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How to Interpret Your Estradiol Blood Test Results

Estradiol, a key female hormone, impacts fertility, heart health, and bone health. Learn how optimizing its levels throughout life can improve women's health.

Michelle Darian
By Michelle Darian
Jovan Mijailovic
Edited by Jovan Mijailovic

Updated April 18, 2024.

A woman sitting on a bed holding pills and looking at her cell phone.

The hormone estradiol is one of three primary forms of estrogen. It has a profound impact on reproductive health and regulating menstruation.

It also impacts the cardiovascular system—the heart and blood vessels—and the musculoskeletal system—bones, ligaments, cartilage, and tendons. So, high or abnormally low estradiol levels can affect your health in several ways. [1]



Key takeaways

  • Estradiol (E2) is the most potent and prevalent form of estrogen during a woman’s reproductive years.
  • Estradiol levels change a lot throughout a woman’s lifespan, and at each stage of life, levels that are too high or too low can negatively impact health.
  • The optimal level of estradiol depends on your current life stage and whether or not you take hormone medications, such as hormonal contraceptives or menopause therapy.
  • Estradiol levels are measured via a blood test either at the request of a physician or through services like InsideTracker.


What is estradiol? 

Estradiol is primarily produced by the ovaries, and the adrenal gland and fatty tissues also secrete it. This hormone plays a crucial role in the development of female sex characteristics—like breasts—and in regulating the menstrual cycle and reproduction.

Optimal estradiol levels during postmenopausal years are associated with a reduced likelihood of age-related conditions like bone mineral density decline and poor cardiovascular health. [2]

Do men produce estradiol? 

While estradiol is primarily known as the female sex hormone, everyone produces it—including men. It contributes to healthy sexual function, but it circulates in much smaller quantities. [3]

How to measure estradiol levels

An estradiol blood test—sometimes called an E2 check—can quickly tell you what your levels of this hormone are. The challenging parts are understanding your results and getting insurance to cover the cost.

Note: InsideTracker Ultimate plan breaks down results and tests estradiol—along with TSH and progesterone. It gives insights into your levels, how they impact your health, and how to optimize them.



Reference ranges for estradiol tests

Estradiol blood levels in your chart show up against a reference range with many variables. Normal ones differ based on menopausal status, menstrual cycle phase, hormonal contraceptive use, and menopausal hormone therapy (MHT). [2,4]

Here are the reference ranges for estradiol:

a table with two different types of normal reference ranges for estradol


» See how your menstrual cycle can affect blood test results

Estradiol throughout the female lifespan

Estradiol can shift a lot. As the table above shows, normal ranges are wide. But at each stage, the hormone can fall outside of that range. Those altered levels can also have different impacts on the body. 

Let’s dive into what estradiol levels mean for pre-, peri-and postmenopausal women.

Premenopausal women

Premenopausal women with decreased estradiol levels may have irregular or infrequent periods, difficulty sleeping, mood swings, and low libido. Since the brain’s pituitary gland manages the section of this hormone, a deficit also indicates something is affecting the communication pathways. [2]

On the other hand, high estradiol levels come with heavier or more frequent periods, worsening premenstrual syndrome (PMS) symptoms, fatigue, and low libido. Fertility treatments and estrogen-containing contraceptives may also cause the increase.

Some other factors that can cause high estradiol are excess body fat, smoking, and eating a diet high in saturated fat and added sugars. Prolonged elevation also has several medical implications for a woman later in life, which you should take care of by consulting a physician. [2]

a diagram showing the phases of Estradiol throughout the female lifespan



Perimenopausal women

Low estradiol during perimenopausal years can contribute to vasomotor symptoms like hot flashes and night sweats and other ones like stress and difficulty sleeping. Improving the levels can reduce the severity of menopausal symptoms you may be experiencing. [5]

Hormonal contraceptive use can stabilize fluctuations in perimenopausal women more than the ones not using hormonal contraceptives. [6] Those with low estradiol levels are also at a higher risk for low bone mineral density and cardiovascular disease compared to those with optimal. [7]

