Hyperandrogenism in women: symptoms, causes, treatment

Hyperandrogenism - a pathology, in which the hormones women undergoing significant changes. It induces the production of too much androgen hormone, which is considered to be masculine. The woman's body this hormone vypolnyaetmnozhestvo necessary functions, but it is an excessive amount leads to unpleasant consequences, the treatment of which is mandatory.

Produced by androgens in women adipocytes, adrenal glands and ovaries. These hormones directly influence the process of puberty in women, the appearance of hair in the genital area and armpits. Androgens regulate the liver, kidneys, and also affect muscular growth and the reproductive system. They need mature women, because estrogen is synthesized, is maintained at a sufficient level of libido and strengthen bone tissue.

What it is?

Hyperandrogenism in women - a collective term that includes a number of diseases and syndromes, accompanied by an absolute or relative increase in the blood concentration of male sex hormones women.

Causes of

There are the following main causes of this syndrome:

• presence adrenal tumors;
• incorrect production of special enzyme synthesizing androgens, resulting in their over-accumulation in the body;
• thyroid disease (hypothyroidism), pituitary tumors;
• disease and malfunction ovarian provoking excessive androgen;
• Obesity in childhood;
• long-term use of steroids in professional occupations in power sports;
• genetic predisposition.

When violations of the ovaries, increasing the adrenal cortex, hypersensitivity of the skin cells to effects of testosterone, tumors of the reproductive and thyroid disease may develop in childhood age.

Congenital hyperandrogenism sometimes does not allow to set up the floor unborn child. The girl may experience large labia, clitoris increased to penis size. Appearance of internal genital organs correct.

One variety adrenogenital syndrome is solteryayuschaya form. The disease is hereditary and is usually detected in the first months of life. As a result of poor performance of the adrenal glands in girls appears vomiting, diarrhea, seizures.

At older ages, hyperandrogenism causes excessive hair growth all over the body, delay the formation of the mammary glands and the emergence of the first month.

Classification

Depending on the level of male sex hormones in the blood is isolated hyperandrogenism:

• absolute (their concentration exceeds the normal values);
• relative (the androgen level is within normal limits, but they are heavily metabolized into a more active form or the sensitivity of the target organs them significantly increased).

In most cases, the cause is hyperandrogenism polycystic ovarian syndrome. it also takes place at:

• adrenogenital syndrome;
• syndrome galactorrhea-amenorrhea;
• adrenal and ovarian neoplasms;
• hypothyroidism;
• Cushing's syndrome, and other pathological conditions.
• woman receiving anabolic steroids, drugs of male sex hormones and cyclosporine.

Depending on the origin was isolated 3 forms of this pathology:

• ovarian (ovarian);
• adrenal;
• mixed.

If the root of the problem lies in these organs (ovaries or adrenal cortex), hyperandrogenism called primary. In the case of pituitary disease, causes a violation of the regulation of androgen synthesis, its regarded as secondary. In addition, this condition can be inherited or develop during the life of the woman (ie, is the acquisition).

The symptoms of hyperandrogenism

Among the symptoms of hyperandrogenism in women dominated the following:

