Establishment of harmonized international reference ranges for plasma estradiol concentrations in postmenopausal women
Authors' conclusion
Cross-calibration of estradiol measurements with the CDC RP enabled the development of harmonized plasma estradiol reference ranges for postmenopausal women who were not using exogenous estrogens, suitable for future studies to establish clinical utility. Increasing obesity in postmenopausal women was associated with increasing estradiol concentration and BMI category-specific reference ranges.
Study context
- Population
- Community-dwelling postmenopausal women of primarily European ancestry aged 38–100 years not using exogenous estrogens, 5 international cohorts
- Participants
- 7,206 women5 cohorts
- Exposure
- All postmenopausal women vs Non-obese
- Outcome
- Reference range (2.5th-97.5th percentile) for plasma estradiol
Methodological details5 international cohorts, LC-MS/MS assays harmonized to CDC reference measurement procedure
- 5 international cohorts
- LC-MS/MS assays harmonized to CDC reference measurement procedure
Main finding
As reported in the abstract
Plasma estradiol reference range (2.5th-97.5th percentile)
| Group | Value | Median (pmol/L) | Reference range (pmol/L) |
|---|---|---|---|
| All postmenopausal women | median 4.9 (2.5th-97.5th percentile 1.1–18.2) pg/mL | 18.0 | 4.0-66.8 |
| Non-obese | median 4.1 (2.5th-97.5th percentile 1.1–12.5) pg/mL | 15.1 | 4.0-45.9 |
Value
All postmenopausal womenmedian 4.9 (2.5th-97.5th percentile 1.1–18.2) pg/mL
Non-obesemedian 4.1 (2.5th-97.5th percentile 1.1–12.5) pg/mL
Median (pmol/L)
All postmenopausal women18.0
Non-obese15.1
Reference range (pmol/L)
All postmenopausal women4.0-66.8
Non-obese4.0-45.9
Observational data: associations, not effects.
Further findings
Assay harmonization and correlates of estradiol
- Separate LC-MS/MS assays correlated closely with CDC reference measurement procedure (RMP); harmonization minimized inter-assay variability
- Estradiol correlated with body mass index (BMI) but not with chronological age
Original publication
Establishment of harmonized international reference ranges for plasma estradiol concentrations in postmenopausal women. J Clin Endocrinol Metab. Published 12 May 2026. doi:10.
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