Is hyperandrogenism treated in women? Hyperandrogenism syndrome: modern approaches to diagnosis and new technologies of therapy

Hyperandrogenism is a pathology in which a woman’s hormonal background undergoes significant changes. Too much of the androgen hormone, which is considered male, is produced. In a woman’s body, this hormone performs many necessary functions, but its excessive amount leads to unpleasant consequences, the treatment of which is mandatory.

Androgens are produced in women by adipocytes, adrenal glands and ovaries. These sex hormones directly influence the process of puberty in women, the appearance hairline in the genital area and armpits. Androgens regulate the functioning of the liver, kidneys, and also affect muscle growth and reproductive system. They are necessary for mature women because they synthesize estrogen, maintain a sufficient level of libido and strengthen bone tissue.

What it is?

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

Causes

The following main causes of this syndrome can be identified:

presence of adrenal tumors;
improper production of a special enzyme that synthesizes androgens, resulting in their excessive accumulation in the body;
pathology thyroid gland(hypothyroidism), pituitary tumors;
diseases and malfunctions of the ovaries, provoking excessive production of androgens;
obesity in childhood;
long-term use of steroids during professional strength sports;
genetic predisposition.

If there are disturbances in the functioning of the ovaries, enlargement of the adrenal cortex, hypersensitivity of skin cells to the effects of testosterone, tumors of the reproductive and thyroid glands, pathology may develop in childhood.

Congenital hyperandrogenism sometimes makes it impossible to accurately determine the sex of a born child. A girl may have large labia and a clitoris enlarged to the size of a penis. Appearance internal genital organs corresponds to the norm.

One of the varieties of adrenogenital syndrome is the salt-wasting form. The disease is hereditary and is usually detected in the first months of a child’s life. As a result of unsatisfactory functioning of the adrenal glands, girls experience vomiting, diarrhea, and convulsions.

In older age, hyperandrogenism causes excess hair growth throughout the body, delayed formation of mammary glands and the appearance of the first menstruation.

Classification

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

absolute (their concentration exceeds normal values);
relative (the level of androgens is within normal limits, but they are intensively metabolized into more active forms or the sensitivity of target organs to them is significantly increased).

In most cases, the cause of hyperandrogenism is polycystic ovary syndrome. It also occurs when:

adrenogenital syndrome;
galactorrhea-amenorrhea syndrome;
neoplasms of the adrenal glands or ovaries;
hypofunction of the thyroid gland;
Itsenko-Cushing syndrome and some other pathological conditions.
a woman taking anabolic steroids, male sex hormones and cyclosporine.

Depending on the origin, there are 3 forms of this pathology:

ovarian (ovarian);
adrenal;
mixed.

If the root of the problem is located in these organs (ovaries or adrenal cortex), hyperandrogenism is called primary. In the case of pathology of the pituitary gland, which causes disturbances in the regulation of androgen synthesis, it is regarded as secondary. In addition, this condition can be inherited or develop during a woman’s life (that is, acquired).

Symptoms of hyperandrogenism

Among all the symptoms of hyperandrogenism in women, the following predominate:

Hirsutism - excessive hair growth in women, the so-called male pattern hair growth, is the most common sign of hyperandrogenism. We can talk about it when hair appears on the stomach along the midline, on the face, and chest. At the same time, bald patches on the head are possible.
This symptom should be distinguished from hypertrichosis - excess hair growth, independent of androgens, which can be either congenital or acquired (with various diseases, for example with porphyrias). It is also necessary to pay attention to the race of the patient - for example, Eskimos and women from Central Asian countries have more hair growth than women in Europe or North America.
Rash on the face, acne, signs of peeling. Often such defects on the face occur during adolescence against the background of hormonal changes in the body. With hyperandrogenism in women, cosmetic defects on the face last much longer, and neither lotions nor creams can save you from this problem.
Opsooligomenorrhea (shortened and separated by a long interval), amenorrhea (absence of menstruation) and infertility - most often this symptom occurs in polycystic ovary syndrome, accompanied by hyperandrogenism.
Overweight. Excess weight in women becomes a common cause of hormonal imbalance, which disrupts the menstrual cycle.
Atrophy of the muscles of the limbs, abdominal muscles, osteoparosis, skin atrophy - most characteristic of Cushing's syndrome (or Itsenko-Cushing in Russian-language literature).
Increased risk of infection. As a result of hormonal imbalance, the functioning of many organs and systems is disrupted, which has a devastating effect on the immune system, increasing the risk of getting and developing infections.
Impaired glucose tolerance - mainly with damage to the adrenal glands, often also with pathology of the ovaries.
Formation of the external genitalia of an intermediate type (hypertrophy of the clitoris, urogenital sinus, partial fusion of the labia majora) - detected immediately after birth or in early childhood; more often with congenital adrenal hyperplasia.
Arterial hypertension, myocardial hypertrophy, retinopathy (non-inflammatory damage to the retina).
Depression, drowsiness, increased fatigue– is due, among other things, to the fact that the secretion of glucocorticoids from the adrenal glands is disrupted.

Hyperandrogenism syndrome may be associated with certain medical conditions. So, among the reasons for increased androgen levels are:

Hyperandrogenism syndrome may be associated with Cushing's syndrome. The reason for the development of this pathology lies in the adrenal glands as a result of excessive production of glucocorticoids. Among the symptoms of this disease can be distinguished: a rounded face, an enlarged neck, fat deposition in the abdominal area. Problems may occur menstrual cycle, infertility, emotional disorders, diabetes mellitus, osteoporosis.
Stein-Leventhal syndrome. With this syndrome, cysts form in the ovaries, but not those that require immediate surgery, but temporary ones. A characteristic phenomenon of polycystic ovary syndrome is an enlargement of the ovary before menstruation and a decrease in size after menstruation has passed. With this syndrome, there is a lack of ovulation, infertility, increased hair growth, and excess weight. There is a disruption in the production of insulin, as a result of which patients may develop diabetes mellitus.
Age-related ovarian hyperplasia. Observed in quite mature age in women as a result of an imbalance between estradiol and estrone. Manifests itself in the form of hypertension, diabetes, excess weight, and uterine cancer.

With hyperandrogenism, it is almost impossible to get pregnant due to the lack of ovulation. But still, sometimes a woman manages to conceive a child, but, unfortunately, it becomes impossible to bear it. A woman with hyperandrogenism experiences a miscarriage or the fetus freezes in the womb.

Hyperandrogenism in pregnant women

Hyperandrogenism during pregnancy becomes one of the most common causes of spontaneous abortion, which most often occurs during early stages. If this disease is detected after conception and pregnancy, it is quite difficult to determine exactly when it arose. In this case, doctors are of little interest in the reasons for the development of hyperandrogenism, since all measures must be taken to maintain pregnancy.

