Hyperestrogenism

Hyperestrogenism is a condition in which there is an increase in estrogen levels, which leads not only to hormonal imbalance, but also to disruptions in the normal functioning of many organs. This problem can occur at any age, and in men and women equally often, which determines the peculiarities of the clinical course. Timely detection of the problem ensures normal development of the child or an adequate hormonal background in adulthood. This puts first the importance of not only correct, but also timely diagnostics.

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Epidemiology

The epidemiology of this problem is that hyperestrogenism is more common in women over 35 years of age. More than 55% of cases of uterine fibroids develop against the background of hyperestrogenism. In women of reproductive age, the cause of hyperestrogenism in 75% of cases is the irrational use of oral contraceptives, while in women over 35 years of age, the etiological factor is most often a hormone-producing ovarian tumor.

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Causes hyperestrogenism

Estrogens are a group of hormones, which include some varieties that ensure the normal functioning of the female and male organism. There are main types of these hormones - estrone, estriol, estradiol. Under normal conditions, the main amount of these hormones is synthesized by the ovaries of a woman, but some amount is also synthesized by adipose tissue and adrenal glands. Men also have this hormone, it is also synthesized by the testicles, adrenal glands and fat cells, but its amount is much less than in women.

Therefore, the main causes of hyperestrogenism development can be divided into primary and secondary. Primary causes are direct increased synthesis of these hormones in the corresponding organs under the influence of certain factors. Such causes include in women:

1. ovarian tumors with hormone-producing function;
2. tumors of the hypothalamus and pituitary gland with increased synthesis of releasing factors and follicle-stimulating hormone - this is a secondary level pathology;
3. adrenal tumor;
4. Chorioepithelioma is a malignant tumor of the uterus of trophoblastic etiology that synthesizes estrogens in increased quantities.

Secondary causes of hyperestrogenism development are those that are not associated with their increased synthesis. These include:

1. taking oral contraceptives without appropriate monitoring and hormonal screening or in the case of an incorrectly selected drug;
2. Excess body weight increases the amount of estrogen that is synthesized by fat cells;
3. viral hepatitis or liver cirrhosis, which is accompanied by cytolysis syndrome and disruption of normal hormonal metabolism, which can be the cause of estrogen accumulation due to insufficient excretion.

These are the main areas that need to be addressed when such a problem arises in order to carry out etiological treatment.

In men, the most common cause of hyperestrogenism is an abnormal increase in the synthesis of this hormone, which occurs with a tumor of the hypothalamus, pituitary gland, adrenal glands, less often the testicles, as well as with excess body weight and metabolic syndrome.

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Risk factors

Based on the main etiological factors of this condition, risk factors for the development of this pathology can be identified. These include: hormonal contraception, uncontrolled or incorrect use of intrauterine devices, excess body weight, a sedentary lifestyle of a woman, concomitant endocrine diseases in the form of hypothyroidism or diabetes mellitus, as well as a genetic predisposition on the maternal line with a constitutional feature.

To know the basic mechanisms of pathogenesis of hyperestrogenism development and clinical symptoms, it is necessary to know the functions of these hormones under normal conditions in the female and male body.

In the female body, estrogens begin to act in utero, when a girl is developing, and they provide for the formation of female genital organs in the fetus. Then, when the girl reaches puberty, these hormones are responsible for the development of secondary sexual characteristics. In an adult woman, they are hormones of the first stage of the cycle. They are secreted under the influence of the follicle-stimulating hormone of the pituitary gland and provide many local functions:

• ensures the growth and proliferation of endometrial cells, preparing the egg for implantation;
• stimulates the synthesis of cervical mucus and maintains an acidic environment in the vagina, thereby performing a protective function against bacteria, fungi and the proliferation of pathogenic flora;
• ensures the growth of the uterus with an increase in the amount of myometrium during puberty and pregnancy;
• ensures rational distribution of fatty tissue according to the female type - on the stomach and hips;
• normalizes cholesterol levels and regulates the breakdown and synthesis of lipids;
• enhances the work of osteoblasts and normalizes the function of the skeletal system;
• ensures normal vitamin metabolism, prevents aging and secondary changes in the skin.

