Androgenic activity is treated in women. Hyperandrogenism in women: causes, symptoms, treatment

Hyperandrogenism in women is a collective term that includes whole line syndromes and diseases accompanied by an absolute or relative increase in the concentration of male sex hormones in a woman’s blood. Today this pathology is quite widespread: according to statistics, 5-7% of teenage girls and 10-20% of women suffer from it childbearing age. And since hyperandrogenism not only entails various defects in appearance, but is also one of the causes of infertility, it is important for women to have an understanding of this condition so that, if they notice such symptoms, they can immediately seek help from a specialist.

You will learn from our article about the causes of hyperandrogenism in women, its clinical manifestations, as well as how the diagnosis is made and the tactics for treating this pathology. But first, let's talk about what androgens are and why they are needed in female body.

Androgens: basic physiology

Androgens are male sex hormones. The leading and most famous representative of them is testosterone. In a woman’s body, they are formed in the cells of the ovaries and adrenal cortex, as well as in subcutaneous fatty tissue (SFA). Their production is regulated by adrenocorticotropic (ACTH) and luteinizing (LH) hormones synthesized by the pituitary gland.

The functions of androgens are multifaceted. These hormones:

are precursors of corticosteroids and estrogens (female sex hormones);
form sexual desire women;
during puberty determine growth tubular bones, and therefore the growth of the child;
participate in the formation of secondary sexual characteristics, namely, female-type hair growth.

Androgens perform all these functions under the condition of their normal, physiological concentration in the female body. An excess of these hormones causes both cosmetic defects and metabolic disorders and a woman’s fertility.

Types, causes, mechanism of development of hyperandrogenism

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).

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. It also occurs when:

adrenogenital syndrome;
neoplasms or ovaries;
and some other pathological conditions.

Hyperandrogenism can also develop as a result of a woman taking anabolic steroids, male sex hormones and cyclosporine.

Clinical manifestations

Such women are worried increased loss hair on the head and its appearance in other places (on the face or chest).

Depending on the causative factor, the symptoms of hyperandrogenism vary from slight, mild hirsutism (increased hair growth) to pronounced virile syndrome(appearance of secondary male sexual characteristics in a sick woman).

Let us consider in more detail the main manifestations of this pathology.

Acne and seborrhea

– hair follicle disease and sebaceous glands, which occurs if their excretory ducts become clogged. One of the reasons (or rather, the pathogenesis links) of acne is precisely hyperandrogenism. It is physiological for puberty, which is why facial rashes are found in more than half of teenagers.

If acne persists in a young woman, it makes sense for her to be examined for hyperandrogenism, the cause of which in more than a third of cases turns out to be polycystic ovary syndrome.

Acne can occur independently or be accompanied (increased production of sebaceous gland secretions selectively - in certain areas of the body). It can also occur under the influence of androgens.

Hirsutism

This term refers to excess hair growth in females in areas of the body that are dependent on androgens (in other words, a woman’s hair grows in places typical for men - on the face, chest, between the shoulder blades, and so on). In addition, the hair changes its structure - from soft and light vellus it becomes hard, dark (they are called terminal).

Alopecia

This term refers to baldness. Alopecia associated with excess androgens means a change in the structure of hair on the head from terminal (saturated with pigment, hard) to thin, light, short vellus and its subsequent loss. Baldness is found in the frontal, parietal and temporal areas heads. As a rule, this symptom indicates prolonged high hyperandrogenism and is observed in most cases with neoplasms that produce male sex hormones.

Virilization (viril syndrome)

This term refers to the loss of female characteristics by the body, the formation of male characteristics. Fortunately, this is a fairly rare condition - it is found in only 1 in 100 patients suffering from hirsutism. The leading etiological factors are adrenoblastoma and ovarian tecomatosis. Less commonly, this condition is caused by androgen-producing adrenal tumors.

Virilization is characterized by the following symptoms:

hirsutism;
acne;
androgenetic alopecia;
decrease in voice timbre (baryphonia; the voice becomes rough, similar to a man’s);
reduction in the size of the gonads;
increase in the size of the clitoris;
muscle growth;
redistribution of subcutaneous fat tissue along male type;
menstrual irregularities up to;
increased sexual desire.

