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The distribution of exogenous estrogens is similar to that of endogenous estrogensEstrogens are widely distributed in the body and are generally found in higher concentrations in the sex hormone target organsEstrogens circulate in the blood largely bound to sex hormone binding globulinSHBGand albumin.
Exogenous estrogens are metabolized in the same manner as endogenous estrogensCirculating estrogens exist in a dynamic equilibrium of metabolic interconversionsThese transformations take place mainly in the liverEstradiol is converted reversibly to estroneand both can be converted to estriolwhich is the major urinary metaboliteEstrogens also undergo enterohepatic recirculation via sulfate and glucuronide conjugation in the liverbiliary secretion of conjugates into the intestineand hydrolysis in the gut followed by reabsorptionIn postmenopausal womena significant proportion of the circulating estrogens exist as sulfate conjugatesespecially estrone sulfatewhich serves as a circulating reservoir for the formation of more active estrogens.
41Molitch MEOill POdell WDMassive hyperlipemia during estrogen therapyJAMA 2271974522-5.
In a small number of case reportssubstantial increases in blood pressure have been attributed to idiosyncratic reactions to estrogensIn a largerandomizedplacebo-controlled clinical triala generalized effect of estrogens on blood pressure was not seenBlood pressure should be monitored at regular intervals with estrogen use.
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