Estrone is one of the lesser known estrogens. It has very little activity compared to the more ubiquitous estradiol. After menopause, however, estrone becomes the primary source of estrogen in women. Learn more about estrone testing and the health effects of low and high levels.

What is Estrone?

Overview of Estrogens

You’re probably familiar with estrogen, the primary sex hormone found in women (and in much lower amounts in men) [1].

But did you know that estrogen is actually a broad term that covers several hormones?

There are 3 major estrogens, all of which act on the estrogen receptor. What differentiates them is how potent they are and where they are produced in the body [1].

Estradiol (E2) is the strongest estrogen. It is responsible for most of the effects we associate with estrogen, such as sexual development in girls and young women [1].

Estrone (E1) stimulates the estrogen receptor about ten times more weakly than E2. Estrone is produced in the ovaries (similar to other estrogens) but also in fat tissue [1].

Estriol (E3) is even weaker than estrone. Levels of estriol are very low in women unless they are pregnant [2].

Estrone (E1) is one of the three types of estrogens. Like estradiol, it is mainly produced in the ovaries. Unlike estradiol, it is also produced in fat tissue.

What Does Estrone Do?

Estrone mostly acts as a precursor to estradiol. Then the body is able to convert estrone into estradiol when needed [3].

This conversion is especially important in postmenopausal women. Before menopause, estradiol is the most common estrogen. Once menopause occurs, the body stops producing estradiol. This leaves estrone as the only major estrogen (and the only potential source of estradiol) found in postmenopausal women [4].

Estrone Testing

Your doctor may order an estrone test if you are experiencing menopausal symptoms or infertility problems. Your estradiol levels may also be checked simply to get a full picture of your estrogen production [5].

An estrone test will usually require a blood sample, but tests that use a saliva sample are also available. Saliva tests can be easier to do because they don’t require needles, and people can collect their own samples at home if necessary. The trade-off is that the results can be inaccurate if the sample is not properly collected [6].

Test results are reported as a numerical value in units of picograms per milliliter (pg/mL). This value reflects the amount of estrone in the blood (or saliva depending on the type of test).

Estrone tests, which can be conducted using either blood or saliva samples, are generally ordered for women experiencing menopausal symptoms or infertility.

Normal Estrone Levels

Blood Tests

Normal ranges can vary depending on the lab performing the test. Estrone levels also differ depending on age and gender [1].

Men

The normal range for adult men is around 12 to 72 pg/mL.

Younger men and adolescent boys will generally have lower levels, depending on their stage of physical development [7].

Women

Estrone ranges in women are a bit more complicated. Levels can vary greatly depending on where they are in their menstrual cycle. Pregnancy and menopause will also effect estrone levels [8].

For each stage of the menstrual cycle, the normal range is [9]:

  • Follicular phase, during a woman’s period and up to ovulation: 37 to 138 pg/mL
  • Mid-cycle, around the time of ovulation: 60 to 229 pg/mL
  • Luteal phase, the last two weeks leading up to the next period: 50 to 114 pg/mL

In postmenopausal women, the normal range is about 14 to 103 pg/mL, while in pregnant women, estrone levels can shoot up as high as 11,500 pg/mL. The placenta, which makes many of its own hormones, is responsible for these extraordinarily high levels [8].

Girls and younger women will have lower levels of estrone, depending on how far along they are in physical development. Most girls reach the equivalent of adult levels of estrone during the stage of puberty when they have their first period [9, 10].

Normal estrone varies greatly during a woman’s monthly hormonal cycle, with a peak around ovulation and a valley during her period.

Saliva Tests

Tests using saliva samples have a different set of reference ranges, simply because there is normally less estrone in saliva than in blood [6].

Men

The normal range for adult men is 1.3 to 3.6 pg/mL [11].

Women

For premenopausal women, the normal range is 3.2 to 7.9 pg/mL [11].

For postmenopausal women, the normal range is 0.9 to 3.1 pg/mL [11].

Limitations

The amount of research done on estrone is quite limited, especially compared to estradiol. It’s not entirely clear what the optimal level of estrone is for the body.

However, researchers are beginning to look at this hormone more closely because of its potential role in cancer development [12, 13].

High Estrone Levels

Causes

1) Estrogen Medications

Women who receive estrogen therapy (also called hormone replacement therapy or HRT) will have higher estrone levels. HRT is most commonly prescribed to postmenopausal women suffering symptoms like hot flashes and night sweats [14, 15].

