" as a contraceptive patch, in combination with etonogestrel under the brand name "NuvaRing" as a contraceptive vaginal ring, and in combination with norethisterone acetate under the brand name "FemHRT" in oral hormone replacement therapy for the treatment of menopausal symptoms.
Estriol
Estriol, also known as 16α-hydroxyestradiol or as estra-1,3,5(10)-triene-3,16α,17β-triol, is a naturally occurring estrane steroid with double bonds between the C1 and C2, C3 and C4, and C5 and C10 positions and hydroxyl groups at the C3, C16α, and C17β positions. The name "estriol" and the abbreviation "E3" were derived from the chemical terms "estrin" (estra-1,3,5(10)-triene) and triol (three hydroxyl groups).
Ethinylestradiol/levonorgestrel
Ethinylestradiol/levonorgestrel (also ethinyl estradiol/levonorgestrel) is a combined birth control pill made up of ethinylestradiol, an estrogen and levonorgestrel a progestin. It is used for birth control, symptoms of menstruation, endometriosis, and as emergency contraception. It is taken by mouth.
Side effects can include nausea, headache, blood clots, breast pain, depression, and liver problems. Use is not recommended during pregnancy, the initial three weeks after childbirth, and in those at high risk of blood clots. However, it may be started immediately after a miscarriage or abortion. Smoking while using combined birth control pills is not recommended. It works by stopping ovulation, making the mucus at the opening to the cervix thick, and making the uterus not suitable for implantation.
Ethinylestradiol/levonorgestrel has been approved for medical use in the United States at least since 1982. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. In the United Kingdom three months of medication costs the NHS about 1.80 pounds. In the United States it costs about $25–50 per month. It is marketed under a large number of brand names.
Levonorgestrel
Levonorgestrel is marketed alone or in combination with an estrogen (specifically ethinylestradiol, estradiol, or estradiol valerate) under a multitude of brand names throughout the world, including "Alesse", Altavera, Alysena, Amethia, Amethyst, Ashlyna, Aviane, Camrese, Chateal, "Climara Pro", Daysee, Emerres, Enpresse, Erlibelle, "Escapelle", Falmina, Introvale, Isteranda, "Jadelle", "Jaydess", Jolessa, "Klimonorm", Kurvelo, Kyleena, Lessina, "Levlen", Levodonna, "Levonelle", Levonest, Levosert, Levora, Liletta, "Loette", "Logynon", "LoSeasonique", Lutera, Lybrel, Marlissa, "Microgynon", "Microlut", Min-Ovral, "Miranova", "Mirena", My Way, Myzilra, Next Choice, "Nordette", Norgeston, NorLevo, "Norplant", Option 2, Orsythia, Ovima, Ovranette, "Plan B", "Plan B One-Step", Portia, "Postinor", "Postinor-2", Preventeza, Ramonna, "Rigevidon", Quartette, Quasense, "Seasonale", "Seasonique", "Skyla", Sronyx, Tri-Levlen, "Trinordiol", Triphasil, "Triquilar", "Tri-Regol", Trivora, and Upostelle, among many others. These formulations are used as emergency contraceptives, normal contraceptives, or in menopausal hormone therapy for the treatment of menopausal symptoms.
Estrone (medication)
Although estrone has been widely marketed in the past, it has mostly been discontinued and remains available in only a few countries. These countries reportedly include Canada, Georgia, Monaco, and Taiwan. However, estrone remains widely available throughout the world in the form of estrone sulfate, which can be found in estropipate (piperazine estrone sulfate), conjugated estrogens (Premarin), and esterified estrogens (Estratab, Menest).
Estriol
In addition to its role as a natural hormone, estriol is used as a medication, for instance in menopausal hormone therapy; for information on estriol as a medication, see the estriol (medication) article.
Estradiol anthranilate
Estradiol anthranilate, or estradiol 3-anthranilate, is a synthetic estrogen and estrogen ester – specifically, the C3 anthranilic acid ester of estradiol – which was described in the late 1980s and was never marketed. In dogs, the oral bioavailability of estradiol anthranilate was found to be 5-fold higher than that of unmodified estradiol. However, a subsequent study found that the oral bioavailability of estradiol and estradiol anthranilate did not differ considerably in rats (4.3% and 3.2%, respectively), suggestive of a major species difference.
