Should You Get Your Estrogen Levels Tested? Here’s What Experts Say

Andi Breitowich, Jillian LoPiano, MD, MPH


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Whether at your annual physical or through one of the many direct-to-consumer companies offering lab tests these days, getting your blood work done can be an effective way to gain deeper insight into your health, especially if you have uncomfortable symptoms and can’t figure out the root cause. But if your panel comes back with something outside the normal range, like high estrogen, you understandably will have some questions!

Estrogen is an essential hormone (which includes estrone, estradiol, and estriol) since it regulates the menstrual cycle, helps maintain bone density, supports reproductive health, and affects mood, says Tamara Guichard, MD, an ob-gyn at Modern Urology. On top of that, estrogen plays a pivotal role in keeping your heart, metabolism, and reproductive organs healthy, she adds.

Estrogen levels naturally fluctuate throughout your life, starting off low when you’re born, shooting up during puberty, and then eventually dropping after menopause.

Meet the experts: Irene Woo, MD, is a reproductive endocrinologist at HRC Fertility. Tamara Guichard, MD, is an ob-gyn at Modern Urology. Jillian LoPiano, MD, MPH, is an ob-gyn and chief health officer at Wisp.

Estrogen levels change throughout the menstrual cycle, too, peaking during ovulation. But, “generally, levels of estradiol (E2) between 30 to 400 pg/mL are considered normal during reproductive years,” says Irene Woo, MD, a reproductive endocrinologist at HRC Fertility. High estrogen is typically defined as “levels exceeding the normal range” for a specific age and menstrual phase, often accompanied by other symptoms (more on this soon), she says.

But “high estrogen” isn’t a diagnosis—rather, it’s usually related to a specific medical condition, such as polycystic ovary syndrome (PCOS), or even lifestyle factors like stress.

Ahead, doctors break down everything you need to know about high estrogen. But remember: It’s always best to consult your own doctor about any symptoms you're experiencing or medical concerns.

What causes high estrogen?

The short answer to this question is “it depends” since there’s no single universal cause of high estrogen. Genetics can play a slight role, but more often than not, high estrogen is associated with the following lifestyle factors or medical conditions, Dr. Woo says.

Pregnancy

If you’re expecting, your estrogen levels naturally rise during pregnancy, says Dr. Woo. In particular, estriol increases during pregnancy to support fetal development and prepare the body for birth, she says. You may experience associated symptoms such as breast tenderness, fatigue, nausea, mood swings, fluid retention, headaches, and changes in sex drive, but having some or all of these symptoms does not necessarily mean there is a problem with estrogen levels during pregnancy, Dr. Woo says. In fact, it’s often normal and expected as the body adjusts, and your estrogen levels drop significantly and return to baseline (or slightly lower if you’re breastfeeding) after giving birth, she adds.

Polycystic Ovary Syndrome (PCOS)

PCOS is caused by an imbalance of reproductive hormones, often leading to high estrogen levels, says Dr. Guichard. In fact, estrogen and estrogen receptors are found to be particularly high in those with PCOS, according to a study published in the journal Cells. Estrogen levels may be chronically elevated in those with PCOS due to additional factors like insulin resistance and other hormone levels, but they can also fluctuate based on menstrual cycle irregularities or medications used to manage symptoms, says Dr. Woo.

Medication

Certain medications such as hormone replacement therapies and those used to treat breast cancer can affect your estrogen levels. Birth control pills can also impact estrogen levels, especially when you first start out, but doctors typically monitor your dosage to avoid potential spikes, adds Dr. Guichard.

Weight

Fat tissue can produce excess estrogen, so those with a higher body fat percentage may have high estrogen levels, says Dr. Guichard. There's an inverse relationship here, too: Higher estrogen levels can influence where fat is deposited in the body, often favoring storage in the hips and thighs in women, Dr. Woo says.

