Estradiol (E2) Hormone Test and its effect on fertility

Importance of estradiol hormone in women:

Hormone estradiol (E2) along with progesterone plays a key role in the development of the female reproductive system, including the uterus, fallopian tubes, and vagina. It brings about many changes in a woman's body during puberty and responsible for bone health, breast development, and overall body shape.

During the menstrual cycle, E2 supports the uterus lining and the growth of the oocytes in the ovaries. Estradiol also helps in LH surge (rise in LH hormone) during the menstrual cycle and causes ovulation. It also works with progesterone to thicken the uterine lining and prepare it for embryo implantation [3]. Fetal growth is monitored by testing E2 during pregnancy, as it is the most common estrogen that is present during pregnancy. After you enter menopause, estradiol continues to maintain the health of bones and joints and promote fat distribution. If you have less E2 at your post-menopause age, then you may suffer from bone loss.

Importance of estradiol hormone in men:

Like women, estradiol hormone (E2) plays a critical role in male. E2 level, in general, is less in males and helps to maintain sperm health, erectile function, maintaining libido, and plays a vital role in sexual functioning [4]. If you are a man undergoing testosterone replacement therapy, then your doctor will suggest you do E2 testing, as this therapy causes changes in estradiol level. High estradiol hormone due to testosterone replacement therapy can result in enlarged breast tissue (Gynecomastia) in males.

The E2 test is a simple blood test done on day 3 of menstrual cycle. It helps to know the amount of estradiol in your blood. Your doctor suggests an E2 test if there is any abnormal development of your male or female sexual characteristics [5].

The E2 blood test in females is recommended under below circumstances-

• As ovarian reserve test, along with AMH and FSH test, if the woman has been trying for pregnancy for more than 12 months
• To understand the cause of irregular menstruation or no menstruation during their childbearing age
• If the doctor suspects the onset of early or delayed puberty
• To check how well your body is responding to hormonal therapy
• To measure the response to fertility treatments
• To check ovarian tumors

The doctor may suggest E2 test in men if they are showing female characteristics like enlarged breasts (gynecomastia) or if there is delay in puberty in boys.

Your age and your gender will make a difference in E2 test results [6]. It is measured in picograms per milliliter (pg/mL) or picomoles per liter (pmol/L). let's see the normal range of E2 in men and women,

In Women:

• In premenopausal woman: 30 to 400 pg/mL (110 to 1468.4 pmol/L)
• In postmenopausal woman: 0 to 30 pg/mL (0 to 110 pmol/L)

In Male:

• In adult males: 10 to 15 pg/mL (36.7 to 183.6 pmol/L)

Discuss with your doctor about the meaning of your test results.

As we all know by now, the estradiol test is routinely prescribed as an ovarian reserve test along with FSH and AMH tests. An abnormally high level of estradiol in women suggests they have a problem with ovaries ability to produce eggs. If your FSH test results are normal, and you are still unable to conceive, high estradiol could also mean that E2 is suppressing FSH. Either of these two things means you might find it difficult to conceive naturally. In a few cases, high levels of estradiol can also indicate hyperthyroidism or ovarian tumor.

Low estradiol level indicates PCOD (polycystic ovarian disease), premature ovarian failure or hypopituitarism. These conditions will also make it difficult to get pregnant. The levels of estradiol naturally decrease when women reach menopause.

As estradiol levels keep changing throughout the month, It is recommended to get tested on day 3 of your menstrual cycle. It is a simple blood test where the doctor will collect the blood sample from your upper arm, and the whole process will take only a few minutes. You may feel slight pain and discomfort during the process.

Your doctor will ask you to stop any medication if you are taking such as psychiatric medicine, steroids, estrogen therapy, birth control pills, certain antibiotics like ampicillin and tetracycline, etc.

As discussed earlier, low estradiol test results indicate primary ovarian insufficiency, also known as premature ovarian failure, which makes it harder for women to get pregnant. Premature ovarian failure is a medical condition when the ovaries stop working and are unable to release eggs.

After menopause, ovaries are unable to produce eggs in a woman, but in this condition, the ovaries are unable to produce eggs, even though a woman hasn’t yet entered menopause. In 90% of women with primary ovarian insufficiency, the cause of infertility is unknown. In the case of IVF, low E2 levels during the treatment could lead to failure in IVF treatment. In such cases, the doctor may prescribe you estrogen therapy or hormone replacement therapy to maintain the required level of estradiol during the treatment.

An E2 alone cannot diagnose a specific disease. If you are not able to get pregnant after trying for at least a year and your doctor thinks that infertility could be a cause, they may prescribe a test to check the levels of follicle-stimulating hormone (FSH), AMH, and E2.

If you are suffering from low estradiol levels your doctor may recommend hormone replacement therapy (HRT) for you. In such cases, the doctor will suggest HRT with a combination of estrogen and progestin also known as EPT or estrogen-progestin therapy [7]. If estrogen alone is taken there is an increased risk of endometrial or uterine cancer, and so your doctor will suggest a combination of progestin with estrogen to eliminate this risk. HRT includes tablets that are to be taken by mouth, usually one tablet a day. Activella, FemHrt, and Prempro are the forms of tablets containing estrogen and progestin.

As your estrogen and progesterone levels are decreased at menopause, you may have symptoms like hot flushes, dryness of the vagina, abnormal bleeding from the vagina, itching around the genitals. estradiol deficiency also causes other problems like mood swings, anxiety, irritability, and depression. HRT can return back these hormones to normal levels and is useful in handling and treating the above bothersome symptoms.

Being underweight can cause low estradiol levels and menstrual irregularities. Hence, Maintaining a healthy body weight will help in keeping the estradiol levels under normal range.

Apart from this, consume flax and sesame seeds and in fruits like oranges, apricots, strawberries, peaches, and other kinds of dry fruits to maintain your E2 hormone levels. These food items contain phytoestrogens that improve estradiol levels naturally.