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Sulfates are the most important circulating conjugates of ethinyl estradiol and glucuronides predominate in urine. The first oxidative metabolite is two-hydroxy ethinyl estradiol, fashioned via the CYP3A4 isoform of cytochrome P450. Part of the very first-pass metabolism of ethinyl estradiol is thought to come about in gastrointestinal mucosa. Ethi