Reason Why ESR is High in Females

An erythrocyte sedimentation rate (ESR) is a blood test that shows if you have inflammation in your body. Interestingly, women tend to have higher ESR levels as compared to men. Several factors contribute to high ESR in females, including hormonal fluctuations related to the menstrual cycle, pregnancy, and use of oral contraceptives. Moreover, health conditions such as anemia, which is more prevalent in women, can also lead to an elevated ESR. Inflammatory conditions like autoimmune disorders are more common in women and may further increase ESR levels. 

In this blog, let’s explore why ESR is higher in females, the factors influencing this, and the clinical implications.

What is ESR, and how do you detect high ESR levels?

The ESR test is primarily used to detect inflammation linked with health conditions such as infections, cancers, and autoimmune diseases. The test measures how quickly red blood cells settle down to the bottom of a tube in one hour. A faster rate indicates a higher ESR, which usually correlates with inflammation or other medical conditions. In simpler terms, a higher ESR means more inflammation in your body.

Normal ESR Values:

Age Group	Male (mm/hr)	Female (mm/hr)
0-15 years	0-10	0-10
15-50 years	0-15	0-20
Over 50 years	0-20	0-30

Common conditions associated with elevated ESR include:

• Infections (bacterial, viral, or parasitic)
• Inflammatory diseases (rheumatoid arthritis, lupus, inflammatory bowel disease)
• Cancer
• Tissue damage (heart attack, surgery, trauma)
• Chronic kidney disease
• Giant cell arteritis
• Polymyalgia rheumatica

Why is ESR Higher in Females?

Women's bodies undergo several physiological and hormonal changes during different phases of life. Several factors impact ESR levels in females-

Hormonal Imbalance

One of the primary reasons for high ESR in women is hormonal fluctuation, especially related to menstrual cycle, pregnancy, and menopause.

• Menstrual Cycle- When the menstruation cycle starts, the levels of estrogen and progesterone fluctuate significantly. These hormones influence the production of fibrinogen, a protein that increases ESR. 

In addition, ESR occurs often during the menstrual cycle's luteal phase (post-ovulation), when progesterone is predominant.

• Pregnancy—ESR levels rise during pregnancy, especially in the second and third trimesters. This increase is due to high fibrinogen levels and changes in plasma volume. 

Research shows that a high ESR value during the third trimester can reach up to 45 mm/hr, much higher than the standard reference range.

• Menopause- Post-menopausal women often experience a decline in estrogen levels. Some studies show that ESR may remain high due to age-related factors such as increased inflammatory markers.

Age-Related Factors

Age plays a significant role in influencing ESR levels. This trend is more pronounced in women.

As women age, chronic low-grade inflammation, often called "inflammaging," increases, which can cause high ESR levels. Health issues like osteoarthritis and cardiovascular diseases, which are more prevalent in older women, can also contribute to high ESR levels.

Anemia and ESR

Anaemia, or iron-deficiency anemia, is more common in women than in men, especially during pregnancy. The deficiency of RBCs causes anemia; they tend to settle more rapidly and increase your ESR levels.

Iron-Deficiency Anemia- A study revealed that women with anemia had significantly higher ESR levels compared to non-anemic women. For instance, women with hemoglobin levels below 12 g/dL had an average ESR of 30 mm/hr, above the normal range.

Medical Conditions Related to High ESR in Women

Do you have a high ESR level? Don't know?

Do you have any health issues, such as diabetes, thyroid, anemia, arthritis, etc.? All these health issues can raise your ESR levels. Therefore, you must know the cause of your high ESR levels so that you can take preventive measures to manage them.

Infections and Inflammatory Diseases

High ESR levels often signal infections or inflammatory diseases like rheumatoid arthritis or lupus, conditions that are more prevalent in women. For instance, systemic lupus erythematosus (SLE) affects women nine times more frequently than men and a high ESR is a common finding in these patients.

Autoimmune Disorders

Autoimmune disorders, which are more common in women, often present with elevated ESR. The chronic inflammation associated with these conditions leads to persistently high ESR levels.

Rheumatoid Arthritis (RA): An elevated ESR is often used to assess disease progression and treatment in RA. Women with RA typically have higher ESR levels than men with the same condition, potentially due to differences in immune system function.

Cardiovascular Risk

Studies suggest that a high ESR can be a major and independent risk factor for developing cardiovascular diseases (CVD) in women. A study found that women with elevated ESR had a 1.5 times increased risk of developing CVD as compared to people with normal ESR levels.

Understanding the Numbers: ESR in Men vs. Women

The following table summarizes key differences in ESR values between men and women across various conditions:

Condition	Men (ESR mm/hr)	Women (ESR mm/hr)
Normal (Age <50)	0-15	0-20
Normal (Age >50)	0-20	0-30
Pregnancy (Third Trimester)	N/A	30-45
Iron-Deficiency Anemia	10-20	20-30
Rheumatoid Arthritis	15-30	20-40
Systemic Lupus Erythematosus	20-40	30-50
Chronic Kidney Disease	15-25	20-35

When to Worry About High ESR

High ESR levels can cause serious health concerns. Here are symptoms associated with high ESR include:

• Fatigue
• Fever
• Weight loss
• Joint pain
• Muscle aches
• Loss of appetite

If you're experiencing any of these symptoms with a high ESR, seeking professional medical advice for a proper evaluation and diagnosis is important. Your health and well-being are our top priority.

The Bottom Line

If your ESR is high, your doctor will order additional tests to detect the underlying cause. Understanding the factors contributing to higher ESR levels in females can help early detection and management of potential health issues. A high ESR in women can be due to multiple factors, such as hormonal factors, age, and health conditions. A healthy lifestyle—a balanced diet, regular physical activity, stress management, and adequate sleep—can significantly contribute to optimal ESR levels and overall well-being.