Estradiol (E2) Values: High Levels and Ranges by Cycle Phase

Short Answer

Estradiol (E2) is the main estrogen produced by the ovaries; its value varies greatly with the phase of the menstrual cycle, pregnancy and hormone treatments. For this reason there is no single "normal" number; the phase-specific range on your report is what counts. During ovulation, in pregnancy and during IVF treatment, a high E2 is often an expected finding. For an unexplained elevation, the TEMD (Society of Endocrinology and Metabolism of Turkey) 2025 guideline recommends investigating ovarian and adrenal gland tumors and hyperthyroidism.

How does it appear on your report?

• Name: The report lists it as "Estradiol (E2)", "E2" or "Östradiol".
• National unit: In the Turkish Ministry of Health's Test Measurement Units list, the unit for E2 is ng/L. The number is the same in ng/L and pg/mL.
• pmol/L: Some reports and guidelines use pmol/L. Multiplying the pg/mL value by approximately 3.67 gives pmol/L. For example, 18.2 pg/mL corresponds to 66.8 pmol/L.
• Phase-specific range: Laboratories may give separate ranges for the follicular, ovulatory and luteal phases, after menopause and in pregnancy.

The "My Test Results" (Tahlillerim) screen in e-Nabız (Türkiye's national health record app) lists results together with their reference values. Out-of-range results are shown highlighted in color. The color is based on the range given by the laboratory; it may not take your cycle day into account. A high E2 on the day of ovulation may appear in color but still be normal.

Normal value and reference range

Status	Example range (pg/mL)	Source
Follicular phase	31–90	University of Iowa
Ovulation period	60–533	University of Iowa
Luteal phase	60–232	University of Iowa
Postmenopausal (immunoassay)	Below 138	University of Iowa
Postmenopausal (mass spectrometry)	1.1–18.2	Harmonized international range, 2026
Pregnancy, 1st trimester	154–3,243	University of Iowa
Pregnancy, 2nd trimester	1,561–21,280	University of Iowa
Pregnancy, 3rd trimester	8,525 to above 30,000	University of Iowa
Men	11–43	University of Iowa

The reference range covers 95% of healthy people; about 1 in 20 healthy people may fall slightly outside the range.

The large difference between the two postmenopausal rows comes from the measurement method. The University of Iowa laboratory states that mass spectrometry is the more appropriate method in children and after menopause. An international study published in 2026 reported the postmenopausal range with this method as 1.1–18.2 pg/mL. In the same study the median is 4.9 pg/mL, and the value rises as body mass index increases.

What does a high value mean?

Starting with common and usually harmless causes:

• Ovulation period: In mid-cycle, E2 naturally rises to its highest level.
• Pregnancy: In pregnancy, E2 rises further with each trimester. In the last trimester it exceeds 8,525 pg/mL.
• IVF treatment: When the ovaries are stimulated with medication, multiple follicles develop. E2 values during this period are not compared with natural-cycle ranges. ESHRE 2025 recommends that the timing of the final egg maturation injection (trigger) not be determined based on E2 level alone.
• Biotin supplements: According to the University of Iowa laboratory, high-dose biotin can make E2 read falsely high.
• Some medicines: The same laboratory states that fulvestrant, used in breast cancer treatment, shows marked cross-reactivity with the E2 test.
• Rarer causes: For an unexplained high E2, TEMD 2025 recommends evaluation for ovarian tumors, adrenal gland tumors and hyperthyroidism.

What does a low value mean?

• First days of the period and menopause: Low E2 is expected during these times.
• Menopausal transition: NICE NG23 does not recommend measuring E2 to identify menopause at age 45 and over. Diagnosis is based on symptoms and menstrual history.
• Premature ovarian insufficiency (POI): The ESHRE 2024 guideline recommends that POI not be diagnosed based on E2 level. Diagnosis uses menstrual history and FSH.
• Hypogonadism: According to TEMD 2025, E2 persistently below 200 pmol/L (about 54 pg/mL), together with absent periods and symptoms of estrogen deficiency, defines female hypogonadism.
• Hypothalamic amenorrhea: Excessive exercise, inadequate nutrition and stress can suppress the hormone axis. According to TEMD 2025, estrogen is low in this condition.

When read together

• E2 + FSH (day 2–4 of the period): According to ASRM 2021, basal FSH and E2 are measured together. Details are in the article FSH and LH Values.
• High FSH + low E2: According to ASRM, this suggests ovarian insufficiency.
• Low or normal FSH + low E2: According to ASRM, this is consistent with hypothalamic amenorrhea. TEMD 2025 also recommends measuring prolactin in this situation.
• E2 + progesterone: In the luteal phase, the E2 range is higher than in the follicular phase. The evidence of ovulation, however, is progesterone; details are in the article Progesterone Value.
• Basal E2 in IVF: According to ESHRE 2025, basal E2 before treatment is not recommended for predicting ovarian response or live birth.

