Is there a cure for hyperandrogenism in women? Hyperandrogenism syndrome: modern approaches to diagnostics and new technologies of therapy

Hyperandrogenism is a pathology in which the hormonal background of a woman undergoes significant changes. There is a production of too much androgen hormone, which is considered male. In the body of a woman, 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 affect 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 the 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 distinguished:

the presence of tumors of the adrenal glands;
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.

With violations of the ovaries, an increase in the adrenal cortex, hypersensitivity of skin cells to the effects of testosterone, tumors of the sex and thyroid glands, pathology may develop in childhood.

Congenital hyperandrogenism sometimes does not allow to accurately determine the sex of the born child. A girl may have large labia, a clitoris enlarged to the size of a penis. Appearance internal genital organs is normal.

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

At an older age, hyperandrogenism causes excessive hair growth throughout the body, a delay in the formation of the 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 the normal range, however, they are intensively metabolized in 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's syndrome and some other pathological conditions.
a woman taking anabolic steroids, male sex hormone preparations and cyclosporine.

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

ovarian (ovarian);
adrenal;
mixed.

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

Symptoms of hyperandrogenism

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

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

Hyperandrogenism syndrome may be associated with certain diseases. So, among the reasons for the increased level of androgens can be identified:

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 this disease can be distinguished: a rounded face, an enlarged neck, deposition of fat in the abdomen. Failures 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 for polycystic ovary syndrome is an increase in the ovary before menstruation and a decrease in it after menstruation has passed. With this syndrome, there is a lack of ovulation, infertility, increased hair growth, overweight. There is a violation of the production of insulin, as a result of which patients may develop diabetes mellitus.
Age-related ovarian hyperplasia. Seen in enough adulthood in women as a result of an imbalance between estradiol and estrone. Manifested in the form of hypertension, diabetes, overweight, oncology of the uterus.

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. In a woman against the background of hyperandrogenism, a miscarriage occurs or the fetus freezes 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 on early dates. If this disease is detected after the conception and bearing of a child, it is quite difficult to determine exactly when it arose. In this case, doctors are of little interest in the causes of the development of hyperandrogenism, since all measures must be taken to maintain pregnancy.

Signs of pathology in women in position are no different from the symptoms that are observed at any other time. Most miscarriages are due to fertilized egg 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 miscarriage occurs. It is almost always accompanied by bloody discharge from the vagina, pulling pains lower abdomen. Also, such a pregnancy is characterized by less pronounced toxicosis, which is present in most women in the first trimester.

Complications

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

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

This simple enumeration of the list is far from over, which speaks in favor of a timely visit to the doctor in order to anticipate their onset. Only timely diagnosis and qualified treatment contribute to the achievement of 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 level. Find out what is the amount of prolactin, free and total testosterone, dehydroepiandrosterone sulfate, androstenedione and FSH levels in blood plasma. The material is taken in the morning, on an empty stomach. Due to the constant change in the hormonal background, patients with hyperandrogenism are tested three times, with intervals of 30 minutes between procedures, then all three portions of the blood are mixed. Dehydroepiandrosterone sulfate, in an amount of more than 800 μg%, indicates the presence of an androgen-secreting tumor of the adrenal glands;
They take a marker to determine hCG (in the case when there are signs of hyperandrogenism, but the main 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 course of the disease and the severity laboratory signs hyperandrogenism.

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

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

Medical therapy:

gonadotropin-releasing hormone agonists (decrease in the production of androgens and estrogen by the ovaries);
estrogen-gestagenic preparations (stimulation of the formation of female hormones);
antiandrogens (suppression of excessive secretion of androgens by both the adrenal glands and the ovaries);
preparations with a high content of the ovarian hormone (progesterone).

Treatment of comorbidities:

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.

Cosmetic types of correction:

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

Polycystic ovary syndrome, which is the most common cause of ovarian hyperandrogenism, responds well in many cases to conservative treatment using a wide range of hormonal drugs.

In 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 even in the stage of intrauterine development of the child, since this pathology leads to the development of a severe degree of 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 surgical, radiation and chemoprophylactic therapy.