These are the main functions that estrogens perform in a woman's body, and in accordance with this, symptoms develop when the amount of these hormones increases.

In a man's body, a small amount of estrogen primarily ensures normal regulation of the general hormonal background and maintenance of testosterone levels, and also affects the function of the central nervous system, libido, and enhances muscle tissue growth.

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Pathogenesis

The pathogenesis of the development of symptoms, both in men and women, depends on the function of these hormones and the source of their increase.

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Symptoms hyperestrogenism

The clinical picture of elevated estrogen levels depends on the level of hormones maintained in the body. Therefore, it is necessary to distinguish between two basic concepts - relative and absolute hyperestrogenism. Absolute hyperestrogenism occurs, ultimately, as a result of some pathology, when the level of hormones increases in the blood and the corpus luteum of the ovary persists, which causes clinical manifestations. Relative hyperestrogenism is a condition in which the level of estrogens does not increase in the blood, but only the amount of progesterone decreases, which is why the clinical picture of hyperestrogenism appears. These two features must be known not only for treatment, but also for the correct differential diagnosis of the pathology.

Hyperestrogenism in women often manifests itself at an older age, often after childbirth, when there is some hormonal imbalance. But similar disorders can also occur in a girl's adolescence, when hormones should act for the first time to start menstruation. This manifests itself in symptoms of premature puberty, when secondary sexual characteristics develop ahead of schedule. But at the same time, there may be a delay in the first menstruation. This happens because a normal menstrual cycle requires a certain drop in estrogen levels at the end of the first phase of the cycle so that the second phase can begin - then the luteinizing hormone increases. If a girl has hyperestrogenism, then the luteal phase is delayed and menstruation does not occur. Juvenile uterine bleeding can often be a symptom of this pathology. Therefore, complaints can be about prolonged menstruation or its heavy nature even before complications of such bleeding appear.

In older women, hyperestrogenism can be the cause of benign uterine tumors – myoma or fibromyoma, as well as endometriosis. This is due to the fact that estrogens stimulate the growth of the myometrium and the secretion of the endometrium, and under the influence of high levels of these hormones, uneven excessive cell division occurs. Therefore, the first signs of hyperestrogenism in women can appear with a long-term increase in the level of these hormones, which will manifest as a clinical picture of myoma.

The symptoms of uterine fibroids may vary - bleeding, pain in the lower abdomen or a feeling of heaviness in the pelvis, impaired sexual intercourse, decreased libido, dysfunction of the bladder or rectum, secondary chronic iron deficiency anemia with frequent bleeding, especially with concomitant hyperestrogenism. These symptoms often appear with significant volumes of fibroids. There are some clinical features depending on the location and form of the formation. With the nodular form of uterine fibroids, clinical manifestations directly depend on the location of the node. With the formation of subserous nodes, menstrual function is not impaired. The clinic of acute abdomen is often observed, since such nodes are very labile in their position and can shift, forming a torsion or necrosis of the node stalk. Sometimes the pain is not sharp, but dull, aching, constant, if the node irritates the peritoneum or nerve endings, then there may also be heaviness in the abdomen. If the subserous myomatous node is of significant size, it can cause a syndrome of compression of adjacent organs with difficulty in the act of defecation due to compression of the rectum, with difficulty in urination or reactivity of the bladder, and compression can also disrupt the outflow of venous blood and lymph with the formation of congestion in the small pelvis and the development of hemorrhoids. Often, with a subserous location of the fibromatous node, local neurological symptoms are observed due to compression of nerve structures with the development of disorders such as paresthesia or osteochondrosis of the lumbar spine. Then it is very important to correctly diagnose the pathology, and not treat these neurological disorders.

With a submucous location of the node, local manifestations are more pronounced. Metrorrhagia may be observed, especially against the background of a delay in the second phase of the cycle. Often there is an injury to such a node. A feature of the clinical picture of myoma against the background of hyperestrogenism, which in this case is absolute, is the rapid growth of such a myoma, which requires immediate action.

