Ovarian hyperthecosis is a disorder of ovarian function. The structure of the ovaries is changed and more male sex hormones are produced.
What is ovarian hyperthecosis?
Ovarian tissue must be examined to diagnose ovarian hyperthecosis. This is a histological finding typical of the disease. The ovaries are enlarged and surrounded by a thick capsule. See AbbreviationFinder for abbreviations related to Hyperthecosis Ovary.
Ovarian hyperthecosis is one of the ovarian insufficiencies. In the case of ovarian insufficiency, the woman’s ovaries can no longer function properly. This means that egg cells no longer mature properly and the female hormones progesterone and estrogen are only insufficiently formed.
In ovarian hyperthecosis, the tissue structure of the ovary is pathologically altered. There is an increased production of male sex hormones, the so-called androgens. Hyperthecosis ovaries is a rather rare disease that tends to run in families. It is closely related to polycystic ovary syndrome. It is also an ovarian failure.
Causes
The mechanism of origin of hyperthecosis ovaries is not exactly clear. Since the disease tends to run in families, genetic factors seem to play a role in its development. Environmental influences are also discussed as influencing factors. In the case of the disease, male hormones are increasingly produced in the ovaries. These cause an excess of androgens and thus the characteristic symptoms.
Symptoms, Ailments & Signs
The patients have no or only a very irregular menstrual cycle. The menstrual period is rare (oligomenorrhea) or does not occur (amenorrhea). It is not uncommon for a cycle to be longer than 35 days. Irregular intermenstrual or additional bleeding can occur in between. Due to the male sex hormones, the affected women look masculine.
Body hair increases and the hair distribution pattern changes. Hair growth increases, especially on the face, chest and abdomen. This androgen-dependent hair growth is also known as hirsutism. The clitoris can enlarge due to the androgen excess (clitoral hypertrophy) and change like a penis. The voice of the patient also changes. The voice becomes deeper and thus increasingly masculine. Male hormones, especially the increased testosterone levels, can trigger acne or make existing acne worse.
Testosterone makes the skin oily and encourages bacteria to multiply. The result is purulent inflammation in the form of pimples. Another symptom of ovarian hyperthecosis is androgenetic alopecia. Hormonal dysregulation leads to shortened hair growth cycles and a reduction in the size of the hair follicles. Only very thin, sometimes barely visible downy hairs grow from these. Gradually, more and more hair is lost and those affected suffer from bald spots on their heads.
Diagnosis & course of disease
Ovarian tissue must be examined to diagnose ovarian hyperthecosis. This is a histological finding typical of the disease. The ovaries are enlarged and surrounded by a thick capsule. The connective tissue supporting structure of the ovary, the so-called stromal tissue, is very pronounced and contains specific vesicles. These are called atretic follicles.
Numerous luteinizing cells are found in the theca interna, a part of the connective tissue cortex of the ovary. These produce more of the luteinizing hormone (LH), which promotes ovulation and the formation of the corpus luteum in a healthy body. Unlike polycystic ovarian syndrome, there are no polycystic degenerations.
The diagnosis is supported by a laboratory blood test. There are drastically increased testosterone and androstenion levels in the blood. Androstenion is a steroid hormone chemically very similar to testosterone. Similarly high levels of testosterone and androsterione are otherwise found only in androgen-producing tumors. Despite the luteinizing cells, the level of luteinizing hormone is within the normal range.
The LH / FSH quotient, i.e. the quotient of luteinizing hormone and follicle-stimulating hormone, is also in the normal range. DHEA (dehydroepiandrosterone) and DHEAS (dehydroepiandrosterone sulfate), two other steroid hormones, are also not elevated. The diagnosis of hyperthecosis ovaries can be made with certainty on the basis of the clear blood count and the histological findings.
Complications
In most cases, ovarian hyperthecosis causes irregular menstrual cycles in women. This irregularity can have a negative impact on everyday life and often leads to mood swings and pain. Additional bleeding occurs and male hormones are produced.
In most cases, this leads to a masculinization of women, which is associated with severe mental health problems or depression. The skin is also affected by hyperthecosis ovaries, so that it is oily and pimples form on the skin. This results in aesthetic complaints that often lead to reduced self-esteem or inferiority complexes.
There is also hair loss and in some cases severe acne. Patients often avoid social contacts because of the symptoms and suffer from severe exhaustion. Hyperthecosis ovaries can be treated with medication.
In most cases, the testosterone level rises briefly after the treatment, but then falls again, so that the symptoms also disappear. As a rule, however, those affected are no longer able to have children. Therefore, psychological treatment is also necessary in many cases.