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

Prevention measures

Prevention is as follows:

regular (2-3 times a year) visits to the gynecologist;
minimization of increased loads (both psycho-emotional and physical);
rejection bad habits(smoking, alcohol abuse);
balanced and rational nutrition: give preference to foods rich in fiber, and give up 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 endure healthy child with this diagnosis? Yes, it is quite. But given the increased risk of miscarriage, this is not easy to do. If you found out about the problem at the stage of pregnancy planning, you should first normalize the hormonal background. In the case when the diagnosis was made already “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. To date, this pathology is considered quite common: the diagnosis of hyperandrogenism is established by 5–7% of girls who have reached puberty and 10–20% of women who are in their childbearing period.

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. That is why every woman needs to have general ideas about this disease: about its causes, clinical picture, features of the diagnosis, as well as treatment tactics.

Fundamentals of physiology - sex hormones

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

The functions of androgens are significant:

estrogens and corticosteroids are their derivatives;
affect the occurrence of sexual desire in women;
affect growth tubular bones during puberty;
due to their influence, secondary sexual characteristics are formed: hair growth along female type, breast growth and voice change.

The normal functioning and development of the body can only occur with a sufficient content of androgens in the blood of a woman. However, their excess is the cause of many cosmetic defects in appearance, the development of metabolic disorders, disruptions in the menstrual cycle up to fertility disorders (the possibility of a woman who is in reproductive period, conceive and bear a child).

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

Etiological factors of the disease

Androgen excess 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 localization of the pathological process, hyperandrogenism can be ovarian, adrenal and mixed. It may 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;
violation of the functions of higher nerve centers: the pituitary and hypothalamus. It is these parts of the brain that affect the functioning of the ovaries;
congenital anomalies of the adrenal cortex - inhibition of the production of one type of hormones and an increase in the synthesis of others is a common thing for such congenital dysfunctions;
producing tumors of the ovaries or adrenal glands affect the quantitative production of hormones, in particular, androgens;

polycystic ovaries - 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 - 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 intake of oral contraceptives, anabolic steroids and glucocorticoids;
decreased production of triiodothyronine and tetracodthyronine due to disruption of the thyroid gland;
chronic dysfunction of hepatocytes.

All the above reasons are only an approximate list of factors affecting 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, in the chest and on the 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 which is not excessive production of androgens, but extraneous causes (for example, porphyria). The patient's racial affiliation also plays a role: in Caucasians, vegetation is sparse 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;
violation of the menstrual cycle, in particular, - opso-oligomenorrhea - too short or long intervals between menstruation, - absence of menstruation or infertility. As a rule, these symptoms are most often found with;
weight gain can be observed in all forms of this pathology (overweight is 20% of the normal value);
decrease in quantity muscle mass in the area of \u200b\u200bthe limbs, abdominals, osteoporosis and atrophy of the skin - symptoms characteristic of;

uneven production of hormones can be the main cause of a decrease in immunity, the supporting function of the body and the occurrence of various infectious diseases;
with pathology from the side of the adrenal glands, a violation of glucose tolerance can be observed, however, the possibility of developing this pathology in the ovarian form of hyperandrogenism is not excluded;
overdevelopment of the external genitalia intermediate type. Enlargement of the clitoris, urogenital sinus, and a marked reduction in the gap between the labia majora can be identified immediately after birth 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 a violation of the synthesis of glucocorticoids.

The occurrence of the above manifestations is the reason for contacting the clinic and conducting further examination.

Complications of hyperandrogenism

Late detection of the disease or incorrectly prescribed therapy can greatly affect the state 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 due tumor process, then metastasis of malignant neoplasms can be attributed to the most dangerous complications. As a rule, such clinical picture characteristic of tumors of the adrenal glands.
in violation of the hormonal background, other diseases of organs and systems may occur. The most common disorders include chronic renal failure, thyroid disease.

Unfortunately, this list does not end, as it can be continued for dozens of positions down. However, it is this fact that should encourage each patient to consult a doctor in time to prevent these complications. Only timely diagnosis and individual prescription of therapy can guarantee the 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, in parallel, determine the level of sexual development of the patient, the regularity of menstruation, the nature of hair growth, and the presence of dermatopathy.