Even when taking estradiol medications or other synthetic forms of estrogen, levels of estrone can still rise. This is because estradiol can be converted into estrone in the body [16].

In one study, postmenopausal women who received estradiol therapy saw an average increase of about 260 pg/mL in their estrone levels [14].

While mostly discontinued, estrone itself is available as a medication for symptoms of menopause. Taking estrone-containing medications will, of course, increase estrone levels as well [17].

Postmenopausal women taking estrogen drugs will need to check different reference ranges when evaluating their estrone levels [9].

Women who take estrogen medication to manage menopausal symptoms will have much higher estrone levels than those who do not.

2) Aging

At first, this one seems counterintuitive. After all, estrogen levels fall off after menopause because the ovaries stop producing estradiol. However, there’s an odd relationship between age and hormone replacement therapy that may result in increased estrone in older women [18].

A study found that older women who take estrogen have higher estrone levels compared to younger women taking the same medication. This is likely due to the reduced metabolism of elderly people. Older women may be slower at eliminating hormones, like estrone, from the body [14].

However, this is an exceptional case: for women not taking estrogen medications, age does not appear to affect estrone levels [19, 14].

Another case where age matters is in prostate enlargement, a condition that affects men. A study of 25 men with enlarged prostates found that estrone levels increase significantly with age [20].

Older women have slower metabolisms and may not clear hormones like estrone as quickly as younger women. Thus, among women taking estrogen medication, the oldest cohort will likely have the highest estrone.

3) Obesity

Estrone is made in several tissues, including fat (adipose tissue)—and, sure enough, increases in fat tissue lead to increases in estrone production [21, 14].

One study of 180 postmenopausal women found that estrone levels are linked to BMI. This association becomes stronger as women get older [14].

Interestingly enough, it appears that visceral fat (the fat in the abdomen that surrounds the organs) produces the most estrone, while subcutaneous fat (the layer of fat under the skin) produces more estradiol [21].

4) Liver Disease

Liver diseases like cirrhosis (scarring of the liver) may cause small increases in estrone levels, possibly because of increased conversion of male sex hormones (androgens) to estrone and estradiol [22, 23].

A small study of 18 men found slight increases in men with alcohol-related cirrhosis, cardiac cirrhosis, and hepatitis [22].

The same effect is seen in women as well. One study compared estrone in postmenopausal women with or without cirrhosis. They found that the women with cirrhosis have, on average, estrone levels that are 46 pg/mL higher than healthy women [24].

5) Hyperthyroidism

Some older studies suggest that estrone levels become elevated in people with an overactive thyroid gland (hyperthyroidism) [25].

One study found that concentrations of estrone are high in men with Graves disease, a form of autoimmune hyperthyroidism. In another study, estrone levels were also raised, but only in half of the hyperthyroidism patients [25, 26].

6) Adrenal Gland Tumors

The adrenal gland is responsible for secreting a number of hormones, including adrenaline and cortisol [27].

Cancer of the adrenal gland can cause the gland to release too many hormones. In very rare cases, tumors in the adrenal glands can secrete high amounts of estrogens. This can lead to high levels of all estrogens, including estrone, which can cause a number of hormonal issues [28, 29].

7) Ovarian Cancer

Estrogens are primarily made in the ovaries in premenopausal women. Unsurprisingly, ovarian tumors often overproduce estrogens, including estrone [30].

A study of 581 women found that estrone levels are significantly higher in women with ovarian cancer [30].

High levels of estrone are of particular concern in ovarian cancer because estrone is linked to cancer cell growth and a worse prognosis [31, 32].

Effects

1) Increases Risk of Breast Cancer

High estrogen levels can increase the risk of a type of breast cancer called estrogen receptor-positive (ER+). In this form of breast tumor, the cancer cells are able to use estrogens to stimulate their own growth [33].

On the other hand, there is estrogen receptor-negative (ER-) breast cancer. This cancer is less common but can be more dangerous. These two types of breast cancer often have different risk factors and treatments [34].

High estrone levels significantly increase the risk of developing ER+ breast cancer, according to a study of 144 postmenopausal women. However, estrone did not affect the risk of ER- breast cancer [35].

In fact, another study of 358 postmenopausal women found that high estrone levels actually reduce the risk of death in people with ER- tumors [36].

High estrone increases the risk of developing a type of breast cancer with estrogen receptors (ER+).