When should you go to the doctor?
Disturbances or severe irregularities in the menstrual cycle should be checked by a doctor. If there is no menstrual bleeding, the cycle lengthens or there are changes in the amount of blood excreted, there are discrepancies that need to be examined and treated. If you experience discomfort or pain in your abdomen, you should consult a doctor. In the case of sexual dysfunction or abnormalities during the sexual act, it is necessary to clarify the symptoms. A feeling of pressure in the abdomen and problems when adopting a stooped posture should be examined by a doctor.
If symptoms occur in a sitting position or if the affected person notices a feeling of tightness in the area of the internal female genital organs, a doctor’s visit is recommended. If you notice an increase in body hair, mood swings or changes in the pitch of your voice, you should have the symptoms checked by a doctor. In the case of hair loss, bald patches of hair on the head or beard growth on the face of a woman, medical examinations are advisable. A blood test in a laboratory is required to clarify the cause. It is advisable to consult a doctor in the event of severe skin blemishes, increased or repeated pimple formation or other abnormalities in the complexion. If there are optical changes in the female genital organs, you need to see a doctor as soon as possible.
Treatment & Therapy
The treatment of hyperthecosis ovaries turns out to be rather difficult. The therapy is usually carried out by administering GnRH analogues. GnRH analogues are substances that are structurally similar to gonadotropin-releasing hormone (GnRH). The GnRH is normally formed in the hypothalamus and causes so-called gonadotropins to be released. Gonadotropins are produced in the anterior pituitary gland. The gonadotropins include, for example, LH, FSH or prolactin. The GnRH analogs bind to the receptors of the pituitary gland just like the body’s own gonadotropin-releasing hormone. As a result, more gonadotropins are released.
First, there is an increase in LH, FSH and testosterone. This is referred to as the flare-up phenomenon. With continuous administration, the hormone levels drop again after three to five weeks due to counter-regulation (down-regulation). DHEA secretion is not affected by this drug therapy. Although drug therapy usually leads to a decrease in androgens, it does not necessarily make the ovaries functional again.
Despite treatment with GnRH analogues in hyperthecosis ovaries, the wish to have children cannot usually be fulfilled. If drug therapy does not work, both ovaries must be removed. After this drastic intervention, the affected women have to take synthetic estrogens and progestins for the rest of their lives.
Prevention
Since the cause of hyperthecosis ovaries is still unclear, the disease cannot be prevented. In order to detect hyperthecosis ovaries in good time, gynecological check-ups should be carried out annually. If the gynecologist diagnoses hyperthecosis ovaries, therapy should be initiated as soon as possible. In this way, the course of the disease may be positively influenced. Ideally, physical damage caused by the androgen excess can be prevented in good time.
Aftercare
Therapy for hyperthecosis ovaries goes directly into the aftercare phase. Appropriate measures can have a positive influence on the course so that the disease does not cause any harmful consequences. In order to avoid androgen excess, regular check-ups by the gynecologist are necessary. Affected women often suffer from the hormonal changes and the associated complexes.
Psychological problems such as feelings of inferiority and often depression occur. Therefore, patients often want cosmetic treatment to reduce the visible signs. A change in lifestyle and eating habits helps against the skin blemishes that often appear. This improves the complexion.
Psychological therapy is recommended in several respects. Here the affected women can bring up the problems associated with the disease. An intensive exchange with fellow sufferers, with relatives or with a psychotherapist also helps to achieve more balance and self-confidence.
If the patients are no longer able to have children due to the disease, the psychological stress increases. In order to avoid depression, targeted psychotherapy is often necessary. Trusting communication with family members, friends and a self-help group also ensures more self-confidence and joie de vivre.
You can do that yourself
The women affected by hyperthecosis ovaries suffer from various complaints due to the hormonal changes, which also appear externally and are therefore often associated with inferiority complexes. The masculinization of the sick patients as well as the changed body hair, voice pitch and hair loss often lead to psychological problems that have to be looked after by a psychologist. In addition, it is possible for the affected women to curb the externally visible changes of the disease through cosmetic measures.
Severe skin blemishes are also treated by a doctor, with the patients contributing to the therapy by adapting their diet and lifestyle. In addition, some of the women suffering from hyperthecosis ovaries are no longer able to have children of their own. This represents a strong psychological burden for the patients, who, if possible, seek psychotherapyis to be worked up. The sick women are exposed to an increased risk of developing depression due to the symptoms and limitations of the disease. Therefore, accompanying psychological care is also appropriate if the symptoms in individual cases are only weak. It is helpful for those affected to inform their social environment about the disease and, if necessary, to seek support in self-help groups.
