Conjugated estrogens

conjugated equine estrogenconjugated estrogenPMUcongestedestrogens, conjugated (usp)premarin
Conjugated estrogens (CEs), or conjugated equine estrogens (CEEs), sold under the brand name Premarin (a contraction of "pregnant mares' urine") among others, is an estrogen medication which is used in menopausal hormone therapy and for various other indications.wikipedia
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Estrogen (medication)

estrogenestrogen creamEstrogenic
Conjugated estrogens (CEs), or conjugated equine estrogens (CEEs), sold under the brand name Premarin (a contraction of "pregnant mares' urine") among others, is an estrogen medication which is used in menopausal hormone therapy and for various other indications.
Conjugated estrogens (brand name Premarin), an estrogen product manufactured from the urine of pregnant mares and commonly used in menopausal hormone therapy, is a mixture of natural estrogens including estrone sulfate and equine estrogens such as equilin sulfate and 17β-dihydroequilin sulfate.

Medroxyprogesterone acetate

depot medroxyprogesterone acetateDepo ProveraMedroxyprogesterone
They are formulated both alone and in combination with progestins such as medroxyprogesterone acetate.
In addition to single-drug formulations, MPA is available in the form of oral tablets in combination with conjugated estrogens (CEEs), estradiol, and estradiol valerate for use in menopausal hormone therapy, and is available in combination with estradiol cypionate as a combined injectable contraceptive.

Wyeth

American Home ProductsWyeth PharmaceuticalsA.H. Robins
Premarin, the major brand of CEEs in use, is manufactured by Wyeth and was first marketed in 1941 in Canada and in 1942 in the United States.
Wyeth manufactured over-the-counter (OTC) drugs Robitussin and the analgesic Advil (ibuprofen) as well as prescription drugs Premarin and Effexor.

Estradiol (medication)

estradiolE2micronized estradiol
However, it has begun to fall out of favor relative to bioidentical estradiol, which is the most widely used form of estrogen in Europe for menopausal hormone therapy. The major estrogen in CEEs, sodium estrone sulfate, itself is inactive, and rather serves as a prodrug of estrone and then of estradiol. On the other hand, the active forms of the equine estrogens in CEEs, such as equilin and 17β-dihydroequilin, have greater potency in the liver relative to bioidentical estradiol, similarly to synthetic estrogens like ethinylestradiol and diethylstilbestrol.
Estradiol differs from non-bioidentical estrogens like conjugated estrogens and ethinylestradiol in various ways, with implications for tolerability and safety.

Estrogen conjugate

conjugateestradiol conjugateestriol conjugate
It is a mixture of the sodium salts of estrogen conjugates found in horses, such as estrone sulfate and equilin sulfate.
Estrogen conjugates have been used as pharmaceutical estrogens, as in estrone sulfate as estropipate (piperazine estrone sulfate) and in conjugated estrogens (Premarin) and estriol glucuronide in Progynon and Emmenin.

Bioidentical hormone replacement therapy

bioidenticalbioidentical hormone therapyand her team of doctors
However, it has begun to fall out of favor relative to bioidentical estradiol, which is the most widely used form of estrogen in Europe for menopausal hormone therapy. On the other hand, the active forms of the equine estrogens in CEEs, such as equilin and 17β-dihydroequilin, have greater potency in the liver relative to bioidentical estradiol, similarly to synthetic estrogens like ethinylestradiol and diethylstilbestrol.
It was supplanted on the market when its manufacturer, Ayerst (later Wyeth Pharmaceuticals), began producing the more easily manufactured conjugated equine estrogens in 1941 under the brand name Premarin; by 1992, Premarin was the most widely prescribed drug in the United States.

Estrogen receptor

estrogenERestrogen receptors
CEEs are estrogens, or agonists of the estrogen receptor, the biological target of estrogens like estradiol.
Natural estrogens (e.g., conjugated estrogens)

Urine

urinaryhuman urinepiss
CEEs are available in the form of both natural preparations manufactured from the urine of pregnant mares and fully synthetic replications of the natural preparations.
Pregnant mare urine is the source of estrogens, namely Premarin.

