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Because hormone disorders can cause a wide variety of symptoms that also are associated with other conditions, a careful evaluation of your symptoms and general health is recommended especially if you experience any unusual symptoms. To arrive at a diagnosis, your health care professional will want to rule out certain conditions.

Your assessment will include a thorough personal medical history, a family medical history and a physical examination. Blood and other laboratory tests may be ordered to measure hormone levels. Brain scans are sometimes ordered to identify abnormalities that may be affecting the endocrine system and DNA testing can detect genetic abnormalities.

Estradiol levels may be tested in the evaluation of precocious puberty in girls (the onset of signs of puberty before age seven), and in assisted reproductive technology (ART) to monitor ovarian follicle development in the days prior to in-vitro fertilization. Estradiol is also sometimes used to monitor HT.

Estrone and/or estradiol levels may be tested if you are having hot flashes, night sweats, insomnia and/or amenorrhea (the absence of periods for extended periods of time). However, due to the day-to-day and even hour-to-hour fluctuations in estradiol levels, they are less helpful than follicle stimulating hormone levels (FSH) for these evaluations. Salivary estradiol testing is less reliable still, and of no value in diagnosing or treating symptoms. In most cases, a woman's age, symptoms and menstrual irregularity is sufficient for making the diagnosis.

Accurate diagnosis of hormonal disorders is important to determining appropriate treatment, which often includes estrogen therapy. The following conditions and symptoms are common hormonal disorders:

• Delayed puberty. Delayed puberty can result from a variety of disruptions to normal hormone production, including central nervous system lesions, pituitary disorders, metabolic and infectious diseases, anorexia or malnutrition, exposure to environmental toxins and over-intensive athletic training.

Signs of delayed puberty include:

• Lack of breast tissue development by the age of 13.

• No menstrual periods for five years following initial breast growth, or by age 16

• Estrogen treatment for girls with delayed puberty is somewhat controversial; some health care professionals advise treatment, others prefer close monitoring.

• Irregular menstrual periods. Once a medical evaluation finds that there is no other serious cause of your irregular cycles, oral contraceptives or cyclic progesterone may be used to regulate your cycle, assuming there is no reason you can't use them.

• Contraception. Oral contraceptives are one of the most popular methods of fertility control in the U.S. Other hormonal methods include the IUD (intrauterine device), the patch and an intravaginal ring.

• Menopausal Symptoms. Declining or fluctuating levels of estrogen and other hormones such as testosterone may begin as early as the late thirties. These hormonal changes trigger many of the physical and emotional changes associated with the transition to menopause. Of course, menopause is a life stage, not a disease, but symptoms associated with menopause can be bothersome and concerning for some women.

These changes may include:

• Irregular menstrual periods
• Hot flashes (sudden warm feeling, sometimes with blushing or sweating)
• Night sweats (hot flashes that occur at night, often disrupting sleep)
• Fatigue (probably from disrupted sleep patterns)
• Mood swings
• Early morning awakening
• Vaginal dryness
• Fluctuations in sexual desire or response
• Difficulty sleeping

There is a wide range of possible menopause-related conditions. Ask your health care professional about any changes you notice.

For symptomatic menopausal women or women with premature menopause, ET or HT remains the gold standard for relief of hot flashes and vaginally-related symptoms. For perimenopausal women with these symptoms, estrogen is usually given short-term (six months to four or five years), with the goal of tapering and eventually discontinuing it.

If you are experiencing moderate to severe menopausal symptoms or not getting symptom relief from non-hormonal methods, hormone therapy may be an option. (To find out about alternative, non-drug methods of relieving menopausal symptoms, visit the menopause topic at Healthywomen.org.)

New, lower-dose versions of the hormone therapies used to treat symptoms of menopause are now available. The U.S. Food and Drug Administration (FDA) has approved both pills and skin patches in lower doses.

The estrogen dosage used for hormone therapy varies widely depending on the symptoms it's intended to manage, as does dosing schedule. Discuss your symptoms and concerns with your health care professional.

In January 2003, the FDA announced that a new warning on all estrogen products for use by postmenopausal women. The so-called "black box" is the strongest step the FDA can take to warn consumers of potential risks from a medication. It advises health care professionals to prescribe estrogen products at the lowest dose and for the shortest possible length of time.

While HT has also until recently been widely used to prevent postmenopausal osteoporosis, the health risks of hormone therapy may outweigh this benefit for many women. Other osteoporosis therapies should be considered first.

Although observational studies over many years indicated that HT prevented heart disease in postmenopausal women, recent placebo-controlled studies indicate, and the FDA has warned, that hormone therapy may actually increase an older woman's risk for heart disease, heart attack and stroke, and should not be initiated in women of any age solely to prevent heart disease.

Moreover, study findings also indicate that older women (65 and older) who initiate HT have twice the rate of developing dementia, including Alzheimer's disease, compared with women who do not take the medication. The research, part of the Women's Health Initiative Memory Study (WHIMS) and reported in the May 28, 2003, Journal of the American Medical Association (JAMA), found the heightened risk of developing dementia in a study of women 65 and older taking Prempro.

The study also found that HT did not protect against the development of mild cognitive impairment (MCI), a form of cognitive decline less severe than dementia.