Ovarian Hyperandrogenism: A Common Cause of Hormonal Imbalance in Women

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Ovarian hyperandrogenism is a condition in which the ovaries produce too much of the male sex hormones, called androgens. Androgens are normally present in small amounts in women, and they play a role in regulating the menstrual cycle, fertility, and body development. However, when the ovaries produce excess androgens, they can cause various symptoms and health problems.

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One of the most common causes of ovarian hyperandrogenism is polycystic ovary syndrome (PCOS), a disorder that affects about 10% of women of reproductive age. PCOS is characterised by irregular or absent periods, multiple cysts on the ovaries, insulin resistance, obesity, and acne. PCOS is also associated with an increased risk of diabetes, cardiovascular disease, endometrial cancer, and infertility.

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The exact mechanism of ovarian hyperandrogenism in PCOS is not fully understood, but it is believed to involve a complex interplay between genetic, environmental, and hormonal factors. Some of the factors that may contribute to ovarian hyperandrogenism in PCOS are:

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• Insulin resistance: Insulin is a hormone that helps the body use glucose for energy. When the body becomes resistant to insulin, it produces more insulin to compensate. High levels of insulin can stimulate the ovaries to produce more androgens.
• Luteinizing hormone (LH): LH is a hormone that triggers ovulation, the release of an egg from the ovary. In PCOS, the levels of LH are often elevated, which can also stimulate the ovaries to produce more androgens.
• Adrenal glands: The adrenal glands are located on top of the kidneys and produce various hormones, including some androgens. In some women with PCOS, the adrenal glands may also overproduce androgens.
• Inflammation: Inflammation is a response of the immune system to injury or infection. Chronic inflammation can disrupt the normal balance of immune cells and create a state of low-grade inflammation in the body. This inflammation can affect the function of the ovaries and other tissues involved in hormone production.

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Symptoms of Ovarian Hyperandrogenism

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The symptoms of ovarian hyperandrogenism vary depending on the severity of the condition and the individual characteristics of each woman. Some of the common symptoms are:

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• Hirsutism: Hirsutism is the growth of coarse, dark hair on areas where women typically have little or no hair, such as the face, chest, abdomen, and back. Hirsutism is caused by the excess androgens stimulating the hair follicles.
• Acne: Acne is a skin condition that causes pimples, blackheads, whiteheads, and inflammation. Acne is caused by excess oil production in the skin glands, which can be triggered by excess androgens.
• Alopecia: Alopecia is the loss or thinning of hair on the scalp or other parts of the body. Alopecia can be caused by excess androgens affecting the hair growth cycle.
• Virilization: Virilization is the development of male characteristics in women, such as deepening of the voice, enlargement of the clitoris, increased muscle mass, and reduced breast size. Virilization is a rare but serious symptom of ovarian hyperandrogenism that indicates very high levels of androgens.

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Diagnosis of Ovarian Hyperandrogenism

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The diagnosis of ovarian hyperandrogenism is based on a combination of clinical signs, laboratory tests, and imaging studies. Some of the tests that may be performed are:

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• Blood tests: Blood tests can measure the levels of hormones such as testosterone, DHEA-S (a precursor of testosterone), LH, FSH (a hormone that stimulates follicle growth), estradiol (a form of oestrogen), progesterone (a hormone that prepares the uterus for pregnancy), insulin, glucose, cholesterol, and triglycerides.
• Pelvic ultrasound: Pelvic ultrasound is an imaging technique that uses sound waves to create pictures of the internal organs. Pelvic ultrasound can detect the presence and size of ovarian cysts or tumours that may cause ovarian hyperandrogenism.
• Other imaging tests: Other imaging tests such as CT scan or MRI may be used to rule out other causes of ovarian hyperandrogenism such as adrenal tumours or congenital adrenal hyperplasia (CAH), a genetic disorder that affects hormone production.

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Treatment of Ovarian Hyperandrogenism

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The treatment of ovarian hyperandrogenism depends on the underlying cause, the severity of symptoms, and the reproductive goals of each woman. Some of the possible treatments are:

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• Lifestyle changes: Lifestyle changes such as weight loss, exercise, healthy diet, stress management, and smoking cessation can help improve insulin sensitivity, reduce inflammation, lower cholesterol levels, and regulate the menstrual cycle.
• Oral contraceptives: Oral contraceptives are pills that contain synthetic hormones that mimic the natural hormones of the menstrual cycle. Oral contraceptives can help reduce the production and effects of androgens, regulate the menstrual cycle, prevent pregnancy, and improve acne and hirsutism.
• Anti-androgens: Anti-androgens are medications that block the action of androgens on the target tissues. Anti-androgens can help treat acne, hirsutism, and alopecia, but they may have side effects such as liver problems, breast tenderness, and menstrual irregularities. Anti-androgens should not be used during pregnancy or by women who are planning to conceive, as they can cause birth defects in male foetuses.
• Metformin: Metformin is a medication that lowers blood glucose levels by improving insulin sensitivity. Metformin can help treat insulin resistance, reduce androgen levels, regulate the menstrual cycle, and improve fertility in women with PCOS.
• Clomiphene citrate: Clomiphene citrate is a medication that stimulates ovulation by blocking the negative feedback of oestrogen on the pituitary gland. Clomiphene citrate can help induce ovulation and increase the chances of pregnancy in women with PCOS who have an ovulation (lack of ovulation).
• Surgery: Surgery may be an option for women with ovarian hyperandrogenism who have ovarian tumours or cysts that do not respond to medical treatment. Surgery may involve removing part or all of the affected ovary or both ovaries. Surgery may also be performed to reduce the size of the ovaries or remove some of the excess stromal tissue that produces androgens. Surgery may affect fertility and hormone levels, so it is usually reserved for severe cases or when other treatments have failed.

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Ovarian hyperandrogenism is a condition that affects many women and can cause various physical and emotional problems. However, with proper diagnosis and treatment, ovarian hyperandrogenism can be managed and its symptoms can be improved. If you are living with ovarian hyperandrogenism, you should consult professional healthcare providers for individualised advice and follow-up.

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Sources

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- Debbo Africa: https://debbo.africa

- Cleveland Clinic. Hyperandrogenism: What It Is, Causes, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/24639-hyperandrogenism (accessed November 14, 2023).

- UpToDate. Ovarian hyperthecosis. https://www.uptodate.com/contents/ovarian-hyperthecosis (accessed November 14, 2023).

- Journal of Medical Human Genetics. Hyperandrogenism in polycystic ovarian syndrome and role of CYP17 gene polymorphisms. https://jmhg.springeropen.com/articles/10.1186/s43042-019-0031-4 (accessed November 14, 2023).

- MedlinePlus. Ovarian overproduction of androgens. https://medlineplus.gov/ency/article/001165.htm (accessed November 14, 2023).

- Journal of Translational Medicine. The interplay between androgens and the immune response in polycystic ovary syndrome: a literature review. https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-023-04116-4 (accessed November 14, 2023).