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Estrogens, Total Test

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Estrogens, Total


Introduction:
A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes.


 

Estrogens, Total Test

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Estrogens, Total

Introduction:
A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes.

 

Estrogens are a group of hormones that are synthesized mainly by the ovaries, a small amount is synthesized by the testes in males and by the adrenal cortex in both sexes. The placenta produces a fairly large amount of estrogen as well.

The three main endogenous estrogens are estradiol, estriol and estrone. Estrogens control female sexual development, the growth and function of female sexual organs and other secondary characteristics such as breast development. Excessive production of estrogen in men causes feminization.

Natural and synthetic estrogens are used to treat amenorrhea and menopausal symptoms. They can inhibit lactation and are also used in treatment of androgen-dependent cancers such as prostate cancer. Estrogens are given in any condition with estrogen deficiency.

Estrogens are used as contraceptives, in combination with progestins (another class of sex hormones).

 

Definition

The estrogens test measures the total amounts of the most important estrogen in the blood. Estrogens are the hormones responsible for female sexual development and function. In women, estrogens are produced primarily in the ovaries. Small amounts of estrogens are produced by the adrenal glands and testicles in men.

The estrogens blood test is used to monitor fertility therapies, detect fetal birth defects, identify tumors in the ovaries of girls before menstruation and in women after menopause, and help detect tumors in the testicles of men.

Because estrogen hormones such as estradiol and estrone fluctuate during a woman’s cycle and even in menopause, some doctors believe that the total estrogen measurement is a more reliable test of estrogen status.

This test does not include a breakdown of each individual estrogen level. If you are interested in knowing the blood levels of estradiol (E2) and estrone (E1), we suggest ordering the following individual tests:

  • Estradiol (LC004515)
  • Estrone  (LC004564)

 

Life Extension also offers a 24 hour urine test for the three major estrogens (Estrone, Estradiol and Estriol) and their metabolites:

  • Urinary Hormone Profile (24 hour) (LCM4098)

 

This test is also included in the Female Hormone Add-On Panel (LCADDF) and the Female Hormone Re-Test Profile (LCRTF).

Fasting is not required. Take all medications as prescribed.

Test Details

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood

 

 

test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Estrogens are the hormones responsible for female sexual development and function. In women, the ovaries are the primary producers of estrogens. In men, the adrenal glands and the testicles produce small amounts of estrogens. The total estrogens test measures the blood levels of the primary estrogens: estriol, estradiol and estrone.

The reasons for ordering a total estrogen blood test are many. These hormones impact reproductive and sexual functioning, as well as bone health, heart health, nerves and metabolism. Both men and women with low levels of estradiol, for example, may be at risk for osteoporosis. Monitoring total estrogen levels helps detect fetal birth defects, identify ovarian tumors in prepubescent girls and post-menopausal women and detect testicular tumors. Total estrogen also helps evaluate symptoms of menopause and the treatment of such. The test more accurately measures the estrogen hormones that fluctuate during a woman’s cycle and during menopause than tests that measure strictly estrogen.

Both men and women should keep their estrogen levels within the normal range for optimal health, aging and libido. Men with higher than normal estrogen levels may need testosterone therapy. Higher levels of estrogen are also known to cause certain cancers, such as breast, ovarian and prostate.

Description

Estrogen therapy, with or without a progestogen (progesterone and progestin), has long been prescribed to treat menopausal symptoms. It has been extensively studied, and it is the most consistently effective therapy for vasomotor symptoms. Data from numerous studies suggest that oral, transdermal, or vaginal hormone therapy reduces the severity of hot flashes by 65-90%.The available data do not suggest that different types of estrogens (eg, conjugated estrogens vs estradiol) differ in efficacy.

Estrogen, a steroid hormone, is derived from the androgenic precursors androstenedione and testosterone by means of aromatization. In order of potency, naturally occurring estrogens are 17 (beta)-estradiol (E2), estrone (E1), and estriol (E3). The synthesis and actions of these estrogens are complex.

