Hyperandrogenism in women

Hyperandrogenism (HA) is a condition in which the levels of male sex hormones, or androgens, in the human body are too high. Androgens include hormones such as testosterone, dihydrotestosterone, and dehydroepiandrosterone (DHEA), and they play an important role in the development of male sexual characteristics and function.

Hyperandrogenism can manifest itself in a variety of ways in men and women:

In men:

1. Increased display of male sex characteristics such as increased beard and mustache growth, increased muscle mass, deep voice, and even mustache formation.
2. Increased hair growth on the body and face.
3. Sexual problems such as erectile dysfunction may occur.
4. In some cases, hyperandrogenism can be associated with medical problems such as polycystic ovarian syndrome (PCOS) or ovarian tumors.

In women:

1. Increased hair growth on the face, chest, abdomen and other areas, which is called hirsutism.
2. Menstrual disorders and infertility.
3. A health threat, as hyperandrogenism can be linked to diseases such as PCOS, which can increase the risk of developing other medical conditions such as diabetes and cardiovascular disease.

Hyperandrogenism can be caused by a variety of factors, including genetic disorders, certain medical conditions, taking certain medications, and other factors.

Causes of the hyperandrogenism

Hyperandrogenism in women can be caused by a variety of reasons. This condition is characterized by excessive levels of male sex hormones, or androgens, in a woman's body. Here are some of the possible causes:

1. Polycystic Ovarian Syndrome (PCOS): PCOS is one of the most common causes of. It is characterized by the formation of cysts on the ovaries, menstrual irregularities and insulin levels, which can lead to increased androgen production.
2. Adrenal Disorders: Hyperandrogenism can be caused by adrenal disorders such as adrenal cortical hyperplasia or tumors that can lead to excess androgen production.
3. Hormonal disorders: Hyperandrogenism can also be caused by disorders of the hypothalamus, pituitary gland, or ovaries that affect androgen regulation.
4. Hyperthermia: Hyperthermia is a condition in which a woman's ovaries become overactive and produce excessive amounts of androgens.
5. External factors: Certain medications, including uncontrolled use of androgenic steroids, can contribute to hyperandrogenism. Poor diet, obesity, and stress can also be risk factors.
6. Genetic factors: Genetic disorders may increase the risk of hyperandrogenism in some women.

Pathogenesis

The pathogenesis of hyperandrogenism in women can be complex and depends on the underlying cause of the condition. Hyperandrogenism refers to the overproduction of male sex hormones, or androgens, in the female body. Here are a few common mechanisms that may underlie the pathogenesis:

1. Polycystic ovary syndrome (PCOS): PCOS is one of the most common causes of hyperandrogenism in women. In this syndrome, the ovaries produce excessive amounts of androgens under the influence of high levels of insulin and other hormones such as gonadotropin (LH).
2. Adrenals: Excessive hyperandrogenism may be associated with adrenal dysfunction, such as adrenal cortical hyperplasia or tumors, resulting in increased androgen release.
3. Hyperthermia: Hyperthermia is a condition in which the ovaries produce excessive amounts of androgens due to overactivity.
4. Hormonal disorders: Disorders of the hypothalamus, pituitary gland, or ovaries can lead to dysregulation of androgens and their overproduction.
5. Genetic factors: Genetic mutations or disorders may increase the propensity for hyperandrogenism.
6. External factors: Certain medications, diet, obesity and stress can also affect the balance of androgens in the body.

Understanding pathogenesis is essential for effective diagnosis and treatment.

Symptoms of the hyperandrogenism

Hyperandrogenism in women can manifest with a variety of symptoms related to excessive levels of male sex hormones, or androgens, in the body. Symptoms can vary depending on the degree and cause. Here are some of the common symptoms:

1. Hirsutism: Hirsutism is increased hair growth on the face, including beard, mustache, sideburns, as well as on the chest, abdomen, back and other areas. The level of hair growth can vary, from a slight increase to more intense hair growth.
2. Menstrual irregularity: Hyperandrogenism can lead to menstrual irregularities, including amenorrhea (no menstruation) or oligomenorrhea (infrequent menstruation).
3. Infertility: Excess androgens can affect ovarian function and lead to infertility in some women.
4. Acne: The appearance of acne (pimples) on the face, back, or other areas may be associated with hyperandrogenism.
5. Oily skin: Skin may become more oily due to increased sebum activity.
6. Increased muscle mass: In some women, GA may be accompanied by an increase in muscle mass.
7. Vocal changes: In rare cases, GA can cause vocal changes, resulting in deepening of the voice.
8. Increased insulin sensitivity: High levels of androgens can impair insulin sensitivity and increase the risk of developing diabetes.