Conducting laboratory research is aimed at determining the level, and globulin that binds sex hormones. After determining the concentration of androgens, it is necessary to clarify the nature of their excess: adrenal or ovarian. Clinical analyzes will help to differentiate these two pathologies:

for adrenal (adrenal) hyperandrogenism is characteristic;
the ovarian type of the syndrome is characterized by an increase in the content of testosterone in the blood and ASD.

With an excessive increase in these indicators, a woman must definitely undergo differential diagnosis with tumor diseases. A CT scan or MRI will help confirm or refute this assumption. And also as additional method may apply ultrasound diagnostics. This method is suitable for the detection of polycystic ovarian deformities.

Treatment

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

The drugs of 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.

And also the syndrome of hyperandrogenism is stopped with the help of corticosteroids. Their use is also justified to prepare a woman for future conception, the gestation period when this disease appears. When high activity Enzyme therapy course can last a year or more.

Treatment of hyperandrogenism in women also consists in the treatment of 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.

When 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 carried out 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 the balance and health of the body include the correct lifestyle, the rejection of bad habits, balanced diet and regular 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 it is the observance of the doctor's recommendations that 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. It occurs in different age groups. The main causes of hyperandrogenism are adrenogenital syndrome (AGS) and polycystic ovaries (PCOS). Treatment of hyperandrogenism is aimed at correcting the hormonal background and preventing the consequences of androgen excess.

Normally, the hormonal status of a woman allows a certain level of androgens in the blood. From them, under the action of aromatase, part of the estrogens is formed. An excessive amount leads to a violation of the reproductive function, increases the risk of cancer. The ICD-10 does not classify this syndrome, as 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 male sex hormones, among which testosterone is best known. In the fair sex, the adrenal cortex, ovaries, subcutaneous adipose tissue and indirectly the thyroid gland. The whole process is "managed" by luteinizing hormone (LH), as well as adrenocorticotropic hormone (ACTH) of the pituitary gland.

In normal concentration, 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- they form estrogens and corticosteroids;
form sexual characteristics- at the level with estrogens, they are responsible for the natural hair growth in women.

The excess content of androgens leads to hyperandrogenism, which manifests itself in endocrinological, cyclic disorders, changes in appearance.

The following can be distinguished primary causes hyperandrogenism.

AGS. Adrenogenital syndrome is characterized by insufficient synthesis or lack of production by the ovaries of the enzyme C21-hydroxylase (converts testosterone to glucocorticoids), which leads to an excess of androgens in the female body.
Polycystic. PCOS can be the cause of androgen excess or a consequence.
Tumors. They can be localized in the ovaries, adrenal glands, in the pituitary gland and hypothalamus, while they produce an excessive amount of androgens.
Other pathologies. Hyperandrogenism can be caused by disruption of the thyroid gland, liver (where hormones are metabolized), and taking hormonal drugs.

These disorders lead to a change in the metabolism of male sex hormones, and there is:

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

Additional factors that may affect the development of hyperandrogenism are:

taking steroids;
elevated prolactin levels;
overweight in the first years of life;
sensitivity (sensitivity) skin to testosterone.

Varieties of pathology

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

Ovarian. It is 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. In case of violation of its work, there is a deficiency of female sex hormones and an excess of male ones. In addition, ovarian hyperandrogenism can be provoked by hormonally active tumors of this localization.
Adrenal. Such hyperandrogenism is caused by tumors of the adrenal glands (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 C21-hydroxylase enzyme. The lack of this substance for a long time can be compensated for by the work of other hormone-producing organs, so the condition has a latent course. With psycho-emotional overstrain, 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, corpus luteum insufficiency during egg maturation.
Mixed. A severe form of hyperandrogenism combines ovarian and adrenal dysfunction. The trigger mechanism for the development of mixed hyperandrogenism is neuroendocrine disorders, pathological processes in the hypothalamus. Manifested by violations fat metabolism often infertility or miscarriage.
Central and peripheral. Associated with dysfunction of the pituitary and hypothalamus, disruption of the nervous system. There is a deficiency of follicle-stimulating hormone, which disrupts the maturation of the follicles. As a result, the level of androgens rises.
Transport. This form of hyperandrogenism is based on a deficiency of globulin, which is responsible for the binding of sex steroids in the blood, and also blocks the excessive activity of testosterone.

