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 the blood of a woman. Today, this pathology is quite widespread: according to statistics, 5-7% of adolescent girls and 10-20% of women suffer from it. childbearing age. And since hyperandrogenism entails not only various defects in appearance, but is also one of the causes of infertility, it is important for women to have an idea about this condition so that, having noticed such symptoms in themselves, they should immediately seek help from a specialist.

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

Androgens: the basics of physiology

Androgens are male sex hormones. The leading, most famous representative of them is testosterone. In the body of a woman, they are formed in the cells of the ovaries and the adrenal cortex, as well as in the subcutaneous adipose tissue (SAT). 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 sex drive women;
growth during puberty tubular bones, and hence the growth of the child;
participate in the formation of secondary sexual characteristics, namely, female type hair.

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, 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).

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 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, preparations of male sex hormones and cyclosporine.

Clinical manifestations

These women are worried increased prolapse hair on the head and their appearance in other places (on the face or chest).

Depending on the causative factor, the symptoms of hyperandrogenism vary from slight, mild hirsutism (increased hairiness) to pronounced viril 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 sebaceous glands that occurs if their excretory ducts are clogged. One of the reasons (more correctly, even to say - the links of pathogenesis) of acne is precisely hyperandrogenism. It is physiological for puberty, which is why rashes on the face are found in more than half of adolescents.

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 will be polycystic ovary syndrome.

Acne can occur on its own or be accompanied (by increased production of sebum secretion selectively - in certain parts of the body). It can also occur under the influence of androgens.

hirsutism

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

Alopecia

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

Virilization (virile syndrome)

This term refers to the loss of the body's signs of a woman, the formation of male characteristics. Fortunately, this is a fairly rare condition - it is found in only 1 out of 100 patients suffering from hirsutism. The leading etiological factors are adrenoblastoma and ovarian tecomatosis. Rarely, androgen-producing tumors of the adrenal glands become the cause of this condition.

Virilization is characterized by the following symptoms:

hirsutism;
acne
androgenetic alopecia;
a decrease in the timbre of the voice (baryphony; the voice becomes rough, like a man's);
reduction in the size of the sex glands;
an increase in the size of the clitoris;
muscle growth;
redistribution of subcutaneous adipose tissue male type;
menstrual irregularities up to;
increased sex drive.

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 evaluating the symptoms and anamnesis data, 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 the 5th-7th day of the menstrual cycle. Determine blood levels total testosterone, SHBG, DHEA, follicle-stimulating hormone, luteinizing hormone, and 17-hydroxyprogesterone.

To find 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 this area.

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

If the results of the above studies are negative, the patient may be prescribed catheterization of the veins that carry blood away 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 tactics of treating hyperandrogenism in women depends on the pathology due to which this condition arose.

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

Adrenogenital syndrome requires the appointment of glucocorticoids.

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

With obesity and hyperinsulism, a woman is shown normalization of body weight (by following dietary recommendations and regular physical activity) and metformin.

Neoplasms of the adrenal glands or ovaries that produce androgens are removed surgically even in spite of their benign nature.

Which doctor to contact

With symptoms of hirsutism, you should contact a gynecologist-endocrinologist. Additional assistance will be provided specialized specialists- dermatologist, trichologist, nutritionist.

Conclusion

Hyperandrogenism in women is a complex of symptoms arising from an increased concentration of male sex hormones in the blood, which accompanies a series of endocrine diseases. The most common causes of it are polycystic ovary syndrome and adrenogenital syndrome.

Content:

Often there is a situation when there are significant changes in hormonal levels. In these cases, hyperandrogenism is diagnosed in women, 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 puberty, hairline appears in the genital area and armpits. They are directly related to the reproductive system and muscle growth, 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 surround the cell layers, and an excess amount of androgens significantly slows down or even stops follicular growth. As a result, overgrowth of follicles occurs, which received the name of follicular atresia. In addition, male hormones that exceed the norm contribute to the development of fibrosis of the ovarian capsule. In the future, multiple cysts are formed on the ovaries - polycystic.

The emergence and development of hyperandrogenism is influenced by the hypothalamus, represented as a regulatory department of the brain. With its help, control over metabolic processes in the body is carried out, under its leadership the sexual and endocrine glands function. The hypothalamus provides interaction between hormonal and nervous system. For direct hormonal metabolism responsible for the pituitary gland, 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 most widespread received adrenogenital syndrome, which promotes an increase in male sex hormones. In the adrenal glands, not only androgens are produced, but also other hormones, for example, glucocorticoids. A special enzyme acts on male hormones and converts them into glucocorticoids. If the process of this synthesis is disturbed, the conversion of androgens does not occur, so they accumulate and exert negative impact on tissues and organs.

