Hyperestrogenia

Hyperestrogenia is a condition in which an increase in the level of estrogen is observed, which leads not only to hormonal imbalance, but also to violations of the normal functioning of many organs. This problem can occur at any age, as well as in men and women equally often, which causes the peculiarities of the clinical course. Timely detection of the problem ensures the normal development of the child or an adequate hormonal background in a more adult age. This puts the importance of not only correct, but also timely diagnostics in the first place.

[1], [2]

Epidemiology

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

[3], [4], [5], [6], [7], [8], [9]

Causes of the hyperestrogenia

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

Therefore, the main causes of the development of hyperestrogenism can be divided into primary and secondary. Primary causes are a direct amplified synthesis of these hormones in the relevant organs under the influence of certain factors. To such reasons belong at 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 is a pathology of the secondary level;
3. adrenal gland tumor;
4. chorionepithelioma - malignant uterine formation of trophoblastic etiology, which synthesizes estrogen in an increased quantity.

Secondary causes of hyperestrogenia are those that are not associated with increased synthesis. These include:

1. reception of oral contraceptives without appropriate monitoring and hormonal screening or in case of an improperly chosen drug;
2. Overweight increases the amount of estrogens that are synthesized by fat cells;
3. viral hepatitis or cirrhosis of the liver, which is accompanied by cytolysis syndrome and normal hormone metabolism is disrupted, which may be the reason for the accumulation of estrogens due to inadequate elimination.

These are the main areas that should be taken into consideration when such a problem arises, for conducting etiological treatment.

In men, the most common cause of hyperestrogenism is an abnormal increase in the synthesis of this hormone, which occurs in tumors of the hypothalamus, pituitary gland, adrenal gland, less frequently in testicles, and also with excessive body weight and metabolic syndrome.

[10], [11], [12], [13], [14]

Risk factors

Based on the main etiological factors of this condition, it is possible to identify the risk factors for the development of this pathology. These include: hormonal contraception, uncontrolled or improper use of intrauterine spirals, excessive body weight, a sedentary lifestyle of a woman, concomitant endocrine diseases in the form of hypothyroidism or diabetes mellitus, and a genetic predisposition on the maternal line with a constitution feature.

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

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

• provides the growth and proliferation of endometrial cells, preparing for the implantation of the oocyte;
• stimulates the synthesis of mucus of the cervix and maintains the acidic environment of the vagina than performs a protective function against bacteria, fungi and reproduction of pathogenic flora;
• provides growth of the uterus with an increase in the number of myometrium at puberty and during pregnancy;
• provides a rational distribution of adipose tissue by female type - on the abdomen and hips;
• normalizes the level of cholesterol and regulates the breakdown and synthesis of lipids;
• strengthens the work of osteoblasts and normalizes the function of the osseous system;
• provides a normal exchange of vitamins, prevents aging and secondary skin changes.

These are the main functions that estrogen perform in the body of a woman, and in accordance with this, symptoms develop with an increase in the amount of these hormones.

In the male body, a small amount of estrogen provides primarily normal regulation of the overall hormonal background and maintenance of testosterone levels, and also affects the central nervous system, libido and increases the growth of muscle tissue.

[15], [16], [17]

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.

[18], [19], [20], [21], [22]

Symptoms of the hyperestrogenia

The clinical picture of an elevated level of estrogen depends on the level of hormones that are maintained in the body. Therefore, it is necessary to distinguish two basic concepts - relative and absolute hyperestrogenia. Absolute hyperestrogenism arises, in the final analysis, a certain pathology, when the level of hormones rises in the blood and the persistence of the yellow body of the ovary occurs, which causes clinical manifestations. Relative hyperestrogenism is a condition in which the estrogen level does not rise in the blood, but only the amount of progesterones decreases, and therefore the hyperestrogenic clinic is manifested. These two features must be known not only for treatment, but also for correct differential diagnosis of pathology.

Hyperestrogenia in women is more often manifested in older age, often after childbirth, when there is a certain failure of the hormonal background. But there can be similar violations in the teenage period in the girl, when the hormones for the first time should start acting for menstruation. This is manifested by the symptoms of premature puberty, when the secondary sexual characteristics develop before the time. However, there may be a delay in the first menstruation. This is due to the fact that for a normal menstrual cycle, a certain decrease in the estrogen level at the end of the first phase of the cycle is necessary in order for the second phase to come - then the luteinizing hormone rises. If a girl has hyperestrogenism, then the luteal phase is delayed and menstruation does not occur. Often the symptom of this pathology may be juvenile uterine bleeding. Therefore, complaints can be for prolonged menstruation or its profuse nature even before the complications of such bleeding occur.