Hormone replacement therapy

menopausal hormone therapyhormone therapyestrogen replacement therapy
Conjugated estrogens (CEs), or conjugated equine estrogens (CEEs), sold under the brand name Premarin (a contraction of "pregnant mares' urine") among others, is an estrogen medication which is used in menopausal hormone therapy and for various other indications.
Estrogens – bioidentical estrogens like estradiol and estriol, animal-derived estrogens like conjugated estrogens (CEEs), and synthetic estrogens like ethinylestradiol

High-dose estrogen

high-dosage estrogenHigh-doseHigh-dose estrogen therapy
Some lesser known uses are as a means of high-dose estrogen therapy in the treatment of breast cancer in both women and men and in the treatment of prostate cancer in men.
Conjugated estrogens (Premarin)

Estrone (medication)

estroneEstrone (E1)oestrin
The major estrogen in CEEs, sodium estrone sulfate, itself is inactive, and rather serves as a prodrug of estrone and then of estradiol.
It can also be taken by mouth in the form of estrone sulfate, as in estropipate (piperazine estrone sulfate; Ogen) and conjugated estrogens (Premarin).

Estrone sulfate (medication)

estrone sulfatesodium estrone sulfate
It is a mixture of the sodium salts of estrogen conjugates found in horses, such as estrone sulfate and equilin sulfate. The major estrogen in CEEs, sodium estrone sulfate, itself is inactive, and rather serves as a prodrug of estrone and then of estradiol.
As the sodium salt (sodium estrone sulfate), it is the major estrogen component of conjugated estrogens (Premarin) and esterified estrogens (Estratab, Menest).

Selective estrogen receptor modulator

SERMselective estrogen receptor modulatorsselective estrogen-receptor modulator
In addition, 17β-dihydroequilenin has shown a selective estrogen receptor modulator (SERM)-like profile of estrogenic activity in studies with monkeys, in which beneficial effects on bone and the cardiovascular system were observed but proliferative responses in breast or endometrium were not seen, although the clinical significance of this is unknown.
Combined therapy with conjugated estrogens and the SERM bazedoxifene, was approved on October 3, 2013, for the treatment of vasomotor symptoms linked with menopause.

Equilin

equilin sulfatesodium equilin sulfate
It is a mixture of the sodium salts of estrogen conjugates found in horses, such as estrone sulfate and equilin sulfate. On the other hand, the active forms of the equine estrogens in CEEs, such as equilin and 17β-dihydroequilin, have greater potency in the liver relative to bioidentical estradiol, similarly to synthetic estrogens like ethinylestradiol and diethylstilbestrol.
It is one of the estrogens present in the estrogen mixtures known as conjugated estrogens (CEEs; brand name Premarin) and esterified estrogens (EEs; Estratab, Menest).

17β-Dihydroequilin

17β-Dihydroequilin sulfate
On the other hand, the active forms of the equine estrogens in CEEs, such as equilin and 17β-dihydroequilin, have greater potency in the liver relative to bioidentical estradiol, similarly to synthetic estrogens like ethinylestradiol and diethylstilbestrol.
As the C3 sulfate ester sodium salt, it is a minor constituent (1.7%) of conjugated estrogens (CEEs; brand name Premarin). However, as equilin, with equilin sulfate being a major component of CEEs, is transformed into 17β-dihydroequilin in the body, analogously to the conversion of estrone into estradiol, 17β-dihydroequilin is, along with estradiol, the most important estrogen responsible for the effects of CEEs.

Esterified estrogens

esterified estrogenestrogens, esterified (usp)Evex
An estrogen preparation very similar to CEEs but differing in source and composition is esterified estrogens.
EEs consist primarily of sodium estrone sulfate and sodium equilin sulfate, and are very similar to conjugated estrogens (CEEs; brand name Premarin).