Diagnostic principles

An increase in the level of androgens in the patient's blood confirms the diagnosis.

In the diagnosis of hyperandrogenism, both complaints, anamnesis and data on the objective status of the patient, as well as laboratory and instrumental methods research. That is, after assessing the symptoms and medical history, it is necessary not only to identify the fact of an increase in the level of testosterone and other male sex hormones in the blood, but also to detect their source - a neoplasm, polycystic ovary syndrome or other pathology.

Sex hormones are examined on days 5-7 of the menstrual cycle. Determine blood levels total testosterone, SHBG, DHEA, follicle-stimulating, luteinizing hormones, as well as 17-hydroxyprogesterone.

To detect the source of the problem, an ultrasound of the pelvic organs is performed (if ovarian pathology is suspected, using a transvaginal sensor) or, if possible, magnetic resonance imaging of the area.

In order to diagnose an adrenal tumor, the patient is prescribed a computer scan, or scintigraphy with radioactive iodine. It is worth noting that small tumors (less than 1 cm in diameter) cannot be diagnosed in many cases.

If the results of the above studies are negative, the patient may be prescribed catheterization of the veins that carry blood from the adrenal glands and ovaries in order to determine the level of androgens in the blood flowing directly from these organs.

Principles of treatment

The treatment tactics for hyperandrogenism in women depend on the pathology that caused this condition.

In most cases, patients are prescribed combined oral contraceptives, which, in addition to contraception, also have an antiandrogenic effect.

Adrenogenital syndrome requires the administration of glucocorticoids.

If the level of androgens in a woman’s blood is elevated due to hypothyroidism or elevated prolactin levels, drug correction of these conditions comes to the fore, after which the concentration of male sex hormones decreases by itself.

In case of obesity and hyperinsulism, a woman is advised to normalize her body weight (by following dietary recommendations and regular physical activity) and taking metformin.

Adrenal or ovarian tumors that produce androgens are removed surgically even despite their benign nature.

Which doctor should I contact?

If you have symptoms of hirsutism, you should contact a gynecologist-endocrinologist. Additional assistance will be provided subject matter experts- dermatologist, trichologist, nutritionist.

Conclusion

Hyperandrogenism in women is a complex of symptoms that arise as a result of increased concentrations of male sex hormones in the blood, accompanying the course of a series of endocrine diseases. The most common causes are polycystic ovary syndrome and adrenogenital syndrome.

Content:

A situation often arises when significant changes in hormonal levels are observed. In these cases, hyperandrogenism in women is diagnosed, in which the androgen hormone is produced in too large quantities. It belongs to the category of male hormones and performs many necessary functions in the female body. The pathological condition causes unpleasant consequences that require mandatory treatment.

What is hyperandrogenism

The production of androgens in the female body is carried out with the help of adipocytes, adrenal glands and ovaries. Under the influence of these hormones, women experience puberty, hair appears in the genital area and armpits. They are directly related to the reproductive system and muscle growth, and regulate the functions of the kidneys and liver. Androgens are of great importance for mature women, participating in the synthesis of estrogen, strengthening bone tissue and supporting normal level libido.

However, in some cases, pathological conditions occur, known in medicine as hyperandrogenism. This pathology is considered the most common cause complete absence of menstruation - amenorrhea and infertility. The follicles of the female ovaries are surrounded by cellular layers, and excess androgens significantly slow down or completely stop follicular growth. As a result, overgrowth of the follicles occurs, which is called follicular atresia. In addition, male hormones that exceed the norm contribute to the development of fibrosis of the ovarian capsule. Subsequently, multiple cysts form on the ovaries - polycystic disease.

The occurrence and development of hyperandrogenism is influenced by the hypothalamus, which is represented as a regulatory section of the brain. With its help, control is exercised over metabolic processes in the body; the reproductive and endocrine glands function under its guidance. The hypothalamus mediates the interaction between hormonal and nervous system. For immediate hormonal metabolism The pituitary gland is responsible, which is the main endocrine gland located in the brain stem.

