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Estrogen Test

Last updated March 10, 2018

Approved by: Maulik P. Purohit MD MPH

Estrogens are sex hormones responsible for the development of the female sex organs and secondary sexual characteristics. They also play a role in the menstrual cycle and pregnancy.


What are the other Names for this Test? (Equivalent Terms)

  • Estradiol (E2) Test
  • Estriol (E3) Test
  • Estrone (E1) Test

What is Estrogen Test? (Background Information)

  • Estrogens are sex hormones responsible for the development of the female sex organs and secondary sexual characteristics. They also play a role in the menstrual cycle and pregnancy
  • Estrogen, when broken down in the body, forms more than 20 different types of fractions. While over 20 fractions of estrogens are known, testing is usually done for these forms:
    • Estrone (E1)
    • Estradiol (E2)
    • Estriol (E3)
  • Estrone (E1) is produced by the adrenal gland (glands located on top of the kidneys), as well as by the fat tissues. E1 is found in both males and females and it is the main estrogen found in post-menopausal women
  • Estradiol (E2) is produced mainly by the ovaries. Small quantities of E2 are synthesized in the adrenal glands, in both men and women. Estradiol level fluctuates with the phase of menstrual cycle; levels are lowest in the beginning, it peaks close to mid-cycle, just before ovulation (usually day 14 of the menstrual cycle)
  • Estriol (E3), produced by the placenta, is the major estrogen during pregnancy. Placental tissues help in delivering nutrients and oxygen to the developing baby from the mother. Estriol levels begin to rise around the 8th week of pregnancy and continue to increase, until shortly before delivery

Estrogen Testing is correlated with the time of the menstrual cycle or pregnancy in females; monitoring of trends helps in:

  • Diagnosing abnormalities of menstruation
  • Early or delayed puberty
  • Infertility issues
  • Finding out any potential birth defects
  • Estrogen Testing also helps in investigating causes of formation of female sexual features (feminization) in males

What are the Clinical Indications for performing the Estrogen Test?

Indications for Estrogen Testing in men include:

  • Feminization symptoms, such as gynecomastia (breast development in males)

Indications for Estrogen Testing in women include:

  • Estradiol testing to evaluate abnormalities of menstrual cycle, such as primary and secondary amenorrhea, fertility problems, abnormal vaginal bleeding, early or delayed sexual development
  • Estrone may be ordered along with estradiol in women experiencing menopausal symptoms, such as lack of menstruation, hot flashes, insomnia, night sweats, and to monitor individuals on hormone replacement therapy (HRT)
  • Unconjugated estriol is a type of estriol that occurs freely in the body and is not bound to proteins. Unconjugated estriol levels are measured between the 15th-20th weeks of pregnancy, to screen for any possible birth defects. Estriol trends may also be monitored during pregnancy

How is the Specimen Collected for Estrogen Test?

Sample required: Blood, urine, or less commonly saliva, depending on the type of clinical situation.

Process:

  • Blood sample is drawn through a needle inserted into the vein (arm)
  • For urinary testing, a 24-hour urine sample is collected. From the beginning of the 24-hour period, every urine sample is collected in a container and kept refrigerated, in between collections. This process can be done, even at home
  • Saliva samples are collected in clean plastic tubes

Preparation required: None

What is the Significance of the Estrogen Test Result?

The normal values of estrogen, called the reference range for estrogen, may vary slightly from lab to lab. Hence, most lab reports come with a reference range, which is used in that particular centre. One such reference range, in wide use, is per the following:

Blood estrogen levels:

  • Pre-menopausal, non-pregnant women: 60-400 pg/mL (picograms per milliliter)
  • Post-menopausal women: < 130pg/mL
  • Males: 10-130 pg/mL
  • Pre-puberty: < 25 pg/mL

Blood estriol levels during pregnancy:

  • First trimester: < 38 ng/mL (nanograms per milliliter)
  • Second trimester: 38-140 ng/mL
  • Third trimester: 31-460 ng/mL

The blood and urine values of estrogens are not interchangeable and hence, should not be compared with each other.

Some of the causes for high estrogen values include:

  • Tumors of the ovary, testes, or adrenal glands
  • Early puberty
  • Hyperthyroidism (over functioning of the thyroid gland)
  • Cirrhosis - a liver disease, due to excessive fibrosis in the liver tissue
  • Pregnancy with more than one developing fetus (multiple pregnancies)
  • Infertility treatments that stimulate ovaries to produce increased levels of estrogens

Some of the causes for low estrogen values include:

  • Decreased function of the pituitary gland (hypopituitarism)
  • Decreased function of the ovaries or testes (hypogonadism)
  • Turner syndrome (a disorder caused by the presence of a single copy of the X chromosome instead of the normal two copies, in females)
  • Anorexia nervosa (a kind of eating disorder)
  • Polycystic ovarian syndrome (PCOS)
  • Abnormal fetal developmental issues during pregnancy
  • After menopause

The laboratory test results are NOT to be interpreted as results of a "stand-alone" test. The test results have to be interpreted after correlating with suitable clinical findings and additional supplemental tests/information. Your healthcare providers will explain the meaning of your tests results, based on the overall clinical scenario.

Additional and Relevant Useful Information:

  • Increased levels of blood estrogens may be caused by drugs, such as ampicillin, glucocorticosteroids, tetracycline, or phenothiazines
  • Clomiphene and oral contraceptive pills may decreased estrogen levels
  • Urinary tract infections and glycosuria (glucose in urine) raise urinary estrogen level
  • Anemia, hypertension, impaired liver or kidney, may affect estrogen levels, as well

Certain medications that you may be currently taking may influence the outcome of the test. Hence, it is important to inform your healthcare provider, the complete list of medications (including any herbal supplements) you are currently taking. This will help the healthcare provider interpret your test results more accurately and avoid unnecessary chances of a misdiagnosis.

References and Information Sources used for the Article:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: Jan. 27, 2014
Last updated: March 10, 2018