Estradiol Levels in Menopause: What to Test Before Making Health Decisions

Current guidelines say you don’t need to check estradiol levels in menopause. Women with estradiol below 5-10 pg/mL have significantly lower bone density and higher fracture risk. Only women at or above 25 pg/mL showed balanced bone formation and resorption. BMD increases up to about 70 pg/mL, then plateaus. It doesn’t stop at bone. The ELITE trial showed early estradiol slowed atherosclerosis progression. Higher levels are linked to lower total cholesterol, lower LDL, lower fasting glucose, and higher HDL in early postmenopausal women. These metabolic benefits were not seen in women more than 10 years postmenopause. In plain terms: adequate estradiol levels protect your bones, your arteries, your lipids, and your blood sugar. And the window to get the most benefit is early. Here’s the problem. Transdermal absorption is variable. I checked my own levels while my symptoms were controlled and found my estradiol was running at about half of the bone-protective range. My hot flashes were gone. My bones were not protected. You can't feel bone loss. You can't feel early atherosclerosis. You can't feel insulin resistance creeping up. But you can measure estradiol. And the data says it matters. Ettinger et al. (1998). J Clin Endocrinol Metab, 83(7), 2239-43. Bagur et al. (2004). Climacteric, 7, 181-188. Rapuri et al. (2004). J Clin Endocrinol Metab, 89(10), 4954-62. Jamka et al. (2021). Ann Agric Environ Med, 28(2), 326-330. Zhu et al. (2021). J Orthop Surg Res, 16. Hodis et al. (2016). N Engl J Med, 374(13), 1221-31. He et al. (2024). Front Endocrinol, 15. Sriprasert et al. (2020). J Women’s Health, 29, 1052-1058. Order Dr. Haver’s new book, The New Perimenopause today: https://thepauselife.com/pages/the-new-perimenopause-book Is Dr. Haver going to be in your area? Check out her upcoming events here: https://thepauselife.com/pages/events Want to learn more about Dr. Haver and her work in the field of menopause? Check out our website: https://thepauselife.com/ Order Dr. Haver’s #1 New York Times bestselling book, The New Menopause today: https://thepauselife.com/pages/the-new-menopause-book Want to try our supplements? Order Here: https://thepauselife.com/collections/supplements Want to sign up for the ‘Pause Life Community? Join now for FREE! https://thepauselife.com/pages/the-pause-life-community Link to Dr. Haver’s Substack: https://drmaryclairehaver.substack.com/ Shop our favorite products here: https://thepauselife.com/pages/favorites There are many topics of interest covered in The ‘Pause Blog. Click this link to go to our searchable site: https://thepauselife.com/blogs/the-pause-blog Medical Disclaimer: The information, including opinions and recommendations, on this platform is meant for informational and educational purposes only. Mary Claire Media, LLC, The ’Pause Life, and the unPAUSED podcast are not medical organizations. Medical advice or medical diagnosis cannot be provided to you through the platform, any associated website, or customer portals. Using this platform does not establish a patient-physician relationship. Please consult a physician before starting any plan that includes supplements or aims to achieve weight loss, even if weight loss is not your primary goal. - About Dr. Mary Claire Haver - Dr. Mary Claire Haver, MD, FACOG, MSCP, is a board-certified OB-GYN, Menopause Society Certified Practitioner. She is the #1 New York Times bestselling author of The New Menopause, a book written to empower women with evidence-based menopause care. She earned her medical degree from Louisiana State University Medical Center and completed her residency in Obstetrics and Gynecology at the University of Texas Medical Branch (UTMB), where she is now an Adjunct Associate Professor. In 2021, she founded Mary Claire Wellness, a clinic committed to providing comprehensive menopause care. In 2023, she launched ThePauseLife.com, a trusted resource for women navigating menopause. A sought-after speaker and educator, Dr. Haver is a regular contributor to national media and has been featured in The New York Times, Forbes, The Today Show, CBS Mornings and Oprah’s Menopause Revolution. Her social media presence has grown to more than 7 million followers, where she continues to demystify menopause with relatable, science-backed content. Through her writing, clinical practice, and digital presence, Dr. Mary Claire Haver has become the trusted voice in menopause care — empowering women worldwide to embrace this life stage with confidence and vitality. When not traveling the globe empowering women to lead their best lives, Mary Claire resides in Galveston, Texas and Telluride, Colorado with her husband Chris, two daughters, Katherine Claire and Madeline Claire, and their chiweenie, Rex. #menopause #perimenopause #womenshealth #pauselife #thenewmenopause #thenewperimenopause