Preparing for the test

• Cycle day: Give blood on whichever day your physician requested. Basal evaluation is usually on day 2–4 of the period.
• Biotin: If you have taken more than 5 mg of biotin in the last 12 hours, tell the laboratory. The Total Testing Process Guide recommends waiting at least 8 hours for people taking 5–10 mg a day.
• Medicines: If you are on hormone therapy, a contraceptive method or a cancer medicine, have it noted on the test request form. Do not stop your medicines on your own.
• Jaundice: According to the guide, high bilirubin can affect E2 measurement. If you have jaundice, tell the laboratory.
• Method: If very low values need to be measured after menopause or in a child, your physician may request mass spectrometry.

Which doctor, which test?

• Obstetrics and Gynecology: The first port of call for irregular periods, pregnancy and menopausal complaints.
• Endocrinology: For unexplained high or low E2, and for questions about E2 in men.
• IVF team: E2 values during treatment are interpreted by the team managing the treatment.
• Tests that may accompany it: FSH, LH, prolactin, TSH and a pregnancy test. If needed, a pelvic ultrasound is ordered.
• For an unexplained elevation: TEMD 2025 recommends evaluation for ovarian and adrenal gland tumors and hyperthyroidism.

In Türkiye

• National guideline: The TEMD 2025 Adrenal and Gonadal Diseases Guideline gives E2 in pmol/L. It uses the 200 pmol/L threshold in defining female hypogonadism.
• Unit standard: In the Ministry's national list, E2 is reported in ng/L. This value is the same as pg/mL.
• Sample quality: The Total Testing Process Guide states that bilirubin can affect many hormone tests, including E2.
• e-Nabız: You can compare E2 results given on different days using the graph. When evaluating, note which day of the cycle you gave blood.

When should I seek emergency care?

• During IVF treatment, if your abdominal pain or bloating increases rapidly or you become short of breath, call your treatment center immediately. With severe symptoms, call 112 (the emergency number in Türkiye).
• If you have a positive pregnancy test and develop severe abdominal pain or bleeding, go to the emergency department.
• If the laboratory or your physician has called you about your result, call back the same day.
• If you have any vaginal bleeding after menopause, see a gynecologist within a few days.
• If you have chest pain, shortness of breath or fainting, call 112 regardless of your hormone result.

Related tests

• Lab Test Guide: all tests
• FSH and LH Values
• Progesterone Value
• High Prolactin
• Beta HCG Values
• Ovulation Test and LH
• Thyroid Tests Guide

What changed? (October 2026)

• New page: based on the TEMD 2025 Adrenal and Gonadal Diseases Guideline and the ESHRE 2025 ovarian stimulation guideline.
• The harmonized international reference range for postmenopausal E2 published in 2026 was added.

Sources

• Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD). Adrenal ve Gonadal Hastalıklar Kılavuzu. 2025. https://file.temd.org.tr/Uploads/publications/guides/documents/AdrenalKilavuz2025.pdf (accessed October 2, 2026)
• T.C. Sağlık Bakanlığı SHGM. Tıbbi Biyokimya Toplam Test Süreci Rehberi. May 2024, Publication No. 1287. https://dosyamerkez.saglik.gov.tr/Eklenti/48692/0/tibbi-biyokimya-toplam-test-sureci-rehberipdf.pdf (accessed October 2, 2026)
• T.C. Sağlık Bakanlığı SHGM. Test Ölçüm Birimleri, Versiyon 2. 15.09.2021. https://dosyamerkez.saglik.gov.tr/Eklenti/41467/0/test-olcum-birimleri-versiyon-2-pdfpdf.pdf (accessed October 2, 2026)
• T.C. Sağlık Bakanlığı. e-Nabız Kullanım Kılavuzu V2.1. 2025. https://enabiz.gov.tr/document/User_Manual.pdf (accessed October 2, 2026)
• University of Iowa Health Care. Pathology Laboratory Handbook: Estradiol (E2). Current version. https://www.healthcare.uiowa.edu/path_handbook/handbook/test748.html (accessed October 2, 2026)
• Cui J, Hankinson SE, Matsumoto AM et al. Establishment of harmonized international reference ranges for plasma estradiol concentrations in postmenopausal women. J Clin Endocrinol Metab 2026;111:2745-2755. https://doi.org/10.1210/clinem/dgag188 (accessed October 2, 2026)
• NICE. Menopause: identification and management (NG23). 2015, last updated April 15, 2026. https://www.nice.org.uk/guidance/ng23 (accessed October 2, 2026)
• Panay N et al. ESHRE, ASRM, CRE WHiRL and IMS Guideline Group on POI. Evidence-based guideline: premature ovarian insufficiency. Hum Reprod Open 2024;2024(4):hoae065. https://doi.org/10.1093/hropen/hoae065 (accessed October 2, 2026)
• ESHRE Guideline Group on Ovarian Stimulation. ESHRE guideline: ovarian stimulation for IVF/ICSI, an update in 2025. Hum Reprod 2026;41:498-514. https://doi.org/10.1093/humrep/deag018 (accessed October 2, 2026)
• Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril 2021;116:1255-1265. https://doi.org/10.1016/j.fertnstert.2021.08.038 (accessed October 2, 2026)