 

 

In brief, these forms of estrogen can be summarized as follows:

  • Estradiol - Primarily produced by theca and granulosa cells of the ovary; it is the predominant form of estrogen found in premenopausal women

 

  • Estrone - Formed from estradiol in a reversible reaction; this is the predominant form of circulating estrogen after menopause; estrone is also a product of the peripheral conversion of androstenedione secreted by the adrenal cortex
  • Estriol - The estrogen the placenta secretes during pregnancy; in addition, it is the peripheral metabolite of estradiol and estrone; it is not secreted by the ovary.

 

Estrogens affect many different systems, organs, and tissues, including the liver, bone, skin, gastrointestinal (GI) tract, breast, uterus, vasculature, and central nervous system (CNS). These effects appear to become most prominent during times of estrogen deficiency, such as the menopausal transition.

 

Menopausal Transition

Menopause is defined as the permanent cessation of menstrual periods that occurs naturally or that follows surgery, chemotherapy, or irradiation. Natural menopause is recognized after a woman has not had menses for 12 consecutive months and after other pathologic or physiologic (eg, lactation) causes are ruled out. The median age of women undergoing menopause is 52 years.

 

 

Symptoms of Menopause

During the menopausal transition, a reduction in ovarian function results in a number of symptoms. Symptoms secondary to changes in ovarian hormones can be difficult to distinguish from those due to general aging and/or other life changes. Symptoms often attributed to estrogen deficiency are many and vary in intensity among women. Symptoms most commonly reported during the menopausal transition include vasomotor symptoms, such as hot flashes and night sweats, vaginal and vulvar dryness, and sleep disturbances.

The prevalence of vasomotor symptoms is 14-51% in premenopausal women, 35-50% in perimenopausal women, and 30-80% in postmenopausal women.Most women have hot flashes for 6 months to 2 years. However, one study group reported that 26% of women had hot flashes for 6-10 years and that 10% had them for more than 10 years.

According to the Study of Women’s Health Across the Nation (SWAN), the prevalence of vasomotor symptoms is highest among African-American women (46%), followed by Hispanic (34%), Caucasian (31%), Chinese (21%), and Japanese (18%) women.

Other symptoms often attributed to menopause, but not necessarily well supported by data, include mood symptoms, cognitive disturbances, somatic symptoms, urinary incontinence, uterine bleeding problems, and sexual dysfunction. All of these may ultimately negatively affect the woman's overall quality of life.

Diseases occurring around the time of Menopause

Menopause is also the time when the incidence and prevalence of other diseases, such as cardiovascular disease and osteoporosis, substantially increase. The effect of these conditions becomes important because women live long after menopause, and hormone status directly impacts disease progression and manifestation.

 

Menopause and Hormone Therapy

Although decreasing estrogen levels alone do not cause all menopausal symptoms, estrogen—with or without progestogen (progesterone and progestin)—has been prescribed for many years to manage menopause. Estrogen was often prescribed to help alleviate symptoms of menopause, as well as to prevent cardiovascular disease (CVD) and osteoporosis.

Some have recommended that the term hormone replacement therapy (HRT) be changed to hormone therapy, to reflect the shift in focus from replacing hormones to using them for symptomatic relief.

Preparations

Several preparations are available for hormone therapy. They include estrogen therapy alone or estrogen in combination with a progestogen (EPT). Unopposed estrogen increases the likelihood of endometrial hyperplasia and endometrial carcinoma.Prolonged use and, possibly, high doses are associated with increased risk of cancer.

When the effect of duration of use was evaluated, the relative risk (RR) ranged from 2.8 for 1-5 years of use to 9.5 for more than 10 years of use.Therefore, the addition of progestogen is advised for endometrial protection in women with a uterus. The exception is when low-dose estrogen is locally administered to treat vaginal atrophy.Of note, no long-term safety data are available regarding use of unopposed, low-dose, local vaginal estrogen therapy.

Delivery systems

Preparations for estrogen therapy and EPT include oral, transdermal, injectable, and vaginal formulations. Transdermal delivery systems include patches, gels, sprays, and lotions, while vaginal products include suppositories, creams, and rings.

Because of the potential risks and existing controversies regarding high-dose oral regimens, the popularity of low-dose preparations and different delivery systems (eg, transdermal patches, gels, and lotions) is increasing. One vaginal preparation, the estradiol acetate ring, delivers a systemic dose of estradiol.

