Estradiol

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)
Prepubertal
Male and female	Less than 15 pg/mL	Less than 55.1 pmol/L
Adult male	8–35 pg/mL	29.4–128.4 pmol/L
Adult female
Follicular phase	30–100 pg/mL	110.1–367 pmol/L
Luteal phase	70–300 pg/mL	256.9–1,101 pmol/L
Postmenopause	Less than 15 pg/mL	Less than 55.1 pmol/L

Levels for males and females are elevated at birth but decrease in a few days to prepubertal values. Levels vary significantly during the female menstrual cycle.

Critical Findings and Potential Interventions ⬆ ⬇

Overview ⬆ ⬇

(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.

Indications ⬆ ⬇

Assist in determining the presence of gonadal dysfunction.
Evaluate menstrual abnormalities, fertility problems, estrogen-producing tumors in women, and testicular or adrenal tumors and feminization disorders in men.
Monitor menotropins (Pergonal) therapy; menotropins is a preparation of FSH and LH used to induce ovulation and increase the chance of pregnancy.

Interfering Factors ⬆ ⬇

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.

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Increased In

Adrenal tumors(related to overproduction by tumor cells)
Estrogen-producing tumors
Feminization in children (related to increased production)
Gynecomastia (newborns may demonstrate swelling of breast tissue in response to maternal estrogens; somewhat common and transient in pubescent males)
Hepatic cirrhosis (accumulation occurs due to lack of liver function)
Hyperthyroidism (related to primary increases in estrogen or response to increased levels of sex hormone–binding globulin)

Decreased In

Ovarian failure (resulting in lack of estrogen synthesis)
Primary and secondary hypogonadism (related to lack of estrogen synthesis)
Turner syndrome (genetic abnormality in females in which there is only one X chromosome, resulting in varying degrees of underdeveloped sexual characteristics)

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

Explain that a blood sample is needed for the test.
Discuss how this test can assist in assessing hormone level.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

Facilitate disease management.
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.
Interventions/actions include the following: 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 Evaluation and Desired Outcomes

Explains 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.