About the Test
Purpose of the test
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 help determine the timing of a woman’s ovulation and 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.
What does the test measure?
Estrogen tests measure one of three components: estrone (E1), estradiol (E2), or estriol (E3) in the blood or urine.
- E1 is directly converted from androstenedione (from the adrenal gland) or indirectly from other androgens. This can also be produced by the ovaries and placenta, testicles, and adipose (fat) tissues. E2 and E1 can be converted into each other as needed. E1 is the primary estrogen in men and post-menopausal women.
- E2 is primarily produced in the ovaries under stimulation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in pre-menopausal women and men’s testicles. Converted from E1 in post-menopausal women, E2 is the most potent estrogen, the one present in the highest concentration in non-pregnant, pre-menopausal women. E2 levels vary depending on a woman’s age and reproductive status. They are a good marker of ovarian function.
- E3 is produced by the placenta, with concentrations rising throughout a woman’s pregnancy. Increasing levels indicate the health of the pregnancy and developing baby. It is part of the second-trimester maternal serum screen performed to evaluate fetal risk due to certain chromosomal abnormalities. Very low levels of E3 are present in non-pregnant women or men.
When should I get an estrogen test?
E2 and/or 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 E2 measurements throughout a woman’s menstrual cycle may be done to monitor follicle development before in vitro fertilization techniques (timed with a surge in E2)
- 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 E1 levels to monitor treatment
E3 testing in women may be ordered:
- During pregnancy, when a health care practitioner may order serial E3 samples to look for a trend, whether there is a rise or fall in the E3 level over time
- Unconjugated E3 is often measured in the 15th to 20th week of gestation as part of the triple/quad screen
E2 and/or 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
Finding an Estrogen Test
How can I get an estrogen test?
Your doctor typically orders an estrogen test. It can be conducted at a medical office, hospital, or laboratory.
Can I take the test at home?
Estrogen testing is not typically offered at home. You’ll need to visit a lab for a sample collection.
How much does the test cost?
The cost of estrogen testing depends on which test is needed, where the test is given, and what type of health insurance coverage you have. While your insurance may cover the cost of testing, you may still be responsible for making a copayment or paying a deductible.
Taking an Estrogen Test
Your health care practitioner will choose which estrogen and sample type to test. Blood is the most common type, but doctors may also use urine, saliva, or amniotic fluid to test estrogen levels.
Before the test
No special preparation or fasting is required for estrogen testing.
During the test
An estrogen blood test involves a health care practitioner drawing blood from a vein in your arm. They will begin by using an alcohol wipe to disinfect the needle’s insertion area. Then, they will tie a rubber tourniquet around your upper arm to help expose the vein. Next, the needle will be inserted into the vein, which may cause minor discomfort. The blood specimen is collected in a tube.
If your doctor opts for a 24-hour urine test, you will be provided with a container to collect your urine over a 24-hour period. You will then have to return the container for it to be tested.
After the test
After the exam, you will be asked to put a little pressure on the spot where your blood was drawn for a couple of minutes once it’s covered with a bandage. You can usually remove the bandage within a couple of hours.
There are typically no side effects beyond some minor bruising. Let the health care provider know if you have any lightheadedness, though that is rare.
Estrogen Test Results
Receiving test results
Estrogen test results should be available within three to five business days, but that may vary depending on where the test is performed.
Interpreting test results
Normal estrogen results depend upon the sex and age of the person tested. With women, it also depends upon their menstrual cycle or whether they are pregnant. Reference ranges will vary somewhat between laboratories, in normal values listed and in the units used.
Increased or decreased levels of estrogen are seen in many metabolic conditions. Care must be used to interpret E1, E2, and E3 results because the levels vary daily and throughout a woman’s menstrual cycle. Beyond daily and cycle variations, illnesses such as high blood pressure (hypertension), anemia, and impaired liver and kidney function can affect estrogen levels.
A health care practitioner 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 do not diagnose a specific condition but give the health care practitioner information about the potential cause of your symptoms or status.
Below are conditions where one might see an increase or decrease in estrogen levels.
Increased levels of E2 or 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:
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
- Polycystic ovary syndrome (PCOS), also called Stein-Levanthal syndrome
- Extreme endurance exercise
When you speak with your doctor about your test result, here are some questions you could ask:
- What type of estrogen test did I have and what are the results?
- Do my test results show that I have a condition that might be affecting my estrogen levels?
- Do I need any follow-up tests based on my test result?
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Endocrine Society. Gynecomastia. Updated January 24, 2022. Accessed November 15, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/gynecomastia
Endocrine Society. Reproductive Hormones. Updated January 24, 2022. Accessed November 15, 2022. https://www.endocrine.org/patient-engagement/endocrine-library/hormones-and-endocrine-function/reproductive-hormones
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