Why ESR Is High In Females?

 While ESR is generally high in females, it is not necessarily a reason to worry unless the numbers are above normal

There are significant differences in the physiology of male and female bodies. A relevant example is ESR (Erythrocyte Sedimentation Rate), which is usually higher in females, as compared to ESR in males. There are various reasons why ESR is high in females. Let us check out the details.

What is ESR?

Also called the 'sed rate', the ESR (Erythrocyte Sedimentation Rate) is a simple test to measure inflammation. In ESR testing, the laboratory measures how quickly red blood cells (erythrocytes) settle to the bottom of a vertical tube of anticoagulated blood over a period of one hour. The results are reported in mm/hr or millimeters per hour. 

The ESR test is a non-specific marker of inflammation. It tells the doctor that inflammation is present, but does not reveal exactly what is causing it or where it is located. It is essentially the first step in identifying inflammation. If inflammation is present, the red blood cells will settle faster to the bottom. That is because inflammation-causing proteins cause the red blood cells to clump together. This forces them to settle to the bottom faster in the ESR test.

Why ESR is high in females?

In women, ESR is generally around 1.22 times higher than males. Females under 50 have ESR in the range of 0-20. In comparison, males under 50 years have ESR in the range of 0-15. For females over 50 years, the ESR is in the range of 0-30. For males above 50, the ESR is in the range of 0-20. There are multiple reasons why ESR is high in females, some of which are explained below.

Hormonal factors - High ESR in females could be due to dominant hormones such as estrogen and progesterone. Women-specific events such as menstrual cycle (especially luteal phase), pregnancy, and menopause can increase fibrinogen and other acute-phase proteins. Estrogen impacts immune response and specific protein generation, which can cause red blood cells to clump together. Use of contraceptives or hormone replacement therapy (HRT) can also lead to increased ESR in females.

Iron deficiency - Women often face iron (hematocrit / hemoglobin) deficiency due to factors like menstruation and pregnancy. This can lead to higher ESR in females. When there are fewer red blood cells, they settle faster at the bottom of the test tube during the ESR test. This can lead to high ESR measurements.

Pregnancy - A number of factors can increase ESR during pregnancy. These include higher fibrinogen, immune changes and increased plasma volume. These factors increase ESR, in physiological terms.

Age-related ESR increase - Increase in low-grade chronic inflammation is noticed with age across both males and females. Since women already have high ESR, this increases even more during old age.

There are various other factors that can increase ESR in both females and males. For example, things like infections and autoimmune / rheumatic diseases can lead to high ESR readings. Similarly, factors like anemia, chronic inflammation, malignancies, obesity, metabolic syndromes, heart attack, tissue injury and specific medications can also result in high ESR.

When to see a doctor?

If the ESR is in normal range, there is usually no reason to worry, even if the ESR is higher than males. However, if the ESR is higher than the normal range for females and/or if there are specific symptoms, it is recommended that you consult a doctor. Based on your symptoms and health profile, the doctor may order further tests to ascertain the reason for the high ESR.