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Introduction ⬇

Urine Estrogen, Total and Fractions (Estradiol [E2] and Estriol [E3]), 24-Hour Urine, and Total Estrogen—Blood

Measurements of estradiol (E2), estriol (E3), and total estrogen, together with the gonadotropin (follicle-stimulating hormone [FSH]) level (see Chapter 6), are useful in evaluating menstrual and fertility problems, male feminization characteristics, estrogen-producing tumors, and pregnancy.

Normal Findings ⬆ ⬇

Normal values vary widely between women and men and in the presence of pregnancy; the menopausal state; or the follicular, ovulatory, or luteal stage of the menstrual cycle.

Urine Estradiol (E2)

Men: 0–6 μg/24 hr or 0–22 nmol/d

Women: follicular phase, 0–13 μg/24 hr or 0–48 nmol/d

Ovulatory peak, 4–14 μg/24 hr or 15–51 nmol/d

Luteal phase, 4–10 μg/24 hr or 15–37 nmol/d

Postmenopausal, 0–4 μg/24 hr or 0–15 nmol/d

Urine Estriol (E3) (wide range of normal)

Men: 1–11 μg/24 hr or 4–40 nmol/d

Women: follicular phase, 0–14 μg/24 hr or 0–51 nmol/d

Ovulatory phase, 13–54 μg/24 hr or 48–198 nmol/d

Luteal phase, 8–60 μg/24 hr or 29–220 nmol/d

Postmenopausal, 0–11 μg/24 hr or 0–40 nmol/d

Pregnancy: First trimester, 0–800 μg/24 hr or 0–2900 nmol/d

Second trimester, 800–12,000 μg/24 hr or 2900–44,000 nmol/d

Third trimester, 5000–12,000 μg/24 hr or 18,000–44,000 nmol/d

Urine Total Estrogens

Men: 4–25 μg/24 hr or 14–92 nmol/d

Women: Menstruating, 4–60 μg/24 hr or 14–219 nmol/d

Postmenopausal, <20 μg/24 hr or <73 nmol/d

Pregnancy: First trimester, 0–800 μg/24 hr or 0–2900 nmol/d

Second trimester, 800–5000 μg/24 hr or 2900–18,350 nmol/d

Third trimester, 5000–50,000 μg/24 hr or 2900–183,000 nmol/d

Blood Total Estrogens

Men: 20–80 pg/mL or 20–80 ng/L

Women: Menstruating, 60–400 pg/mL or 60–400 ng/L

Postmenopausal, <130 pg/mL or <130 ng/L

Prepuberty, <25 pg/mL or <25 ng/L

Puberty, 30–280 pg/mL or 30–280 ng/mL

Procedural Alert

Normal values are guidelines and must be interpreted in conjunction with clinical findings

Procedure ⬆ ⬇

  1. Obtain a venous blood sample if needed for total estrogen.

  2. Collect a 24-hour urine specimen and use boric acid preservative for all estrogen tests. Keep the container refrigerated or on ice during collection.

  3. Follow general collection procedures for a 24-hour urine specimen (see Long-Term, Timed Urine Specimen [2-Hour, 24-Hour]).

  4. Record the age and sex of the patient.

  5. Ensure that the number of gestation weeks is communicated if patient is pregnant.

  6. Document the number of days into the menstrual cycle for the nonpregnant woman.

Clinical Alert

Estradiol may be used for monitoring persons on menotropins; i.e., combination of FSH and luteinizing hormone used to promote ovarian follicular growth. Serial measurements of E2 during ovulation induction enable the healthcare provider to minimize high E2 levels caused by ovarian overstimulation and thereby decrease side effects

Clinical Implications ⬆ ⬇

  1. Increased urine E2 is found in the following conditions:

    1. Feminization in children (testicular feminization syndrome)

    2. Estrogen-producing tumors

    3. Precocious puberty related to adrenal tumors

    4. Hepatic cirrhosis

    5. Hyperthyroidism

    6. In women, E2 increases during menstruation, before ovulation, and during the 23rd to 41st weeks of pregnancy.

  2. Decreased urine E2 occurs in:

    1. Primary and secondary hypogonadism

    2. Kallmann syndrome

    3. Hypofunction or dysfunction of the pituitary or adrenal glands

    4. Menopause

  3. Increased urine E3 occurs in pregnancy; there is a sharp rise when delivery is imminent.

  4. Decreased urine E3 is found in:

    1. Cases of placental insufficiency or fetal distress (abrupt drop of >40% on 2 consecutive days). Serial monitoring of E3 for 4 consecutive days is recommended to evaluate fetal distress.

    2. Congenital heart disease

    3. Down syndrome

  5. Blood and urine total estrogens are increased in:

    1. Malignant neoplasm of adrenal gland

    2. Malignant neoplasm of ovary

    3. Benign neoplasm of ovary

    4. Granulosa cell tumor of ovary

    5. Lutein cell tumor of ovary

    6. Theca cell tumor of ovary

    7. Testicular tumors

  6. Blood and urine total estrogens are decreased in:

    1. Ovarian hypofunction (ovarian agenesis, primary ovarian malfunction)

    2. Intrauterine death

    3. Preeclampsia

    4. Hypopituitarism

    5. Hypofunction of adrenal cortex

    6. Menopause

    7. Anorexia nervosa

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of test, procedure for urine collection, and interfering factors.

  2. Emphasize the importance of compliance with the procedure. The patient must be able to adjust daily activities to accommodate urine collection protocols.

  3. Do not administer radioisotopes for 48 hours before specimen collection.

  4. Obtain healthcare provider’s approval to discontinue all medications for 48 hours before specimen collection. Drugs deemed necessary must be documented and communicated.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Have the patient resume medications and normal activity.

  2. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel patient regarding abnormal findings. Monitor appropriately.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Interfering Factors ⬆

  1. Total estrogens

    1. Oral contraceptives

    2. Estrogen therapy

    3. Progesterone therapy

    4. Pregnancy and after administration of acetazolamide during pregnancy

  2. E2

    1. Radioactive pharmaceuticals

    2. Oral contraceptives

  3. E3

    1. Glucose and protein interfere with outcome.

    2. Day-to-day physiologic variation can be as much as 30%; therefore, single determinations are of limited use.

    3. Kidney disease—in which case a serum assay would be more accurate