Hyperandrogenism is closely associated with disorders central genesis when the hypothalamus and pituitary gland begin to malfunction. An important role is played by the adrenal glands, which are formed in the form of two small endocrine glands located above the kidneys.

Causes of hyperandrogenism

This pathology arises and develops for various reasons. Among them greatest distribution received adrenogenital syndrome, which increases male sex hormones. The adrenal glands produce not only androgens, but also other hormones, such as glucocorticoids. A special enzyme acts on male hormones and converts them into glucocorticoids. If the process of this synthesis is disrupted, the conversion of androgens does not occur, so they accumulate and have negative impact on tissues and organs.

Quite often, hyperandrogenism appears under the influence of an adrenal tumor. The number of cells producing androgens increases, and the amount of male sex hormones increases accordingly. In addition, the ovaries or ovarian tumors, which contain cells that promote the production of androgens, can play a negative role. A serious cause may be the pathology of any endocrine organ such as the pituitary gland or thyroid gland. If the functions of the hypothalamus and pituitary gland are impaired, body weight during illness can increase significantly.

Symptoms of hyperandrogenism

Hyperandrogenism manifests itself in the form of acne when clogged excretory ducts and hair follicles are affected. This situation is typical for women over 20 years of age.

Excessive influence of androgens leads to increased secretion production by the sebaceous glands. As a result, seborrhea occurs, under the influence of which it suffers hairy part head, neck and face. In some cases, the chest and back are affected.

Symptoms of hyperandrogenism can manifest as alopecia. This mechanism is based on periods of growth and rest, which is rhythm of life hair follicles. They react differently to increased amount androgens. The greatest sensitivity to male hormones manifests itself in the crown area, as well as in the forehead and temples. Blood vessels located near the follicles are subject to spasms, which disrupts blood circulation and all normal processes. As a result, the follicles die, and androgenic alopecia forms, indicating a high level of production of male hormones.

Hyperandrogenism can manifest as hirsutism. In this case, women experience excessive growth hair in areas dependent on the action of androgens. The reason for this condition is the prolonged effect of excess male hormones on the hair follicles. As a result, vellus hair become hard, rod-shaped and pigmented. Under the influence, masculine traits can be formed.

Hyperandrogenism of ovarian origin

This type of pathology is more common in women of reproductive age, in approximately 4-5% of cases. It occurs for many reasons, but the key factor is considered to be a malfunction of the pituitary-hypothalamus system. As a result, excessive production of LH is stimulated, and the ratio between the gonadotropic hormones LH and FSH increases.

If LH is observed in large or excessive quantities, hyperplasia occurs connective tissue protein membrane of the ovaries. In this case, the granulosa and outer layer of the follicles suffer. For this reason, the number of ovarian androgens increases and masculinization becomes noticeable. FSH produced in insufficient quantities leads to untimely maturation of follicles and the onset of anovulation, which requires treatment.

Adrenal hyperandrogenism

One form of pathology is adrenal hyperandrogenism, characterized by a delay in cortisol production. Because of this, the production of ACTH by the pituitary gland and further synthesis of hydroxyprogesterone are stimulated. Ultimately, hyperproduction of androgens occurs.

ACTH accumulates in the blood and cortisol levels increase. Increased amounts of 17-hydroxycorticosteroids or 17-ketosteroids are excreted in the urine. These indicators have great importance and are used in the diagnosis of AGS. All of these movements are associated with the adrenal cortex, therefore this type AHS is called adrenal hyperandrogenism. Most often it manifests itself in congenital form, but can occur in postnatal and postnatal form. This pathology has a negative impact on reproductive abilities and may negatively affect your ability to become pregnant.

Diagnostics

First, you need to determine the reason why there is an increase in the number of androgens in women. Installed exact time when the characteristic symptoms of this pathology appeared. As a rule, they appear gradually, at the beginning of puberty. In some cases, with the onset reproductive age, perhaps them sudden appearance. Thus, based on the data obtained, the appearance of hyperandrogenism is associated with the presence of tumors in the adrenal glands and ovaries.