The signs of pathology in pregnant women are no different from the symptoms that are observed at any other time. Miscarriage in most cases is due to the fact that ovum unable 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 influence a miscarriage occurs. It is almost always accompanied by bloody vaginal discharge, nagging pain lower abdomen. Also, such a pregnancy is characterized by less severe toxicosis, which is present in most women in the first trimester.

Complications

The range of possible complications for all the diseases described above is extremely large. Only a few of the most important ones can be noted:

Metastasis malignant tumors– a complication more typical for adrenal tumors.
At congenital pathology developmental anomalies are possible, the most common of which are anomalies in the development of the genital organs.
Complications from other organ systems that are negatively affected by the change hormonal levels with pathology of the adrenal glands, pituitary gland and ovaries: chronic renal failure, pathology of the thyroid gland, etc.

With this simple enumeration, the list is far from complete, which speaks in favor of timely consultation with a doctor in order to anticipate their onset. Only timely diagnosis and qualified treatment contribute to achieving positive results.

Hirsutism

Diagnostics

Diagnosis of hyperandrogenism in women in a clinical laboratory:

The amount of ketosteroids-17 in urine is determined;
Definition of main hormonal levels. Find out what is the amount of prolactin, free and total testosterone, dehydroepiandrosterone sulfate, androstenedione and the level of FSH in the blood plasma. The material is collected in the morning, on an empty stomach. Due to constant changes in hormonal levels, for patients with hyperandrogenism, the test is done three times, with intervals of 30 minutes between procedures, then all three portions of blood are mixed. Dehydroepiandrosterone sulfate, in an amount of more than 800 mcg%, indicates the presence of an androgen-secreting adrenal tumor;
A marker is taken to determine hCG (in the case where there are signs of hyperandrogenism, but the basic level of androgens remains normal).

Instrumental examination: a patient with suspected hyperandrogenism is referred for MRI, CT, intravaginal ultrasound (to visualize tumor formations).

Treatment of hyperandrogenism

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

In this regard, patient management and determination of treatment tactics should be primarily individual, taking into account all the characteristics of each specific patient. In many situations, treatment of hyperandrogenism involves a whole complex of therapeutic measures both conservative and operational directions.

normalization of body weight;
regular exercise (walking, running, aerobics and swimming are good options);
a special hypocaloric diet (the amount of calories burned should be greater than the calories acquired).

Drug therapy:

gonadotropin-releasing hormone agonists (reducing the production of androgens and estrogens by the ovaries);
estrogen-gestagen drugs (stimulation of the formation of female hormones);
antiandrogens (suppression of excess androgen secretion by both the adrenal glands and the ovaries);
drugs with a high content of the ovarian hormone (progesterone).

Treatment of associated pathologies:

diseases of the thyroid gland and liver;
PCOS (polycystic ovary syndrome), when excessive production of male sex hormones is accompanied by a lack of ovulation;
AGS ( adrenogenital syndrome).

Surgical intervention:

removal of hormone-producing tumors.

Cosmetological types of correction:

bleaching unwanted hair;
at home - plucking and shaving;
in a beauty salon - depilation, electrolysis, hair removal using wax or laser.

Polycystic ovary syndrome, which is the most common cause of ovarian hyperandrogenism, is highly treatable in many cases. conservative treatment using a whole range of hormonal drugs.

For Cushing's syndrome with signs of hyperandrogenism in patients suffering from oncological pathologies adrenal glands, the only effective treatment is surgery.

Treatment of congenital adrenal hyperplasia should begin at the stage of intrauterine development of the child, since this pathology leads to the development of severe hyperandrogenism.

In a situation where hyperandrogenism in a patient is a symptom of an androgen-secreting ovarian tumor, the only effective treatment option is a combination of surgery, radiation and chemoprophylactic therapy.

Treatment of women suffering from hyperandrogenism in the postmenopausal period consists of prescribing Climen according to the generally accepted regimen, which has a pronounced antiandrogenic effect.

Prevention measures

Prevention is as follows:

regular (2-3 times a year) visits to the gynecologist;
minimizing increased stress (both psycho-emotional and physical);
refusal bad habits(smoking, alcohol abuse);
balanced and rational diet: give preference to foods rich in fiber and avoid fried and spicy food, as well as conservation;
timely treatment of diseases of the liver, thyroid gland and adrenal glands.

Is it possible to conceive and carry to term? healthy child with such a diagnosis? Yes, it is quite. But given the increased risk of miscarriage, this is not easy to do. If you learned about the problem at the stage of pregnancy planning, you should first normalize your hormonal levels. In the case when the diagnosis has already been made “after the fact”, the tactics of further therapy (which, we note, is not always necessary) will be determined by the attending physician, and you will only have to unconditionally follow all his recommendations.

It is a collective diagnosis in which there are a number of syndromes and diseases leading to an increase in the concentration of male sex hormones in female body. Today, this pathology is considered quite common: the diagnosis of hyperandrogenism is established in 5–7% of girls who have reached puberty and 10–20% of women in their childbearing years.

The problem of treating this disease is so acute not only because of the appearance of defects in the appearance of women, but also because of infertility. This is why every woman needs to have general ideas about this disease: its causes, clinical picture, features of diagnosis, as well as treatment tactics.

Basic physiology - sex hormones

Male hormones reproductive system. The main representative of these secretions is testosterone. Not many people know that these hormones are present in small quantities in a woman’s body. They are synthesized in the cells of the ovaries, the adrenal cortex and the pancreas. The pituitary gland monitors the production of a regulated amount of androgens through the release of adrenocorticotropic and luteinizing hormones.

The functions of androgens are significant:

estrogens and corticosteroids are their derivatives;
influence the emergence of sexual desire in a woman;
affect growth tubular bones during puberty;
thanks to their influence, secondary sexual characteristics are formed: hair growth female type, breast growth and voice changes.

Normal functioning and development of the body can only occur if there is a sufficient level of androgens in a woman’s blood. However, their excess is the cause of many cosmetic defects in appearance, the development of metabolic disorders, disruptions in the menstrual cycle, even impaired fertility (the possibility of a woman in reproductive period, conceive and bear a child).

Androgenism in women is also a characteristic indicator of hormonal imbalance.

Etiological factors of the disease

Excess androgen in women is the main characteristic of the above syndrome, however, there are three types of this disease. Androgenism in women is one of them. Depending on the location of the pathological process, hyperandrogenism can be ovarian, adrenal and mixed. It can be primary or secondary in nature.