Estrogen

oestrogenestrogensestrogenic
CEEs are estrogens, or agonists of the estrogen receptor, the biological target of estrogens like estradiol.
Examples include estriol glucuronide (Emmenin, Progynon), estradiol benzoate, conjugated estrogens (Premarin), diethylstilbestrol, and ethinylestradiol.

Ethinylestradiol

ethinyl estradiolethinyloestradiol17-R-ethinylestradiol
On the other hand, the active forms of the equine estrogens in CEEs, such as equilin and 17β-dihydroequilin, have greater potency in the liver relative to bioidentical estradiol, similarly to synthetic estrogens like ethinylestradiol and diethylstilbestrol.
EE is an estrogen similarly to natural estrogens like estradiol and conjugated estrogens (Premarin) and synthetic estrogens like diethylstilbestrol.

List of combined sex-hormonal preparations

List of combined sex-hormonal preparations
Conjugated estrogens (Premarin)

17β-Dihydroequilenin

In addition, 17β-dihydroequilenin has shown a selective estrogen receptor modulator (SERM)-like profile of estrogenic activity in studies with monkeys, in which beneficial effects on bone and the cardiovascular system were observed but proliferative responses in breast or endometrium were not seen, although the clinical significance of this is unknown.
17β-Dihydroequilenin, or β-dihydroequilenin, also known as δ 6,8 -17β-estradiol or 6,8-didehydro-17β-estradiol, as well as estra-1,3,5(10),6,8-pentaen-3,17β-diol, is a naturally occurring steroidal estrogen found in horses which is closely related to equilin, equilenin, and estradiol, and, as the 3-sulfate ester sodium salt, is a minor constituent (0.5%) of conjugated estrogens (Premarin).

Conjugated estrogens/medroxyprogesterone acetate

combination of CEEs and MPA
Conjugated estrogens/medroxyprogesterone acetate
Conjugated estrogens/medroxyprogesterone acetate (CEs/MPA), sold under the brand names Prempro and Premphase, is a combination product of conjugated estrogens (Premarin), an estrogen, and medroxyprogesterone acetate (Provera), a progestogen, which is used in menopausal hormone therapy for the treatment of menopausal symptoms.

Women's Health Initiative

NIH Women's Health InitiativeWHIWomen's Health Initiative Calcium/Vitamin D Supplementation Study
As part of the Women's Health Initiative sponsored by the National Institutes of Health, a large-scale clinical trial of menopausal HRT showed that long-term use of estrogen and a progestin may increase the risk of strokes, heart attacks, blood clots, and breast cancer.
Women assigned to the intervention group who had previously undergone a hysterectomy were treated with unopposed estrogen, specifically conjugated estrogens (Premarin), manufactured by (Wyeth), at a dosage of 0.625 mg/day ("E-alone," n = 5310; placebo, n = 5429).

17α-Dihydroequilin

The 17α-estrogens in CEEs such as 17α-estradiol and 17α-dihydroequilin have low estrogenicity and are thought to contribute minimally to its effects.
The compound, as the 3-sulfate ester sodium salt, is present in conjugated estrogens (Premarin), a pharmaceutical extract of the urine of pregnant mares, and is the third highest quantity constituent in the formulation (13.8%).

Progynon

Emmenin, which was an extract of the urine of pregnant women, was the predecessor of Premarin, and Progynon was a very similar competing product.
Ayerst followed suit, with the introduction of Premarin (conjugated equine estrogens) in 1941.

Norgestrel

dextronorgestrelNorgestrel (13-methylnorethisterone)Norgestrel (18-methylnorethisterone)
Prempak-C is a combination of CEEs and norgestrel which is used in the United Kingdom and Ireland, and Prempak N is a combination of CEEs and medrogestone which is used in South Africa.
Norgestrel is used in combination with ethinylestradiol or quinestrol in combined birth control pills, alone in progestogen-only birth control pills, and in combination with estradiol or conjugated estrogens in menopausal hormone therapy.