Diagnosis of the disease occurs different methods. Blood and urine are examined first. The content of male sex hormones and their breakdown products is determined. The presence of other types of hormones is determined. Additional diagnostics are carried out using ultrasound examination of the genital organs. Tomography, ultrasound and other types of special studies are used to check the adrenal glands.

Treatment of hyperandrogenism

Treatment measures are carried out in accordance with the main causes of the disease and the expected result. For example, in the case of planning a pregnancy, the therapy will be prescribed differently than in the treatment of ordinary external manifestations of pathology.

Conservative treatment includes weight loss measures, organization dietary nutrition, exercise and sports, as well as taking medications that reduce the secretion of androgens.

At the same time, existing concomitant diseases are treated, due to which hyperandrogenism appears in women. Among them, attention should first be paid to liver diseases and thyroid gland, adrenogenital syndrome and polycystic ovary syndrome. Benign and malignant tumors that secrete androgens are removed by surgical intervention. In some cases it is carried out complex treatment, combining several different methods.

Hyperandrogenism syndrome in women is frequent violation which affects endocrine system. The disease is accompanied by an increase in the amount of male sex hormones. This negatively affects both the body as a whole and the functioning of the reproductive system. This condition occurs in 5% of women, which is quite high rate. The opposite situation is called hypoandrogenism - this is when men have a lack of male sex hormones.

Hyperandrogenic syndrome is a condition that is accompanied by increased production the body produces androgens (male sex hormones). Sometimes their normal concentration is observed, which may still have negative impact on the body. An excess of androgens in the female population is manifested by the appearance of masculine features. The patient also has problems with reproductive function. This syndrome also occurs in men. In them it manifests itself (by enlargement of the mammary glands as in women). Also, such men often suffer from impotence and other problems.

Androgens are a group of human body. They are produced by the testes in men or the ovaries in women. These hormones are also produced by the adrenal cortex. Their list includes:

and others.

Androgen synthesis is controlled by substances produced by the pituitary gland. These include adenocorticotropic hormone. Androgen formation begins with the conversion of cholesterol to pregnenolone. This process is observed in all tissues that are classified as steroid-producing. Subsequently, synthesis continues in completely different organs. Most often they have nothing to do with steroidogenesis.

The output produces different hormones depending on the organ that is involved in the process. The ovaries produce testosterone, estrone,... The adrenal glands produce... This organ also produces testosterone. In the process of producing androgens, not only organs take part, but also peripheral tissues, for example, subcutaneous fatty tissue.

Symptoms of hyperandrogenism in women

Signs of hyperandrogenism in women are:

. Characterized by increased male-type hair growth. In this case, hair growth that is uncharacteristic for women is observed. It can be localized on the stomach, back, face, chest. In the presence of increased hair growth, the diagnosis of hyperandrogenism should be distinguished from. Last state has the same symptoms, but does not appear due to increased androgens. Increased hair growth can develop due to the characteristics of a woman’s body, which is the norm. A striking example are representatives from Central Asian countries;

acne. Characterized by the formation of acne on the skin (most often on the face). Accompanied by damage to the hair follicles and sebaceous glands, blockage of the excretory ducts. This problem often worries teenagers, which does not indicate the presence of this syndrome. After 20 years, more than half of women diagnosed with acne are diagnosed with an excess of male sex hormones;
seborrhea. Characterized by increased secretion of the sebaceous glands. This process is observed on the head, face, neck and other parts of the body. Seborrhea often causes the development of acne or other skin problems among women;
alopecia. Hair follicles are very sensitive to increased levels of androgens in the blood. Most of all, this phenomenon is observed in the frontal, temporal and parietal regions. Under the influence of male hormones, the hair in these areas changes, becomes much thinner, and eventually falls out completely. As a result, bald patches form. Androgenetic alopecia often observed in women who have significantly increased levels of male hormones;

virilization. Characterized by the appearance of pronounced masculine traits in women. This symptom is present in patients with serious pathologies in whom androgens are produced in large quantities;
menstrual irregularities. Women are given different diagnoses depending on the nature of the disorder. Opso-oligomenorrhea (the presence of too much or short period between menstruation), amenorrhea ( complete absence menstruation throughout long period);
. May be observed in the presence of pathologies of the adrenal glands or ovaries;
amyotrophy;

decreased immunity as a result;
impaired glucose tolerance;
presence of genitals intermediate type. Such a woman may experience fusion of the labia, clitoral hypertrophy and other defects. These problems are congenital in nature and appear due to hyperplasia of the adrenal cortex. Such a person may be called an androgyne, which means the union of a man and a woman in one body;
chronic depression, drowsiness, loss of strength and other signs of hyperandrogenism.