2) Increases Risk of Ovarian Cancer

As mentioned earlier, ovarian cancer may increase the level of estrone in the body. The inverse may also be true: high estrone levels can increase the risk of ovarian cancer [37].

In a clinical trial of 581 women, higher levels of estrone were linked to a higher risk of developing ovarian cancer, although the increase was modest [37].

3) Increases Risk of Diabetes in Men

Estrogen levels on the high end of normal can protect against type 2 diabetes in postmenopausal women. However, research suggests this may not be true in men. In fact, high estrone may actually increase the risk of men developing diabetes [38, 39].

A study of 1458 men found a significant correlation between high estrone levels and the likelihood of having diabetes. On top of that, men with twice the normal amount of free estrone have a 93% higher chance of developing diabetes than those with average levels [39].

4) Symptoms of High Estrogen

Besides increasing the risk of certain conditions, estrogens themselves can cause a number of side effects when at high levels [40, 41].

These symptoms are associated with estradiol, but some estrone is converted to estradiol in the tissues. Thus, estrone may contribute to these effects as well [40, 41, 3, 42].

Some symptoms of high estrogen levels in women include swelling and tenderness in the breast, bloating, and headaches [40].

Symptoms in men may include erectile dysfunction, gynecomastia (breast growth), and infertility [43, 44, 45].

Estrone may contribute to symptoms associated with high estrogens. In women, these include pain and bloating; in men, these include erectile dysfunction, breast growth, and infertility.

Ways to Decrease Estrone

1) Exercising and Losing Weight

Body weight and estrone levels are closely linked. Estrone is made in visceral fat; thus, the more fat there is in the abdomen, the more estrone is produced [14].

One study investigated the effects of exercise in 173 overweight, postmenopausal women. Participants averaged 171 minutes per week of moderate exercise for an entire year [46].

At the 3 month mark, there was already a noticeable decrease in estrogen levels, with estrone decreasing by about 4%. At the end of the year, the total estrone reduction was about 12% [46].

However, this lowering effect was only seen in women who lost body fat; it follows that you have to decrease fatty tissues to effectively decrease estrone [46].

2) Eating More Fiber

Increasing your intake of dietary fiber may help reduce estrone levels, according to a study of 242 postmenopausal women [47].

More specifically, women that eat fiber-rich diets have estrone levels that are 22% lower compared to women who get little fiber [47].

The researchers theorize that lignin, a fiber that gives woody plants their structure, may play a major role. Lignin binds to some compounds (including, possibly, estrogens), deactivates them, and makes it easier for the body to remove them. Examples of lignin-rich foods include carrots, broccoli, and whole grains [47].

3) Eating Anti-Estrogenic Foods

Certain foods may help reduce estrone by blocking an enzyme called aromatase. This enzyme is responsible for converting androgens (male hormones) into estrogens [48].

Some foods that contain natural aromatase blockers include [48]:

  • Mushrooms
  • Celery
  • Carrots
  • Spinach
  • Grapes

Indole-3-carbinol is a plant compound that reduces the activity of estrogens. Eating vegetables that contain this compound may also help lower estrone levels. Examples include [49, 50]:

  • Cabbage
  • Cauliflower
  • Broccoli
  • Brussels sprouts
  • Kale

4) Avoiding Alcohol

Those wanting to decrease their estrone levels may want to avoid drinking any alcohol. A study of 244 postmenopausal women found that those who drink even a moderate amount of alcohol have increased estrogen levels [51].

Premenopausal women are also at risk. According to one study, premenopausal women who drank more than 10 g of alcohol each day had 18% higher estradiol levels than women who did not [52].

This estrogen-elevating effect may be due to alcohol increasing the activity of aromatase, the enzyme that produces estrogens [53].

5) Green Tea

In a study of 72 postmenopausal women, those who drank green tea daily had 20% lower estrone levels than those who drank it less than once a week [54].

Another study in 130 postmenopausal women found similar results. Those who regularly drank green tea had 13% lower estrone levels than those who did not [55].

Low Estrone Levels

Causes

1) Menopause

Estrone is the primary estrogen in women’s bodies after menopause. The ovaries stop producing estrogens after menopause, including estrone. Even though estrone can still be made in other tissues, the overall level of estrone is likely to fall [56].

2) Drug Interactions

Aromatase Inhibitors

Aromatase inhibitors (like letrozole, anastrozole, or tamoxifen) are a group of medications used to treat certain types of breast cancer. They work by blocking aromatase, an enzyme that helps create estrogen in the body [57].