Another consequence of hyperestrogenism is the development of endometriosis, since endometrial hyperplasia against the background of increased estriol often causes the dispersion of endometrial foci throughout the uterus and internal genital organs. In this case, the symptoms manifest themselves in the form of profuse bloody discharge, which begins several days before the expected menstruation and lasts more than a week. Such discharge is often brown in color, different from normal menstrual discharge. Such a cycle is accompanied by severe nagging pain in the lower abdomen long before the onset of menstruation. If endometriosis is located in the ovary, cysts are formed that contribute to irritation of the peritoneum with a corresponding reaction. In this case, there may be a pronounced pain syndrome, which is often accompanied by clinical manifestations of acute abdomen.

These are the main clinical manifestations that women may experience under the influence of hyperestrogenism.

Hyperestrogenism in men primarily causes inhibition of testosterone production, and the symptoms observed in this case are associated with inhibition of the function of this hormone. In this case, the man shows signs of gynecomastia - engorgement of the mammary glands with possible milk secretion may be observed. Symptoms also appear in the form of female-type fat deposition, decreased sexual desire, impotence, and obesity.

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Complications and consequences

The consequence of hyperestrogenism is endometrial hyperplasia, which is a dangerous condition in terms of bleeding. If we are talking about long-term hyperestrogenism, then uterine myoma often develops against this background. The nodular form of uterine myoma is dangerous due to the development of bleeding, especially with a submucous location of the myomatous node, which requires immediate medical action. Also, one of the consequences may be infection of the myomatous node, which requires anti-inflammatory therapy. Complications may arise in the form of the "birth" of a myomatous node located submucously or its necrosis, which is accompanied by symptoms of acute abdomen and requires immediate treatment and timely differential diagnostics.

Complications of hyperestrogenism during the development of endometriosis can lead to the development of chronic posthemorrhagic anemia, since bloody discharge is possible, which is often repeated.

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Diagnostics hyperestrogenism

When a girl of puberty goes to see a doctor, the anamnesis data is diagnostically important. Often girls are embarrassed to talk about such intimate, in their opinion, things, so you need to question the mother and find out the date of the first menstruation, the interval between periods, the duration of the cycle. Hyperestrogenism in a girl can be suspected based on complaints of prolonged heavy menstruation. In this case, endometrial hyperplasia occurs under the influence of estriol and this is accompanied by similar symptoms. External signs that are diagnostically significant are the girl's short stature, well-developed secondary sexual characteristics, premature ossification, increased hairiness.

In women of reproductive age, hyperestrogenism can be fully diagnosed only with a comprehensive examination, since external manifestations may not be informative regarding the cause. When examining a woman on a chair, it is possible to determine the presence of uterine fibroids, their size, shape and location. If we are talking about endometriosis, then internal endometriosis can also be determined in the form of individual brown or brown areas against the background of the mucous membrane of the uterus or vagina.

Hyperestrogenism can also be diagnosed based on subjective symptoms of delayed ovulation. In this case, a negative fern and pupil symptom is determined when ovulation should occur according to the cycle. This allows one to suspect pathology and conduct further diagnostics.

Instrumental diagnostics of hyperestrogenism can be performed on any day of the cycle, and the result that determines endometrial hyperplasia is diagnostically significant. Therefore, the "gold standard" for diagnosing pathology is ultrasound. In this case, a transvaginal examination is performed and the thickness of the endometrium is determined - it will be significantly hyperplastic. Additional signs are a delay in ovulation and an entire follicle. Then it is important to track the dynamics of ovulation and whether it occurs at all, this may require several consecutive studies. If hyperplasia remains at the same level or increases, then we can talk about probable hyperestrogenism.

Tests that allow an accurate diagnosis to be made are hormonal screening. In order to track the entire cycle and study the woman's hormonal background, it is necessary to determine the level of estrogens, progesterone, luteinizing and follicle-stimulating hormones. An increase in estrogens may be due to hypoprogesteronemia or a decrease in luteinizing hormone. This is important for determining treatment tactics and drug dosages.

Diagnostics in men is somewhat simplified, since complaints and appearance with signs of gynecomastia allow one to suspect pathology. Confirmation of the diagnosis is carried out by determining estrogens and testosterone.

