Estrogens

Estrogen tests are used to detect a deficiency or excess in a woman and to help diagnose a variety of conditions associated with this imbalance. They may also be used to help determine the timing of a woman's ovulation and may be ordered to monitor the health status of the developing baby and placenta during pregnancy. In a man, estrogen testing may be performed to detect a hormone excess and its cause.

Estrogen tests measure one of three components: estrone (E1), estradiol (E2), or estriol (E3). These tests each have different uses.

In Girls and Women

Estradiol (E2) and/or estrone (E1) testing may be ordered to:

• Help diagnose early-onset puberty, when a young girl develops secondary sex characteristics sooner than expected; or delayed puberty, when a girl shows delayed development of secondary sex characteristics or start of menstruation
• Investigate menstrual abnormalities, such as lack of menstrual periods (amenorrhea), infertility, and abnormal vaginal bleeding
• Evaluate the function of the ovaries and detect ovarian failure
• Monitor follicle development in the ovary in the days prior to in vitro fertilization by making serial measurements of estradiol
• Monitor hormone replacement therapy that is given to assist fertility
• Monitor menopausal hormone replacement therapy that is given to alleviate symptoms associated with estrogen deficiency
• Detect estrogen-producing tumors
• Monitor anti-estrogen therapy, as in breast cancer

Estriol (E3) testing:

• May sometimes be ordered serially to help monitor a high-risk pregnancy; when it is used this way, each sample should be drawn at the same time each day.
• An unconjugated estriol test is one of the components of second trimester maternal serum screening. Decreased levels have been associated with various genetic disorders, including Down syndrome, neural tube defects, and adrenal abnormalities.

In Boys and Men

Estradiol (E2) and/or estrone (E1) testing in boys or men may be ordered to:

• Help diagnose delayed puberty
• Help diagnose the cause of enlarged breasts (gynecomastia) or other signs of feminization
• Detect a relative estrogen excess that is due to a testosterone or androgen deficiency
• Detect estrogen-producing tumors

In Girls and Women

Estradiol (E2) and/or estrone (E1) testing in girls and women may be ordered when:

• A girl's sex organs develop earlier or later than normally expected
• A woman has symptoms such as abnormal vaginal bleeding after menopause or abnormal or lack of menstrual cycles
• A woman is experiencing infertility; a series of estradiol measurements over the course of a woman's menstrual cycle may be done to monitor follicle development prior to in vitro fertilization techniques (timed with a surge in estradiol).
• A woman is having symptoms of menopause, including hot flashes, night sweats, insomnia, and/or irregular or lack of menstrual periods
• A menopausal woman is taking hormone replacement therapy; her health practitioner may periodically order estrone levels to monitor treatment.

Estriol (E3) testing in women may be ordered:

• During pregnancy, a health practitioner may order serial estriol samples to look for a trend, whether there is a rise or fall in the estriol level over time.
• Unconjugated estriol is often measured in the 15th to 20th week of gestation as part of the triple/quad screen.

In Boys and Men

Estradiol (E2) and/or estrone (E1) testing in boys and men may be ordered when:

• A boy has delayed puberty, characterized by delayed development of muscle mass, lack of deepening of the voice or growth of body hair, slow or delayed growth of testicles and penis
• A man shows signs of feminization, such as enlarged breasts

Normal estrogen results depend upon the sex and age of the person being tested. With women, it also depends upon their menstrual cycle or whether they are pregnant. Reference ranges will vary somewhat between laboratories, both in normal values listed and in units used.

Increased or decreased levels of estrogens are seen in many metabolic conditions. Care must be used in the interpretation of estrone, estradiol, and estriol results because the levels vary on a day-to-day basis and throughout a woman's menstrual cycle.

A health practitioner who is monitoring a woman's hormones will be looking at trends in the levels, rising or lowering over time in conjunction with the menstrual cycle or pregnancy rather than evaluating single values. Test results are not diagnostic of a specific condition but give the health practitioner information about the potential cause of a person's symptoms or status.

Below are conditions with which one might see an increase or decrease of estrogen levels.

Increased levels of estradiol (E2) or estrone (E1) are seen in:

Girls and Women:

• Early (precocious) puberty
• Tumors of the ovary or adrenal glands

Boys and Men:

• Enlarged breasts (gynecomastia)
• Tumors of the testicles (testicular cancer) or adrenal glands
• Delayed puberty

Both Women and Men:

• Hyperthyroidism
• Cirrhosis

In women, decreased levels of estrogen are seen in:

• Turner syndrome, an inherited condition in women caused by a missing or abnormal X chromosome and characterized by underdeveloped female sex characteristics
• Low level of pituitary hormones (hypopituitarism)
• Dysfunction of the ovaries (female hypogonadism)
• Failing pregnancy (estriol)
• Eating disorders such as anorexia nervosa
• After menopause (estradiol)
• PCOS (Polycystic ovarian syndrome, Stein-Levanthal syndrome)
• Extreme endurance exercise

Blood and urine results are not interchangeable. Your health practitioner will choose which estrogen and sample type to test. In addition to blood and urine, estrogen testing is occasionally also performed on saliva or on amniotic fluid.

Beyond daily and cycle variations, illnesses such as high blood pressure (hypertension), anemia, and impaired liver and kidney function can affect estrogen levels.

Some drugs, such as glucocorticosteroids, ampicillin, estrogen-containing drugs, phenothiazines, and tetracyclines, can increase estrogen levels in the blood. Glucose in the urine and urinary tract infections can increase levels in the urine. Drugs that may decrease levels include clomiphene and oral contraceptives.

Yes. Although they are present in amounts far less than in women, they are present and are needed for hormonal balance and the function of other glands.