Saliva
Large male hormone profile
This profile measures oestradiol, testosterone, and DHEA in men via saliva testing.
€ 200,00
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Hormones · Saliva
Estradiol
The free estradiol in saliva; varies strongly with the cycle and cannot be compared one to one with estradiol in blood.
At a glance
- Measured in saliva
- In 2 test panels
- Check the preparation
Explanation
Estradiol: what is measured?
Estradiol (E2) is the most important female sex hormone and before menopause is made mainly in the ovaries. Saliva contains only the free part that is not bound to proteins in the blood. The amount in saliva is many times lower than in blood, which places high demands on the measurement. The value varies strongly with the cycle, low in the first days and high around ovulation, and also changes over the day.
What can it detect?
- A rough indication of estradiol production, for example with absent periods, although estradiol in blood together with FSH says more
- Absorption of estradiol with hormone treatment through the skin, although the saliva value is then often falsely high
Result
What does the result mean?
Estradiol too high
In women before menopause, a high value around ovulation and in pregnancy is normal. Outside those times, a high value is often due to hormone treatment, especially with gel or cream: this can contaminate the saliva through the hands or the mouth. Bleeding gums, eating or drinking just before collection can also raise the result. In men, a raised value can fit overweight or the use of testosterone or anabolic substances.
Estradiol too low
A low value is normal in the first days of the cycle, with use of the pill, during breastfeeding and after menopause. In women under 40 without periods, a low value can fit reduced function of the ovaries or disturbed control due to underweight, intensive training or stress; this is assessed with blood tests. Around menopause a low value says little, because the value fluctuates strongly from month to month.
After an abnormal result
With symptoms that fit a hormone disorder, the GP usually has estradiol, FSH and LH measured in blood, together with the cycle day. An abnormal saliva value without symptoms usually does not lead to further tests.
Reliability
How reliable is the test?
The value in saliva cannot be compared one to one with blood, and for saliva there are few agreed cut-off values. The meaning of an abnormal saliva value has been little studied. The result depends strongly on the cycle day and on the time of collection. With absent periods, estradiol and FSH in blood say more (Dutch GP guideline (NHG) on amenorrhea); menopause is diagnosed from symptoms and the menstrual pattern, not from a hormone value (NHG guideline on menopause).
What can affect the result?
- Cycle day and timing: without the cycle day the result cannot be interpreted; collect at the agreed time of day.
- Collection: do not eat, drink, smoke or brush your teeth just before collecting; brushing your teeth and blood from the gums can strongly disturb the result. Rinse your mouth with water about ten minutes beforehand.
- Hormone gel or cream on the skin can contaminate the sample and give a falsely high result; the pill and hormone therapy make the result unusable for assessing your own production.
- The values in saliva are so low that measurement methods are inaccurate; results differ strongly between laboratories.
Preparation
- Fill the first tube straight after waking up and the next ones after 30 and 60 minutes. Do you have a cycle and not use the pill? Do the test on day 19, 20 or 21 (with a cycle of 26 to 29 days). If you use the pill, do the test at the start of your pill-free week.
- Do not eat, drink, smoke or brush your teeth until after the third tube. Do not use mouthwash or dental floss that day.
- Do you use hormone preparations such as hydrocortisone or progesterone? Then stop 48 hours beforehand, in consultation with your doctor.
- Stop supplements that affect hormones, such as maca, 5 days beforehand.
Who it is for
Who is the test useful for?
Useful for
With absent or very irregular periods, with fertility questions or in men with breast development, estradiol in blood, together with FSH and LH, says more than a saliva value. Around menopause a measurement adds little, because the values vary strongly. In people without symptoms, an abnormal value says little.
How common is it?
Natural menopause starts on average around the age of 51 and affects all women; a large share have symptoms. Early menopause (before the age of 40) affects about 1 in 100 women. How often an abnormal estradiol in saliva occurs in women without symptoms is not known.
NHG guideline on menopause
Drawbacks and risks
- An abnormality without symptoms means little, but can cause unnecessary worry or wrongly be seen as a reason for hormones or supplements.
- Without the cycle day, a normal peak around ovulation can be read as 'too high' and a normal value at the start of the cycle as 'too low'.
Get tested
Estradiol: test panels
Estradiol is part of these test panels. You order online and have your blood drawn at a collection point or collect the sample at home.
Evidence
Sources
This explanation is based on Dutch guidelines and independent information. It is general information, not a diagnosis. Discuss an abnormal result with your GP.
More about risks and results