According to the focus of the onset of 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 way the pathology develops, 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 turn into active forms;
absolute - the permissible norm of the content of androgens is exceeded.

How does it manifest

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

Before puberty

Prior to puberty, hyperandrogenism is due to genetic disorders or hormonal imbalance during fetal development.
It is 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 is fused, the clitoris is excessively enlarged, the fontanel is overgrown already in the first month. Subsequently, the girls observed:

long upper and lower limbs;
high growth;
excessive amount of hair on the body;
late onset of menstruation (or absent at all);
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.

At puberty

AT puberty girls with hyperandrogenism may experience:

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

At reproductive age

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

baryphony - coarsening of the voice;
alopecia - baldness, hair loss on the head;
masculinization - an increase in muscle mass, a change in the figure according to the male 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, lactation persists after childbirth;
metabolic disease- is 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;
psychoemotional disorders- a tendency to depression, a feeling of loss of strength, anxiety, sleep disturbance;
cardiovascular disorders- Tendency to hypertension, episodes of tachycardia.

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

In menopause

In women with the onset of menopause, a syndrome of hyperandrogenism occurs due to a decrease in estrogen levels. By this time, many note the appearance of "male hair", especially in the chin and upper lip. This is considered normal, but hormone-producing ovarian tumors must be ruled out.

Diagnostics

Confirmation of pathology requires a comprehensive examination.

Collection of anamnesis. Information about the menstrual cycle, the physique of a woman, the degree of hair coverage of her face and body, the timbre of her voice are taken into account - those signs that indicate an excess of androgens.
Blood tests . For sugar content and for determining the level of testosterone, cortisol, estradiol, 17-hydroxyprogesterone, SHBG (a globulin that binds sex hormones), DHEA (dehydroepiandrosterone). Tests for hormones 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 more detailed diagnostics.

Consequences for the body

Estrogens are responsible not only for the "feminine 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:

problems with pregnancy- infertility, miscarriage in the early and late periods;
increased risk of developing cancer- endometrium, breast, cervix;
gynecological diseases- more often there are dysfunctions, ovarian cysts, endometrial hyperplasia and polyps, cervical dysplasia, mastopathy;
somatic diseases- a tendency to hypertension and obesity, strokes, heart attacks are more common.

Treatment

Treatment of hyperandrogenism in women is aimed at correcting the hormonal imbalance and eliminating the root cause. Clinical guidelines depends on the age of the woman, 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 that have an antiandrogenic effect. In some cases, gestagens are enough, for example, Utrozhestan. This therapy is used to correct adrenal and ovarian hyperandrogenism. This tactic does not eliminate the cause of the disease, but helps to fight the symptoms and reduces the risk of complications of hyperandrogenism in the future. It is necessary to take hormones constantly.
Adrenogenital syndrome. It is stopped with the help of corticosteroids, which are also used in preparing a woman for pregnancy. Among the drugs, the most famous is Dexamethasone. "Veroshpiron" can be used to correct the water-salt balance in AGS.
Androgen derived tumors. For the most part they are benign neoplasms but still need to be removed surgically.

With 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 supervision due to the increased risk of pregnancy complications. Reviews of women and doctors confirm this.

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

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

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.
Stromal tecomatosis of the ovaries.
virilizing tumors.
Other rarer variants.

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 out. Moreover, the object of incessant and most close attention, especially over the past decade, is PCOS, otherwise called the syndrome of hyperandrogenic dysfunction of polycystic ovaries, ovarian sclerocystosis, Stein-Leventhal syndrome. Such close interest in this problem is justified.