Nonoral preparations avoid a first-pass hepatic effect. Therefore, they may not produce changes in lipids, clotting factors, and inflammatory markers. As a result, they may possibly decrease health risks and adverse effects. Data have indicated that transdermal preparations, when compared with oral estrogen, are not associated with an increased risk of venous thromboembolism.

EPT may be continuous (ie, daily administration of estrogen and progestogen) or continuous sequential (ie, daily administration of estrogen, with progestogen added on certain days).

 

Hormone Therapy and Vasomotor Symptoms

As previously mentioned, estrogen therapy, with or without a progestogen, has long been prescribed to treat menopausal symptoms and is the most consistently effective therapy for vasomotor symptoms.Numerous studies suggest that oral, transdermal, or vaginal hormone therapy reduces the severity of hot flashes by 65-90%. The different types of estrogens (eg, conjugated estrogens vs estradiol) have not so far been found to differ in efficacy.

High-dose versus low-dose therapy

Data also indicate that low-dose preparations are effective in reducing the severity and number of hot flashes compared with commonly prescribed doses, though a dose-response relationship may be observed. Low-dose estrogen is often considered to be 0.3mg or less of conjugated estrogen, 0.5mg or less of oral micronized estradiol, 2.5 μ g or less of ethinyl estradiol, or 25 μ g or less of transdermal estradiol.

 

Differences between high- and low-dose preparations tend to be greatest at 4 weeks after the start of hormone therapy and are reduced after 8-12 weeks. Low-dose preparations are desirable because they may be safer than high-dose forms in terms of cardiovascular disease (CVD), venous thromboembolism, stroke, and breast cancer. In addition, they also decrease unacceptable adverse effects, such as irregular bleeding and breast tenderness.

Women who are starting low-dose estrogen therapy should be counseled that it may take 8-12 weeks for their vasomotor symptoms to be relieved. If a low-dose estrogen is selected, a low dose of progestogen can also be prescribed. This reduction can be accomplished either by decreasing the daily dose or by increasing the interval between cycles. No current guidelines have been established. However, low doses of oral medroxyprogesterone acetate (ie, 1.5mg/day), when combined with low doses of oral conjugated estrogen (0.30-0.45mg/day), provide adequate endometrial protection.Likewise, a low dose of norethisterone acetate (0.125mg/day), when combined with estradiol (0.025mg/day) in a transdermal preparation, also provides endometrial protection.

Furthermore, if low-dose estrogens are used with cyclic progestogen regimens, intervals between progestogen use can be lengthened without significantly compromising endometrial protection. Examples of this approach include using medroxyprogesterone acetate 10mg/day for 14 days every 3 months or every 6 months.

Nonhormonal Therapy

For a variety of reasons, some women do not wish to take hormones and are more interested in herbal products. In comparisons of oral estrogen therapy (0.625mg of conjugated estrogen with or without medroxyprogesterone acetate 2.5mg/day) with a variety of herbal supplements, hormone therapy was the only treatment that reduced vasomotor symptoms.Herbal formulations that have been shown to reduce symptoms with short-term use contain mostly black cohosh.

A study by Freeman et al found that the use of escitalopram (10-20mg/day), a selective serotonin reuptake inhibitor (SSRI), can be a useful alternative to estrogen/progesterone; escitalopram reduces and alleviates more severe hot flashes.
Cardiovascular Disease Prevention

Results from epidemiologic studies in the 1980s and 1990s, such as the Nurses' Health Study, suggested that hormone therapy was protective against coronary heart disease (CHD) and related mortality.Data from retrospective studies also supported the notion that hormone therapy was cardioprotective. Indeed, findings from a meta-analysis suggested that hormone therapy decreased the risk of CVD in women by 40-50%. The conclusion from another meta-analysis was that hormone therapy should probably be recommended for women who have undergone a hysterectomy and for those with CHD or who are at high risk of CHD.

In fact, the data regarding the multiple benefits of hormone therapy were so convincing that a 1998 American College of Obstetricians and Gynecologists (ACOG) Educational Bulletin stated, "Hormone replacement therapy should be considered to relieve vasomotor symptoms, genital urinary tract atrophy, and mood and cognitive disturbances, as well as to prevent osteoporosis and cardiovascular disease." Of note, the bulletin did mention that these perceived benefits must be assessed against the potential increased risk of breast cancer.

