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Estradiol (E2)

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Estradiol is one of the steroid sex hormones. In women, it is synthesized in the ovaries, placenta, and adrenal glands. Its synthesis is controlled by FSH, LH, and prolactin.
In men, estradiol is mainly produced through the conversion of testosterone in peripheral tissues, as well as in the seminal vesicles and adrenal glands.

Functions of Estradiol

  • In women, estradiol ensures female sexual development, the formation of secondary sexual characteristics during puberty, and regulation of the menstrual cycle. It is also essential for embryo implantation and uterine growth during pregnancy.
  • The ratio of estradiol to testosterone is crucial for its effects.
  • Estradiol has anabolic properties, enhances bone metabolism and growth, and reduces cholesterol levels while increasing blood clotting activity.
  • It influences neurotransmitters, improving alertness and focus.
     

    Estradiol Level Variations

  • Daily fluctuations in estradiol levels correlate with LH rhythm.
  • Highest estradiol levels: 3:00 PM – 6:00 PM.
  • Lowest estradiol levels: 12:00 AM – 2:00 AM.
  • At the start of the menstrual cycle, estradiol levels gradually increase, peaking during the follicular phase.
  • During pregnancy, estradiol levels rise until childbirth, then normalize by day 4 postpartum.
  • With age, estradiol levels decrease in women and reach male levels during postmenopause.
  • The analysis is performed on a blood sample drawn from a vein.
  • The test should be taken after 8–14 hours of fasting.
  • Before the test, avoid physical exertion, emotional stress, and alcohol consumption.
  • If no specific timing is prescribed, women with menstrual cycles should take the test on days 2–4 of the cycle.
  • Discuss with your doctor any medications that may affect estradiol levels.

Indications for Testing

  • Hirsutism
  • Anovulation
  • Oligomenorrhea and amenorrhea
  • Infertility
  • Dysfunctional uterine bleeding
  • Delayed or premature puberty
  • Hypogonadism
  • Premenstrual syndrome (PMS)
  • Bacterial vaginosis
  • Evaluation of the feto-placental function
  • Signs of feminization in men
  • Diagnosis of menstrual and fertility disorders in adult women

Causes of Increased Estradiol Levels

  • Follicular persistence
  • Endometriotic ovarian cysts
  • Hormone-producing ovarian tumors
  • Liver cirrhosis

Medications that Increase Estradiol Levels:

  • Anabolic steroids
  • Carbamazepine
  • Clomiphene
     

    Causes of Decreased Estradiol Levels

  • Turner syndrome
  • Testicular feminization syndrome
  • Hypogonadism
  • Hyperprolactinemia
  • Pituitary dwarfism
  • Luteal phase deficiency
  • Chronic inflammation of internal reproductive organs
  • Chronic prostatitis (in men)

  • Medications that Decrease Estradiol Levels:

  • Aminoglutethimide
  • Cimetidine
  • Dexamethasone
  • Nafarelin
  • Octreotide