Synonym/Acronym
E2.
Rationale
To assist in diagnosing female fertility problems that may occur from tumor or ovarian failure.
Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.
Normal Findings
Method: Liquid chromatography/mass spectrometry.
| Age | Conventional Units | SI Units (Conventional Units × 3.67) |
|---|
| 12 mo–10 yr | | | | Male and female | Less than 17 pg/mL | Less than 62.4 pmol/L | | 11–15 yr | | | | Male | Less than 40 pg/mL | Less than 147 pmol/L | | Female | Less than 300 pg/mL | Less than 1,100 pmol/L | | Adult male | Less than 50 pg/mL | Less than 184 pmol/L | | Adult female | | | | Early follicular phase | 20–150 pg/mL | 73–551 pmol/L | | Late follicular phase | 40–350 pg/mL | 147–1,285 pmol/L | | Midcycle peak | 150–750 pg/mL | 551–2,753 pmol/L | | Luteal phase | 30–450 pg/mL | 110–1,652 pmol/L | | Postmenopause | Less than 20 pg/mL | Less than 73 pmol/L |
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Study type: Blood collected in a gold-, red-, red/gray-, or green-top [heparin] tube; related body system: Endocrine and Reproductive systems.
Estrogens are steroid hormones named for their role in the female estrous cycle. Estrogens are responsible for the development of secondary female sex characteristics (development of breasts, appearance of pubic hair), maintenance of the menstrual cycle, maintenance of the placenta during pregnancy, and initiation of lactation (via a feedback loop involving prolactin). The three types of estrogen commonly measured are estrone (E1), estradiol (E2), and estriol (E3).
Estrogens are produced by the ovaries, testes, liver, adrenal glands, and in fatty tissue (e.g., breast tissue). Ovarian estrogen hormone formation begins with the conversion of cholesterol into androstendione in the theca interna cells, followed by conversion to estradiol in ovarian granulosa cells. Estradiol, the most powerful of the estrogens, is the main estrogen produced in women who are not pregnant during the period between puberty and menopause. Estriol is the primary estrogen secreted during pregnancy, and it is provided by the placenta. Secretion of estrogens is influenced by the pituitary gonadotropins follicle-stimulating hormone (FSH) and luteinizing hormone (LH). After menopause, the ovaries stop producing estrogens, and the secondary sources (liver, adrenal glands, and breast tissue) provide estrogens mostly in the form of estrone.
Factors That May Alter the Results of the Study
- Drugs and other substances that may increase estradiol levels include cimetidine, clomiphene, dehydroepiandrosterone, diazepam, estrogen/progestin therapy, ketoconazole, mifepristone (some patients with meningiomas and not receiving any other drugs), nafarelin, nilutamide, phenytoin, tamoxifen, and troleandomycin.
- Drugs and other substances that may decrease estradiol levels include cimetidine, danazol, fadrozole, formestane, goserelin, leuprolide, megestrol, mifepristone (pregnant women with expulsion of fetus), mepartricin, nafarelin (women being treated for endometriosis), and oral contraceptives.
Other Considerations
- Estradiol is secreted in a biphasic pattern during normal menstruation; the highest levels occur immediately prior to ovulation in the midcycle, then rapidly decrease after ovulation until the luteal phase when there is a second moderate increase. Knowledge of the phase of the menstrual cycle may assist interpretation of estradiol levels.
Before the Study: Planning and Implementation
Teaching the Patient What to Expect
- Discuss how this test can assist in assessing hormone level.
- Explain that a blood sample is needed for the test.
After the Study: Implementation & Evaluation Potential Nursing Actions
Treatment Considerations
- Discuss symptoms of ovarian failure: hot flashes, irritability, night sweats, trouble becoming pregnant, eye and vaginal dryness, concentration difficulty, low sex drive, periods that are irregular or skipped.
- Explain it may be necessary to monitor hormone levels: estradiol, follicle stimulating hormone, or prolactin.
- Treatment options include hormone therapy with vitamin supplements to prevent osteoporosis.
Clinical Judgement
- Consider how to diminish the emotional impact of fertility concerns as related to the desire to have children.
Follow-Up and Desired Outcomes
- Explain that study results may indicate the need for additional testing to evaluate or monitor progression of the disease process and determine the need for a change in therapy.
- Agrees to genetic counseling and screening related to a specific disease process.