The mechanism thought to mediate this reduction in CVD is the beneficial effects on lipids and lipoproteins, particularly increased high-density-lipoprotein cholesterol, and decreased low-density lipoprotein-cholesterol concentrations. Also noted are reductions in fibrinogen, fasting glucose, and insulin levels, as well as beneficial effects on arterial walls.The effects of hormone therapy on hemostatic variables are complex, and the data are conflicting.

 

Hormone Therapy and Breast Cancer

The potential link between hormone therapy and breast cancer has been controversial for many years. Observational studies, reported primarily in the 1970-1990s, tended to show an increased risk of breast cancer among women who use hormone therapy. The findings have typically shown that EPT carries a greater risk than does estrogen therapy. Some studies have not demonstrated an increased risk with estrogen therapy. The increased risk tends to be associated with long use (ie, >5 years).

Data from 51 epidemiologic studies revealed a significant increase in breast cancer with hormone therapy, with greatest increases observed with prolonged hormone therapy. Women taking EPT or progestogen alone for more than 5 years had an RR of 1.15 compared with women who never received these treatments. Women who used 3 hormones for at least 5 years had an RR of 1.53. Among women taking estrogen alone, the risk of breast cancer increased only when duration of use was 5 years (RR, 1.34) or longer. Of interest, the increase in risk disappeared approximately 5 years after the cessation of hormone therapy.

Data from the Nurses’ Health Study revealed an increase in risk of breast cancer (RR, 1.77) among women who used estrogen plus testosterone compared with women who were never given hormone therapy.In addition, the risk of breast cancer rose among recipients of EPT (RR, 1.58). Patients taking estrogen alone had a relatively low risk (RR, 1.15), though it was still greater than that of nonusers.

Results from the WHI have confirmed an increased risk of breast cancer in EPT users. The EPT arm of the WHI was initially halted early secondary to an increased risk of total and invasive breast cancers in the women taking EPT compared with placebo after slightly more than 5 years of use. It was determined that there were 8 additional cases of breast cancer for every 10,000 women over 1 year. For the invasive breast cancers in the EPT group, they were larger, more likely to be node positive, and diagnosed at a significantly more advanced stage compared with placebo. Although the trend was for increased in-situ breast cancers in the EPT group, it was not statistically significant.

Women in the estrogen-alone arm of the WHI did not experience an increase in breast cancer after more than 7-year follow-up. In fact, fewer breast cancers occurred in the women given estrogen therapy than in those given placebo. However, the difference was not statistically significant.

Mammographic breast-density increases in women taking hormone therapy. Although the biologic importance of this finding has not been established, mammographic abnormalities require additional medical evaluation. Abnormal mammograms among women participating in the WHI were noted within the first year of treatment. Other investigators have also reported this finding. EPT slows the changes from a relatively dense pattern to the fatty pattern normally seen in women as they age. The effect of EPT is greater than that of estrogen therapy.Transdermal EPT does not appear to increase breast density to the same degree that oral EPT does.

Of interest, the Surveillance Epidemiology and End Results (SEER) registries of the National Cancer Institute indicated a notable reduction of 6.7% in the incidence of breast cancer, particularly estrogen receptor–positive tumors, beginning in mid-2002. This timing corresponded to the WHI report of an increase in breast cancer with EPT; this report led to the discontinuation of hormone therapy in many women. Some investigators suggested that this subsequent discontinuation of hormone therapy was what reduced the incidence of breast cancer. Others, including the International Menopause Society, urged caution in linking these trends.

Hormone Therapy and Osteoporosis

Existing evidence largely supports the efficacy of hormone therapy in increasing bone mineral density and decreasing the risk of fracture. A meta-analysis of 22 randomized trials showed a significant reduction of 35% in nonvertebral fractures among women who began hormone therapy before the age of 60 years, with a possible attenuation of the benefit when hormone therapy is started after age 60 years. The WHI investigators also reported significant decreases in the fracture risk with estrogen therapy and EPT.