Quite often, hyperandrogenism appears under the influence of a tumor of the adrenal glands. The number of cells that produce androgens increases, and the number of male sex hormones increases accordingly. In addition, the ovaries or ovarian tumors, which include 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 the thyroid gland. With impaired functions of the hypothalamus and pituitary gland, 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 old.

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

Symptoms of hyperandrogenism may 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 is manifested in the region of the crown, as well as in the forehead and temples. Blood vessels located near the follicles are prone to spasms, which disrupts blood circulation and all normal processes. As a result, the follicles die, and androgenetic alopecia is formed, indicating a high level of production of male hormones.

Hyperandrogenism may manifest as hirsutism. In this case, women have overgrowth hair in areas dependent on the action of androgens. The reason for this condition is the long-term effect on the hair follicles of an excess amount of male hormones. As a result, vellus hair become hard, rod 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 about 4-5% of cases. It occurs for many reasons, but the key link is considered to be a malfunction of the pituitary-hypothalamus system. As a result, there is stimulation of excessive production of LH, the ratio between the gonadotropic hormones LH and FSH increases.

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

Adrenal hyperandrogenism

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

ACTH builds up in the blood, and cortisol levels rise. An increased amount of 17-hydroxycorticosteroids or 17-ketosteroids is 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 species AGS is called adrenal hyperandrogenism. Most often, it manifests itself in congenital form, but can occur in postnatal and post-abdominal form. This pathology has a negative impact on reproductive ability and may adversely affect the 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.

The disease is diagnosed different methods. First of all, blood and urine are examined. The content of male sex hormones and their decay products is determined. The presence of other types of hormones is established. Additional diagnostics is carried out with the help of ultrasound examination of the genital organs. To check the adrenal glands, tomography, ultrasound and other types of special studies are used.

Treatment of hyperandrogenism

Therapeutic measures are carried out in accordance with the main causes of the disease and the expected result. For example, in the case of pregnancy planning, the therapy will not be the same as in the treatment of the usual external manifestations of the pathology.

Conducting conservative treatment includes measures for weight loss, organization diet food, physical education and sports, as well as taking drugs that reduce the release of androgens.

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

The syndrome of hyperandrogenism 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 state occurs in 5% of women, which is enough 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 androgens (male sex hormones). Sometimes their normal concentration is observed, which can still have negative impact on the body. An excess of androgens in the female part of the population is manifested by the appearance of male features. Also, the patient has problems with reproductive function. This syndrome also occurs in men. In them, it manifests itself (an increase in the mammary glands as in women). Also, such men often suffer from impotence and other problems.

Androgens are a group produced human body. They are produced by the testicles in men or the ovaries in women. Also, these hormones are 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. The formation of androgens begins with the conversion of cholesterol to pregnenolone. This process is observed in all tissues that are steroid-producing. Subsequently, the synthesis continues in completely different organs. Most often they have nothing to do with steroidogenesis.

At the output, different hormones are formed depending on the organ that is included in the process. The ovaries produce testosterone, estrone,. The adrenal glands produce,. This organ also produces testosterone. In the process of androgen production, not only organs, but also peripheral tissues, for example, subcutaneous adipose tissue, take part.

Symptoms of hyperandrogenism in women

Signs of hyperandrogenism in women are:

. It is characterized by increased male pattern hair growth. In this case, there is an uncharacteristic hairline for women. It can be localized on the abdomen, back, face, chest. In the presence of increased hairiness, the diagnosis of hyperandrogenism should be distinguished from. Last state has the same signs, but does not appear due to increased androgens. Increased body hair can develop due to the characteristics of the woman's body, which is the norm. A prime example are representatives from Central Asian countries;

acne. It is characterized by the formation of acne on the skin (most often on the face). It is 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 the women who have acne are diagnosed with an excess of male sex hormones;
seborrhea. It is characterized by increased secretion of the sebaceous glands. This process is observed on the head, face, neck and other parts of the body. Often seborrhea 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 in these areas, the hair changes, becomes much thinner, and eventually falls out completely. As a result, bald patches are formed. Androgenetic alopecia often observed in women who have significantly increased levels of male hormones;

virilization. It is characterized by the appearance of pronounced masculine features in women. This symptom is present in patients with serious pathologies in which androgens are produced in large quantities;
violation of the menstrual cycle. Women are diagnosed differently depending on the nature of the disorder. Opsooligomenorrhea is common (the presence of too much or short span between periods), 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;
the presence of sexual organs 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 can be called an androgyne, which means the combination 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 such reasons:

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

dysfunction of the adrenal cortex. It is a congenital pathology, which is characterized by an increase in the production of some hormones and the suppression of others. In 95% of cases, a decrease in the concentration of aldosterone is observed, which leads to the incorrect formation of the external genital organs of a woman;
the formation of tumors of the ovaries or adrenal glands, which disrupt normal process hormone production. They are also called androgen-secreting. With localization 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 affecting the increase in the production of male hormones in women. Multiple cysts form in the ovaries, which causes. The elevated levels of androgens that are observed in PCOS lead to infertility, obesity, and increased hairiness. During the diagnosis of a sick woman, a chronic absence of ovulation is detected;

adrenogenital syndrome. It is characterized by excessive formation 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 mainly deposited on the face, neck, torso. Other symptoms of the disease are menstrual irregularities, infertility, muscle atrophy (mainly on the limbs), osteoporosis, lack of glucose tolerance, osteoporosis, chronic depression. In men, there is an increase in the mammary glands, impotence;
prolactinoma. A tumor located in the pituitary gland. This education affects the production, which is responsible for breast growth, milk formation;

ovarian hyperthecosis and stromal hyperplasia. There is an unnatural growth of their tissues. Most often found in adulthood 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;
prolonged and uncontrolled intake different type(including oral contraceptives);
violation of the thyroid gland;
chronic liver disease.

Increased androgen production in pregnant women

An excess of androgens in women who are carrying a fetus is a dangerous condition. In 20-40% of all cases, pregnancy ends in spontaneous abortion at an early stage. This happens due to a non-developing fetus or anembryony (the absence of an embryo in the fertilizing egg).

Such a problem may be chronic. Each subsequent pregnancy ends in a miscarriage, which leads to such a condition as habitual miscarriage. Secondary infertility develops, and hormonal disorders become more pronounced.

The most critical moments that a woman experiences are the periods when the fetus begins to additionally produce male sex hormones. It happens naturally and 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 the child and prescribes the appropriate medications to normalize the hormonal background.

Diagnosis of the disease

The symptoms and treatment of this problem depend on the cause of the problem. 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 an increased study of certain organs - the ovaries, adrenal glands, etc.

Diagnosis of hyperandrogenism includes:

blood and urine analysis. 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 a high level of androgens has been detected in women, the treatment of this condition occurs with the use of different methods. It all depends on the reason, which should be in without fail defined. Mainly appointed:

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

Prevention

The increased growth of androgens in women is treated in compliance with certain rules that allow you to prevent further development diseases. These include:

balanced diet. It is important to consume healthy food, refuse fatty, salty, smoked, fried, limit the use of sweets;
weight normalization. Excess weight directly affects the increase in the production of male sex hormones;
moderate physical activity. You can join the pool or the gym. Physical activity should be daily excessive load should be avoided;
stress prevention. Increased psycho-emotional stress also negatively affects the hormonal background of a woman;
rejection bad habits- smoking, alcohol abuse;
regular visits to the gynecologist;
it is necessary to treat diseases of the thyroid gland, adrenal glands, liver and other organs in a timely manner.

Complications

If the treatment of hyperandrogenism in women was absent or did not give positive result develop the following complications:

diabetes;
habitual 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, revised and supplemented, Moscow, Triada-X.
Savicheva A.M., Bashmakova M.A. Urogenital chlamydia in women and its consequences. Ed. E.K. Ailamazyan - N. Novgorod.: Publishing house of 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 preterm pregnancy complicated by premature rupture of membranes"; Makarov O.V., Kozlov P.V. (Edited by Volodin N.N.) - RASPM; Moscow; TsKMS GOU VPO RSMU-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, he worked at a hospital for a mining company in the Republic of Guinea (West Africa). From 2009 to the present, 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 the hormonal background of a woman undergoes significant changes. There is too much production a large number androgen hormone, which is considered male. In the body of a woman, this hormone performs many necessary functions, but its excessive amount leads to backfire for which treatment is required.

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 mature women, since 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;
thyroid pathology (hypothyroidism), pituitary tumors;
diseases and malfunctions of the ovaries, provoking excessive production of androgens;
childhood obesity;
long-term use of steroids during professional activities power types 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. The appearance of the 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 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'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.

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 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 (in various diseases, such as porphyrias). 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 menstrual cycle.
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.
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 the early children's period; more often with congenital hyperplasia 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. There may be menstrual irregularities, 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. At 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. It is observed at a fairly mature age in women as a result of an imbalance between estradiol and estrone. Manifested as 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 in the early stages. 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 not able to attach well to the wall of the uterus due to hormonal imbalance in organism. As a result, even with a slight negative external influence miscarriage occurs. It is almost always accompanied spotting 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.
With 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 exposed negative influence hormonal changes in the pathology of the adrenal glands, pituitary gland and ovaries: chronic kidney 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 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 led to the development of this pathological condition, as well as on 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 high content ovarian hormone (progesterone).

Treatment of comorbidities:

diseases of the thyroid gland and liver;
PCOS (polycystic ovary syndrome) overproduction male sex hormones 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 as early as the stage prenatal 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 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);
giving up 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 bear a healthy child with such a diagnosis? Yes, it is quite. But given the increased risk of miscarriage, this is not easy to do. If you 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.