By blocking estrogen production, aromatase inhibitors can reduce estrone levels. In fact, one study found that letrozole reduces estrone to almost undetectable levels [58].

Other studies have found similar results with other aromatase inhibitors, such as tamoxifen and anastrozole [59, 60].

NSAIDs

There is some evidence that NSAIDs (like ibuprofen, naproxen, and aspirin) may also lower estrone levels, at least in men [61].

A study including 1766 men found that use of prescription or over-the-counter NSAIDs decrease estrone levels, but only in obese males [61].

Effects

1) Increases the Risk of Heart Disease

A number of studies have revealed that estrogens have a protective effect on the heart. Postmenopausal women have much higher rates of heart disease, likely due to lower estrogen levels [62, 63].

Some research suggests that estrogen therapy may reduce the risk of coronary heart disease by as much as 50% in postmenopausal women [62, 64].

Postmenopausal women with heart disease who have estrone levels below 15 pg/mL are at a greater risk of dying, according to one study [56].

Another recent study in 304 women might explain exactly how estrone contributes to heart health. They found that estrone improves the function of the endothelium, the innermost layer of the heart that helps control contractions (and, thus, the rhythm of the heart) [65].

2) Increases the Risk of Metabolic Syndrome

When a person has some combination of high blood pressure, high blood sugar, high cholesterol, and obesity, they are considered to have metabolic syndrome [66].

Low estrogen levels contribute to nearly all of the symptoms associated with metabolic syndrome. This is why postmenopausal women are more likely to have metabolic syndrome compared to premenopausal women [67, 66].

Many studies show that restoring estrogen levels in postmenopausal women can improve blood sugar, cholesterol, and blood pressure, while also reducing abdominal fat [68, 69].

3) Symptoms of Low Estrogen

A variety of symptoms are associated with low estrogen levels, many of which are also seen during menopause [70].

Some symptoms of low estrogen include mood swings, headaches, increased risk of urinary tract infections (UTIs), absent or irregular periods, and vaginal dryness [71, 72, 73, 74].

Ways to Increase Estrone

1) Milk

It’s no secret that the milk you buy from the store is full of hormones, including estrogen [75].

But what effect does this have on people who drink cow’s milk?

A study including men, women, and children tested this by giving participants 500 mL or more of cow’s milk for up to 21 days. They found that concentrations of estrone increased significantly for everyone in the study [76].

2) Black Tea

According to a study of 130 postmenopausal women, black tea may help boost estrone levels. Researchers discovered that estrone levels in regular black tea drinkers are 19% higher than in women who drank little to no black tea [55].

3) Avocado and Grapefruit

Oddly enough, avocado and grapefruit may help increase estrone levels in women [47].

A study of 242 postmenopausal women found that those who ate the most avocados had estrone levels that were 26% higher than those that did not eat as much. Similarly, the top eaters of grapefruit had 29% higher levels of estrone [47].

4) Yoga

Yoga is great for mental health and has been shown to improve quality of life. There is some evidence that yoga may have biological effects as well: in a case report of 2 postmenopausal women, estradiol levels increased after 4 months of yoga [77, 78].

Yoga may also help improve certain postmenopausal symptoms, like sleep issues, joint pain, and mood swings [79].

Irregular Estrone Levels?

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Takeaway

Estrone is one of the weaker types of estrogen. However, it is the main source of estrogens in postmenopausal women.

For women, estrone levels can vary wildly depending on a number of factors, including the stage of their menstrual cycle, if they’ve gone through menopause, and if they are pregnant. Broadly speaking, normal levels are between 37 pg/mL (low point during periods) and 229 pg/mL (high point during ovulation).

In adult men, estrone levels should remain fairly constant throughout their lifetime, with a normal range being about 12 to 72 pg/mL.

If you want to lower your estrone levels, getting more exercise and fiber in the diet are great approaches.

If you’re more concerned about naturally raising your levels, certain foods like milk, black tea, avocados, and grapefruit might help.

About the Author

Mathew Eng, PharmD

PharmD

Mathew received his PharmD from the University of Hawaii and an undergraduate degree in Biology from the University of Washington.

Mathew is a licensed pharmacist with clinical experience in oncology, infectious disease, and diabetes management. He has a passion for personalized patient care and believes that education is essential to living a healthy life. His goal is to motivate individuals to find ways to manage their chronic conditions.

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