The causes of the syndrome are:

hereditary predisposition - most women with hyperandrogenism syndrome have relatives who suffered from this disease;
dysfunction of higher nerve centers: pituitary gland and hypothalamus. It is these parts of the brain that influence the functioning of the ovaries;
congenital anomalies of the adrenal cortex - suppression of the production of one type of hormones and an increase in the synthesis of others is common for such congenital dysfunctions;
producing tumors of the ovaries or adrenal glands affect the quantitative production of hormones, in particular androgens;

polycystic ovary syndrome is one of the most common causes that affects the synthesis of male hormones in a woman’s body;
adrenogenital syndrome - a pathology in which an excessive amount of male hormones is produced by the adrenal glands;
prolactinoma - a neoplasm in the pituitary gland that affects the production of prolactin;
Itsenko-Cushing's disease is a disease characterized by excessive synthesis of hormones by the adrenal cortex;
ovarian hypertrophy;
increased activity of enzymes that affect the rate of production of steroid hormones;
unbalanced and uncontrolled use of oral contraceptives, anabolic steroids and glucocorticoids;
decreased production of triiodothyronine and tetrazodothyronine due to disruption of the thyroid gland;
chronic dysfunction of hepatocytes.

All of the above reasons are only an approximate list of factors influencing the development of the disease.

Symptoms of hyperandrogenism

Symptoms hormonal disorders always differ in their specificity, it is very difficult to confuse them with another disease. The main manifestations of the clinical picture are considered to be:

- excessive hair growth is typical for men, however, in this case it is observed in females. Increased hair growth along the midline of the abdomen, chest and face - typical signs. In parallel with the increase in vegetation, bald patches appear on the head. It is necessary to differentiate this manifestation from, the cause of the development of which is not excessive production of androgens, but extraneous causes (for example, porphyria). The patient’s race also plays a role: Caucasians have sparse vegetation compared to Eskimos;
acne and peeling of the epithelium is a cosmetic defect, which is often an external manifestation of more serious problems hidden inside the body;
menstrual irregularities, in particular - opso-oligomenorrhea - too short or long intervals between menstruation, - absence of menstruation or infertility. As a rule, these symptoms most often occur with;
weight gain can be observed in all forms of this pathology (excess weight is 20% of the normal value);
reduction in quantity muscle mass in the area of the extremities, abdominal area, osteoporosis and skin atrophy are symptoms characteristic of;

uneven production of hormones can be the main cause of decreased immunity, the body’s support function and the occurrence of various infectious diseases;
with pathology of the adrenal glands, impaired glucose tolerance may be observed, however, the possibility of the development of this pathology in the ovarian form of hyperandrogenism cannot be excluded;
excessive development of the external genitalia related to intermediate type. Enlargement of the clitoris, urogenital sinus and a noticeable decrease in the gap between the labia majora can be detected immediately after the birth of a child or during infancy. As a rule, this manifestation is a consequence of congenital pathology of the adrenal cortex;
diseases of cardio-vascular system, namely arterial hypertension, left ventricular myocardial hypertrophy, retinopathy;
asthenic syndrome: constant fatigue, drowsiness, apathy or depression. These manifestations are associated with impaired glucocorticoid synthesis.

The occurrence of the above-described manifestations is a reason to contact the clinic and conduct further examination.

Complications of hyperandrogenism

Late detection of the disease or incorrectly prescribed therapy can greatly affect the condition of the body. Some of the most important complications are:

if pathology endocrine system congenital, then various developmental anomalies appear, the most common are developmental anomalies of the reproductive system.
if hyperandrogenism is caused tumor process, then metastasis of malignant neoplasms can be considered the most dangerous complications. As a rule, this clinical picture characteristic of adrenal tumors.
If hormonal levels are disrupted, other diseases of organs and systems may occur. The most common disorders include chronic renal failure and thyroid disease.

Unfortunately, this list does not end, as it can be continued dozens of positions down. However, it is precisely this fact that should encourage every patient to consult a doctor in time to prevent these complications. Only timely diagnosis and individual prescription of therapy can guarantee positive dynamics of the disease.

Diagnosis of hyperandrogenism

To diagnose this disease, it is necessary to collect all the necessary anamnestic indicators, conduct a physical examination and, at the same time, determine the patient’s level of sexual development, the regularity of menstruation, the nature of hair growth, and the presence of dermatopathy.

Laboratory tests are aimed at determining levels and sex hormone-binding globulin. After determining the concentration of androgens, it is necessary to clarify the nature of their excess: adrenal or ovarian. Clinical tests will help differentiate these two pathologies:

It is typical for adrenal (adrenal) hyperandrogenism;
The ovarian type of syndrome is characterized by an increase in testosterone levels in the blood and ASD.

If these indicators increase excessively in a woman, it is imperative to carry out differential diagnosis with tumor diseases. A CT or MRI will help confirm or refute this assumption. And also as additional method may be applied ultrasound diagnostics. This method is suitable for identifying polycystic ovarian deformities.

Treatment

The main feature of the treatment of hyperandrogenism is the duration of the course. The prescribed therapy requires mandatory differentiated approach to patient management tactics. As a rule, estrogen-progestin oral contraceptives, which have an antiandrogenic effect, are used to correct hyperandrogenism.

Drugs in this group are aimed at reducing the production of gonadotropins and the rate of ovulation, inhibiting the synthesis of ovarian secretions, and increasing the amount of globulins that bind sex hormones.

Hyperandrogenism syndrome can also be treated with corticosteroids. Their use is also justified to prepare a woman for future conception, the gestational period when this disease appears. When high activity enzymes, the course of therapy can last a year or more.

Treatment of hyperandrogenism in women also involves treating the external manifestations of the disease. For example, peripheral blockade of androgen receptors is often used to eliminate dermatopathy. In parallel with it, therapy is used to eliminate concomitant diseases of the endocrine system.

If obesity occurs, measures are taken to reduce body weight, namely a low-carbohydrate diet and moderate physical exercise. All adjustments to the prescribed treatment should be made only by the attending physician after laboratory and clinical studies.

Prevention of hyperandrogenism

This disease does not have any specific preventive measures. However, the main points aimed at maintaining balance and health of the body include a correct lifestyle, giving up bad habits, balanced diet and systematic exercise.

Every woman should know and remember that excessive weight loss can lead to hormonal imbalance and contribute to the development of not only hyperandrogenism syndrome, but also other diseases of the endocrine system. Sports should also be moderate, because professional sports often push women to use steroids, leading to various health problems.

The main thing is to remember that often your health is in your own hands and following the doctor’s recommendations can solve all problems. Hypoandrogenism is a complex disease that requires comprehensive treatment.

Hyperandrogenism in women is a condition in which an increased level of androgens is determined in the blood, and clinical data of an excess of male sex hormones are also recorded. Occurs in different age groups. The main causes of hyperandrogenism are adrenogenital syndrome (AGS) and polycystic ovary syndrome (PCOS). Treatment of hyperandrogenism is aimed at correcting hormonal levels and preventing the consequences of excess androgens.

Normally, a woman’s hormonal status allows for a certain level of androgens in the blood. From them, under the influence of aromatase, some estrogens are formed. Excessive amounts lead to reproductive dysfunction and increase the risk of cancer. There is no classification of this syndrome in ICD-10, since it is not a disease.

What causes hyperandrogenism in women?

