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Printer Friendly Version Estrogen Hormone Testing: Estradiol and Estrone
Estrogen Hormone Testing: Estradiol and Estrone
DESCRIPTION Both men and women produce estrogen hormones. Estrogens are responsible for female sexual development and function, such as breast development and the menstrual cycle. In women, estrogens are produced mainly in the ovaries and in the placenta during pregnancy. Small amounts are also produced by the adrenal glands. In men, small amounts of estrogens are produced by the adrenal glands and testicles.
The two major naturally occurring estrogens are estrone (E1) and estradiol (E2).
- Estrone (E1) is a hormone produced by the ovaries and is the major source of estrogen in women who have gone through menopause. Small amounts of estrone are made throughout the body in most tissues, especially fat and muscle. It also may be measured in men or women who might have cancer of the ovaries, testicles, or adrenal glands.
- Estradiol (E2) is a hormone produced by the ovaries, and levels vary over the course of the menstrual cycle. Levels are usually measured to evaluate early puberty, fertility problems, menstrual problems, menopause, gynecomastia (enlarged breasts in males) or the presence of female sex characteristics, and as a tumor marker for ovarian, testicular, or adrenal gland cancers. Estradiol is the most commonly measured type of estrogen for nonpregnant women. The amount of estradiol in a woman's blood varies throughout her menstrual cycle. After menopause, estradiol production drops to a very low but constant level.
Estrone levels may be elevated in patients with polycystic ovarian syndrome and endometriosis. Tests may be used to aid in the diagnosis of an ovarian tumor, Turner syndrome, and hypopituitarism.
Estradiol is the most important form of estrogen found in the body. Most of it is made in and released from the ovaries, adrenal cortex, and the placenta, which forms during pregnancy to feed a developing baby. Estradiol is responsible for the growth of the womb (uterus), Fallopian tubes, and vagina. It promotes breast development and the growth of the outer genitals. The hormone also plays a role in the distribution of body fat in women.
Estradiol levels are used in evaluating ovarian function. Estradiol levels may be increased in cases of early (precocious) puberty in girls and gynecomastia in men. In males, it may help in the diagnosis of the cause of gynecomastia or in the detection of estrogen-producing tumors. Its main use has been in the differential diagnosis of amenorrhea – for example, to determine whether the cause is menopause, pregnancy, or a medical problem. Estradiol is also sometimes used to monitor menopausal hormone replacement therapy.
Increased levels of estrogens are seen in the following:
- Early (precocious) puberty
- Tumors of the ovary, testes, or adrenal glands
Decreased levels of estrogen are seen in the following:
- Turner syndrome
- After menopause (estradiol)
- PCOS (Polycystic ovarian syndrome, Stein-Levanthal syndrome)
POLICY Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism.
Measurement of estrogen hormones is considered medically necessary to diagnosis hyperestrogenism in symptomatic males.
Measurement of estrogen hormones is considered medically necessary for monitoring hormone replacement therapy in postmenopausal females.
Measurement of estrogen hormones is considered medically necessary for monitoring antiestrogen therapy.
Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients (absence of signs, symptoms, or disease).
POLICY EXCEPTIONS None
POLICY GUIDELINES Benefits will not be provided for the following contract exclusions:
- Services and supplies related to infertility, artificial insemination, intrauterine insemination and in-vitro fertilization regardless of any claim of Medical Necessity.
- For treatment related to sex transformations, sexual function, sexual dysfunctions or inadequacies regardless of Medical Necessity.
Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY 10/01/2013: New policy added.
- Endocrine Physician Advisory Committee
- Estradiol test - http://www.nlm.nih.gov/medlineplus/ency/article/003711.htm
- Estrogens - http://women.webmd.com/estrogens
CODE REFERENCE This may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.
174.0 - 174.9
Malignant neoplasm of female breast
Malignant neoplasm of ovary
186.0 - 186.9
Malignant neoplasm of testis
194.0 - 194.9
Malignant neoplasm of other endocrine glands and related structures
Benign neoplasm of ovary
227.0 - 227.9
Benign neoplasm of other endocrine glands and related structures
Neoplasm of uncertain behavior of ovary
Neoplasm of uncertain behavior of testis
Other anterior pituitary disorders
Iatrogenic pituitary disorders
Other ovarian hyperfunction
Other ovarian failure
Postablative testicular hypofunction
Other testicular hypofunction
Delay in sexual development and puberty, not elsewhere classified
Precocious sexual development and puberty, not elsewhere classified
Hypertrophy of breast
Atrophy of breast
617.0 - 617.9
Follicular cyst of ovary
Corpus luteum cyst or hematoma
Other and unspecified ovarian cyst
Hypertrophy of uterus
Hypertrophy of clitoris
Absence of menstruation
Scanty or infrequent menstruation
Excessive or frequent menstruation
Irregular menstrual cycle
Other disorder of menstruation and other abnormal bleeding from female genital tract
Symptomatic menopausal or female climacteric states
Postmenopausal atrophic vaginitis
Symptomatic states associated with artificial menopause
Alopecia, unspecified [Male pattern baldness in female]
Hormone replacement therapy (postmenopausal)
Use of aromatase inhibitors