Estradiol valerate
Estradiol valerate is and has been available in the form of vials and ampoules for intramuscular injection in concentrations of 5, 10, 20, and 40 mg/mL and in the form of oral tablets at doses of 0.5, 1, 2, and 4 mg per tablet. In the United States, it is specifically available in formulations of 10, 20, and 40 mg/mL (as Delestrogen, as well as generics). Aside from estradiol valerate, the only other injectable estrogen formulations that remain available in the United States are estradiol cypionate (5 mg/mL in oil) and conjugated estrogens (25 mg/vial in solution).
Estradiol
Estradiol is an estrane steroid. It is also known as 17β-estradiol (to distinguish it from 17α-estradiol) or as estra-1,3,5(10)-triene-3,17β-diol. It has two hydroxyl groups, one at the C3 position and the other at the 17β position, as well as three double bonds in the A ring. Due to its two hydroxyl groups, estradiol is often abbreviated as E2. The structurally related estrogens, estrone (E1), estriol (E3), and estetrol (E4) have one, three, and four hydroxyl groups, respectively.
Methylestradiol
Methylestradiol is marketed in combination with normethandrone in the form of oral tablets containing 0.3 mg methylestradiol and 5 mg normethandrone.
Mestranol
Mestranol was employed as the estrogen component in many of the first oral contraceptives, such as mestranol/noretynodrel (brand name "Enovid") and mestranol/norethisterone (brand names "Ortho-Novum", "Norinyl"), and is still in use today. In addition to its use as an oral contraceptive, mestranol has been used as a component of menopausal hormone therapy for the treatment of menopausal symptoms.
Pharmacokinetics of estradiol
Polyestradiol phosphate is an ester prodrug of estradiol in the form of a polymer which is used via intramuscular injection primarily to treat prostate cancer, but also to treat breast cancer and menopausal symptoms. It has an extremely long duration of action, with a terminal half-life of about 70 days (10 weeks) following a single intramuscular administration of the medication. In addition, unlike most other estradiol esters, the estradiol levels achieved with polyestradiol phosphate are highly constant and uniform. Levels of estradiol in men with intramuscular injections of polyestradiol phosphate once every 4 weeks were about 350 pg/mL with 160 mg, 450 pg/mL with 240 mg, and almost 700 pg/mL with 320 mg, all measured after 6 months of treatment. Polyestradiol phosphate has been discontinued in many countries, and remains available today in only a few countries, mostly the Nordic countries of Europe.
Polyestradiol phosphate
Polyestradiol phosphate (PEP), sold under the brand name Estradurin, is an estrogen medication which is used primarily in the treatment of prostate cancer in men. It is also used in women to treat breast cancer, as a component of hormone therapy to treat low estrogen levels and menopausal symptoms, and as a component of feminizing hormone therapy for transgender women. It is given by injection into muscle once every four weeks.
Common side effects of PEP include headache, breast tenderness, breast development, feminization, sexual dysfunction, infertility, and vaginal bleeding. PEP is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. It is an estrogen ester in the form of a polymer and is an extremely long-lasting prodrug of estradiol in the body. The time it takes for 50% of a dose of PEP to be eliminated from the body is more than two months. Because PEP works by being converted into estradiol, it is considered to be a natural and bioidentical form of estrogen. The safety profile of parenteral estradiol esters like PEP is greatly improved relative to synthetic oral estrogens like ethinylestradiol and diethylstilbestrol.
PEP was discovered around 1953 and was introduced for medical use in the United States in 1957. Along with estradiol undecylate and estradiol valerate, it has been frequently used in the United States and Europe as a parenteral form of estrogen to treat men with prostate cancer. However, it is no longer available in the United States.
Pharmacokinetics of estradiol
Rectal administration of estriol, which has similar properties to estradiol, has also been studied. Administration of a rectal suppository containing 100 mg estriol resulted in estriol levels in pregnant women at term increasing by about 53%. Estriol levels at term are normally between 5,000 and 20,000 pg/mL, which suggests that estriol levels may have increased following the suppository by about 5,000 to 10,000 pg/mL (precise levels were not provided).
