Question 1

What is estrogen?

Accepted Answer

Oestrogen, or estrogen, is a hormone that is commonly known for regulating female reproductive functions. Nonetheless, oestrogens play a crucial role in the physiology of women, directly impacting their health and social lives.[1]
Oestrogens are more than one hormone: when we talk about &lsquo;oestrogen&rsquo;, we are talking about a family of steroid hormones whose primary function involves the development of female sexual characteristics. The female body produces three natural oestrogens:[1]


	Oestradiol (E2) is an oestrogen produced in the ovaries of premenopausal women thanks to the regulation of follicle-stimulating hormone (FSH) and luteinising hormone (LH). Oestradiol is the most abundant and potent of the three, and is the marker measured in an estrogen level test kit.
	Oestrone (E1) is a less potent metabolite of oestradiol. It is produced in the fatty tissue and it can still be synthesised via the conversion of androstenedione (an adrenal hormone) in postmenopausal women.
	Oestriol (E3) is also an oestradiol metabolite. It is the least common oestrogen in non-pregnant women; however, it is abundantly produced by the placenta during pregnancy.

Question 2

What does estrogen do?

Accepted Answer

Oestrogens are in charge of developing the sexual characteristics of the female body, which includes the function and anatomy of their reproductive system; this makes oestrogen the most important hormone for female reproduction. While these hormones are conventionally female and related to sexual characteristics, they are also important for the male body and other organs.[2]

Hormones need receptors to execute their functions. In the case of oestrogens, they have two types of receptors which can be found in the following parts of the body:


	Genital tract: oestrogen promotes the development of female reproductive organs and regulates the menstrual and ovarian cycles.[1]
	
		In the ovary, oestrogen promotes the maturation of ovarian follicles (which contain an oocyte). Around 14 days before menstruation, oestrogens make LH levels increase drastically, causing the release of the oocyte (ovulation).[3]
		In the uterus, it helps the endometrial cells to grow during the follicular phase of the menstrual cycle; this thickened endometrium is required for optimal implantation.[4]
		In the vagina, oestrogen promotes the lubrication and development of the epithelial lining of the vagina and the vulva. This lining serves as a protective barrier from infections and other dangers.[4]
	
	
	Breast: it promotes the development of breast cells during puberty.[1][5] It also promotes the development of mammary tissue during pregnancy and milk production post-partum.[4][6]
	Skin: oestrogen increases the concentration of hyaluronic acid and keeps the skin hydrated.[1]
	Bone: increases mineral density and decreases bone reabsorption, resulting in stronger bones.[1][5]
	Liver: promotes the production of sex hormone-binding globulin, which is a transport protein that carries oestrogens from the blood to other tissues.[1]
	Lipids: oestrogen increases triglycerides and high-density lipoprotein (HDL), producing a decrease of low-density lipoprotein (LDL). This has a positive effect on lipid profile and may have a protective effect on cardiovascular health.[1][7]

Question 3

What are low estrogen symptoms?

Accepted Answer

Low estrogen levels mainly affect women, causing:


	Irregular menstrual cycles.
	Absence or complete disappearance of periods.
	Infertility (having trouble conceiving).
	Breast tenderness (which may be normal in the second half of the menstrual cycle, when oestrogen levels decrease naturally).
	Fatigue.
	Sleeping problems, such as insomnia.
	Mood swings, including depression.
	Decreased vaginal lubrication.
	Increased risk of vaginal infections.
	Increased risk of urinary tract infections.
	Hot flashes.
	Bone deterioration and increased risk of fractures.
	Headaches.
	Irregular sexual development if present during puberty.


Men can also be affected by low levels of oestrogen, resulting in:


	Sexual dysfunction.
	Decreased sexual desire.
	Sleeping problems.
	Fatigue.
	Excess fat around the belly.

Question 4

What causes low estrogen levels?