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Differential diagnosis

Differential diagnostics of hyperestrogenism should be carried out, first of all, between the relative and absolute increase in the level of these hormones. Hormonal screening will help with this - an increase in estrogens against the background of a normal level of progesterone indicates absolute hyperestrogenism. It is also necessary to clearly differentiate the etiology of the process - an ovarian or adrenal tumor, or a secondary nature of the process.

If the increase in estrogen occurs with the clinical picture of uterine bleeding, then it is necessary to conduct differential diagnostics of hyperestrogenism with luteal phase insufficiency. The main diagnostic sign is the level of hormones.

Treatment hyperestrogenism

Before choosing a treatment method, it is necessary to clarify the etiology of the process. If we are talking about absolute hyperestrogenism caused by primary damage to the ovary or hypothalamic-pituitary system, then the treatment should be comprehensive, not excluding surgical intervention. In case of exogenous pathology, it is necessary to stop taking contraceptives. But if we are talking about relative hyperestrogenism, then before using drug treatment it is necessary to normalize the regime. Considering that the exchange of sex hormones occurs with the participation of the liver, it is necessary to exclude all factors that could disrupt its function. Diet for hyperestrogenism is very important. During the treatment period, it is necessary to adhere to the recommendations on the principle of excluding fried foods, fatty foods, hot spices, bakery products from the diet. This will help not only in correcting the hormonal state, but also improve overall well-being.

The main goal of drug treatment is to eliminate clinical symptoms and normalize hormone levels. For this purpose, various groups of drugs are used, mainly from the group of hormonal agents.

Gonadotropin-releasing factor agonists, which help normalize estrogen levels at the secondary level, thereby reducing the amount of synthesized estrogen. These drugs include:

1. Diphereline is a drug that has an antigonadotropic effect. The mechanism of action of the drug is that the active substance of the drug is a peptide that is similar to the natural female releasing hormone, which releases gonadotropic hormone. In this case, a certain amount of it is released, and after several months during the course of treatment, a natural depletion of hormones occurs, so the amount of gonadotropin decreases. Therefore, the amount of estrogens gradually decreases - which is a pathogenetic method of treating pathology. The drug is available in vials with different dosages. For the full effect of treatment, it is necessary to adhere to the course. The dosage of the drug is determined individually based on the determination of the level of estriol, but most often treatment is carried out starting from the first day of the cycle and for five days, the course is from three to six months. If there is a concomitant delay in ovulation, then stimulation or progesterone is administered under the control of hormones. Precautions – should not be used in combination with gonadotropic drugs, as this may cause ovarian hyperstimulation at the initial stage of treatment and their atresia. Side effects are most common in the form of hot flashes, dry skin, itching, remote osteoporosis, as well as abdominal pain and dyspeptic symptoms.
2. Buserelin is an antiestrogenic drug from the group of gonadotropic factor agonists. The mechanism of action of the drug is competitive binding to hypothalamic receptors and the synthesis of releasing hormone, which first causes an increase and then a blockade of the production of pituitary gonadotropic hormones. This is how the effect of treatment with the drug is manifested. The form of release of the drug is a solution for intranasal administration and an injection form. The dosage of the drug for the treatment of hyperestrogenism is usually 3.75 milligrams of the drug intramuscularly once a week. The course of treatment is from four to six months. Precautions - if there are stones in the kidneys or gall bladder, the drug should be used with caution. Side effects can be in the form of allergic reactions, as well as initial engorgement of the mammary glands, discharge from the uterus in small quantities. It is also possible to act on the central nervous system with the development of headaches, increased depression.
3. Zoladex is a drug whose main active ingredient is goserelin. It is a gonadotropic releasing hormone agonist that acts on the same principle as all drugs in this group. With long-term course treatment, the drug inhibits the production of estrogens. The drug has features of use associated with the form of release - these are deposited forms. Method of administration of the drug: under local anesthesia of the abdominal skin, the drug is administered at a dose of 3.6 milligrams, then after four weeks, the second dose of the drug is administered. After this, hormonal screening and examination are recommended - as a rule, involution of the hyperplastic endometrium occurs and such treatment is sufficient. Due to the fact that the drug is slowly released, its effect lasts for 28 days. Side effects are possible local - at the site of administration of the drug, itching, burning, signs of inflammation are possible. Systemic side effects include hypotension, headache, arrhythmia, dizziness. Precautions: in case of concomitant bronchial asthma, the drug should be used with caution, as it may increase bronchial obstruction.
4. Danazol is a drug that prevents the increase in estrogen levels due to competitive action. The active substance of the drug is a synthetic analogue of the hormone estrogen, so with prolonged intake it binds to sensitive receptors on target tissues and reduces their amount. This reduces the need for natural estrogens and their synthesis decreases. The method of administration of the drug is oral. Dosage - 400-800 milligrams per day, it is better to divide into 2 or 4 doses. The course of treatment for hyperestrogenism is at least four months, but six months is better. Precautions - in case of liver dysfunction or hepatitis, it is better not to use the drug, and it is also necessary to dose the drug, starting with a minimum dose of 200 milligrams per day. Side effects are possible in the form of hair loss, weight gain, edema, as well as allergic and dyspeptic phenomena.