In fact, all of the hormone therapy preparations are indicated for the prevention of osteoporosis. Ultralow doses of oral or transdermal estrogen have also been shown to increase bone mineral density and decrease bone turnover in postmenopausal women and are indicated for osteoporosis prevention. Data about fractures are not yet available.

The stance adopted by the ACOG is that the use of hormone therapy for osteoporosis prevention or treatment needs to be individualized and needs to include the woman’s need for treatment of vasomotor symptoms. Although other medications are available, such as bisphosphonates and selective estrogen receptor modulators, selected women with vasomotor symptoms may benefit from hormone therapy.

Hormone Therapy, Cognition, and Quality of Life

Limited data have linked the menopausal transition to a variety of mental health conditions, including depression, anxiety, and irritability, as well as to decreased cognitive function. The WHIMS substudy of the WHI was designed to address the effects of hormone therapy on cognitive function. In addition, issues related to health-related quality of life were analyzed in the WHI.

Observational studies and several randomized, controlled trials have provided limited evidence that hormone therapy positively affects cognition. The WHIMS did not confirm these positive findings. No improvement in global cognitive function was observed in women using hormone therapy. In fact, the incidence of dementia and mild cognitive impairment increased among women taking hormone therapy. The increase was statistically significant only in the EPT group.

As with the findings for CVD, cognitive results differed in the WHI and other studies. As with CVD, some have hypothesized that hormone therapy may have been started at too late an age or too long after the onset of menopause to provide any benefit. Observations from animal and human studies support this critical-period hypothesis. Therefore, additional data are needed to elucidate the effect of the timing of hormone therapy on cognitive function.

Quality of life

Data about the effects of hormone therapy on health-related quality of life do not suggest a positive effect. The WHI data did indicate a significant improvement in the sleep-disturbance score with hormone therapy. However, no overall improvement was noted in health-related quality of life among women using hormone therapy.

Other Benefits and Risks of Hormone Therapy

Hormone therapy may also improve the incidence of colorectal cancer.

A continuation of the WHI Estrogen-Alone Trial followed postmenopausal women with prior hysterectomy for a median of 5.9 years. Use of combined equine estrogens was not associated with an increase or a decrease in deep vein thrombosis, coronary heart disease, strokes, hip fractures, colon cancer, or total morbidity. A continued decreased risk of breast cancer was noted.

 

Hormone Therapy After the WHI

Over the years, the number of prescriptions for hormone therapy has reflected scientific findings. In the 1970s, the number of prescriptions increased to approximately 30 million per year. This practice was likely due to data describing the cardioprotective effects of hormone therapy.

In the 1980s, reports of increased rates of endometrial cancer with unopposed estrogen lead to a decrease in annual prescriptions to about 15 million. Then, the addition of progestogen for endometrial protection renewed interest in hormone therapy, and prescriptions again increased.

Between 1995 and 2002, annual prescriptions peaked at about 91 million. Termination of the estrogen-progestin arm of the WHI in July 2002 and release of the HERS II data received considerable media attention and raised serious questions about the safety of hormone therapy in postmenopausal women. Many women stopped taking hormones and began to seek out alternative therapies. Prescriptions for hormone treatment immediately decreased. Of note, prescriptions for vaginal preparations did not change during this time.

In a 2010 published study by the WHI, estrogen plus progestin therapy appeared to increase the risk of breast cancer mortality and incidence when compared with placebo.

Current Recommendations for Hormone Therapy

In response to the findings from the WHI, many health organizations revised their recommendations regarding hormone therapy. Although hormone therapy should not be used for disease prevention, it is still appropriate as a treatment to relieve menopausal symptoms. The US Food and Drug Administration (FDA) required labeling information to include the following statement: "Estrogens with or without progestins should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman." ACOG, NAMS, and the US Preventive Services Task Force echoed these same recommendations.

Additional data on the health-related effects of hormone therapy in postmenopausal women are obviously needed. Although the WHI provided important information, only 1 hormonal preparation was evaluated. Many other preparations are available, including formulations with substantially lowered doses and formulations with different delivery systems. Until more data are available, following the current recommendations is prudent.