Accepted Answer

Oestrogen production rises significantly during puberty and maintains shifting levels caused by ovarian cycles throughout a woman&rsquo;s reproductive life, almost coming to a halt after menopause.[8] However, oestrogen deficiency may occur in premenopausal women too:


	Premature ovarian insufficiency (POI, commonly known as early menopause): an ovary has a limited amount of oocytes (immature eggs) that decreases after each ovulation. Eventually, oocytes reach a critically low level in the late forties to early fifties, resulting in a naturally occurring form of ovarian insufficiency (menopause).[9] When this occurs before the 40 years of age, it is called POI and may be caused by:[9]
	
		Genetic problems, especially Turner syndrome.
		Autoimmune disorders, such as autoimmune thyroiditis, Addison&rsquo;s disease, type 1 diabetes, or coeliac disease.
		Endometriosis.
		Cigarette smoking.
		Cancer therapy, especially chemotherapy or radiotherapy that involves the pelvis.
		Excessive exercise, especially when associated with low weight.[10] On the other hand, 150 minutes per week of moderate-to-vigorous aerobic exercise may decrease the risk of breast cancer in healthy women.[11]
	
	
	Low weight and eating disorders (anorexia and bulimia).[10]
	Oophorectomy (surgical removal of ovaries).[8]
	Increased prolactin levels, which reduces oestrogen production.[8]
	Drugs that increase prolactin, such as antidepressants, antipsychotics, oestrogens, anti-androgens, anti-hypertensives, etc.[8]

Question 5

What happens when estrogen levels are low?

Accepted Answer

Decreased oestrogen production opens the doors for multiple problems, evidenced by the increased risk of disease women face from the moment they reach menopause.[8] In general, women that experience low oestrogen levels (indifferent from the cause) are at increased risk of:


	Infertility: low oestrogen levels impair ovulation and cause irregular periods.[9]
	Vaginal atrophy: vaginal walls become thinner and the vagina turns less acid, creating a higher risk of inflammation and infections. Vaginal lubrication, another protective layer, is also impaired and results in painful intercourse.[12]
	Tall stature: low oestrogens during puberty cause delayed epiphyseal closure, resulting in longer bones.[8]
	Osteoporosis: loss of bone mass, bone fragility, and porosity.[8]
	Arthralgia (joint pain): joint pain, stiffness, and dysfunction are common findings in aged postmenopausal women.[8] Low oestrogen levels may also influence the increased risk of rheumatoid arthritis seen in postmenopausal women.[13]
	Alzheimer&rsquo;s disease.[8]
	Parkinson&rsquo;s disease.[8]
	Schizophrenia.[8]

Question 6

What are high estrogen symptoms?

Accepted Answer

Women with high levels of oestrogen may experience the following symptoms:


	Irregular menstruations.
	Heavier or lighter (spotting) menstrual bleeding.
	The usual symptoms that appear a few days before menstruation (premenstrual syndrome) become more intense, such as mood swings, bloating, breast tenderness, headaches, etc.
	Excessive fat, especially around the pelvis (hips, waist, thighs).
	Depression or anxiety.
	Forgetfulness.
	Fatigue or sleepiness.
	Hair loss.
	Decreased sexual desire.
	Higher chances for developing breast lumps and uterine myomas or fibroids (benign, non-cancerous tumours).


Men can be affected by high levels of oestrogens, especially oestradiol. The symptoms may be more serious and clinically evident than those caused by low levels of oestrogen:


	Gynaecomastia (enlargement of the breasts in males).
	Erectile dysfunction.
	Fertility problems.

Question 7

What causes high estrogen levels?

Accepted Answer

Oestrogen levels are usually altered by increased production, increased intake, or metabolic disruption.


	Hormone replacement therapy (HRT): this therapy employs oestrogens and, sometimes, progestogens to relieve menopause symptoms and extend the benefits of these hormones to postmenopausal women.[14] However, HRT should not cause dangerously high oestrogen levels if the treatment is taken as indicated and monitored by a physician.
	Hormonal contraceptives: many hormonal contraceptives employ oestrogen and progestogen to prevent ovulation and, thus, pregnancy.[15] Similarly to HRT, well-guided and responsible use of contraceptives should not cause dangerously high levels of oestrogen.
	Oestrogen-producing tumours: some ovarian tumours are capable of producing oestrogens. Granulosa cell tumours and thecomas are common examples.[16]
	Obesity: oestrogen production in fatty tissue is increased as people gain more weight.[17]
	Personal care and household products: numerous everyday products (cosmetics, fragrances, plastics) contain compounds that have oestrogenic-disrupting properties, resulting in increased activity. Some examples are bisphenol A, phthalates, parabens, benzophenones, nitro musks, etc.[8]

Question 8

What happens when estrogen levels are high?

