Low Estradiol: What It Means and What to Do Next
Low estradiol means your body is making little of its main estrogen. Whether that is a problem depends on your stage of life. After menopause it is expected: Quest's postmenopausal range is under 31 pg/mL. In a woman who still has periods and is not on hormones, an early-cycle level below Quest's range of 19–144 pg/mL is low, and the useful next question is what FSH is doing. High FSH points to the ovaries (perimenopause, menopause or primary ovarian insufficiency); low or normal FSH points to the brain's signal, as with under-eating, intense exercise, stress or high prolactin. The birth control pill also lowers measured estradiol. Low estrogen that lasts years before menopause thins the bones, so it is worth finding the cause.
What Causes Low Estradiol?
Perimenopause and Menopause
The ovaries make less estradiol as eggs run out. Levels swing during the transition and settle low after the last period, which is normal for that stage.
Primary Ovarian Insufficiency
The ovaries stop working normally before age 40, so estradiol falls and FSH rises. It needs a doctor's care because of its effects on bone and heart health.
Hypothalamic Amenorrhea
Low body weight, eating too little for your activity, intense training or major stress can make the brain turn down the signal to the ovaries. Periods stop, estradiol is low, and FSH and LH are low or normal rather than high.
High Prolactin
A prolactin-secreting pituitary tumor (prolactinoma), some medications such as antipsychotics, an underactive thyroid and breastfeeding all raise prolactin, which suppresses ovulation and estradiol.
Pituitary or Hypothalamic Disorders
Tumors, surgery, radiation or severe blood loss after childbirth can damage the pituitary so it no longer stimulates the ovaries or testes.
Hormonal Birth Control
The combined pill, patch and ring suppress your ovaries. Their synthetic estrogen is not measured by the estradiol test, so the result can read low even though you are getting estrogen.
Medications
Aromatase inhibitors (letrozole, anastrozole) and GnRH drugs such as leuprolide lower estradiol on purpose, for breast cancer, endometriosis or fertility treatment.
Low Testosterone in Men
Men make estradiol from testosterone, so low testosterone usually brings low estradiol with it. Aromatase inhibitors taken alongside testosterone therapy can push it too low.
Associated Symptoms
What to Do Next
1. Retest to confirm
A single abnormal result should be confirmed with a repeat test. Temporary factors like stress, illness, or medications can affect results.
2. Related tests to consider
3. When to see a doctor
If your Estradiol is significantly abnormal, if you have severe symptoms, or if repeated results confirm the abnormality, consult a healthcare professional for appropriate evaluation and treatment.
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This page is for informational purposes only and does not constitute medical advice. Consult a healthcare provider for interpretation of your results.
Content reviewed for accuracy by the JustLabs editorial team.