Estradiol (E2) Test: Normal Range by Cycle Phase and What Results Mean
Estradiol is the main oestrogen produced by the ovary. Levels vary sharply through the cycle — 20–150 pg/mL in the early follicular phase, 150–750 pg/mL at the ovulatory peak, and below 30 pg/mL after menopause. It is measured alongside FSH on day 3, and is used to monitor follicle growth during IVF.
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Detailed Clinical Overview
Estradiol is produced mainly by the granulosa cells of the developing ovarian follicle, with smaller contributions from the adrenal glands and from conversion of androgens in fat tissue. It builds the endometrium, provides the feedback that triggers the LH surge, maintains bone density and vaginal and urethral tissue, and influences mood, skin and cardiovascular physiology.
In fertility care, estradiol has two main uses. On day 3 alongside FSH, it validates the FSH result — a raised estradiol suppresses FSH and can make reduced ovarian reserve look normal. During IVF stimulation, serial estradiol measurements track how many follicles are responding and are central to deciding the trigger timing and to recognising the risk of ovarian hyperstimulation syndrome.
In men, estradiol is produced by conversion of testosterone in fat and other tissues. A raised level relative to testosterone contributes to gynaecomastia and reduced libido, and is common in obesity, in liver disease and with anabolic steroid use.
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Frequently Asked Questions
Q: What is the normal estradiol level?
A: It depends on the cycle phase: 20 to 150 pg/mL in the early follicular phase, 40 to 350 in the late follicular phase, 150 to 750 at the ovulatory peak and 30 to 450 in the luteal phase. Postmenopausal levels are below 30 pg/mL, and normal male levels are 10 to 40 pg/mL.
Q: On which day should estradiol be tested?
A: Day 2 to 4 of the cycle for a baseline fertility assessment, alongside FSH. During IVF or ovulation induction, it is tested on specific days determined by the fertility unit to track follicle growth. Always record the cycle day on the request form.
Q: Why is estradiol tested with FSH?
A: Because estradiol suppresses FSH. If an early follicle has already begun developing on day 3 and estradiol is raised, FSH can be pushed into the normal range even when ovarian reserve is genuinely poor. A normal FSH with a raised estradiol is falsely reassuring and should not be relied on.
Q: What are the symptoms of low estradiol?
A: Hot flushes, night sweats, vaginal dryness and discomfort during intercourse, disturbed sleep, mood changes, reduced concentration, and over time accelerated bone loss. In younger women these symptoms alongside irregular or absent periods warrant assessment for primary ovarian insufficiency.
Q: What estradiol level indicates menopause?
A: Below 30 pg/mL together with a raised FSH above 25 to 40 mIU/mL and 12 months without periods. During perimenopause estradiol fluctuates unpredictably and can be high one month and low the next, so a single value should not be used to declare menopause.
Q: Why is estradiol monitored during IVF?
A: Serial estradiol measurements show how many follicles are responding to stimulation and how mature they are, which determines the timing of the trigger injection. Very high or rapidly rising levels also warn of ovarian hyperstimulation syndrome, allowing the protocol to be adjusted before it becomes serious.
Q: What does high estradiol mean in men?
A: Raised estradiol in men, produced by conversion of testosterone in fat tissue, contributes to gynaecomastia, reduced libido and infertility. It is common in obesity, liver disease and anabolic steroid use. It is interpreted as a ratio with testosterone rather than in isolation.
Q: Do I need to fast for an estradiol test?
A: No. Fasting does not affect estradiol. What matters is the cycle day in women, and stopping biotin supplements for three days beforehand, since biotin interferes with many immunoassays.
Q: Does estradiol confirm ovulation?
A: No. Estradiol rises before ovulation and triggers the LH surge, but it does not prove that an egg was released. A serum progesterone measured about seven days after expected ovulation, often called a day 21 progesterone, is the test that confirms ovulation occurred.
Q: Can estradiol be measured accurately in postmenopausal women?
A: Standard immunoassays are unreliable at these very low concentrations. Where an accurate low-level result matters — in postmenopausal women, men and children — a mass spectrometry (LC-MS/MS) method should be used. Ask your laboratory which method it uses if the result will drive a clinical decision.
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