1. Hirsutism - excess hair growth in women, so-called male-pattern hair growth on, is the most common sign of hyperandrogenism. On it you can talk with the appearance of hair on his stomach in the midline, on the face, chest. However, the color may bald areas.
2. It is necessary to distinguish between the symptoms of hypertrichosis - excessive hair growth is not dependent on androgens, which may be either congenital or acquired (in various diseases, such as porphyria). It should also pay attention to the racial affiliation of the patient - so eskimosok women and immigrants from Central Asian countries expressed more body hair than women in Europe or North America.
3. Rash on the face, acne, signs of flaking. Often these defects on the face are in the period of adolescence on the background of hormonal changes the body. When hyperandrogenism in women cosmetic blemishes on the face last much longer, and no lotions or creams from this problem do not save.
4. Opsooligomenoreya (shortened and separated by an interval long periods), amenorrhea (absence of menstrual periods) and infertility - often this symptom occurs with polycystic ovaries, accompanied by hyperandrogenism.
5. Overweight. Overweight women hormonal becomes frequent cause of failure, which interferes with the menstrual cycle.
6. Atrophy of muscles, abdominal muscles, osteoparoz, atrophy of the skin - the most characteristic of Cushing's syndrome (or Cushing's in Russian literature).
7. Increased risk of infection. As a result of hormonal failure disturbed the functioning of many organs and systems that destructive effect on immunity, increasing the risk of exposure and the development of infections.
8. Impaired glucose tolerance - mainly in lesions of the adrenal gland, and often also with pathology of the ovaries.
9. The formation of external genitalia intermediate type (clitoridauxe, urogenital sinus, partial fusion of the labia majora) - is detected immediately after birth or in early childhood period; often with congenital adrenal hyperplasia.
10. Arterial hypertension, myocardial hypertrophy, retinopathy (nevospolitelnoe retinal damage).
11. Depression, drowsiness, fatigue - due above all to the fact that impaired secretion of adrenal glucocorticoids.

hyperandrogenism syndrome may be associated with certain diseases. Thus, we can distinguish among the causes of increased androgen levels:

1. hyperandrogenism syndrome may be associated with Cushing's syndrome. The cause of this disease is in the adrenal glands resulting in excess production of glucocorticoids. Among the symptoms of this disease are: round face, increased neck fat deposition in the abdominal area. There may be failures of the menstrual cycle, infertility, emotional disorders, diabetes, osteoporosis.
2. Stein-Leventhal syndrome. In this syndrome, the cysts are formed in the ovaries, but not those that require immediate operating and temporary. A characteristic phenomenon for polycystic ovary syndrome is an increase in the ovary before menstruation and reducing it after the monthly pass. With this syndrome, there is no ovulation, infertility, increased body hair, overweight. Is a disturbance of insulin, resulting in patients may develop diabetes.
3. Age hyperplasia of the ovaries. There is a fairly mature age women as a result of an imbalance between estradiol and estrone. It manifested as hypertension, diabetes, obesity, cancer of the uterus.

When hyperandrogenism is almost impossible to conceive due to a lack of ovulation. Yet sometimes a woman unable to conceive a child, but make it unfortunately becomes impossible. A woman on the background of hyperandrogenism happens miscarriage or fading occurs fetus in the mother's womb.

Hyperandrogenism in pregnant women

Hyperandrogenism during pregnancy is becoming one of the most common causes of spontaneous abortion, which most often occurs in the early stages. If the disease is detected after conception and childbearing, to determine exactly when it appeared quite difficult. In this case, doctors have little interest in the causes of hyperandrogenism, because you need to take all measures to maintain pregnancy.

Signs of disease in women in the state are no different from the symptoms that occurred at any other time. Miscarriage in most cases due to the fact that the fertilized egg is not able to attach well to the wall of the uterus due to hormonal imbalance in the body. As a result, even with a slight negative external impact occurs miscarriage. He is almost always accompanied by bleeding from the vagina, pulling pain in the abdomen. Also, such a pregnancy is characterized not as pronounced toxicosis, which is present in most women during the first trimester.

complications

The spectrum of possible complications in all diseases is very large as described above. We can only point out some of the most important:

1. Metastasis of malignant tumors - complication more typical for adrenal tumors.
2. In congenital pathology possible developmental abnormalities, the most common of them - the abnormal development of reproductive organs.
3. Complications of other organ systems that are subjected to the negative effects of hormonal changes with adrenal disease, pituitary and ovarian cancer: chronic kidney disease, thyroid pathology and etc.

This simple enumeration of the list is far from over, which speaks in favor of timely treatment to the doctor, in order to anticipate their attack. Only prompt diagnosis and efficient treatment contribute to the achievement of positive results.