Reasons for the development of the problem

The development of hyperandrogenism syndrome is observed due to the following reasons:

hereditary factors. Androgenism in women can be transmitted from mother to daughter. If this problem is identified in the family, there is Great chance the fact that it will be inherited;
violation normal operation brain, in particular, or. These departments are involved in the formation of reproductive hormones;

dysfunction of the adrenal cortex. It is a congenital pathology, which is characterized by an increase in the production of some hormones and inhibition of others. In 95% of cases, a decrease in the concentration of aldosterone is observed, which leads to improper formation of the woman’s external genitalia;
formation of tumors of the ovaries or adrenal glands that disrupt normal process hormone production. They are also called androgen secretors. When localized on the ovaries, testosterone production increases, on the adrenal glands -;
polycystic ovary syndrome. This is a disease that is characterized by the absence of tumors, but which affects the increase in the production of male hormones in women. Multiple cysts form in the ovaries, which causes. The increased level of androgens, which is observed in PCOS, leads to infertility, obesity, and increased hair growth. During the diagnosis of a sick woman, a chronic lack of ovulation is revealed;

adrenogenital syndrome. Characterized by excessive production of male sex hormones by the adrenal glands;
. Accompanied by an increase in hormones produced by the adrenal cortex - glucocorticoids. In a sick woman, it is observed where fat is predominantly deposited on the face, neck, and torso. Other symptoms of the disease are menstrual irregularities, infertility, muscle atrophy (mainly in the limbs), osteoporosis, lack of glucose tolerance, osteoporosis, chronic depression. In men, enlargement of the mammary glands and impotence are observed;
prolactinoma. A tumor localized in the pituitary gland. This formation affects the production, which is responsible for breast growth and milk formation;

ovarian hyperthecosis and stromal hyperplasia. Unnatural growth of their tissues is observed. Most often found in mature age after 60 years. When examining patients, an increase in the level of estradiol and estrone is determined. The disorder is accompanied by obesity, development arterial hypertension, impaired glucose tolerance, uterine cancer;
high activity of 5-alpha reductase, which is involved in the production of steroid hormones;
long-term and uncontrolled use different types(including oral contraceptives);
dysfunction of the thyroid gland;
chronic liver diseases.

Increased androgen production in pregnant women

Excess androgens in pregnant women is a dangerous condition. In 20-40% of all cases, pregnancy ends in spontaneous abortion in the early stages. This happens due to a non-developing fetus or anembryony (absence of an embryo in the fertilized egg).

This problem may be chronic nature. Each subsequent pregnancy ends in miscarriage, which leads to a condition called recurrent miscarriage. Secondary infertility develops, and hormonal disorders become more pronounced.

The most critical moments that a woman experiences are considered to be the periods when the fetus begins to additionally produce male sex hormones. It happens naturally and it is observed:

from 12 to 13 weeks of pregnancy;
from 23 to 24;
from 27 to 28.

If it was detected before pregnancy high level androgens in women, treatment occurs at all stages - both before and during gestation. The doctor determines the risk for the woman and child and prescribes appropriate medications to normalize hormonal levels.

Diagnosis of the disease

Symptoms and treatment for this problem depend on the cause. To determine them, an analysis of the patient’s condition is carried out. The attending physician takes into account when the characteristic symptoms of hyperandrogenism appeared - in childhood, adolescence or adulthood. Such an analysis will determine the direction of further diagnostics. It should be aimed at increased examination of certain organs - ovaries, adrenal glands, etc.