It is important to note that the symptoms of hyperandrogenism can vary from woman to woman and depend on the severity of the condition.

Diagnostics of the hyperandrogenism

Diagnosing hyperandrogenism in women involves several steps and procedures to determine the presence of this condition, identify its cause and severity. The following are the main methods and tests that can be used in the diagnostic process:

1. Medical history: The doctor begins by gathering information about the patient's medical and family history. This includes questions about menstrual cycles, symptoms of hyperandrogenism, any relatives with similar problems, and medications.
2. Physical Exam: The physician performs a physical examination of the patient, including evaluation of the patient's scalp, skin and hair condition, and other physical signs associated with GA.
3. Blood tests: Blood tests are done to measure levels of androgens such as testosterone, dihydrotestosterone (DHT), and dehydroepiandrosterone (DHEA-S). These tests can help determine how high androgen levels are in the body.
4. Measurement of hormones: Your doctor may also perform tests to measure levels of other hormones such as follicle-stimulating hormone (FSH), leutinizing hormone (LH), and prolactin to detect the presence of other medical conditions that may be causing GA symptoms.
5. Ovarian ultrasound: Ultrasound may be used to detect cysts on the ovaries and assess their size and structure, which may indicate polycystic ovarian syndrome (PCOS).
6. Computed tomography (CT) or magnetic resonance imaging (MRI) of the adrenal glands: If adrenal abnormalities are suspected, CT or MRI of the adrenal glands are performed for additional diagnosis.
7. Additional tests: Depending on the situation, additional tests and studies may be needed to determine the cause of GA, such as checking for diabetes or other medical conditions.

Diagnosis requires a comprehensive approach and may include various medical tests and examinations. After a thorough diagnosis, the doctor will be able to determine the cause of hyperandrogenism and develop a treatment plan, which may include correction of hormone levels, lifestyle changes, drug therapy and other methods depending on the diagnosis.

Treatment of the hyperandrogenism

Treatment of hyperandrogenism in women depends on the cause and severity of the condition. The main goal of treatment is to reduce the levels of male sex hormones, or androgens, in the body and eliminate the symptoms of HA. Here are some of the methods and approaches used in the treatment of GA:

1. Treatment of the underlying condition: If hyperandrogenism is caused by another medical condition, such as polycystic ovarian syndrome (PCOS) or adrenal disorders, treatment is aimed at managing and correcting that underlying condition.
2. Androgen-reducing medications: Your doctor may prescribe medications that lower the level of androgens in your blood. These medications may include androgen antagonists, anti-estrogens, combined oral contraceptives, and androgen-reducing drugs.
3. Lifestyle correction: Lifestyle changes, including weight loss in the case of obesity, proper diet and physical activity levels, and stress management are important measures.
4. Hair removal procedures: Hair removal procedures such as electrolysis, laser hair removal, and waxing may be used to manage hirsutism (increased hair growth on the face and other areas).
5. Medications to improve insulin sensitivity: If diabetes mellitus or impaired insulin sensitivity is diagnosed, appropriate medications may be prescribed.
6. Surgery: In rare cases when other methods are not effective, surgery such as resection of ovarian tumors or other surgical procedures may be necessary.

Treatment should be individualized and depend on the patient's specific situation and diagnosis. It is important to consult with your doctor to determine the best treatment and monitoring plan. Follow the doctor's recommendations and have regular checkups to monitor the condition and the effectiveness of treatment.

Prevention

Prevention of hyperandrogenism in women can include a number of measures and practices that can help reduce or manage the risk of developing this condition. Here are some recommendations for preventing this condition:

1. Adherence to a healthy lifestyle:

   • Maintain a normal weight or work on losing excess weight if obese, as excess fatty tissue can contribute to GA.
   • Engage in regular physical activity, which helps improve insulin sensitivity and manage androgen levels.
   • Eat a balanced and healthy diet and avoid excessive intake of high glycemic index carbohydrates.