Hyperandrogenism in women is a hormonal imbalance in which the concentration of male sex hormones (androgens) increases. The sex hormones are active substances, which perform a regulatory function and provide 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: the maturation of germ cells, pregnancy and childbirth.

Normally, a certain amount of male sex hormones circulate in the body of a woman. However, in some cases, their concentration may exceed the permissible values, as a result of which the woman will begin to show male signs, and the normal functioning of the ovaries is disrupted. Of particular danger is the increase in the content of androgens 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 the hormonal balance, you can use folk remedies. This treatment of hyperandrogenism has a mild complex action on the body, improves metabolism and normalizes the functioning of the ovaries. In order for the therapy to be effective, it is necessary to take medicinal drugs systematically.

Androgens in women

Normally, a certain amount of male sex hormones circulate in the female body. Androgens are produced by the adrenal glands, ovaries and, in small amounts, subcutaneous adipose tissue. The regulation of the synthesis of male sex hormones is carried out with the help of pituitary hormones. Androgens are precursors to other hormones: corticosteroids and estrogens. Also, these substances are involved in the process of human growth and puberty. The ratio of androgens and estrogens forms the 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. Also, this condition increases the likelihood of developing diseases of the organs of the reproductive system, in particular, erosion, dysplasia and cervical cancer.

Disease classification

Depending on the source of male sex hormones, it happens:

hyperandrogenism of ovarian origin;
adrenal hyperandrogenism;
mixed.

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

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 sensitivity to hormones of target cells increases.

Causes of pathology

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

Adrenogenital syndrome.
This disease is the most common cause of hyperandrogenism in women. In this case, a normal amount of androgens is produced in the adrenal glands, but their further transformation does not occur.
Normally, male sex hormones are produced in the adrenal glands, and then, under the action of a special enzyme, they turn into glucocorticoids - others are very important hormones. However, if a woman develops no enough of this enzyme or the enzyme itself is defective, androgens do not turn into glucocorticoids, but remain unchanged in the woman's body, binding to target cells and exerting a pathological effect.
Tumors of the adrenal glands.
Tumor development increases the number of active cells of the adrenal glands, 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. Violation of the normal functioning of the pituitary gland.
Pituitary hormones regulate the production of other hormones, in particular androgens. Violation of the normal functioning of the pituitary gland causes complex endocrine disorders organism, including can cause hyperandrogenism in women.
Hypersensitivity target cells.
Some women have individual features hyperandrogenism, in particular (excessive hairline) and acne, but the concentration of androgens in their body does not exceed the norm. Symptoms of this pathology appear in them, because skin cells in such women are overly sensitive to androgens, and even their slight concentration leads to the manifestation of pathological symptoms.

Symptoms of pathology

Signs of hyperandrogenism can be different. They depend on the form of the disease, the level of androgens and the woman's sensitivity to them. The first signs of a violation in the congenital form of the disease are noted during the puberty of the girl.

Hyperandrogenism is manifested by skin disorders: acne, oily seborrhea, plentiful acne.
Overgrowth hair on the face, arms and legs.
Also, the girl's menstrual cycle may be disturbed: menstruation is irregular, delays often occur, in some patients menstruation may be absent.

As the disease progresses and the accumulation of male sex hormones, the girl may develop pathological changes in the ovarian tissue, in particular, polycystic. There comes a state of amenorrhea, an insufficient amount of female sex hormones is produced. Hyperplasia of the endometrium of the uterus also develops. Emerging violations are often manifested.

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 a depressive state and neurosis.

In more severe cases of hyperandrogenism, violations of 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 features, 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 mellitus, in which the cells of the pancreas produce enough 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 take several years. If hyperandrogenism is caused by a tumor process in the ovaries or adrenal glands, the symptoms of the disease are similar, but they 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 organism against this background can become a serious obstacle to the conception and birth of a healthy child. However, in some girls with this disease, pregnancy is still possible. It all depends on the form and severity of the disease.

Hyperandrogenism can cause a violation of the structure of ovarian tissue and the development of polycystic. Also, a dense capsule can form around the organ. It hinders normal functioning ovaries: estrogen production, ovulation. In the case 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 a miscarriage in the first or second trimester of pregnancy increases. 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, can lead to this. A decrease in the amount of progesterone is often observed with hyperandrogenism in women.

It is also difficult for women with this disease to give birth. They may experience delayed withdrawal. amniotic fluid. An insufficient amount female sex hormones can cause weak contractile activity of the uterus.

Diagnosis of the disease

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

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

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, impaired reproductive function. A systematic approach is essential for his therapy.

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

Folk recipes:

Also, in addition to taking medicinal drugs, it is necessary to change the way of life. Women with hyperandrogenism are often overweight. Such a woman needs to fight obesity. For these purposes, it is useful to adjust the 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.