Diagnosis of hyperandrogenism includes:

blood and urine tests. A study is being conducted to determine the level of androgens and their metabolic products;
Ultrasound of the pelvis. Both conventional and transvaginal are often prescribed;
Ultrasound of the adrenal glands;
tomography.

Treatment

If high levels of androgens have been identified in women, treatment of this condition occurs with the use of different methods. It all depends on the reason, which must be in mandatory determined. Mainly prescribed:

taking glucocorticosteroids;
taking antiandrogens. They suppress the production of male sex hormones;
taking estrogen-progestin drugs. They contain female sex hormones;
use of gonadotropin-releasing hormone agonists. Drugs of this type act on the pituitary gland, which allows normalization hormonal background;
surgical treatment when tumors are detected;
normalization of weight, adherence to the principles of healthy eating, physical activity.

Prevention

Increased growth of androgens in women is treated in compliance with certain rules that help prevent further development diseases. These include:

balanced diet. It is important to consume healthy food, give up fatty, salty, smoked, fried foods, limit your consumption of sweets;
normalization of weight. Excess weight directly affects the increase in the production of male sex hormones;
moderate physical activity. You can sign up for a swimming pool or gym. Physical activity should be daily, but excessive load should be avoided;
prevention of stress. Increased psycho-emotional stress also negatively affects a woman’s hormonal background;
refusal bad habits– smoking, alcohol abuse;
regular visits to the gynecologist;
It is necessary to promptly treat diseases of the thyroid gland, adrenal glands, liver and other organs.

Complications

If treatment for hyperandrogenism in women was absent or did not provide positive result, the following complications develop:

diabetes;
recurrent miscarriage;
infertility;

Also, sick women complain of cosmetic defects - oily and problematic skin, increased hair growth and others.

Bibliography

Emergency care for extragenital pathology in pregnant women. 2008, 2nd edition, corrected and expanded, Moscow, “Triad-X”.
Savicheva A.M., Bashmakova M.A. Urogenital chlamydia in women and its consequences. Ed. E.K. Ailamazyan - N.Novgorod: Publishing house NGMA, 1998. -182 p.
Zaporozhan V.M., Tsegelsky M.R. Obstetrics and gynecology. - K.: Health, 1996.-240 p.
New honey technology (Methodological recommendations) “Management of premature pregnancy complicated by premature rupture of membranes”; Makarov O.V., Kozlov P.V. (Edited by Volodin N.N.) - RASPM; Moscow; TsKMS GOU VPO RGMU-2006.
Diseases of the cervix, vagina and vulva / Ed. V.N. Prilep-

Graduated from the Kirov State Medical Academy in 2006. In 2007, she worked at the Tikhvin Central district hospital on the basis of the therapeutic department. From 2007 to 2008 - employee of a mining company hospital in the Republic of Guinea (West Africa). From 2009 to the present day he has been working in the field of information marketing. medical services. We work with many popular portals, such as Sterilno.net, Med.ru, website

Hyperandrogenism is a pathology in which a woman’s hormonal background undergoes significant changes. There is too much production large quantity androgen hormone, which is considered male. 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 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 of occurrence

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;
pathologies of the 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 activities by force 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 does not allow one 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. The appearance of the internal genital organs is normal.

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 cramps.

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.

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 a common symptom 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 (in various diseases, for example, porphyria). 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 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, genitourinary sinus, partial fusion of the labia majora) - detected immediately after birth or in early childhood; more often when congenital hyperplasia adrenal cortex.
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. There may be irregularities in the 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. At 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. It is observed at a fairly mature age in women as a result of an imbalance between estradiol and estrone. Manifests itself in the form of hypertension, diabetes mellitus, overweight, 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 in the 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 uterine wall due to hormonal imbalance in organism. As a result, even with a slight negative external influence a miscarriage occurs. It is almost always accompanied bloody discharge from the vagina, nagging pain 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 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.
With 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 affected negative influence changes in hormonal levels in pathologies 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 FSH level in 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 reason for 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 high content ovarian hormone (progesterone).

Treatment of associated pathologies:

diseases of the thyroid gland and liver;
PCOS (polycystic ovary syndrome) when overproduction male sex hormones are 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 intrauterine development child, because 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 Clymene 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);
giving up 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 bear a healthy child with this 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.