Progesterone preparations can be used in complex therapy to treat insufficiency of the second phase of the cycle, which will even better normalize the hormonal balance. For this purpose, it is preferable to use such preparations on the fourteenth day of the cycle.

1. Mirolyut is a drug whose active ingredient is levonorgestrel from the gestagen group. The drug can be used to reduce the severity of endometrial hyperplasia against the background of hyperestrogenism. For this purpose, an intrauterine device is used, which is inserted for several years after a thorough examination and examination. Precautions - the drug should not be taken in case of bloody discharge from the uterus, with an active myoma, and should also be taken with caution in case of liver dysfunction. Side effects are possible in the form of local and systemic manifestations. Local symptoms are the appearance of burning, itching, pain, discomfort or minor bloody discharge from the uterus. Of the systemic manifestations, dizziness, headache, and breast engorgement are most often observed.
2. Provera is a drug containing mainly medroxyprogesterone. It helps to replenish the deficiency of this hormone and normalizes its level in the blood. The advantage of the drug is its selective action on progesterone receptors, which are located in the uterus. This contributes to the fact that the drug does not act on the egg, but only on the endometrial epithelium, which contributes to a faster reduction in hyperplasia against the background of previous hyperestrogenism. The drug is available in the form of tablets of one hundred and five hundred milligrams. The dosage of the drug for the treatment and normalization of progesterone balance is 400-800 milligrams in two doses. Side effects are possible in the form of allergic reactions, as well as uterine bleeding, which requires an increase in the dose and a repeat consultation with a doctor. Precautions - after two weeks of use, you need to check the hormone level to avoid hypersecretion.

Vitamins for the treatment of hyperestrogenism are very important, especially at the time of recovery, when hormonal treatment has already been carried out and it is necessary to resume the proliferative activity of the endometrium and follicle growth. For this, you can use injection forms of vitamins - B1, B6 - every other day, or multivitamin complexes in tablet form for long-term use.

Physiotherapy can be used to improve endometrial reparation, but not in the acute period or during hormonal therapy. Balneological treatment with mud applications to the lower abdomen is recommended. Magnetic therapy can also be used.

Surgical treatment of hyperestrogenism is performed only if the cause is an ovarian tumor. Most often, this is a benign process, so the scope of surgical intervention is limited to either ovarian resection or adnexectomy. Before surgery, an ultrasound of the pelvic organs is mandatory to exclude a malignant process.

Folk treatment of hyperestrogenism

Traditional treatment of hyperestrogenism can be used as a complex therapy, in which this effect is only enhanced. For this purpose, not only means are used that reduce the severity of bleeding in endometrial hyperplasia, but also to normalize the level of estrogens. The following traditional remedies are used:

1. You need to make a sitz bath from an infusion of chamomile and nettle. To do this, brew two bags of chamomile grass and several stems with nettle leaves in a liter of water, leave until the solution becomes warm. Then you need to add a teaspoon of honey and take such a bath, sitting in it for at least ten minutes.
2. Vegetable juices stabilize the endometrium very well, which prevents the development of complications that can develop against the background of hyperestrogenism. For such a medicinal solution, use one hundred milliliters of fresh carrot or beet juice, add a crushed aloe leaf and take 50 milliliters daily in the morning and evening.
3. Peony extract, which can be purchased at a pharmacy, normalizes the level of estrogens in a woman's body. To use, take two drops of the extract and dilute it with four drops of water, take it in the morning and evening for at least three weeks.