Ddrastic shifts in estradiol during menopause lead to irregularities in the menstrual cycle, such as shorter or longer times between periods. Consistently high levels can increase the risk for clinical conditions post-menopause. So, optimizing the hormone's values throughout perimenopausal years is critical for overall health as you age. [8]

A graph with a green background and a line graph with the words, estrad


» Explore why menopause happens and what you can do about it

Postmenopausal women

During the postmenopausal years, a woman’s body stops converting a weaker form of estrogen—estrone—to estradiol. The process contributes to a decline and subsequent low levels of the hormone when compared to premenopause. [4]

Factors like elevated testosterone levels, excess body fat, stress, and alcohol intake may increase estradiol levels in postmenopausal women. While higher estradiol may protect them from hot flashes and night sweats, it can lead to altered mood and increased frailty.

Note: The exogenous estrogens from Menopause Hormone Therapy (MHT) can also contribute to higher estradiol levels. Consult with your physician before modifying any use of MHT. [9, 10]



Similar to perimenopause, low estradiol in your postmenopausal years can increase the frequency and severity of hot flashes, night sweats, anxiety, and sleeping troubles. It can also negatively impact bone mineral density, increasing osteoporosis and cardiovascular disease risk. [6]

Most people don't know where their heart health status stands until it's too late. InsideTracker Ultimate plan calculates a score that includes a comprehensive analysis of all the markers affecting your heart— including ApoB, triglycerides, HDL, LDL, and total cholesterol.



Does estradiol affect other biomarker levels? 

Estradiol is delicately connected to many processes in the body. So, it’s no surprise that altered estradiol levels are positively or negatively linked to other blood biomarkers.

Premenopause 

Elevated estradiol is associated with decreased total and LDL cholesterol levels—and vice versa. Estradiol upregulates LDL receptors, which improves the body’s ability to clear LDL particles from the bloodstream. [11, 12]

In premenopausal women, elevated estradiol levels are associated with reduced hs-CRP levels—a marker of inflammation. Estradiol has an anti-inflammatory effect on cellular tissue by reducing associated markers and spreading cells that fight inflammation. [13, 14]

» Learn how to balance your hormones

Postmenopause

Elevated estradiol levels are associated with increased hs-CRP and CRP levels. This relationship may be explained by increases in adipose tissue in postmenopausal years.

It secretes estradiol, promoting inflammation. This effect contrasts the association observed between estradiol and hs-CRP in premenopausal women. [15]

Note: Elevated estradiol levels are associated with increased testosterone and DHEAS, as they are precursors to the hormone.

» Learn why it's harder for women in menopause to lose weight

Can you improve unoptimized estradiol levels?

InsideTracker displays estradiol blood test results using the reference ranges provided. Still, it takes the analysis further by creating optimal zones based on menopausal status and exogenous hormone use for females.

For lab values outside a given optimal zone, a person may see food, supplements, and physical activity recommendations that can positively impact estradiol levels. 

Note: Estradiol levels outside the reference range should be addressed with a healthcare practitioner who can account for your medical history. 

Track your estradiol levels for optimal health

When you measure your estradiol with InsideTracker’s Ultimate Plan, you can track your levels over time, understand its impact on your other biomarkers, and receive recommendations to improve this marker. 

Continuously reassessing estradiol is a critical health management component, as high and low levels are associated with notable symptoms and risks of disease. [15]

That's why InsideTracker recommends monitoring this hormone and working with a healthcare provider for support. Currently, estradiol is only included in the Ultimate Plan. The insights are based on biological sex, so if you use gender-affirming hormone therapy, select the option that aligns with it.

Disclaimer: InsideTracker doesn't diagnose or treat medical conditions. Consult your physician for any health concerns.




References:

[1] B. J. Delgado and W. Lopez-Ojeda, “Estrogen,” StatPearls - NCBI Bookshelf, Jun. 26, 2023. https://www.ncbi.nlm.nih.gov/books/NBK538260/

[2] F. Mauvais-Jarvis, D. J. Clegg, and A. L. Hevener, “The role of estrogens in control of energy balance and glucose homeostasis,” Endocrine Reviews, vol. 34, no. 3, pp. 309–338, Jun. 2013, doi: 10.1210/er.2012-1055.