Hyperandrogenism in women is a hormonal imbalance in which the concentration of male sex hormones (androgens) increases. Sex hormones are active substances, which perform a regulatory function and ensure the appearance of secondary sexual characteristics and the difference between men and women. Sex hormones play a key role in the process of human reproduction: maturation of germ cells, pregnancy and childbirth.

Normally, a certain amount of male sex hormones circulates in a woman’s body. However, in some cases, their concentration may exceed permissible values, as a result of which the woman will begin to experience male characteristics, and the normal functioning of the ovaries is disrupted. A particular danger is the increase in androgen levels during pregnancy. An increase in the amount of male sex hormones may be associated with their secretion in the ovaries or adrenal glands. To normalize hormonal balance, you can use folk remedies. This treatment for hyperandrogenism is mild complex action on the body, improves metabolism and normalizes ovarian function. In order for therapy to be effective, medications must be taken systematically.

Androgens in women

Normally, a certain amount of male sex hormones circulates in the female body. Androgens are produced by the adrenal glands, ovaries and, in small quantities, by subcutaneous fat. Regulation of the synthesis of male sex hormones is carried out using pituitary hormones. Androgens are precursors to other hormones: corticosteroids and estrogens. These substances are also involved in the process of human growth and puberty. The ratio of androgens and estrogens shapes libido.

However, if the amount of androgens in a woman’s body exceeds the norm, she develops pathological processes, metabolic disorders occur and reproductive function. This condition also increases the likelihood of developing diseases of the reproductive system, in particular erosion, dysplasia and cervical cancer.

Classification of the disease

Depending on the source of male sex hormones, there are:

hyperandrogenism of ovarian origin;
adrenal hyperandrogenism;
mixed.

Depending on the origin, there are two forms of the disease;

hereditary;
acquired.

Depending on the amount of androgens, two types of the disease are distinguished:

absolute hyperandrogenism – there is an increase in the concentration of male sex hormones in the blood;
relative - the concentration of androgens remains normal, but their activity increases or the sensitivity to hormones of target cells increases.

Causes of pathology

Hyperandrogenism is a complex of syndromes that have similar manifestations, but are caused by for various reasons:

Adrenogenital syndrome.
This disease is the most common cause of hyperandrogenism in women. In this case, the adrenal glands produce a normal amount of androgens, but do not convert them further.
Normally, male sex hormones are produced in the adrenal glands, and then, under the action of a special enzyme, are converted into glucocorticoids - others are very important hormones. However, if a woman does not produce sufficient quantity of this enzyme or the enzyme itself is defective, androgens are not converted into glucocorticoids, but remain unchanged in the woman’s body, binding to target cells and producing a pathological effect.
Adrenal tumors.
The development of a tumor increases the number of active adrenal cells, and therefore increases the production of male sex hormones.
.
In this case, there is an increase in the number of ovarian cells that produce androgens. Disruption of the normal functioning of the pituitary gland.
Pituitary hormones regulate the production of other hormones, in particular androgens. Disruption of the normal functioning of the pituitary gland causes complex endocrine disorders organism, including can cause hyperandrogenism in women.
Increased sensitivity target cells.
Some women experience individual signs hyperandrogenism, in particular (excessive hair growth) and acne, but the concentration of androgens in their body does not exceed the norm. Symptoms of this pathology appear in them because the skin cells in such women are overly sensitive to androgens, and even a small concentration of them leads to the manifestation of pathological symptoms.

Symptoms of pathology

Signs of hyperandrogenism may vary. They depend on the form of the disease, the level of androgens and the woman’s sensitivity to them. The first signs of a disorder in the congenital form of the disease are observed during the girl’s puberty.

Hyperandrogenism is manifested by skin disorders: acne, oily seborrhea, abundant acne.
Excess growth hair on the face, arms and legs.
Also, a girl’s menstrual cycle may be disrupted: menstruation is irregular, delays often occur, and in some patients menstruation may be absent.