2. Monitoring of medical conditions:

   • If you have a family history of hyperandrogenism or other medical conditions associated with it, discuss it with your doctor for closer monitoring and prevention efforts.
   • Monitor hormone levels and other medical parameters as needed.

3. Regular checkups:

   • Have regular checkups with a gynecologist or endocrinologist to detect abnormalities in the reproductive system and androgen levels.

4. Stress Management:

   • Stress can make GA symptoms worse. Practice relaxation techniques, meditation and other techniques to reduce stress.

5. Medication management:

   • If you are taking medications, discuss their potential effects on androgen levels with your doctor. Uncontrolled use of androgenic steroids can worsen GA.

6. Communicating with your doctor:

   • In case of GA symptoms such as increased hair growth, menstrual irregularities or other changes, consult your doctor for timely diagnosis and treatment.

Prevention requires attention to lifestyle, health monitoring and regular medical checkups. Following your doctor's recommendations and maintaining a healthy lifestyle can help reduce the risk of hyperandrogenism and improve a woman's overall health.

Forecast

The prognosis of hyperandrogenism in women depends on many factors, including the cause of GA, its severity, the timeliness of diagnosis and initial treatment, and the effectiveness of treatment. In most cases, GA can be successfully managed and its symptoms reduced, but results can vary.

Here are some general considerations for the forecast:

1. Polycystic ovarian syndrome (PCOS): PCOS, as one of the most common causes of GA in women, usually requires long-term management. Women with PCOS may face a high risk of developing diabetes mellitus, cardiovascular disease and infertility, so regular medical monitoring and treatment is important.
2. Adrenal abnormalities: If GA is associated with adrenal abnormalities, the prognosis depends on how well these abnormalities can be controlled with medical treatment or surgery.
3. Other causes: The prognosis of GA caused by other medical causes will depend on the underlying cause and the success of its treatment.
4. Treatment effectiveness: With proper diagnosis and treatment, many women can manage her symptoms and lead normal lives. However, the effectiveness of treatment can vary, and some women may require long-term treatment or maintenance therapy.
5. Complications: GA can increase the risk of developing complications such as diabetes, cardiovascular disease, infertility, and others. Professional medical supervision and treatment can help prevent or manage these complications.

It is important to emphasize that effective diagnosis, treatment and adherence to doctor's recommendations can significantly improve the prognosis of hyperandrogenism in women. Women with this condition should lead an active lifestyle, take good care of their health and see their doctor regularly for monitoring and support.

List of popular books on gynecology and endocrinology

1. "Clinical Gynecology.

   • Author: Ernst Bilens
   • Year of release: 2016

2. "General Endocrinology.

   • Author: Anthony Wainland Feltus
   • Year of release: 2018

3. "Gynecology and Obstetrics and Gynecology. Obstetrics and Gynecology: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.

   • Authors: National Institute for Health and Clinical Effectiveness (NICE)
   • Year of release: 2019

4. "Endocrinology and Metabolism.

   • Author: Philip A. Marsden
   • Year of release: 2020

5. "Modern Endocrinology and Diabetes" (Modern Endocrinology and Diabetes)

   • Author: Mark J. Carniol
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6. "Gynecology: A Practical Approach (Gynecology: A Practical Approach)

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7. "Endocrinology: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.

   • Authors: National Institute for Health and Clinical Effectiveness (NICE)
   • Year of release: 2018

8. "Hormones and Metabolism: Clinical Endocrinology and General Medicine" (Hormones and Metabolism: Clinical Endocrinology and General Medicine)

   • Author: J. Larry Jameson
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9. "Obstetrics and Gynecology. Obstetrics and Gynecology: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.

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10. "Endocrinology and Metabolism: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.

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Literature used

• Dedov, I. I. Endocrinology : national guide / ed. By I. I. Dedov, G. A. Melnichenko. I. Dedov, G. A. Melnichenko. - 2nd ed. Moscow : GEOTAR-Media, 2021.
• Savelieva, G. M. Gynecology : national guide / edited by G. M. Savelieva, G. T. Sukhikh, V. N. Serov, V. E. Radzinsky, I. B. Manukhin. - 2nd ed. Moscow : GEOTAR-Media, 2022.