First, only in the 90s. In the twentieth 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 the numerous publications of 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 - consistently encounters various manifestations of this pathology, and not only from the outside 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 an 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 action program 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 advances 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 conjugated 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 anomaly 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 leads to hyperandrogenism, while insulin sensitivity at the post-receptor level in peripheral tissues almost halved, which adversely affects the state of metabolism as a whole. Moreover, reactive hyperinsulinism, which occurs compensatory in response to pathological resistance of target cells to insulin, contributes to additional excessive activation of androgen-synthesizing cells of the ovarian-adrenal complex, i.e., further potentiates the androgenization of the woman's body, starting from childhood.

Clinical characteristics

From the point of view of classical terminology, PCOS is characterized by two obligate signs: 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 latest 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 classic signs of hyperandrogenism described by the Chicago gynecologists I. F. Stein and M. L. Leventhal almost 70 years ago (1935), taking into account the latest ideas 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 status of women with PCOS, the clinical picture of this comorbidity (hyperandrogenism along with hyperinsulinism) has received a very figurative and clear reflection 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 (only about ten signs), 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, the semiotics of only hyperandrogenic dermopathy, without virilization, attracts attention. 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 most striking and "catchy" when it comes to medical diagnostics, but also a factor that most traumatizes the psyche of the patient. The Ferriman-Gallway scale allows you to assess the severity of hirsutism in points within a minute. This technique has been used for more than 40 years and has won universal recognition in world practice. The scale easily calculates the indicator of the so-called hormonal number (a four-point score in nine androgen-dependent zones). It reflects the androgenic saturation of the patient, as a rule, much more accurately than the indicator of serum testosterone concentration, which is available in domestic laboratory practice for measurement only in the total amount - 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 by 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 oncological alertness of the doctor should be extremely high in any case - even in the absence of viril signs - especially if a woman goes to the doctor with long-standing hirsutism III degree, as well as in the II degree of severity of the disease, quickly formed due to the "galloping" course of the disease.

Androgenetic alopecia— a reliable diagnostic marker of virilous GAS variants. Like other types of endocrine alopecia, it is diffuse rather than focal (nested) in nature. But unlike baldness in other diseases of the endocrine glands (primary hypothyroidism, polyglandular insufficiency, panhypopituitarism, etc.), androgenetic alopecia is characterized by a certain dynamics. As a rule, it manifests with hair loss in the temporal regions (bitemporal alopecia with the formation of symptoms of "temporal bald patches" or "priest councilor's bald patches" 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 SHA. On the other hand, baldness as a formidable indicator of the severe course of SGA is more often observed and forms faster (sometimes ahead of hirsutism) in this very age group, which requires the exclusion of an androgen - producing tumor .

Symptoms of insulin resistance and hyperinsulinism

Classical manifestations of pathology carbohydrate metabolism(impaired glucose tolerance or type 2 diabetes). In PCOS, the combination of hyperandrogenism and insulin resistance, named by R. Barbieri et al. in 1988, HAIR syndrome (hyperandrogenism and insulin resistance), occurs most often. Even among adolescents with developing PCOS, insulin resistance is detected by a standard glucose tolerance test with 75 g of glucose in about a third of cases (mainly by the type of IGT), and at an older age - in more than half of patients (55-65%), and by 45 years the frequency diabetes can 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, it is in patients with PCOS and IGT, first diagnosed at a young age, that the "acceleration" of diabetes has been clearly proven. Especially often, intolerance to carbohydrates progresses towards obvious pathology in those who reach the extreme degree of obesity and have a family history of diabetes (D.A. Ehrmannet al., 1999).
Relatively rarely (only in 5%), the combination of HAIR is supplemented with a third element - the most typical clinical stigma of insulin resistance in the form of acanthosis nigricans and is designated as the HAIR-AN syndrome. Black acanthosis (acanthosis nigricans) is a papillary-pigmentary degeneration of the skin, manifested by hyperkeratosis and hyperpigmentation (mainly on the neck, in the axillary and inguinal areas). This feature is especially pronounced against the background extreme degrees obesity, and, conversely, as weight loss and correction of insulin sensitivity, the intensity of acanthosis weakens.
Massive obesity and/or redistribution of subcutaneous fat according to 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 in the pre-pubertal history of an isolated pubarche is the first sign of the onset of androgenization in the form of sexual hair growth before the onset of estrogenization of the mammary glands, especially in combination with a lack of body weight at birth.