In older women, hyperestrogenism may be the cause of the formation of benign uterine structures - fibroids or fibroids, as well as the formation of 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 a high level of these hormones, uneven excessive division of cells occurs. Therefore, the first signs of hyperestrogenism in women can appear with a prolonged increase in the level of these hormones, which will manifest by the clinic of myoma.

Symptoms of uterine fibroids can be diverse - bleeding, lower abdominal pain or a feeling of heaviness in the pelvis, violation of sexual intercourse, decreased libido, impaired bladder or rectum function, secondary chronic iron deficiency anemia with frequent bleeding, especially with concomitant hyperestrogenia. These symptoms often appear even with significant amounts of fibroid. There are certain features of the clinic, depending on the location and form of education. With the nodular form of uterine fibroids, clinical manifestations directly depend on the site of the node. With the formation of subserous nodules, the menstrual function is not impaired. Often there is a clinic of the acute abdomen, because such nodes are very labile in their position and can be displaced, forming a torsion or necrosis of the knee's leg. Sometimes the pains are not sharp, but stupid, aching, permanent, if the knot irritates the peritoneum or nerve endings, then there may also be a heaviness in the abdomen. If the subserous myomatous node is of considerable size, then it can cause compression syndrome of neighboring organs with difficulty of defecation with compression of the rectum, with difficulty urinating or reactivity of the bladder, and compression can disrupt the outflow of venous blood and lymph with stagnation in the pelvis and development hemorrhoids. It is not uncommon for a subserous arrangement of the fibromatous node to observe local neurological symptoms due to the compression of nervous structures with the development of disorders like paresthesias or osteochondrosis of the lumbar spine. Then it is very important to correctly diagnose pathology, and not treat these neurological disorders.

With submucous site of the node, local manifestations are more pronounced. Metroragy can be observed, especially against the backdrop of the delay of the second phase of the cycle. Often there is a trauma to such a knot. The peculiarity of the myoma clinic against the background of hyperestrogenism, which in this case is absolute, is the rapid growth of such fibroids, which requires immediate action.

Another consequence of hyperestrogenism is the development of endometriosis, since endometrial hyperplasia against the background of an increase in estriol often causes the dissemination of endometrial foci throughout the uterus and internal genital organs. In this case, the symptoms are manifested in the form of copious bleeding, which begins a few days before the expected menstruation and lasts more than a week. Such discharge is often brown, different from normal menstrual flow. This cycle is accompanied by strong pulling pains in the lower abdomen long before the appearance of menstruation. If the endometriosis is located in the ovary, then cysts are formed, which contribute to irritation of the peritoneum with the corresponding reaction. In this case, there may be severe pain syndrome, which is often accompanied by clinical manifestations of an acute abdomen.

These are the main clinical manifestations that can occur in women under the influence of hyperestrogenia.

Hyperestrogenia in men primarily causes oppression of testosterone production, and the symptoms that are observed in this case are associated with the oppression of the function of this hormone. In this case, a man has signs of gynecomastia - breast engorgement with possible milk release may be observed. There are also symptoms in the form of fat deposits on a female type, decreased sexual desire, impotence, obesity.

[23], [24], [25], [26], [27], [28]

Complications and consequences

The consequence of hyperestrogenism is endometrial hyperplasia, which is a dangerous condition in terms of the development of bleeding. If it is a question of prolonged hyperestrogenism, then more often against this background, the uterine myoma develops. The nodular form of uterine fibroids is dangerous for the development of bleeding, especially with the submucous location of the myomatous node, which requires immediate medication. Also one of the consequences may be infection of the myoma node, which requires anti-inflammatory therapy. There may be complications in the form of "birth" of the myomatous node, placed submucous or its necrosis, which is accompanied by symptoms of an acute abdomen and requires immediate therapeutic actions and timely differential diagnosis.

