Estrogens

Estrogen tests may be used for a variety of reasons:

• Estrone levels may be elevated in patients with polycystic ovarian syndrome and endometriosis. Tests may be used 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 in evaluating ovarian function. Estradiol levels are increased in cases of early (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. A doctor may sometimes order a total estrogens test. This test measures estrone and estradiol together but does not measure estriol.
• Estriol 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, one that measures estriol that is not bound to a protein, is one of the components of the triple or quad screen. Decreased levels have been associated with various genetic disorders including Down syndrome, neural tube defects, and adrenal abnormalities. It is ordered during pregnancy, along with maternal alpha-fetoprotein (AFP maternal), human chorionic gonadotropin (hCG), and inhibin-A tests, to assess the risk of carrying a fetus with certain abnormalities.

A doctor may order an estrone or estradiol, along with other tests, when a woman has symptoms such as pelvic heaviness, abnormal vaginal bleeding, abnormal menstrual cycles, is experiencing infertility, and when a female's sex organs are developing earlier or later than normally expected. A doctor may also order estrone and/or estradiol when a woman is having hot flashes, night sweats, insomnia, and/or amenorrhea, symptoms of menopause. When a woman is taking hormone replacement therapy, her doctor may periodically order estrone levels to monitor treatment.

When a woman is experiencing fertility problems, her doctor may use estradiol measurements over the course of the menstrual cycle to monitor follicle development prior to in vitro fertilization techniques (timed with a surge in estradiol). Estradiol testing may also be ordered when a man shows signs of feminization, such as gynecomastia, that may be due to an estrogen-producing tumor.

During pregnancy, a doctor may order serial estriol samples to look for a trend, 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 screen or quad screen.

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 their concentrations will vary on a day-to-day basis and throughout the menstrual cycle. A doctor 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 doctor additional information about the potential cause of a person's symptoms or status. Below are conditions where one might see an increase or decrease of estrogen levels.

Increased levels of estrogens are seen in:

• Normal menstrual cycle
• Early (precocious) puberty
• Gynecomastia
• Tumors of the ovary, testes, or adrenal glands
• Hyperthyroidism
• Cirrhosis

Decreased levels of estrogen are seen in:

• Turner syndrome
• Hypopituitarism
• Hypogonadism
• Failing pregnancy (estriol)
• Eating disorder anorexia nervosa
• After menopause (estradiol)
• PCOS (Polycystic ovarian syndrome, Stein-Levanthal syndrome)
• Extreme endurance exercise

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

Beyond daily and cycle variations, illnesses such as hypertension, anemia, and impaired liver and kidney functions can affect estrogen levels in the body.

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.