Laboratory and instrumental diagnostics

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

According to this document, which still guides the vast majority of researchers involved in this problem, the diagnosis of PCOS is a diagnosis of exclusion. For its verification, in addition to the presence of two clinical criteria inclusions mentioned above (anovulation + hyperandrogenism), a third one is also needed - 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 consider 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 a differentiated therapy on an individual basis. It's about about the next research.

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

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

bilateral increase in the volume of both ovaries (according to our data, more than 6 ml/m² of 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 up to 8 mm in diameter are visualized from both, as well as an increase in the area of the hyperechoic stroma of the medulla of both ovaries;
ovarian-uterine index (mean ovarian volume/uterine thickness)> 3.5;
thickening (sclerosis) of the capsule of both ovaries.

3. Laboratory signs of insulin resistance:

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

However, in April 2003 experts American Association clinical endocrinologists 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 was 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).
Cholesterol lipoprotein high density among women< 50 мг/дл (1,3 ммоль/л).
Arterial pressure> 130/85 mmHg Art.
Glycemia: fasting 110-125 mg/dl (6.1-6.9 mmol/l); 120 minutes after a glucose load of 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 is no independent diagnostic value does not have. At the same time, the more paraclinical signs from the above list in the same patient with hyperandrogenic ovarian dysfunction, the more justified, justified, effective and safe will be the attempt of an endocrinologist/gynecologist to apply new technologies and modern protocols for differentiated treatment.

Treatment

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

Basic Therapy

The arsenal of assistance to 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 for two main treatment scenarios: a) for thin people without hyperinsulinism - antiandrogenic +/- estrogen-progestogen drugs; b) for everyone who has overweight body, and for thin people with insulin resistance, insulin sensitizers combined with weight management measures.

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 that increase the sensitivity of insulin receptors. It should immediately be noted that the group of metformin and glitazones is indicated, although for the absolute majority of patients, but not for all. It is clear that when selecting individuals for whom therapy with insulin-sensitizing drugs is indicated, women who meet the criteria for peripheral refractoriness to the hormone have a clear advantage.

Today's powerful search engines for scientific and medical literature allow you to track the appearance of the latest data, even in remote corners of the planet, within a few weeks of their appearance in print or on the World Wide Web. 10 years have passed since the publication in 1994 of an article by a team of authors from Venezuela and the United States on the first experience of using metformin in PCOS. Over the years, about 200 more papers on this issue have appeared. Most of them provide information on non-randomised, uncontrolled and usually small trials. This level of scientific analysis does not meet the modern stringent requirements for evidence-based medicine. Therefore, the publication of systematic analytical reviews and the results of meta-analyses based on pooled data from similar trials are of exceptional interest. Such works have appeared only during the last half a year, and their discussion is important both for practice and for the development of theory. A summary of the most apparent systematically reproducible effects of metformin in PCOS is given below.

Clinical Effects

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

Laboratory Effects

Decreased levels of insulin, insulin-like growth factor type 1 (IGF-1).
Decrease in cholesterol, triglycerides, LDL and VLDL levels, increase in HDL concentration.
Decreased 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), belonging to the group of insulin sensitizers. It has become familiar not only for endocrinologists (in the treatment of type 2 diabetes mellitus), but also for 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).

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

Reception duration: minimum six months, maximum 24 months, average duration one year.

Interruption / withdrawal of the drug should be carried out within a few days for any acute illness and when conducting radiopaque studies for other conditions (risk of lactic acidosis).

Conclusion

The syndrome of hyperandrogenism 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 in 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 literature inquiries, please contact the editor

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

The syndrome of hyperandrogenism in women is endocrine pathology, which develops due to excessive activity in the body of androgens (male sex hormones). This deviation occurs as often as the 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 disease;
Hormone-producing ovarian tumors;
Frenkel's disease (overgrown ovarian stroma);
The action of hormonal drugs;
Liver diseases that have become chronic;
The presence of hyperandrogenism syndrome in the next of kin;
polycystic ovaries;
A benign pituitary tumor (prolactinoma) that produces a hormone (prolactin) that is responsible for breast development and milk production
Excess production of androgens by the adrenal glands.