Hyperandrogenism is characterized by an increased concentration in the female body of androgens, which are related to male sex hormones, among which the most famous is testosterone. In the fair sex, the adrenal cortex, ovaries, and subcutaneous tissue are responsible for their synthesis. fatty tissue and indirectly the thyroid gland. The whole process is “guided” by luteinizing hormone (LH), as well as adrenocorticotropic hormone (ACTH) of the pituitary gland.

In normal concentrations, androgens in the female body exhibit the following properties:

responsible for growth- participate in the growth spurt mechanism and contribute to the development of tubular bones during puberty;
are metabolites- from them estrogens and corticosteroids are formed;
form sexual characteristics- at the level with estrogens, they are responsible for natural hair growth in women.

Excessive androgen content leads to hyperandrogenism, which manifests itself in endocrinological, cyclic disorders, and changes in appearance.

The following can be distinguished primary causes hyperandrogenism.

AGS. Adrenogenital syndrome is characterized by insufficient synthesis or absence of ovarian production of the enzyme C21-hydroxylase (converts testosterone into glucocorticoids), which leads to an excess of androgens in the female body.
Polycystic disease. PCOS can be a cause or a consequence of androgen excess.
Tumors. They can be localized in the ovaries, adrenal glands, pituitary gland and hypothalamus, and they produce excess amounts of androgens.
Other pathologies. Hyperandrogenism can be caused by disruption of the thyroid gland, liver (hormone metabolism occurs here), or by taking hormonal medications.

The listed disorders lead to changes in the metabolism of male sex hormones, and the following occurs:

their excessive education;
conversion to active metabolic forms;
increased sensitivity of receptors to them and their rapid death.

Additional factors that may influence the development of hyperandrogenism are:

taking steroids;
increased prolactin levels;
excess weight in the first years of life;
sensitivity (sensitivity) skin to testosterone.

Types of pathology

Depending on the cause, level and mechanism of development of pathology, there are the following types hyperandrogenism.

Ovarian. Characterized by disorders of genetic or acquired origin. Ovarian hyperandrogenism is characterized by rapid development and sudden appearance symptoms. In the ovaries, androgens are converted to estrogens by the enzyme aromatase. If its functioning is disrupted, a deficiency of female sex hormones and an excess of male hormones occurs. In addition, ovarian hyperandrogenism can be provoked by hormonally active tumors of this localization.
Adrenal. This hyperandrogenism is caused by adrenal tumors (most often androsteromas) and adrenogenital syndrome. The latter pathology is caused by genetic abnormalities of the gene that is responsible for the formation of the enzyme C21-hydroxylase. The deficiency of this substance over a long period of time can be compensated by the work of other hormone-producing organs, so the condition has a hidden course. With psycho-emotional stress, pregnancy and other stress factors, the enzyme deficiency is not covered, so the AGS clinic becomes more obvious. Adrenal hyperandrogenism is characterized by ovarian dysfunction and menstrual irregularities, lack of ovulation, amenorrhea, and insufficiency of the corpus luteum during egg maturation.
Mixed. A severe form of hyperandrogenism combines dysfunction of the ovaries and adrenal glands. The trigger mechanism for the development of mixed hyperandrogenism is neuroendocrine disorders, pathological processes in the hypothalamus region. Manifested by violations fat metabolism, often infertility or miscarriage.
Central and peripheral. Associated with dysfunction of the pituitary gland and hypothalamus, disruption of the nervous system. There is a deficiency of follicle-stimulating hormone, which impairs the maturation of follicles. As a result, androgen levels increase.
Transport. This form of hyperandrogenism is based on a deficiency of globulin, which is responsible for binding sex steroids in the blood and also blocks excessive testosterone activity.

Based on the site of origin of the pathology, the following types of hyperandrogenism are distinguished:

primary - originates in the ovaries and adrenal glands;
secondary - the center of origin in the pituitary gland.

According to the method of development of pathology, the following are distinguished:

hereditary;
acquired.

According to the degree of concentration of male hormones, hyperandrogenism occurs:

relative - the level of androgens is normal, but the sensitivity of target organs to them is increased, and male sex hormones tend to convert into active forms;
absolute - the permissible norm for androgen content is exceeded.

How it manifests itself

Hyperandrogenism manifests itself clear signs, often they are easy to notice even to the average person. Symptoms excessive concentration male hormones depend on age, type and degree of development of the pathology.

Before puberty

Before puberty, hyperandrogenism is caused by genetic disorders or hormonal imbalance during fetal development.
Clinically manifested by defective anatomy of the external genitalia and pronounced male secondary sexual characteristics.

Adrenal hyperandrogenism in newborn girls is manifested by false hermaphroditism - the vulva fusions, the clitoris becomes excessively enlarged, and the fontanelle becomes overgrown already in the first month. Subsequently, girls experience:

long upper and lower limbs;
high growth;
excessive amount of body hair;
late onset of menstruation (or absent altogether);
secondary female sexual characteristics are weakly expressed.

Diagnosis is difficult to carry out with this pathology and ovotestis - the presence of male and female germ cells, which happens with true hermaphroditism.

During puberty

IN puberty girls with hyperandrogenism may experience:

acne on the face and body- blockage of ducts sebaceous glands and hair follicles;
seborrhea - excessive production of secretions by the sebaceous glands;
hirsutism - excessive hair growth on the body, including in “male” places (arms, back, inside thighs, chin);
NMC - unstable menstrual cycle, amenorrhea.

During reproductive age

If the pathology manifests itself in reproductive age, all of the above signs can be joined by:

baryphonia - deepening of the voice;
alopecia - baldness, hair loss on the head;
masculinization - increase in muscle mass, change in male body type, redistribution subcutaneous tissue fat from the hips to the abdomen and upper torso;
increased libido- excessive sexual desire;
breast reduction- mammary glands are small in size, lactation continues after childbirth;
metabolic disease- expressed in insulin resistance and the development of type 2 diabetes mellitus, hyperlipoproteinemia, obesity;
gynecological problems- disruptions in the menstrual cycle, lack of ovulation, infertility, endometrial hyperplasia;
psycho-emotional disorders- tendency to depression, feeling of loss of strength, anxiety, sleep disturbance;
cardiovascular disorders- tendency to hypertension, episodes of tachycardia.

All these symptoms are combined into one concept - viril syndrome, which implies the development of male characteristics and the loss of female characteristics by the body.

In menopause

In women at the onset of menopause, hyperandrogenism syndrome occurs due to a decrease in estrogen levels. By this time, many people notice the appearance of “male hair,” especially in the chin and upper lip. This is considered normal, but it is necessary to exclude hormone-producing ovarian tumors.

Diagnostics

Confirmation of pathology requires a comprehensive examination.