Diagnostics

Diagnosis hyperandrogenism in women in clinical laboratory:

1. Determined number of 17-ketosteroids in urine;
2. Determination of the main hormone levels. Find out what amount of prolactin, free and total testosterone, dehydroepiandrosterone sulfate, androstenedione and FSH levels in the blood plasma. Fence material produced in the morning on an empty stomach. Due to the constant hormonal changes, patients hyperandrogenism tries to do three times, at intervals between treatments of 30 minutes, then all three portions of mixed blood. Dehydroepiandrosterone sulfate, in an amount of more than 800 mg%, indicates the presence androgensekretiruyuschey adrenal tumors;
3. Take a marker to determine the hCG (when there are signs of hyperandrogenism, but the main androgen level is normal).

Research tool: patient with suspected hyperandrogenism directed to MRI, CT, ultrasound intravaginal (for visualization of tumor formations).

treatment of hyperandrogenism

The choice of treatment of hyperandrogenism is largely dependent on the background of the disease, which was the cause of this pathological condition, as well as the severity of the disease and laboratory signs of expression hyperandrogenism.

In this regard, management of patients and determining treatment strategy should be preferably individually, with all the features of each particular patient. In many situations, the treatment of hyperandrogenism means carrying out a whole range of therapeutic measures both conservative and operative directions.

Recommendations relating to lifestyle:

• normalization of body weight;
• regular exercise (well suited walking, jogging, aerobics and swimming);
• special hypocaloric diet (the amount of calories should be greater than acquired).

Drug therapy:

• agonists, gonadotropin-releasing hormone (androgen decline and ovarian estrogen);
• estrogen-progestin drugs (stimulation of the formation of the female hormones);
• anti-androgens (androgen suppression excess allocation as the adrenal glands and ovaries);
• preparations containing high ovarian hormone (progesterone).

Treatment of comorbidities:

• thyroid disease and liver;
• PCOS (Polycystic Ovarian Syndrome), when the excessive production of the male sex hormone is accompanied by a lack of ovulation;
• AGS (adrenogenital syndrome).

Surgical intervention:

• removing hormone producing tumors.

Cosmetology types of correction:

• bleaching unwanted hair;
• at home - plucking and shaving;
• in the beauty salon - hair removal, electrolysis, hair removal with wax or laser.

Polycystic ovary syndrome is the most common cause of ovarian hyperandrogenism, in often lends itself well to the use of a whole range of hormonal conservative treatment drugs.

In Cushing's syndrome with evidence of hyperandrogenism in women suffering oncological pathologies of the adrenal gland, the only effective treatment is surgical.

Treatment of congenital adrenal hyperplasia should be started as early as the stage of prenatal development of the child, as this pathology leads to the development of severe hyperandrogenism.

In a situation where the patient is hyperandrogenism androgensekretiruyuschey symptom of tumor of the ovary, the only viable treatment option is a combination of operational, radiation and chemopreventive therapy.

Treatment of women with hyperandrogenism in postmenopausal women, is the appointment of Klimena conventional scheme, which has a pronounced anti-androgenic effect.

preventive measures

Prevention is as follows:

• regular (2-3 times per year) visit gynecologist;
• minimization of heavy loads (such as psycho-emotional and physical);
• avoiding harmful habits (smoking, alcohol abuse);
• balanced and balanced diet: Give preference to products rich in fiber, and give up the fried and spicy foods, as well as conservation;
• timely treatment of liver diseases, thyroid and adrenal glands.

Is it possible to conceive and bear a healthy child with this diagnosis? Yes, it is quite. But taking into account the increased risk of miscarriage, make it easy. If you have learned about the problem at the planning stage of pregnancy, you should first normalize hormones. In the case where the diagnosis was already "in fact," tactic to further treatment (which, we note, is not always is required) determined by a physician, and you will only have to unconditionally comply with all its recommendations.