Environmental Factors

Exposure to estrogen-like chemicals (such as xenoestrogen) in pesticides, plastics/BPA, and certain cosmetics may contribute to higher estrogen levels since they disrupt the body’s natural hormonal balance, Dr. Guichard says. In particular, makeup, hair dye, and skincare products that contain parabens, phthalates, bisphenol A (BPA), and triclosan can potentially disrupt hormonal balance, Dr. Woo says. To reduce exposure and minimize any risk, Dr. Woo says to look for products labeled as “paraben-free,” or “phthalate-free,” or opt for natural and organic alternatives.

Alcohol

Excessive alcohol intake can interfere with your liver function which is crucial for estrogen metabolism, so if you heavily drink, your estrogen levels can be high, says Dr. Woo.

Stress

Chronic stress may also disrupt hormone balance, says Dr. Woo. Why? When the hypothalamus (the part of the brain that helps with hormone regulation) perceives stress, the adrenal glands are stimulated to produce cortisol, the stress hormone. Cortisol can sometimes disrupt the main hormone of the HPA axis, which regulates reproductive hormones including estrogen. This disruption can result in menstrual irregularities or even anovulation (lack of ovulation), she says.

Signs And Symptoms Related To High Estrogen

Here are some of the common indicators of conditions that may be associated with high estrogen, according to Dr. Woo and Dr. Guichard.

Should you get your estrogen levels tested?

Estrogen levels can vary significantly depending on your menstrual cycle phase and age, says Dr. Woo. That said, estrogen testing is not necessary in healthy women, says Jillian LoPiano, MD, MPH, a board-certified ob-gyn and chief health officer at Wisp. Doctors don’t typically “check levels” or draw estrogen labs to look for conditions, but if a patient comes in with specific complaints, a physician will form a diagnosis and draw appropriate labs (like estradiol) accordingly, she says.

However, many women do opt to get their hormones tested these days—even if they aren’t exhibiting symptoms. If you suspect your estrogen levels are high or simply want to get tested, a gynecologist, endocrinologist, or primary care physician can order a blood test to measure your levels, says Dr. Woo. From there, they’ll likely test your estradiol (E2) since it’s the main form of estrogen tested, though estrone (E1) and estriol (E3) may also be evaluated depending on your age, symptoms, and medical history, she says. These tests are usually covered by insurance if deemed “medically necessary” by your healthcare provider, but cost and coverage depend on your specific insurance plan, she adds.

If you discover you have high estrogen—meaning higher than “normal” considering your age, where you’re at in your cycle, whether or not you’re pregnant, and other factors— you may be referred to a reproductive endocrinologist who specializes in hormonal health and can provide expert interpretation of your lab results, Dr. Woo says. The doctor will then look for the root cause of the high estrogen and suggest appropriate treatment options.

Treating Conditions Related To High Estrogen

Lifestyle changes can go a long way in managing conditions related to high estrogen. Stress management techniques like yoga, mindfulness, and/or therapy can help reduce estrogen-related fluctuations, says Dr. Woo. Cutting back on alcohol can also help tone down your estrogen levels by improving liver function responsible for estrogen metabolism, Dr. Guichard adds.

A healthy diet and regular exercise may help lower your levels if they're due to excess estrogen production from fat tissue, Dr. Woo says.

In some cases, such as in those with PCOS or other chronic health conditions, medication such as aromatase inhibitors or hormone blockers may also be prescribed depending on your specific medical condition, says Dr. Woo. But if you suspect a prescription medication is the culprit of your high estrogen, talk to a doctor about adjusting your dose or prescribing an alternative drug, she adds.

Treating conditions related to high estrogen involves a multifaceted and tailored approach based on the individual, so it’s essential to consult with a doctor to pinpoint the underlying cause, says Dr. Woo. It’s also always a good idea to keep an open line of communication with your doctor so they can monitor your symptoms and determine how often you should test your estrogen levels, says Dr. Guichard. Regular testing isn’t usually necessary, and your “levels” are not followed by and large, but it may be helpful to monitor a specific condition, check-in on your hormones, and/or adjust treatment if needed, she says.

The bottom line: Estrogen greatly fluctuates throughout your life without a cause for concern, but if you’re worried or experience regular symptoms, talk with your doctor about testing options and lifestyle changes.

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