Anamnesis collection. Information about the menstrual cycle, the woman’s physique, the degree of hair coverage of her face and body, and the timbre of her voice are taken into account - those signs that indicate an excess of androgens.
Blood tests . For sugar content and to determine the level of testosterone, cortisol, estradiol, 17-hydroxyprogesterone, SHBG (globulin that binds sex hormones), DHEA (dehydroepiandrosterone). Hormone tests are carried out on the fifth to seventh day of the cycle.
Ultrasound. It is necessary to conduct an ultrasound examination of the thyroid gland, adrenal glands and pelvic organs.
CT, MRI. If you suspect a brain tumor in the pituitary gland or hypothalamus.

If necessary, the range of examinations can be expanded for a more detailed diagnosis.

Consequences for the body

Estrogens are responsible not only for “female appearance” and the realization of reproductive potential, but also protect the body from many pathological conditions. An imbalance between estrogens and androgens can lead to the following consequences:

pregnancy problems- infertility, early and late pregnancy loss;
increased risk of cancer- endometrium, mammary gland, cervix;
gynecological diseases- dysfunctions, ovarian cysts, endometrial hyperplasia and polyps, cervical dysplasia, mastopathy occur more often;
somatic diseases- a tendency to hypertension and obesity, strokes and heart attacks occur more often.

Treatment

Treatment of hyperandrogenism in women is aimed at correcting hormonal imbalances and eliminating the root cause. Clinical guidelines depends on the woman’s age, the realization of her reproductive potential, the severity of symptoms and other disorders in the body.

Standard approach. Most often, treatment regimens for this pathology are based on the use of combined hormonal drugs, which have an antiandrogenic effect. In some cases, gestagens, for example, Utrozhestan, are sufficient. This therapy is used to correct adrenal and ovarian hyperandrogenism. This tactic does not eliminate the cause of the disease, but helps fight the symptoms and reduces the risks of complications of hyperandrogenism in the future. It is necessary to take hormones constantly.
Adrenogenital syndrome. It can be treated with corticosteroids, which are also used to prepare a woman for pregnancy. Among the drugs, the most famous is Dexamethasone. "Veroshpiron" can be used to correct the water-salt balance in AHS.
Androgen-derived tumors. For the most part they are benign neoplasms, but are still subject to surgical removal.

In case of infertility, it is often necessary to resort to ovulation stimulation, IVF, and laparoscopy if polycystic ovaries are diagnosed. Established hyperandrogenism and pregnancy require careful medical monitoring due to the increased risk of pregnancy complications. Reviews from women and doctors confirm this.

“Many women have uterine discharge (menstruation), but not all. They occur in light-skinned people with a feminine appearance, but not in those who are dark and masculine...”
Aristotle, 384 -322 BC. e.

Hyperandrogenism syndrome is a fairly large group of endocrine diseases that arise due to very diverse pathogenetic mechanisms, but are united according to the principle of similar clinical symptoms due to excess quantity and/or quality (activity) of male sex hormones in the female body. The most common hyperandrogenic conditions are:

Polycystic ovary syndrome (PCOS):
a) primary (Stein-Leventhal syndrome);
b) secondary (within the neuroendocrine form of the so-called hypothalamic syndrome, with hyperprolactinemia syndrome, against the background of primary hypothyroidism).
Idiopathic hirsutism.
Congenital dysfunction of the adrenal cortex.
Ovarian stromal tecomatosis.
Virilizing tumors.
Other rarer options.

In most cases, the causes of the formation of these diseases have been studied in sufficient detail, and there are specific effective methods for their correction. Nevertheless, the interest of scientists and clinicians of various specialties in the problem of hyperandrogenism does not dry up. Moreover, the object of constant and most careful attention, especially over the last decade, is PCOS, otherwise called hyperandrogenic dysfunction syndrome of polycystic ovaries, sclerocystic ovaries, Stein-Leventhal syndrome. Such close interest in this problem is justified.

Firstly, only in the 90s. In the 20th century, it was possible to obtain irrefutable evidence that PCOS is not only the most common hyperandrogenic condition (about 70-80% of cases), but also one of the most common endocrine diseases in girls and women childbearing age. Judging by numerous publications in recent years, the extremely high incidence of PCOS, which ranges from 4 to 7% in the population, is impressive. Thus, approximately every 20th woman at various stages of her life - from infancy to old age - is consistently faced with various manifestations of this pathology, and from not only reproductive sphere, but also many others functional systems and organs.

Secondly, the last decade has been marked by a number of events and discoveries that have served as the key to a new understanding of many issues in the pathogenesis of PCOS. This, in turn, became a powerful impetus for the rapid development of very original, effective and promising methods not only for the treatment and rehabilitation of already formed pathology, but also for its long-term hormonal and metabolic consequences, and also became the basis for an attempt to create a preventive program of action aimed at prevention of the development of the disease and its numerous somatic complications.

Therefore, in this article, special emphasis is placed primarily on the problems of diagnosis and achievements in the treatment of PCOS.

Etiopathogenesis

Relatively recently - at the end of the last century - the latest scientific concept was proposed and thoroughly argued that two interrelated components take part in the pathogenesis of PCOS:

increased activity of cytochrome P-450C17alpha, which determines the excessive production of androgens in the ovaries/adrenal glands;
hyperinsulinemic insulin resistance, leading to multiple defects in the regulation of carbohydrate, fat, purine and other types of metabolism.

These two components are combined in the same patient not in a random way, but quite naturally - through a single primary mechanism. A lot of fairly convincing information has been obtained about the existence of a single universal congenital enzyme abnormality in PCOS, which determines excessive phosphorylation of serine (instead of tyrosine), both in steroidogenic enzymes (17β-hydroxylase and C17,20-lyase) and in substrates of the β-subunit of the insulin receptor (IRS-1 and IRS-2). But at the same time, the final effects of such a pathological phenomenon differ: the activity of steroidogenesis enzymes, on average, doubles, which entails hyperandrogenism, while insulin sensitivity at the post-receptor level in peripheral tissues is almost halved, which adversely affects the state of metabolism as a whole. Moreover, reactive hyperinsulinism, which occurs compensatoryly in response to pathological resistance of target cells to insulin, promotes additional excessive activation of androgen-synthesizing cells of the ovarian-adrenal complex, i.e., it further potentiates the androgenization of the woman’s body, starting with childhood.

Clinical characteristics

From the point of view of classical terminology, PCOS is characterized by two obligate features: a) chronic anovulatory ovarian dysfunction, which determines the formation of primary infertility; b) a symptom complex of hyperandrogenism, which has distinct clinical (most often) and/or hormonal manifestations.

Along with this, the newest model of the pathogenesis of PCOS has made it possible to significantly clarify and expand the understanding of the “complete clinical portrait” of the disease. The palette of its symptoms, along with the classical signs of hyperandrogenism described by Chicago gynecologists I. F. Stein and M. L. Leventhal almost 70 years ago (1935), taking into account the latest concepts in most patients, includes a variety of (dys)metabolic disorders due to hyperinsulinism, which were first identified more than 20 years ago, thanks to the pioneering work of researchers G. A. Burghen et al. (Memphis, 1980). Due to the abundance of such fundamental changes in the health of women with PCOS, the clinical picture of this combined pathology (hyperandrogenism along with hyperinsulinism) was very imaginative and clearly reflected not only in the statements of the ancient Greek philosopher (see epigraph), but also in the articles of modern authors.