Estradiol (medication)
Estradiol was first isolated in 1935. It was also originally known as "dihydroxyestrin" or "alpha-estradiol". It was first marketed, as estradiol benzoate, in 1936. Estradiol was also marketed in the 1930s under brand names such as Progynon-DH, Ovocylin, and Dimenformon. Micronized estradiol, via the oral route, was first evaluated in 1972, and this was followed by the evaluation of vaginal and intranasal micronized estradiol in 1977. Oral micronized estradiol was first approved in the United States under the brand name Estrace in 1975.
In 1931, Butenandt found that the benzoic acid ester of estrone had a prolonged duration of action. Subsequently, Schwenk and Hildebrant synthesized estradiol benzoate from estradiol in 1933, and estradiol benzoate was introduced by Schering-Kahlbaum for medical use via intramuscular injection under the brand name Progynon-B in 1936. It was the first estrogen ester to be marketed, and has since been followed by many additional esters, for instance estradiol valerate and estradiol cypionate in the 1950s. Ethinylestradiol was synthesized from estradiol by Inhoffen and Hohlweg in 1938 and was introduced for oral use by Schering in the United States under the brand name Estinyl in 1943. It remains widely used in combined oral contraceptives.
Estriol sulfamate
Estriol sulfamate (developmental code name J1034), or estriol 3-"O"-sulfamate, is a synthetic estrogen and estrogen ester which was never marketed. It is the C3 sulfamate ester of estriol. The drug shows substantially improved oral estrogenic potency (vagina, uterus) relative to estriol in rats but without an increase in hepatic estrogenic potency. However, the closely related compound estradiol sulfamate (E2MATE) failed to show estrogenic activity in humans, which is due to the fact that it is additionally a highly potent inhibitor of steroid sulfatase and prevents its own bioactivation into estradiol.
Estradiol (medication)
Estradiol is a naturally occurring estrane steroid. It is also known as 17β-estradiol (to distinguish it from 17α-estradiol) or as estra-1,3,5(10)-triene-3,17β-diol. It has two hydroxyl groups, one at the C3 position and the other at the C17β position, as well as three double bonds in the A ring (the estra-1,3,5(10)-triene core). Due to its two hydroxyl groups, estradiol is often abbreviated as E2. The structurally related estrogens, estrone (E1), estriol (E3), and estetrol (E4) have one, three, and four hydroxyl groups, respectively.
Estradiol acetate
Estradiol acetate, sold under the brand names Femtrace, Femring, and Menoring, is an estrogen medication which is used in hormone therapy for the treatment of menopausal symptoms in women. It is taken by mouth or given as a vaginal ring once every three months.
Side effects of estradiol acetate include breast tenderness, breast enlargement, nausea, headache, and fluid retention. Estradiol acetate is a synthetic estrogen and hence is an agonist of the estrogen receptor (ER), the biological target of estrogens like estradiol. It is an estrogen ester and a prodrug of estradiol in the body. Because of this, it is considered to be a natural and bioidentical form of estrogen.
Estradiol acetate was introduced for medical use in 2001. It is available in the United States and the United Kingdom. The formulation for use by mouth has been discontinued in the United States.
Estetrol (medication)
In addition to a single-drug formulation, estetrol is under development in combination with the progestin drospirenone for use as a birth control pill to prevent pregnancy with the tentative brand name Estelle. Drospirenone is also a potent antimineralocorticoid and antiandrogen in addition to progestogen, and in relation to this, is said to have a progesterone-like medication profile. As of April 2018, estetrol/drospirenone are in phase III clinical trials for pregnancy prevention.
Pharmacokinetics of estradiol
Lauritzen (1986) reported that 3 hours after a single rectal dose of 1 mg micronized estradiol, estradiol levels increased by 620 pg/mL and estrone levels increased by 120 pg/mL. Subsequently, Lauritzen (1987, 1990) reported that 0.5 mg/day and 1 mg/day rectal estradiol resulted in respective estradiol levels of 363 pg/mL and 515 pg/mL 6 hours following the last dose. These estradiol levels are fairly similar to those achieved by vaginal estradiol. The estradiol-to-estrone ratio of rectal estradiol is about 5:1, which likewise is the same as that of vaginal estradiol. Absorption of rectal estradiol occurs rapidly within 30 to 60 minutes, maximal estradiol levels occur at 3 hours post-dose, and circulating estradiol levels are reportedly maintained for 4 to 10 hours. The duration of rectal estradiol is said to necessitate repeated administration 1 to 2 times per day.