Normal Estradiol Levels by Population
Normal estradiol levels vary significantly by sex and menopausal status: premenopausal women range from 31-2864 pmol/L (8-780 pg/mL) depending on menstrual cycle phase, postmenopausal women should be <26 pmol/L (<7 pg/mL), and adult men range from 12-136 pmol/L (3-37 pg/mL). 1
Premenopausal Women
Estradiol levels fluctuate dramatically throughout the menstrual cycle, requiring phase-specific interpretation 1:
- Early follicular phase (days -15 to -6): 31-771 pmol/L (8-210 pg/mL) 1
- Late follicular phase (days -5 to -1): 104-1742 pmol/L (28-475 pg/mL) 1
- LH peak/ovulation (day 0): 275-2864 pmol/L (75-780 pg/mL) 1
- Early luteal phase (days +1 to +4): 95-1188 pmol/L (26-324 pg/mL) 1
- Mid luteal phase (days +5 to +9): 151-1941 pmol/L (41-529 pg/mL) 1
- Late luteal phase (days +10 to +14): 39-1769 pmol/L (11-482 pg/mL) 1
These reference intervals were established using highly accurate LC-MS/MS methodology traceable to CDC reference methods, making them reliable for clinical decision-making 1.
Postmenopausal Women
Estradiol levels in postmenopausal women should be <26 pmol/L (<7 pg/mL). 1 More recent data using sensitive LC-MS/MS methods suggest basal estradiol concentrations range from undetectable to 10.7 pg/mL in normal, untreated postmenopausal women 2.
Critical Clinical Threshold
Any postmenopausal woman with estradiol levels above 54.5 pg/mL (approximately 200 pmol/L) requires further diagnostic workup to evaluate for estrogen-producing tumors or other pathology, as recommended by the Endocrine Society and Society for Endocrinology 3.
Adult Men
The reference interval for adult men is 12-136 pmol/L (3-37 pg/mL). 1 Estradiol in men increases with age and pubertal stage during development, but shows minimal variation in adulthood 4.
Important Measurement Considerations
Assay Methodology Matters
The method used to measure estradiol significantly impacts results 2:
- LC-MS/MS or GC-MS/MS methods provide the most accurate measurements, particularly at low concentrations typical in postmenopausal women and men 1, 4, 2
- Radioimmunoassays often overestimate estradiol levels, especially at low concentrations, with reported ranges showing undetectable to 10.5 pg/mL where LC-MS/MS shows 3.1-4.9 pg/mL 2
- The limit of detection for high-quality LC-MS/MS methods is approximately 4 pmol/L for estradiol 4
Special Populations
For premenopausal women on ovarian suppression therapy with aromatase inhibitors, estradiol must be suppressed to postmenopausal ranges (<26 pmol/L or <7 pg/mL) to ensure therapeutic efficacy 3.
For transgender women on gender-affirming hormone therapy (GAHT), if on therapy for ≥12 months, interpret estradiol within the reference range for the affirmed gender (premenopausal female ranges); if GAHT stopped for ≥3 months, use reference ranges for sex assigned at birth 5.
Common Pitfalls
- Timing of sample collection is critical in premenopausal women—always document cycle day when interpreting results 1
- Pregnancy must be excluded before interpreting elevated estradiol as pathologic in women of reproductive age 6
- Assay-specific reference ranges should be used when the laboratory method differs from LC-MS/MS, as immunoassays lack specificity at low concentrations 2
- Estrone versus estradiol: In postmenopausal women, estrone typically exceeds estradiol, whereas the reverse is true in premenopausal women 4