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

[29], [30]

Diagnostics of the hyperestrogenia

In the case of contacting a doctor of a girl of pubertal age, a diagnostic history is important. Often girls are embarrassed to talk about such intimate things, in their opinion, so you need to interview your mother and find out the date of the first menstruation, the interval between the monthly, the duration of the cycle. Suspect hypersensitivity in the girl can be based on complaints of prolonged profuse menstruation. In this case, endometrial hyperplasia occurs under the influence of estriol and this is accompanied by similar symptoms. External signs that are diagnostic significant, this is a low growth of the girl, well developed secondary sexual characteristics, premature ossification, increased hairiness.

In women of reproductive age, the diagnosis of hyperestrogenism can be complete only with a comprehensive examination, as external manifestations may be uninformative in relation to the cause. When examining a woman on the chair, you can determine the presence of uterine myoma, its size, shape and location. If it is a question of endometriosis, it is also possible to determine internal endometriosis in the form of separate areas of brown or brown color against the background of the mucous uterus or vagina.

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

Instrumental diagnostics of hyperestrogenia can be performed on any day of the cycle, with the diagnostic result being significant in determining endometrial hyperplasia. Therefore, the "gold standard" of pathology diagnosis is ultrasound. In this case, a transvaginal examination is performed and the thickness of the endometrium is determined - it will be significantly hyperplastic. Also, additional signs are ovulation delay and a whole follicle. Then it is important to follow the dynamics of ovulation and whether it occurs at all, this may require several consecutive studies. If the hyperplasia is maintained at the same level or increases, then we can talk about the likely hyperestrogenia.

Analyzes that allow you to establish an accurate diagnosis are hormonal screening. In order to trace the whole cycle and study the hormonal background of a woman, it is necessary to determine the level of estrogens, progesterone, luteinizing and follicle-stimulating hormone. The increase of estrogen can be on the background of hypoprogesteronemia or against the background of a decrease in luteinizing hormone. This is important for determining the tactics of treatment and the dose of drugs.

Diagnosis in men is slightly 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.

[31], [32], [33], [34], [35]

Differential diagnosis

Differential diagnosis of hyperestrogenism should be carried out, first of all, between the relative and absolute increase in the level of these hormones. This will help hormonal screening - the increase in estrogen against the background of a normal level of progesterone indicates an absolute hyperestrogenism. It is also necessary to clearly differentiate the etiology of the process - the tumor of the ovary or the adrenal gland, or the secondary nature of the process.

If the increase of estrogen passes with the clinic of uterine bleeding, then it is necessary to carry out differential diagnostics of hyperestrogenia with insufficiency of the luteal phase. The main diagnostic sign is the level of hormones.

Treatment of the hyperestrogenia

Before choosing a method of treatment, it is necessary to clarify the etiology of the process. If it is an absolute hyperestrogenism caused by a primary ovarian lesion or a hypothalamic-pituitary system, then treatment should be comprehensive, not excluding surgical intervention. In the case of exogenous pathology, it is necessary to stop taking contraceptives. But if it is a relative hyperestrogenism, then before the application of drug treatment it is necessary to normalize the regimen. Given that the exchange of sex hormones takes place with the participation of the liver, it is necessary to exclude all factors that could violate its function. The diet with hyperestrogenia is very important. For the period of treatment it is necessary to adhere to recommendations on the principle of exclusion from the diet of fried foods, fatty foods, spicy spices, bakery products. This will help not only to correct the hormonal state, but also improve overall health.

The main goal of drug treatment is the elimination of clinical symptoms and the normalization of the level of hormones. For this purpose, different groups of drugs are used, the main one from the group of hormonal drugs.

Gonadotrophin releasing factors that contribute to the normalization of the estrogen level at the secondary level, and due to this the amount of synthesized estrogen is reduced. Such preparations include:

1. Diferelin 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, which is similar to the natural female rhizome-releasing hormone, which releases the gonadotropic hormone. At the same time, a certain amount of it is released, and several months later, during the course of treatment, there is a natural depletion of hormones, so the amount of gonadotropin decreases. Therefore, the amount of estrogen 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 follow the course. The dosage of the drug is determined individually based on the level of estriol, but most often treatment is carried out from the first day of the cycle and for five days, the course is three to six months. If there is a concomitant delay in ovulation, then under the control of hormones, stimulation or administration of progesterone is carried out. Precautions - can not be used in conjunction with gonadotropic drugs, as this can cause ovarian hyperstimulation at the initial stage of treatment and their atresia. Side effects occur most often in the form of hot flushes, dry skin, itching, distant osteoporosis, as well as abdominal pain and dyspepsia.
2. Buserelin is an antiestrogenic drug from the group of agonists of gonadotropic factors. The mechanism of action of the drug is to competitively bind to the receptors of the hypothalamus and the synthesis of the releasing hormone, which first causes an increase, and then a blockade in the production of gonadotropic hormones of the pituitary gland. So the effect of treatment with the drug manifests itself. The release form of the agent is a solution for intranasal administration and an injection form. The dosage of the drug for the treatment of hyperestrogenism, as a rule, is 3.75 mg of the drug intramuscularly once a week. The course of treatment is from four to six months. Precautions - In the presence of stones in the kidneys or gallbladder should be used with caution. Side effects can be in the form of allergic reactions, as well as the initial engorgement of the mammary glands, secretions from the uterus in a small amount. 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. This agonist is a gonadotropin releasing hormone, which acts on the principle of the same as all drugs of this group. With prolonged course treatment, the drug inhibits the production of estrogens. The drug has specific features associated with the form of release - it's deposited forms. Method of application: under local anesthesia of the abdominal skin, administer the drug 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, an involution of 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 the drug, itching, burning, signs of inflammation. From systemic side effects hypotension, headache, arrhythmia, dizziness are possible. Precautions - with concomitant bronchial asthma, the drug should be used with caution, since it is possible to strengthen bronchial obstruction.
4. Danazol  is a drug that prevents the increase in estrogen levels due to competitive effects. The active substance of the drug is a synthetic analogue of the estrogen hormone, therefore, with a prolonged intake, it binds to sensitive receptors on target tissues and reduces their number. This reduces the need for natural estrogens and their synthesis is reduced. The method of administration is oral. Dosage - 400 -800 milligrams per day, it is better to divide into 2 or 4 admission. The course of treatment of hyperestrogenia is not less than four months, but it is better half a year. Precautions - if liver function is impaired or hepatitis is present, it is best not to apply the drug, but also 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, the appearance of edema, as well as allergic and diarrheal phenomena.

Progesterone preparations can be used in complex therapy to treat the insufficiency of the second phase of the cycle, which further normalizes the hormonal balance. For this, 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 group of gestagens. The drug can be used to reduce the severity of endometrial hyperplasia on the background of hyperestrogenism. To this end, use an intrauterine device, which is placed for several years after a thorough examination and examination. Precautions - the drug should not be taken in the case of bloody discharge from the uterus, with an active myome, and should be taken with caution in case of violations of the liver function. Side effects are possible in the form of local and systemic manifestations. Local symptoms are the appearance of burning, itching, pain, discomfort or minor bleeding from the uterus. Of systemic manifestations, dizziness, headache, and breast engorgement are most common.
2. Provera is a medication containing mainly medroxyprogesterone. It helps to replenish the deficit of this hormone and normalizes its level in the blood. The advantage of the drug is its selective effect on progesterone receptors, which are located in the uterus. This contributes to the fact that the drug does not act on the ovum, but acts only on the epithelium of the endometrium, which contributes to a faster reduction of hyperplasia on the background of the previous hyperestrogenia. The drug is available in the form of tablets of one hundred and five hundred milligrams. The dosage of the drug for treatment and normalization of the balance of progesterone is 400-800 milligrams in two doses. Side effects are possible in the form of allergic manifestations, as well as uterine bleeding, which requires an increase in the dose and a second consultation of the doctor. Precautions - after two weeks of use, you need to check the hormone level to avoid hypersecretion.

Vitamins for the treatment of hyperestrogenia are very important, especially at the time of recovery, when hormonal treatment has already been performed and the proliferation of endometrial proliferation and follicle growth is necessary. To do this, you can use injectable forms of vitamins - B1, B6 - every other day, or multivitamin complexes in tablet form for long-term use.

Physiotherapeutic treatment can be performed to improve the repair of the endometrium, but not in an acute period and not during hormonal therapy. It is recommended balneological treatment with mud applications on the lower abdomen. Magnetotherapy is also possible.