[3] M. Schulster, A. Bernie, and R. Ramasamy, “The role of estradiol in male reproductive function,” Asian Journal of Andrology, vol. 18, no. 3, p. 435, Jan. 2016, doi: 10.4103/1008-682x.173932.

[4] H. G. Burger, G. E. Hale, D. Robertson, and L. Dennerstein, “A review of hormonal changes during the menopausal transition: focus on findings from the Melbourne Women’s Midlife Health Project,” Human Reproduction Update, vol. 13, no. 6, pp. 559–565, Jul. 2007, doi: 10.1093/humupd/dmm020.

[5] A. Iorga, C. M. Cunningham, S. Moazeni, G. Ruffenach, S. Umar, and M. Eghbali, “The protective role of estrogen and estrogen receptors in cardiovascular disease and the controversial use of estrogen therapy,” Biology of Sex Differences, vol. 8, no. 1, Oct. 2017, doi: 10.1186/s13293-017-0152-8.

[6]Clearing confusion about perimenopause | British Columbia Medical Journal.” https://bcmj.org/articles/clearing-confusion-about-perimenopause

[7] J. C. Prior, “Perimenopause: The complex endocrinology of the menopausal transition,” Endocrine Reviews, vol. 19, no. 4, pp. 397–428, Aug. 1998, doi: 10.1210/edrv.19.4.0341.

[8] P. K. Mansfield, M. Carey, A. C. Anderson, S. H. Barsom, and P. B. Koch, “Staging the menopausal transition: Data from the TREMIN Research Program on Women’s Health,” Women’s Health Issues, vol. 14, no. 6, pp. 220–226, Nov. 2004, doi: 10.1016/j.whi.2004.08.002.

[9] L. Butler and N. Santoro, “The reproductive endocrinology of the menopausal transition,” Steroids, vol. 76, no. 7, pp. 627–635, Jun. 2011, doi: 10.1016/j.steroids.2011.02.026.

[10] S. E. Brown and S. E. Hankinson, “Endogenous estrogens and the risk of breast, endometrial, and ovarian cancers,” Steroids, vol. 99, pp. 8–10, Jul. 2015, doi: 10.1016/j.steroids.2014.12.013.

[11] S. L. Mumford, S. Dasharathy, A. Z. Pollack, and E. F. Schisterman, “Variations in lipid levels according to menstrual cycle phase: clinical implications,” Clinical Lipidology, vol. 6, no. 2, pp. 225–234, Apr. 2011, doi: 10.2217/clp.11.9.

[12] S. L. Mumford et al., “A Longitudinal Study of Serum Lipoproteins in Relation to Endogenous Reproductive Hormones during the Menstrual Cycle,” The Journal of Clinical Endocrinology & Metabolism, vol. 95, no. 9, pp. E80–E85, Sep. 2010, doi: 10.1210/jc.2010-0109.

[13] A. J. Gaskins et al., “Endogenous reproductive hormones and C-reactive protein across the menstrual cycle: the BioCycle Study,” American Journal of Epidemiology, vol. 175, no. 5, pp. 423–431, Feb. 2012, doi: 10.1093/aje/kwr343.

[14] K. Wander, E. Brindle, and K. O’Connor, “C‐reactive protein across the menstrual cycle,” American Journal of Biological Anthropology, vol. 136, no. 2, pp. 138–146, Feb. 2008, doi: 10.1002/ajpa.20785.

[15] M. S. Williams, M. Cushman, P. Ouyang, S. R. Heckbert, R. R. Kalyani, and D. Vaidya, “Association of Serum Sex Hormones with Hemostatic Factors in Women On and Off Hormone Therapy: The Multiethnic Study of Atherosclerosis,” Journal of Womens Health, vol. 25, no. 2, pp. 166–172, Feb. 2016, doi: 10.1089/jwh.2015.5465.

[16] Ι. Lambrinoudaki et al., “Endogenous sex hormones and risk factors for atherosclerosis in healthy Greek postmenopausal women,” European Journal of Endocrinology, vol. 154, no. 6, pp. 907–916, Jun. 2006, doi: 10.1530/eje.1.02167.