As the disease progresses and male sex hormones accumulate, the girl may develop pathological changes in ovarian tissue, in particular polycystic disease. Amenorrhea occurs and an insufficient amount of female sex hormones is produced. Hyperplasia of the endometrium of the uterus also develops. Emerging disorders often manifest themselves.

Manifestations of hyperandrogenism continue after menopause. These women experience male pattern hair loss. They also suffer from skin diseases. Hormonal imbalance and external manifestations hyperandrogenism often leads to the development of depression and neurosis.

In more severe cases of hyperandrogenism, disturbances in the structure of the genital organs and reproductive function occur. Against the background of this condition, a woman may develop pseudohermaphroditism, late start menstruation, masculine appearance, poor breast development, rough voice. Another symptom of this condition is male pattern obesity.

An increase in the concentration of male sex hormones provokes systemic disorders of the body:

metabolic diseases;
promotion blood pressure;
heart failure.

With hyperandrogenism, the sensitivity of cells to the hormone insulin is impaired. This can lead to the development of type 2 diabetes, in which the cells of the pancreas produce a sufficient amount of insulin, but it cannot fully perform its functions. This condition is difficult to treat.

If the disease is not caused by a tumor, then the symptoms of this pathology gradually increase. This process can last several years. If hyperandrogenism is caused by a tumor process in the ovaries or adrenal glands, the symptoms of the disease are similar, but increase very quickly.

Hyperandrogenism during pregnancy

An increase in the concentration of androgens affects the general hormonal background of a woman and reproductive function. Pathological changes against this background can become a serious obstacle to the conception and birth of a healthy child. However, pregnancy is still possible for some girls with this disease. It all depends on the form and severity of the disease.

Hyperandrogenism can cause disruption of the structure of ovarian tissue and the development of polycystic disease. Also, a dense capsule may form around the organ. This prevents normal functioning ovaries: estrogen production, ovulation. When the amount of androgens exceeds a certain critical level, the patient experiences anovulation.

If the patient develops mild hyperandrogenism, conception may still occur. However, in this case, the likelihood of miscarriage in the first or second trimester of pregnancy increases. This can be caused by both an excess of male sex hormones and a decrease in the level of progesterone, a hormone that plays a key role in bearing a baby. A decrease in the amount of progesterone is often observed with hyperandrogenism in women.

Women with this disease also have a difficult time giving birth. They may experience untimely withdrawal amniotic fluid. An insufficient amount female sex hormones can cause weak contractile activity of the uterus.

Diagnosis of the disease

To make an accurate diagnosis, anamnesis is collected, including family history, in order to establish a hereditary predisposition to this pathology. A physical examination of the patient is also carried out, which allows us to identify external manifestations of hyperandrogenism: skin diseases, enhanced growth hair, developmental disorders of the genital organs. However, the main diagnostic criterion- This is an increase in the concentration of androgens in the blood. Conduct laboratory test blood for hormones. It is important to determine the concentration of all hormones, this will help determine the cause of the pathology.

To exclude the possibility of a tumor, an ultrasound examination of the organs is performed abdominal cavity and pelvis, as well as more informative computed tomography adrenal glands Ultrasonography also detects polycystic ovary syndrome.

Treatment of the disease

Hyperandrogenism is a disease that has a complex negative effect on a woman’s body and causes many disorders: endocrine and metabolic pathologies, reproductive dysfunction. A systematic approach is important for its treatment.

Traditional medicine proposes to correct the hormonal balance of a woman’s body using oral contraceptives. However, such treatment completely eliminates the possibility of pregnancy. There are folk remedies that help normalize metabolism and hormonal balance in the body. This treatment has a mild effect. To achieve positive effect, it is necessary to use folk remedies systematically and for a long time. Treatment of hyperandrogenism with folk remedies lasts at least six months.

Traditional recipes:

Also, in addition to taking medications, it is necessary to change your lifestyle. Women with hyperandrogenism are often overweight. Such a woman needs to fight obesity. For these purposes, it is useful to adjust your diet and exercise. Moderate sport exercises will help improve well-being and metabolism. Weight correction is necessary not only to improve a woman’s well-being, but also for her psychological comfort.