Surgical treatment of hyperestrogenia is carried out only if the cause of this is an ovarian tumor. Most often, this is a benign process, so the amount of surgical intervention is limited to either ovarian resection or adnexectomy. Be sure to perform an ultrasound of the pelvic organs before surgery to exclude the malignant process.

Alternative treatment of hyperestrogenism

Alternative treatment of hyperestrogenia can be used in the form of complex therapy, in which this effect only increases. For this purpose, not only drugs that reduce the severity of bleeding with endometrial hyperplasia, but also to normalize the level of estrogens are used. Use such alternative means:

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

Treatment with herbs should be done with some peculiarities. Phytotherapy should be carried out in the second phase of the menstrual cycle, when the increase in the level of estrogen should be compensated for 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 substitution medications. The main medicinal herbs that are used for this purpose are the following:

1. The bovine uterus is a plant that promotes the stimulation of the function of the yellow body and the release of progesterone, has an anti-inflammatory effect and prevents the development of bleeding against the background of endometrial hyperplasia. For medical infusion it is necessary to take three tablespoons of herbs, pour boiling water and boil over low heat for another five minutes, this infusion should be covered and insisted for three hours. Take this infusion in warm form five times a day for two tablespoons. The course of treatment is one month.
2. Decoction of the calyx bark normalizes the function of not only the ovary with the synthesis of excess estrogens, but also activates the endogenous protective mechanisms of the vagina in relation to secondary infections. For broth you need to pour bark with hot water and boil for ten minutes, then insist for another ten minutes. This broth should be drunk three tablespoons a day in a warm form.
3. The root of burdock and plants of the golden mustache are also used in this case. For this, use the infusion of these herbs and consume them half a glass twice a day.

Homeopathic remedies are also widely used to inhibit the production of estrogen. Such drugs have both a hysterotropic effect and a systemic central effect on the hypothalamus, which inhibits the production of releasing factors and decreases the production of estrogens. The dosage of different drugs can be different, which determines the selective level of estrogen released. The main homeopathic remedies:

1. Sepia is a homeopathic remedy of inorganic origin. The drug has a regenerating effect, which is good for restoring the endometrium and increases the sensitivity of the receptors to the action of progesterone - this normalizes the effect of excess estrogens. The drug is released in the pharmacological form of homeopathic granules and drops are dosed three granules three times a day for half an hour before meals or an hour after. It is necessary to dissolve the granules until completely dissolved and not washed down with water. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. Precautions - it is impossible to use the drug for women asthenic physique and depressed mood.
2. Ipecakuana is a homeopathic remedy of natural origin. The drug is released in the pharmacological form of the homeopathic solution in ampoules and is dispensed on the third part of the ampoule once a week with possible oral use. Side effects are not common, but there may be stool disorders, dyspepsia and allergic reactions. Precautions - it is impossible to use the drug for an acute process in the uterus.
3. Sanguine and Stramonium - the combination of two homeopathic remedies has a more pronounced effect. The drug is released in the pharmacological form of homeopathic drops and is dosed ten drops once a day in both preparations in one spoon. In this case, the drops should be diluted in a tablespoon of water and taken irrespective of the intake of food. Adverse events were not identified.
4. Witch hazel is a homeopathic remedy based on a plant that is especially effective in severe uterine bleeding against hyperestrogenic and endometrial hyperplasia. The drug is released in granules and its dosage is eight granules once a day. Side effects are rare, a skin rash is possible on the hands.

[36], [37], [38], [39]

Prevention

Prevention of hyperestrogenism should be carried out by every woman, since these are nonspecific measures. First of all, it is necessary to use hormonal means for contraception correctly and controlled. It is also necessary to constantly prevent chronic stressful situations, which contribute to the disruption of metabolism and the ovario-menstrual cycle. If you find any violations in terms of reproductive function in women or girls, you should immediately contact a doctor.

[40], [41], [42]

Forecast

The prognosis for hyperestrogenia is positive for recovery in case of correct and timely diagnosis of the cause. If the cause is a hormone-producing tumor, then a timely and correct treatment strategy is needed to prevent the progression of the process.

Hyperestrogenia is a state of increasing estrogen levels in the body, which can be absolute or relative. This condition can be in girls, women, as well as 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 fibroids. A man should pay attention to the symptoms of gynecomastia. In any case, a comprehensive diagnosis of pathology and timely treatment is needed.

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