Symptoms of pathological androgenization

The clinic of hyperandrogenism consists of a few symptoms (about ten signs in total), but, depending on the severity of the process, the general appearance of patients can vary significantly. And with PCOS, which is formed due to a relatively low hyperproduction of predominantly not the most aggressive androgens, attention is drawn to the semiotics of only hyperandrogenic dermopathy - without virilization. This fundamentally distinguishes it from cases of extremely severe androgenization in virilizing tumors of the ovaries and adrenal glands, which have a completely different nosological origin.

Hirsutism- it's not only sign of PCOS, the brightest and most “catchy” when it comes to medical diagnostics, but also the factor that most traumatizes the patient’s psyche. The Ferryman-Gallway scale allows you to evaluate the severity of hirsutism in points within a minute. This technique has been used for more than 40 years and has gained universal recognition in world practice. The scale easily calculates the so-called hormonal number (a four-point score in nine androgen-dependent zones). It reflects the androgen saturation of the patient, as a rule, much more accurately than the indicator of testosterone concentration in the blood serum, which is available in domestic laboratory practice to measure only in total quantity - in the form of total testosterone. It is well known that the latter, even with severe pathology, can remain within the reference norm (due to a decrease in the level of the biologically inactive fraction of the hormone associated with the TESH transport protein), while the result of visual screening diagnostics using the hormonal Ferriman-Gallway number deserves more confidence , since a direct correlation of the value of this marker with the concentration of free androgens has been repeatedly shown. It is the free fraction of testosterone that determines the severity of the process, therefore, in practice, the hormonal score for assessing hirsutism may well be considered as a reliable “mirror” of hyperandrogenism. In our own work, we have long been using the original gradation of the severity of hirsutism according to the hormonal number: I degree - 4-14 points, II - 15-25 points, III - 26-36 points. Experience shows that the doctor’s oncological alertness should be extremely high in any case - even in the absence of virile signs - especially if a woman consults a doctor with long-standing hirsutism III degree, as well as with the II severity of the disease, which quickly formed due to the “galloping” course of the disease.

Androgenetic alopecia is a reliable diagnostic marker for virile variants of GAS. Like other types of endocrine alopecia, it is diffuse and not focal (clustered) in nature. But unlike baldness in other diseases of the endocrine glands (primary hypothyroidism, polyglandular insufficiency, panhypopituitarism, etc.), androgenic alopecia is characterized by certain dynamics. As a rule, it manifests itself as hair loss in the temporal areas (bitemporal alopecia with the formation of symptoms of “temporal receding hairline” or “receding hairline of the Privy Councilor” and “widow’s peak”), and then spreads to the parietal region (parietal alopecia, “baldness”). The peculiarities of the synthesis and metabolism of androgens in the perimenopausal period explain the fact that up to 13% of women at this age have a “widow’s peak” or more pronounced forms of baldness in the absence of other signs of GAS. On the other hand, baldness as a formidable indicator of a severe course of GAS is more often observed and forms faster (sometimes ahead of hirsutism) precisely in this age group, which requires excluding an androgen-producing tumor.

Symptoms of insulin resistance and hyperinsulinism

Classic manifestations of pathology carbohydrate metabolism(impaired glucose tolerance or type 2 diabetes mellitus). In PCOS, a combination of hyperandrogenism and insulin resistance, named by R. Barbieri et al. in 1988, HAIR (hyperandrogenism and insulin resistance) syndrome is the most common. Even among adolescents with emerging PCOS, insulin resistance is detected by a standard glucose tolerance test with 75 g of glucose in approximately a third of cases (mainly of the IGT type), and at an older age - in more than half of patients (55-65%), and by 45 years of age the frequency diabetes may be 7-10% versus 0.5-1.5% in the peer population. It should be noted that recently, according to the results of six prospective studies, “acceleration” of diabetes was clearly proven in patients with PCOS and IGT, first diagnosed at a young age. Especially often, intolerance to carbohydrates progresses towards obvious pathology in those who reach extreme obesity and have a family history of diabetes (D.A. Ehrmannet al., 1999).
Relatively rarely (only in 5%), the combination of HAIR is supplemented by a third element - the most typical clinical stigma of insulin resistance in the form of acanthosis nigricans and is designated as HAIR-AN syndrome. Acanthosis nigricans (acanthosis nigricans) is a papillary pigment degeneration of the skin, manifested by hyperkeratosis and hyperpigmentation (mainly on the neck, axillary and groin areas). This sign is especially pronounced against the background extreme degrees obesity, and, conversely, as you lose weight and correct insulin sensitivity, the intensity of acanthosis weakens.
Massive obesity and/or redistribution of subcutaneous fat according to the android type (abdominal “apple” type): body mass index more than 25 kg/m², waist circumference more than 87.5 cm, and its ratio to hip circumference more than 0.8.
The presence of isolated pubarche in a pre-pubertal history is the first sign of the debut of androgenization in the form of pubertal hair growth before the onset of estrogenization of the mammary glands, especially in combination with a deficiency of body weight at birth.

Laboratory and instrumental diagnostics

Paradoxical as it may seem, despite the colossal breakthrough of theoretical medicine in understanding the molecular biological and genetic mechanisms of the development of PCOS, the world has still not made an agreed decision on the criteria for diagnosing PCOS, and the only document that at least partially regulates the examination process is and designed to prevent overdiagnosis of the disease rather than ensure its detection on early stages, are recommendations from the US National Institutes of Health adopted at a conference in 1990.

According to this document, which still guides the vast majority of researchers working on this problem, the diagnosis of PCOS is a diagnosis of exclusion. To verify it, in addition to the presence of two clinical criteria inclusions discussed above (anovulation + hyperandrogenism), a third one is also necessary - the absence of other endocrine diseases ( congenital dysfunction adrenal cortex, virilizing tumors, Itsenko-Cushing's disease, primary hyperprolactinemia, thyroid pathology). Fully sharing this point of view, over the past 15 years, we have considered it necessary for each patient to complete the diagnosis of PCOS with three additional examinations. This is extremely important not only and not so much for confirming the diagnosis, but for further use as criteria when choosing differentiated therapy on an individual basis. It's about about the following studies.

1. On the seventh to tenth day of the menstrual cycle - “gonadotropic index” (LH/FSH) >> 2, PRL is normal or slightly increased (in approximately 20% of cases).