Herbal treatment should be carried out with some special features. Phytotherapy should be carried out in the second phase of the menstrual cycle, when the increase in estrogen levels should be compensated by a small amount of progesterone. At the same time, it is necessary to monitor the general condition of the woman and concomitant therapy with replacement medications. The main medicinal herbs used for this purpose are the following:

1. Orthilia secunda is a plant that helps stimulate the function of the corpus luteum and the secretion of progesterone, has an anti-inflammatory effect and prevents the development of bleeding against the background of endometrial hyperplasia. For a medicinal infusion, take three tablespoons of the herb, pour boiling water over it and simmer for another five minutes, cover the infusion and leave it for three hours. Take this infusion warm five times a day, two tablespoons at a time. The course of treatment is one month.
2. A decoction of viburnum bark normalizes the function of not only the ovary with the synthesis of excess estrogens, but also activates the endogenous defense mechanisms of the vagina in relation to secondary infections. For the decoction, you need to pour hot water over the bark and boil it for ten minutes, then leave it for another ten minutes. This decoction should be drunk three tablespoons a day warm.
3. Burdock root and golden mustache plants are also used in this case. For this, use an infusion of these herbs and drink half a glass twice a day.

Homeopathic remedies are also widely used to suppress estrogen production. Such drugs have both a hysterotropic effect and a systemic central effect on the hypothalamus, which suppresses the production of releasing factors and reduces estrogen production. The dosage of different drugs may vary, which determines the selective level of estrogen released. The main homeopathic remedies are:

1. Sepia is a homeopathic remedy of inorganic origin. The drug has a regenerating effect, which has a good effect on the restoration of the endometrium and increases the sensitivity of receptors to the action of progesterone - this normalizes the effect of excess estrogens. The drug is available in the pharmacological form of homeopathic granules and drops, dosed three granules three times a day half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not to drink water. Side effects are not common, but stool disorders, dyspeptic phenomena and allergic reactions may occur. Precautions - the drug cannot be used by women with an asthenic physique and depressive mood.
2. Ipecacuanha is a homeopathic remedy of natural origin. The drug is produced in the pharmacological form of a homeopathic solution in ampoules and is dosed in a third of an ampoule once a week with possible oral use. Side effects are rare, but stool disorders, dyspeptic phenomena and allergic reactions may occur. Precautions - the drug cannot be used in acute uterine processes.
3. Sanguinaria and stramonium - a combination of two homeopathic remedies has a more pronounced effect. The drug is available in the pharmacological form of homeopathic drops and is dosed ten drops once a day of both drugs in one spoon. In this case, the drops should be diluted in a tablespoon of water and taken regardless of food intake. Side effects have not been identified.
4. Hamamelis is a homeopathic remedy based on a plant that is especially effective for severe uterine bleeding due to hyperestrogenism and endometrial hyperplasia. The drug is available in granules and its dosage is eight granules once a day. Side effects are rare, skin rash on the hands is possible.

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Prevention

Hyperestrogenism prevention should be carried out by every woman, since these are non-specific measures. First of all, it is necessary to use hormonal contraceptives correctly and in a controlled manner. Constant prevention of chronic stressful situations that contribute to metabolic and ovarian-menstrual cycle disorders is also necessary. If any disorders in terms of reproductive function are detected in a woman or a girl, it is necessary to immediately consult a doctor.

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Forecast

The prognosis for hyperestrogenism is positive for recovery in case of correct and timely diagnosis of the cause. If the cause is a hormone-producing tumor, then in this case, timely and correct treatment tactics are necessary to prevent the progression of the process.

Hyperestrogenism is a condition of increased estrogen levels in the body, which can be absolute or relative. This condition can occur in girls, women, and men. Diagnostically significant signs of this pathology in women are uterine bleeding with hyperproliferation of the endometrium, as well as the formation of endometriosis and myoma. In men, attention should be paid to the symptoms of gynecomastia. In any case, a comprehensive diagnosis of the pathology and timely treatment are necessary.