Bioidentical Hormone Therapy

Bioidentical hormones are plant-derived compounds that have the same chemical and molecular structure as those of hormones produced by the human body. Pharmacists can custom prepare and package (compound) bioidentical hormones according to a physician’s specifications.

After results of the WHI were reported in 2002, interest in bioidentical hormones increased because they have been promoted as a safer alternative to traditional hormone therapy, with the ability to tailor dosages of various estrogens. Although the existing studies on bioidentical hormones have not shown an increase in breast cancer, these studies have been too short in duration or methodologically flawed to show changes. These findings have unfortunately been interpreted as proof of safety rather than as inconclusive. This may be misleading to the public.

Thus, the primary disadvantages of bioidentical hormone therapy are that these preparations have not undergone rigorous clinical testing for safety or efficacy and that they are not regulated by the FDA. Therefore, in addition to safety questions, quality assurance is a concern. Issues include the purity, potency, and quality of the products. Because these products are not FDA regulated, their labeling does not need to include the warning the FDA now requires for traditional hormone therapy.

No evidence suggests that bioidentical hormone therapy is safer than regulated hormone therapy. Professional medical societies (eg, ACOG , NAMS, The Endocrine Society ) have published position statements regarding bioidentical hormones. These groups have expressed concerns regarding the lack of safety and efficacy data.

Reference Range(s)

Females:

  • Prepubertal: < 40.0 pg/mL
  • Postmenopausal: < 40.0 pg/mL
  • HMG Treatment (therapeutic range): 400-800 pg/mL
  • Days 1-10 of menstrual cycle: 61-394 pg/mL
  • Days 11-20 of menstrual cycle: 122-437 pg/mL
  • Days 21-30 of menstrual cycle: 156-350 pg/mL

 

Males:

  • Prepubertal: < 40.0 pg/mL
  • Adult: 40.0-115.0 pg/mL

 

Why is this test important?

Hormones are a chemical substance secreted by one tissue and traveling to another to affect other tissues in your body. They act as chemical messengers. Maintaining proper balance of these important "messengers" is key to optimal health. These sex hormones are involved in the growth, maintenance, and repair of reproductive tissues. But that's not all. They influence other body tissues and bone mass as well.

Estrogen is a group of hormones primarily responsible for the development of female sex organs and secondary sex characteristics. While estrogen is one of the major female sex hormones, small amounts are found in males. Estradiol (E2) is produced in women mainly in the ovary. In men, the testes and adrenal glands are the principal source of estradiol. In women, normal levels of estradiol provide for proper ovulation, conception, and pregnancy, in addition to promoting healthy bone structure and regulating cholesterol levels.

What does the test include?

The HealthCheckUSA Estrogen (Total) Blood Test involves a blood draw by a qualified lab technician. The test includes:

  • Estrogen (Total) Hormone Blood Test

 

Why Do I Need This Hormone Blood Test?

To measure or monitor your hormone levels if you are a woman who has unexplained abnormal menstrual cycles, abnormal or heavy vaginal bleeding, infertility, symptoms of menopause, or any other hormonal alterations; fatigue, moodiness, low sex drive, loss of muscle tone, increased body fat. If you are a man who has unexplained hormonal alterations like fatigue, moodiness, low sex drive, loss of muscle tone, increased body and experiencing periods of not being able to get or maintain an erection (erectile dysfunction) and have questions about your fertility. If you are not experiencing any symptoms it is still prudent to learn what your baseline is, or what is normal for you, for future health and wellness.

How is it used?

Estrogen tests may be used for a variety of reasons:

  • Estrone levels may be elevated in patients with polycystic ovarian syndrome and endometriosis. Tests may be used to aid in the diagnosis of an ovarian tumor, Turner syndrome, and hypopituitarism. In males, it may help in the diagnosis of the cause of gynecomastia or in the detection of estrogen-producing tumors.