Accepted Answer

An excessively high concentration of oestrogens is harmful to the body and may lead to undesirable outcomes:


	Polycystic ovary syndrome (PCOS): this condition is characterised by plenty of hormonal disturbances (including androgens, oestrogens, and insulin) that affect oocyte maturation, prevent ovulation, and result in water-filled follicles (cysts) in the ovaries. This is a common condition that affects many women during their reproductive lives, causing hirsutism (hair growth in masculine areas), alopecia (hair loss), amenorrhoea (absent menstruations), and infertility. It also represents a risk factor for developing hypertension, type 2 diabetes mellitus, depression, among other diseases.[8]
	Gynaecological cancers (endometrial cancer, ovarian cancer, and breast cancer): the development and growth of endometrial, ovarian, and breast tissues are deeply influenced by oestrogens levels. For this reason, high levels of this hormone may facilitate the evolution of certain types of cancer in these organs.[8]
	Other types of cancer: high oestrogen levels are also related to non-gynaecological cancers, such as gastric, lung, liver, pituitary, and thyroid cancers.[8]
	Systemic lupus erythematosus: this condition is very rare in men and high oestrogens may play a role in its development.[8]
	Endometriosis: caused by the growth of endometrial tissue outside the uterus, causing pain, bleeding, fatigue, and infertility.[8]
	Blood clots: excessive oestrogens are associated with a small but significant risk increase for venous thromboembolism.[18]
	Short stature: high levels of oestrogen during puberty signal the bones to stop growing earlier, resulting in short stature in boys and girls.[8]


Men may be affected by high oestrogen levels, resulting in:[8]


	Hypogonadism (underdevelopment of male sexual characteristics).
	Gynaecomastia (growth of breast tissue in men).
	Prostatic cancer.

Question 9

When should estrogen levels be checked?

Accepted Answer

Oestradiol (E2) levels can be tested in the following situations:


	Menopause symptoms.
	Vaginal bleeding after menopause.
	Trouble conceiving (infertility).
	Menstruations are irregular or abnormal.
	Absent menstruations during childbearing age.
	Delayed puberty (girls and boys).
	Early puberty (girls).
	Female characteristics in a boy or man (gynaecomastia).
	Monitoring treatments for infertility.
	Monitoring treatments for menopause.
	Suspicion of oestrogen-producing tumours.

Question 10

What is an estrogen dominance test?

Accepted Answer

Oestrogen dominance is a condition described by Dr John Lee in 1996. His theory claimed that this metabolic condition occurred when oestrogen levels were high in relation to progesterone levels. If there was an elevated oestrogen-progesterone ratio, even when oestrogen levels were normal, he considered the patient might be presenting &lsquo;oestrogen dominance&rsquo;, proposing progesterone as treatment.[19]

This has been criticised for lacking scientific evidence in the past[20] and, as our understanding of biochemistry and the ovarian cycle has advanced, the oestrogen dominance theory is now considered incorrect. The logic behind this theory suggested that a person that is going to be tested for oestrogen should also be tested for progesterone (oestrogen dominance test); however, this is misleading. Progesterone should be tested when requested by your doctor, usually during pregnancy or for the determination of ovulation date.[21]

Question 11

How to test estrogen levels at home?

Accepted Answer

Vitall offers two simple ways to test oestrogen blood levels at home. You can get tested for oestrogen (E2), luteinising hormone (LH), and follicle-stimulating hormone (FSH) with the Female Hormones (Menopause) Home Test Kit and get your results delivered securely online usually within 24 hours.

If you are looking for a fertility test, the Female Fertility (Sex Hormones) Home Test Kit may suit your needs. This home test kit includes the same hormones as the previous test kit but adds prolactin, a vital hormone during the diagnosis of oestrogen and ovulation problems.

Oestrogen (Estradiol) Testing (E2)

The Oestrogen (Estradiol) test is also known as a Estrogen, Oestrone (E1), Oestradiol (E2) and Oestriol (E3) test.

What Is The Oestrogen (Estradiol) Test For?

How To Test Oestrogen (Estradiol)

Estrogen (Estradiol) Test Kit