Effects of estrogen and progesterone administration on extracellular fluid

To determine the effect of estrogen and progesterone on plasma volume (PV) and extracellular fluid volume (ECFV), we suppressed endogenous estrogen and progesterone by using the gonadotropin-releasing hormone (GnRH) antagonist ganirelix acetate in seven healthy women (22 +/- 1 yr). Subjects were administered GnRH antagonist for 16 days. Beginning on day 5 of GnRH antagonist administration, subjects were administered estrogen (E(2)) for 11 days, and beginning on day 12 of GnRH antagonist administration, subjects added progesterone (E(2)-P(4)) for 4 days. On days 2, 9, and 16 of GnRH antagonist administration, we estimated ECFV (inulin washout), transcapillary escape rate of albumin (TER(alb)), and PV (Evans blue dye). Plasma E(2) concentration increased from 17.9 +/- 4.5 (GnRH antagonist) to 195.9 +/- 60.1 (E(2), P < 0.05) to 245.6 +/- 62.9 pg/ml (E(2)-P(4), P < 0.05). Compared with GnRH antagonist (1.3 +/- 0.5 ng/ml), plasma P(4) concentration was unchanged during E(2) (0.9 +/- 0.3 ng/ml) and increased to 9.4 +/- 3.1 ng/ml during E(2)-P(4) (P < 0.05). Both E(2) (44.1 +/- 3.1 ml/kg) and E(2)-P(4) (47.7 +/- 2.8 ml/kg) increased PV compared with GnRH antagonist (42.8 +/- 1.3 ml/kg, P < 0.05). Within-subjects TER(alb) was a strong negative predictor of PV (mean r = 0.92 +/- 0.03, P < 0.05), and TER(alb) was lowest during E(2)-P(4) (5.7 +/- 0.5, 4.1.0 +/- 1.1, and 2.8 +/- 0.9%/h, P < 0.05, for GnRH antagonist, E(2), and E(2)-P(4), respectively). ECFV was reduced during E(2) (227 +/- 31 ml/kg, P < 0.05) compared with both GnRH antagonist (291 +/- 37 ml/kg) and E(2)-P(4) (283 +/- 19 ml/kg). Thus the percentage of extracellular fluid in the plasma compartment increased to 21.0% (P < 0.05) during E(2) compared with GnRH antagonist (16.1%) and E(2)-P(4) (17.2%) administration. Thus E(2) increased PV via actions on the capillary endothelium to lower TER(alb) and favor intravascular water retention, whereas during E(2)-P(4) PV increased via the combined responses of ECFV expansion and lower TER(alb).