 

  • Estradiol levels are used in evaluating ovarian function. Estradiol levels are increased in cases of early (precocious) puberty in girls and gynecomastia in men. Its main use has been in the differential diagnosis of amenorrhea – for example, to determine whether the cause is menopause, pregnancy, or a medical problem. In assisted reproductive technology (ART), serial measurements are used to monitor follicle development in the ovary in the days prior to in vitro fertilization. Estradiol is also sometimes used to monitor menopausal hormone replacement therapy. A doctor may sometimes order a total estrogens test. This test measures estrone and estradiol together but does not measure estriol.
  • Estriol may sometimes be ordered serially to help monitor a high risk pregnancy. When it is used this way, each sample should be drawn at the same time each day. An unconjugated estriol test, one that measures estriol that is not bound to a protein, is one of the components of the triple or quad screen. Decreased levels have been associated with various genetic disorders including Down syndrome, neural tube defects, and adrenal abnormalities. It is ordered during pregnancy, along with maternal alpha-fetoprotein (AFP maternal), human chorionic gonadotropin (hCG), and inhibin-A tests, to assess the risk of carrying a fetus with certain abnormalities.

 

When is it ordered?

A doctor may order an estrone or estradiol, along with other tests, when a woman has symptoms such as pelvic heaviness, abnormal vaginal bleeding, abnormal menstrual cycles, is experiencing infertility, and when a female's sex organs are developing earlier or later than normally expected. A doctor may also order estrone and/or estradiol when a woman is having hot flashes, night sweats, insomnia, and/or amenorrhea, symptoms of menopause. When a woman is taking hormone replacement therapy, her doctor may periodically order estrone levels to monitor treatment.

When a woman is experiencing fertility problems, her doctor may use estradiol measurements over the course of the menstrual cycle to monitor follicle development prior to in vitro fertilization techniques (timed with a surge in estradiol). Estradiol testing may also be ordered when a man shows signs of feminization, such as gynecomastia, that may be due to an estrogen-producing tumor.

During pregnancy, a doctor may order serial estriol samples to look for a trend, a rise or fall in the estriol level over time. Unconjugated estriol is often measured in the 15th to 20th week of gestation as part of the triple screen or quad screen.

 

What does the test result mean?

Increased or decreased levels of estrogens are seen in many metabolic conditions. Care must be used in the interpretation of estrone, estradiol, and estriol results because their concentrations will vary on a day-to-day basis and throughout the menstrual cycle. A doctor is monitoring a woman's hormones will be looking at trends in the levels, rising or lowering over time in conjunction with the menstrual cycle or pregnancy rather than evaluating single values. Test results are not diagnostic of a specific condition but give the doctor additional information about the potential cause of a person's symptoms or status. Below are conditions where one might see an increase or decrease of estrogen levels.
Increased levels of estrogens are seen in:

  • Normal menstrual cycle
  • Early (precocious) puberty
  • Gynecomastia
  • Tumors of the ovary, testes, or adrenal glands
  • Hyperthyroidism
  • Cirrhosis

 

 

Decreased levels of estrogen are seen in:

  • Turner syndrome
  • Hypopituitarism
  • Hypogonadism
  • Failing pregnancy (estriol)
  • Eating disorder anorexia nervosa
  • After menopause (estradiol)
  • PCOS (Polycystic ovarian syndrome, Stein-Levanthal syndrome)
  • Extreme endurance exercise

 

Is there anything else I should know?

Blood and urine results are not interchangeable. Your doctor will choose which estrogen and sample type to test for based upon what she is looking for.

Beyond daily and cycle variations, illnesses such as hypertension, anemia, and impaired liver and kidney functions can affect estrogen levels in the body.

Some drugs, such as glucocorticosteroids, ampicillin, estrogen-containing drugs, phenothiazines, and tetracyclines can increase estrogen levels in the blood. Glucose in the urine and urinary tract infections can increase levels in the urine. Drugs that may decrease levels include clomiphene and oral contraceptives.

 

References

http://emedicine.medscape.com/article/276107-overview#showall

http://www.drugs.com/drug-class/estrogens.html

http://www.healthcheckusa.com/Estrogen-Total/46863/

http://www.bloodtest.org/products/estrogens-total

http://www.healthtestingcenters.com/estrogen-levels.aspx

http://www.lef.org/Vitamins-Supplements/ItemLC004549/Estrogens-Total-Blood-Test.html

https://www.questdiagnostics.com/testcenter/BUOrderInfo.action?tc=439&labCode=AMD

http://labtestsonline.org/understanding/analytes/estrogen/tab/test

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