2. On the seventh to tenth day of the menstrual cycle, characteristic signs are revealed on ultrasound:

bilateral increase in the volume of both ovaries (according to our data, more than 6 ml/m² body surface area, i.e., taking into account individual parameters of physical development in terms of height and body weight at the time of pelvic ultrasound);
ovarian tissue of the “polycystic” type, i.e., 10 or more small immature follicles with a diameter of up to 8 mm are visualized on both, as well as an increase in the area of hyperechoic stroma of the medulla of both ovaries;
ovarian-uterine index (average ovarian volume/uterine thickness) > 3.5;
thickening (sclerosis) of the capsule of both ovaries.

3. Laboratory signs of insulin resistance:

an increase in basal (fasting) serum insulin levels or an increase in the calculated HOMAIR glucose-insulin index.

However, in April 2003, experts American Association Clinical endocrinologists have developed a new document, according to which it was decided to rename the complex of clinical and biochemical disorders, known since 1988 as (dys)metabolic syndrome X, into insulin resistance syndrome. And when verifying it, it is proposed to focus not on hormonal indicators, but on surrogate biochemical parameters.

Identification of insulin resistance syndrome

Triglycerides >150 mg/dL (1.74 mmol/L).
Lipoprotein cholesterol high density among women< 50 мг/дл (1,3 ммоль/л).
Arterial pressure> 130/85 mm Hg. Art.
Glycemia: fasting 110-125 mg/dl (6.1-6.9 mmol/l); 120 minutes after the glucose load 140-200 mg/dl (7.8-11.1 mmol/l).

Concluding the conversation about the technology for diagnosing PCOS in modern clinical practice, we especially emphasize that each of these symptoms, in isolation from the others, has no independent diagnostic value does not have. Moreover, the more paraclinical signs from the list given in one and the same patient with hyperandrogenic ovarian dysfunction, the more justified, justified, effective and safe will be the endocrinologist/gynecologist’s attempt to apply new technologies and modern protocols for differentiated treatment.

Treatment

Individual management tactics for patients with PCOS often depend not only on the established nosological variant of the pathology, but also on the situation in the family where pregnancy is planned. Taking this into account, therapy for PCOS can be conditionally divided into two groups: basic - when complex treatment is performed over a long period of time; rehabilitation program and there is a systematic preparation of a young woman for pregnancy, and a situational one - when, at the request of the patient, the issue of restoring fertility is urgently resolved.

Basic therapy

The arsenal of help for patients with PCOS is now represented by a large pharmacotherapeutic group of drugs that have specific and fundamentally different effects on different pathogenetic links. An individual set of measures is developed taking into account the presence/absence of indications of insulin resistance, eating behavior and bad habits. Basic therapy provides two main treatment scenarios: a) for thin people without hyperinsulinism - antiandrogenic +/- estrogen-progestin drugs; b) for everyone who has overweight body, and for thin people with insulin resistance - insulin sensitizers in combination with measures to normalize weight.

The most tangible and significant consequence of the discovery of the role of insulin resistance in the formation of PCOS was a new therapeutic technology using medicines, increasing the sensitivity of insulin receptors. It should be noted right away that the group of metformin and glitazones is indicated, although for the absolute majority of patients, but not for all. It is quite obvious that when selecting individuals for whom therapy with insulin-sensitizing drugs is indicated, women who meet the criteria of peripheral refractoriness to the hormone have a clear advantage.

Modern powerful systems for searching scientific and medical literature make it possible to track the appearance of the latest data even in remote corners of the planet within a few weeks after their appearance in print or on the World Wide Web. Ten years have passed since the publication in 1994 of an article by a team of authors from Venezuela and the United States about the first experience of using metformin in PCOS. Over the years, about 200 more works on this issue have appeared. Most of them report on non-randomized, uncontrolled, and generally small trials. This level of scientific analysis does not meet today’s stringent requirements for evidence-based medicine. Therefore, publications of systematic analytical reviews and the results of meta-analyses based on summary data from similar trials are of exceptional interest. Similar works appeared only during the last six months, and their discussion is important both for practice and for the development of theory. A summary of the most obvious systematically reproducible effects of metformin in PCOS is given below.

Clinical effects

Improvement menstrual function, induction of spontaneous and stimulated ovulation, increasing the frequency of conception.
Reducing the incidence of spontaneous miscarriages, reducing the incidence of gestational diabetes, improving pregnancy outcomes in the absence of a teratogenic effect.
Reduction of hirsutism, acne, oily seborrhea, and other symptoms of hyperandrogenism.
Decreased appetite, body weight, blood pressure.

Laboratory effects

Reduced levels of insulin, insulin-like growth factor type 1 (IGF-1).
Reducing cholesterol, triglycerides, LDL and VLDL levels, increasing HDL concentrations.
Reduced levels of androgens, LH, plasminogen activator inhibitor.
Increased levels of testosterone-estradiol-binding globulin, a binding protein for IGF-1.

Russian doctors of various specialties are most familiar with the drug Siofor 500 and 850 mg (Berlin-Chemie/Menarini Pharma GmbH), which belongs to the group of insulin sensitizers. It has become familiar not only to endocrinologists (in the treatment of type 2 diabetes mellitus), but also to gynecologists-endocrinologists - it was with this drug that the history of treating PCOS with sensitizers in our country began (M. B. Antsiferov et al., 2001; E. A. Karpova, 2002; N. G. Mishieva et al., 2001; G. E. Chernukha et al., 2001).

Dosage regimen: first week = 1 table. at night, second week = + 1 table. before breakfast, third week = + 1 table. before lunch. The average daily dose is 1.5-2.5 g.

Duration of admission: minimum six months, maximum 24 months, average duration one year.

A break/cancellation in taking the drug should be carried out for several days in case of any acute illness and when conducting X-ray contrast studies for other conditions (risk of lactic acidosis).

Conclusion

Hyperandrogenism syndrome is widespread, and the most common cause of its development at any age is polycystic ovary syndrome. The formation of PCOS in children and adolescents is a factor high risk the occurrence of not only reproductive disorders, but also a complex of very serious dysmetabolic disorders during childbearing and perimenopausal age. Modern ideas about the pathogenesis and natural evolution of ovarian hyperandrogenism serve as the basis for expanding the indications for therapy with insulin sensitizers, including Siofor.

For questions about literature, please contact the editor

D. E. Shilin, doctor medical sciences, Professor
Russian Medical Academy postgraduate education Ministry of Health of the Russian Federation, Moscow

Hyperandrogenism syndrome in women is endocrine pathology, which develops due to excessive activity of androgens (male sex hormones) in the body. This deviation occurs as often as pathology of the thyroid gland. There are many factors that can trigger this disease:

Cushing's syndrome (increased levels of hormones in the adrenal cortex);
Thyroid diseases;
Hormone-producing ovarian tumors;
Frenkel's disease (enlarged ovarian stroma);
The effect of hormonal drugs;
Liver diseases that have become chronic;
The presence of hyperandrogenism syndrome in close relatives;
Polycystic ovary syndrome;
A benign tumor of the pituitary gland (prolactinoma), which produces a hormone (prolactin) responsible for breast development and milk production;
Excessive production of androgens by the adrenal glands.