There are 3 types of hyperandrogenism: mixed, adrenal and ovarian. Also, hyperandrogenism is 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 and 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 characteristic of the pubertal stage of development, because signs of acne (red painful acne, black dots, comedones) are observed in most adolescents. If such inflammations on the skin do not go away even in adulthood, one should be examined for hyperandrogenism, which, in turn, may be due to polycystic ovaries. 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 called rapid baldness. With androgenetic alopecia, a change in the hair structure occurs. At first, the hair becomes very thin and colorless, and then it begins to fall out. This sign suggests that hyperandrogenism has been progressing for a long time.
Hirsutism is the appearance of an excessive amount of rigid and dark hair face, arms, chest. This disease is almost always accompanied by infertility and scanty menstruation.

Viral Syndrome. Virilization is a rare pathology in which a woman exhibits exclusively male features. Causes viril syndrome there may be a neoplasm on the adrenal glands, adrenoblastoma and ovarian hyperplasia. During virilization, the following symptoms are observed:

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

There are also symptoms that are much less common:

arterial hypertension;
Obesity;
Diabetes mellitus type 2;
Cell receptor sensitivity 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 a 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, the patient's health worsens. In most cases, hyperandrogenism syndrome occurs when moderate amount androgens.

When diagnosing, they use: laboratory research of genes, analysis for the concentration of dehydroepiandrosterone sulfate and instrumental methods examinations (ultrasound, scintigraphy, CT, MRI), make an anamnesis (when the symptoms first appeared, what medications the woman took in recent times). Spend clinical examination patients: skin rashes, overgrowth hair, coarsening of the voice timbre, structure of body hair and gynecological examination (the size of the clitoris and labia). At the same time, experts determine the level of testosterone, follicle-stimulating and luteinizing hormones. But not all women need to study the hormonal background. 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 enough.

Hirsutism is more accurate diagnostic indicator increased activity male hormones than high levels of testosterone in the blood. The second indicator may be normal despite the fact that the signs of the disease have long appeared.

One of the most important diagnostic criteria counts androgenetic alopecia. Important is the fact that first the hair falls out on the temples, and then on 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 was provoked by tumors of the adrenal glands and ovaries, it is necessary to remove them surgically. If the cause was not tumors, but malfunctions 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. Such goals may include the elimination of symptoms and signs of the disease and the restoration of fertility. In case of malfunction of the named areas of the brain, a woman becomes overweight, therefore its normalization is main stage treatment. To do this, you need to adjust the diet, go in for sports.

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

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

In case of violation of reproductive function, which is associated with ovarian or adrenal hyperandrogenism, a woman is prescribed drugs that cause the egg to come out of the ovary (Clomiphene).

If the drugs did not help to completely get rid of the disease, apply surgical methods. The most popular of these is laparoscopy. It is carried out by insertion into the abdominal cavity special device, which displays the image on the screen. After that, a second incision is made, through which, with the help of surgical instruments peculiar “notches” are applied to the ovaries so that the egg can freely exit.

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

Folk methods of treatment

Folk ways will not help to completely cure the syndrome of hyperandrogenism 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, keep it on low heat for another 10 minutes. After that, cool the broth, 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 the leaves of the plant. After that, crumble them, mix with 500 ml of vodka. Pour the mixture into a container, 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 whole infusion should be drunk on an empty stomach in the morning.
Herbal collection of red brush, motherwort, mountain ash, nettle, viburnum bark, chamomile, shepherd's purse. Grind all these herbs with a blender, mix. Add 2 tablespoons of the mixture to 500 ml of boiling water, leave to infuse for 7-8 hours. You need to drink the tincture in one day. It is necessary to use the collection for 2-3 months.
Red brush tincture. Add one tablespoon of the purified plant to a container of boiling water (200 ml). Leave the broth to infuse (for one hour), then strain, cool. Take the infusion at least three times a day half an hour before meals.
Collection of red brush and leuzea. Grind herbs, 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 a red brush for hypertension is strictly contraindicated. In addition, any self-treatment, including folk methods without consulting a doctor can cause serious harm to health.