Estrogen

Estrone tests may be done to aid in the diagnosis of an ovarian tumor, Turner’s syndrome, and hypopituitarism. In males, it may help in the diagnosis of the cause of gynecomastia or in the detection of estrogen-producing tumors.

Estradiol levels are used to help evaluate ovarian function. Estradiol helps diagnose the cause of precocious puberty in girls and gynecomastia in men. Its main use has been in the differential diagnosis of amenorrhea (for example, to determine whether the cause is menopause, pregnancy, or a medical problem). In assisted reproductive technology (ART), serial measurements are used to monitor follicle development in the ovary in the days prior to in-vitro fertilization. Estradiol is also sometimes used to monitor menopausal hormone replacement therapy.

Estriol, along with alpha-fetoprotein (AFP maternal), human chorionic gonadotropin (hCG), and inhibin-A (an ovarian and placental hormone) tests, are used to assess the risk of carrying a fetus with certain abnormalities, such as Down syndrome.

Your doctor may order an estrone or estradiol (along with other tests) if you have symptoms such as pelvic heaviness, abnormal vaginal bleeding, abnormal menstrual cycles, or if your sex organs (women’s) are developing earlier or later than normally expected. They may also order estrone and/or estradiol if you are having hot flashes, night sweats, insomnia, and/or amenorrhea, symptoms of menopause. If you are on hormone replacement therapy, your doctor may use estrone levels to monitor your treatment.

If you are having fertility problems, your doctor may use estradiol measurements over the course of your menstrual cycle to monitor follicle development prior to in vitro fertilization techniques (timed with a surge in your estradiol level).

If you are pregnant, your doctor may order serial (multiple) samples to look for a trend, a rise or fall in the estriol level over time. Unconjugated estriol (estriol not bound to sex hormone binding globulin) is often measured in the 15th to 20th week of gestation as part of the triple screen.

Increased or decreased levels of estrogen are seen in many metabolic conditions. Care must be used in the interpretation of estrone, estradiol, and estriol levels because their levels will vary on a day-to-day basis and throughout the menstrual cycle. If your doctor is monitoring your hormone levels, s/he often will be looking at trends in your levels, rising or lowering over time, rather than at single values. Below are conditions where one might see an increase or decrease of estrogen levels. It must be remembered that a diagnosis cannot be made solely based on one test result. 

Increased levels of estrogen                   Decreased levels of estrogen
are seen in:                                             are seen in:
Normal pregnancy                                     Turner syndrome
Precocious puberty                                    Hypopituitarism
Tumors of the ovary, testes, or adrenal     Hypogonadism
Cirrhosis                                                    After menopause (estradiol)                                                                   Failing pregnancy (estriol)
                                                                  Stein-Levanthal syndrome 
                                                                  (polycystic ovary syndrome) 
                                                                  Anorexia nervosa
                                                                  Extreme endurance exercise

Blood, urine, and saliva results are not interchangeable. Your doctor will choose which estrogen and sample type to test for based upon what they are looking for.

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

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