There are 3 types of hyperandrogenism: mixed, adrenal and ovarian. Hyperandrogenism is also divided into primary (impaired functioning of the adrenal cortex or ovaries) and secondary (malfunctions of the hypothalamus and pituitary gland), congenital and acquired.

The clinical picture of the disease can be bright or mild. Main symptoms:

Acne is a skin disease caused by inflammation of the sebaceous glands. It is one of the factors in the origin and development of hyperandrogenism syndrome. This disease is typical for the pubertal stage of development, therefore signs of acne (red painful acne, blackheads, comedones) are observed in most adolescents. If such skin inflammations do not go away even in adulthood, you should be tested for hyperandrogenism, which, in turn, may be a consequence of polycystic ovary syndrome. In some cases, acne is accompanied by seborrhea (excessive activity of the sebaceous glands in certain areas of the skin), which can be caused by androgens.
Alopecia is the name given to rapid baldness. With androgenetic alopecia, a change in the hair structure occurs. First, the hair becomes very thin and colorless, and then hair loss begins. This sign suggests that hyperandrogenism has been progressing for a long time.
Hirsutism is the appearance of an excessive amount of hard and dark hair on the face, hands, chest. This disease is almost always accompanied by infertility and scanty menstruation.

Virile syndrome. Virilization is a rare pathology in which a woman exhibits exclusively male characteristics. Reasons virile syndrome there may be a neoplasm on the adrenal glands, adrenoblastoma and ovarian hyperplasia. The following symptoms are observed during virilization:

Irregular menstruation, amenorrhea;
Increased libido;
Acne;
Changing the timbre of the voice;
Increased muscle mass;
Enlargement and swelling of the clitoris;
Excess weight in the upper body;
Alopecia (baldness in the parting area);
Hair growth around the nipples, on the stomach, cheeks.

There are also symptoms that are much less common:

Arterial hypertension;
Obesity;
Diabetes mellitus type 2;
Sensitivity of cell receptors to male hormones.

Hyperandrogenism syndrome can occur at any age. Girls suffering from this disease are prone to depression, overwork and colds. Signs of pathology can also be caused by a lack of estrogens (female sex hormones) and a lack of protein that regulates the activity of androgens.

Diagnostics

Many inexperienced doctors diagnose hyperandrogenism only if there is a large amount of androgens in the body. For this reason, women with hyperandrogenism, whose androgen levels are normal, do not receive timely treatment. As a result, the signs of the disease become more pronounced, and the patient’s health worsens. In most cases, hyperandrogenism syndrome occurs when moderate amount androgens.

When diagnosing, use: laboratory research of genes, analysis of the concentration of dehydroepiandrosterone sulfate and instrumental methods examinations (ultrasound, scintigraphy, CT, MRI), make an anamnesis (when symptoms first appeared, what medications the woman took in Lately). Conduct clinical examination patients: skin rashes, excessive growth hair, deepening of the voice, body hair structure and gynecological examination (size of the clitoris and labia). At the same time, specialists determine the level of testosterone, follicle-stimulating and luteinizing hormones. But not all women need hormonal testing. With symptoms such as acne and seborrhea, the level of male sex hormones usually does not exceed the norm, so standard procedures will be quite sufficient.

Hirsutism is more accurate diagnostic indicator increased activity male hormones than high levels of testosterone in the blood. The second indicator may be normal even though the signs of the disease have appeared for a long time.

One of the most important diagnostic criteria counts androgenetic alopecia. The important fact is that hair falls out first at the temples, and then at the parietal region.

Treatment and prevention

Treatment for a woman is prescribed taking into account the form of hyperandrogenism and the reasons that caused it. If the disease is caused by tumors of the adrenal glands and ovaries, they must be removed surgically. If the cause was not a tumor, but a malfunction in the functioning of the pituitary gland and hypothalamus, then the therapy will depend on the goal that the woman wants to achieve during treatment. These goals may include eliminating symptoms and signs of disease and restoring fertility. If the named areas of the brain do not work properly, a woman becomes overweight, so normalizing it is main stage treatment. To do this, you need to adjust your diet and exercise.

If a woman is not planning a child, but wants to get rid of the unaesthetic manifestations of hyperandrogenism, she is prescribed antiandrogenic oral contraceptives (Diana is 35).

If the disease occurs due to the absence of an enzyme that transforms male sex hormones into glucocorticoids, drugs such as Metipred and Dexamethasone are prescribed.

If reproductive function is impaired, which is associated with ovarian or adrenal hyperandrogenism, the woman is prescribed drugs that force the egg to release from the ovary (Clomiphene).

If the drugs do not help completely get rid of the disease, use surgical methods. The most popular of them is laparoscopy. It is carried out by introducing into the abdominal cavity special device, which displays an image on the screen. After this, a second incision is made through which, using surgical instruments A kind of “notch” is applied to the ovaries so that the egg can be released freely.

To prevent the disease, you should visit a gynecologist several times a year, monitor weight fluctuations, and adhere to proper nutrition, give up bad habits, treat liver and thyroid diseases in a timely manner, avoid stressful situations.

Traditional methods of treatment

Traditional methods will not help completely cure hyperandrogenism syndrome in women, but they are very good as an adjuvant. Here are some of the most effective recipes:

Basil tincture. Add 2 tablespoons to a glass of boiling water, then boil the mixture again, and keep it on low heat for another 10 minutes. After this, cool the broth and strain. You need to take 2-3 times a day, 100 ml.
Infusion of boron uterus. First you need to dry about 50 g of plant leaves. After this, crumble them and mix with 500 ml of vodka. Pour the mixture into a container and leave for a month. The tincture should not be exposed to light. You need to take at least 4 times a day, 35 drops.
Licorice tincture. Add one tablespoon of licorice to a container of boiling water (200 ml). Leave the infusion for an hour and then strain. The entire infusion should be drunk on an empty stomach in the morning.
Herbal collection of red brush, motherwort, rowan, nettle, viburnum bark, chamomile, shepherd's purse. Grind all these herbs using a blender and mix. Add 2 tablespoons of the mixture to 500 ml of boiling water and leave to steep for 7–8 hours. You need to drink the tincture in one day. The collection must be consumed for 2–3 months.
Red brush tincture. Add one tablespoon of the peeled plant to a container of boiling water (200 ml). Leave the broth to steep (for one hour), then strain and cool. You need to take the infusion at least three times a day, half an hour before meals.
Collection of red brush and leuzea. Grind the herbs and mix them. Then pour one teaspoon of the mixture into water (one glass). Take the infusion 3-4 times a day half an hour before meals.

Please note that the use of red brush for hypertension is strictly contraindicated. In addition, any independent treatment, including traditional methods without consulting a doctor, may cause serious harm to health.