Hormone therapy Menopause Average number of moderate-to-severe hot flashes per week with placebo and different doses of oral<unk> in menopausal women<unk> is used in menopausal hormone therapy to prevent and treat moderate to severe menopausal symptoms such as hot flashes, vaginal dryness and atrophy, and osteoporosis (bone loss). As unopposed estrogen therapy (using estrogen alone without progesterone) increases the risk of endometrial hyperplasia and endometrial cancer in women with intact uteruses,<unk> is usually combined with a progestogen like progesterone or medroxyprogesterone acetate to prevent the effects of<unk> on the endometrium. This is not necessary if the woman has undergone a hysterectomy (surgical removal of the uterus). A 2017 meta-analysis found that<unk> had no effect on depressive symptoms in peri- and postmenopausal women. Hypogonadism Estrogen is responsible for the mediation of puberty in females, and in girls with delayed puberty due to hypogonadism (low-functioning gonads, which can result in low sex hormone levels) such as in Turner syndrome,<unk> is used to induce the development of and maintain female secondary sexual characteristics such as breasts, wide hips, and a female fat distribution. It is also used to restore<unk> levels in adult premenopausal women with hypogonadism, for instance those with premature ovarian failure or who have undergone oophorectomy. It is used to treat women with hypogonadism due to hypopituitarism as well. Transgender women<unk> is used as part of feminizing hormone therapy for transgender women. The drug is used in higher dosages prior to sex reassignment surgery or orchiectomy to help suppress testosterone levels; after this procedure,<unk> continues to be used at lower dosages to maintain<unk> levels in the normal premenopausal female range. Birth control Although almost all combined oral contraceptives contain the synthetic estrogen ethinylestradiol, natural<unk> itself is also used in some hormonal contraceptives, including in<unk> containing oral contraceptives and combined injectable contraceptives. It is formulated in combination with a progestin such as dienogest, nomegestrol acetate, or medroxyprogesterone acetate, and is often used in the form of an ester prodrug like<unk> valerate or<unk> cypionate. Hormonal contraceptives contain a progestin and/or estrogen and prevent ovulation and thus the possibility of pregnancy by suppressing the secretion of the gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH), the peak of which around the middle of the menstrual cycle causes ovulation to occur. Hormonal cancer Prostate cancer<unk> is used as a form of high-dose estrogen therapy to treat prostate cancer and is similarly effective to other therapies such as androgen deprivation therapy with castration and antiandrogens. It is used in the form of long-lasting injected<unk> prodrugs like polyestradiol phosphate,<unk> valerate, and<unk> undecylate, and has also more recently been assessed in the form of transdermal<unk> patches. Estrogens are effective in the treatment of prostate cancer by suppressing testosterone levels into the castrate range, increasing levels of sex hormone-binding globulin (SHBG) and thereby decreasing the fraction of free testosterone, and possibly also via direct cytotoxic effects on prostate cancer cells. Parenteral<unk> is largely free of the cardiovascular side effects of the high oral dosages of synthetic estrogens like diethylstilbestrol ad ethinylestradiol that were used previously. In addition, estrogens may have advantages relative to castration in terms of hot flashes, sexual interest and function, osteoporosis, cognitive function, and quality of life. However, side effects such as gynecomastia and feminization in general may be difficult to tolerate and unacceptable for many men. Breast cancer High-dose estrogen therapy is effective in the treatment of about 35% of cases of breast cancer in women who are at least 5 years menopausal and has comparable effectiveness to antiestrogen therapy with medications like the selective estrogen receptor modulator (SERM) tamoxifen. Although estrogens are rarely used in the treatment of breast cancer today and synthetic estrogens like diethylstilbestrol and ethinylestradiol have most commonly been used,<unk> itself has been used in the treatment of breast cancer as well. It has been used orally at very high doses (30 mg/day) in the treatment of therapy-naive breast cancer and orally at low doses (2 to 6 mg/day) in the treatment of breast cancer in women who were previously treated with and benefited from but acquired resistance to aromatase inhibitors. Polyestradiol phosphate is also used to treat breast cancer. Other uses Infertility Estrogens may be used in treatment of infertility in women when there is a need to develop sperm-friendly cervical mucous or an appropriate uterine lining. It is also commonly used during in vitro fertilization (IVF). Estrogen helps maintain the endometrial lining of the uterus and help prepare for pregnancy. Research shows higher pregnancy rate if the mother takes estrogen in addition to progesterone.<unk> is the predominant form of estrogen during reproductive years and is most commonly prescribed. Lactation suppression Estrogens can be used to suppress and cease lactation and breast engorgement in postpartum women who do not wish to breastfeed. They do this by directly decreasing the sensitivity of the alveoli of the mammary glands to the lactogenic hormone prolactin. Tall stature Estrogens have been used to limit final height in adolescent girls with tall stature. They do this by inducing epiphyseal closure and suppressing growth hormone-induced hepatic production and by extension circulating levels of insulin-like growth factor-1 (IGF-1), a hormone that causes the body to grow and increase in size. Although ethinylestradiol and conjugated estrogens have mainly been used for this purpose,<unk> can also be employed. Breast enhancement Estrogens are involved in breast development and<unk> may be used as a form of hormonal breast enhancement to increase the size of the breasts. Both polyestradiol phosphate monotherapy and pseudopregnancy with a combination of high-dosage intramuscular<unk> valerate and hydroxyprogesterone caproate 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 following discontinuation of treatment. Aside from those without prior established breast development, evidence is lacking for a sustained increases in breast size with estrogens. Schizophrenia<unk> has been found to be effective in the adjunctive treatment of schizophrenia in women. It has been found to significantly reduce positive, negative, and cognitive symptoms, with particular benefits on positive symptoms. Other estrogens, as well as selective estrogen receptor modulators (SERMs) like raloxifene, have been found to be effective in the adjunctive treatment of schizophrenia in women similarly. Estrogens may be useful in the treatment of schizophrenia in men as well, but their use in this population is limited by feminizing side effects. SERMs, which have few or no feminizing side effects, have been found to be effective in the adjunctive treatment of schizophrenia in men similarly to in women and may be more useful than estrogens in this sex. Sexual deviance<unk> has been used at high doses in the treatment of sexual deviance, such as paraphilias, in men. It has specifically been used for this indication in the form of subcutaneous pellet implants of<unk> and intramuscular injections of<unk> undecylate. Available forms<unk> is available in a variety of different formulations, including oral, intranasal, transdermal/topical, vaginal, injectable, and implantable preparations. An ester may be attached to one or both of the hydroxyl groups of<unk> to improve its oral bioavailability and/or duration of action with injection. Such modifications give rise to forms such as<unk> acetate (oral and vaginal),<unk> valerate (oral and injectable),<unk> cypionate (injectable),<unk> benzoate (injectable),<unk> undecylate (injectable), and polyestradiol phosphate (injectable; a polymerized ester of<unk> , which are all prodrugs of<unk>
Estradiol 
Estrogen
Estrogen 
Alfatradiol
Androgen
17α-Estradiol
Progesterone 
Progesterone