Hyperthecosis ovarii is a disorder of ovarian function. In it, the structure of the ovaries is altered and more male sex hormones are produced.
What is hyperthecosis ovarii?
Hyperthecosis ovarii is one of the ovarian insufficiencies. In ovarian insufficiency, a woman’s ovaries, or ovaries, can no longer work properly. This means that eggs no longer mature properly and the female hormones progesterone and estrogen are insufficiently produced. In hyperthecosis ovarii, the tissue structure of the ovary is pathologically altered. There is an increased production of male sex hormones, the so-called androgens. Hyperthecosis ovarii is a rather rare disease with a high familial incidence. It is closely related to polycystic ovary syndrome. It is also an ovarian insufficiency.
Causes
The mechanism of origin of hyperthecosis ovarii is not well understood. Because the condition runs in families, genetic factors appear to play a role in its development. Environmental influences are also under discussion as influencing factors. In the disease, male hormones are increasingly produced in the ovaries. These cause an excess of androgens and thus the characteristic symptoms.
Symptoms, complaints, and signs
Patients have no menstrual cycle or a very irregular one. Menstrual periods are infrequent (oligomenorrhea) or absent (amenorrhea). It is not uncommon for a cycle to be longer than 35 days. In between, there may be irregular periods or additional bleeding. Due to the male sex hormones, the affected women masculinize externally. Body hair increases and the hair distribution pattern changes. Hair growth increases especially on the face, chest and abdomen. This androgen-dependent hairiness is also known as hirsutism. The clitoris can enlarge due to the androgen excess (clitoral hypertrophy) and change to resemble a penis. The patient’s voice pitch also changes. The voice becomes deeper and thus increasingly masculine. Due to the male hormones, especially the increased testosterone level, acne can be triggered or existing acne can be aggravated. Testosterone makes the skin oily and favors the proliferation of bacteria. The result is purulent inflammation in the form of pimples. Another symptom of hyperthecosis ovarii is androgenetic alopecia. Hormonal dysregulation leads to shortened hair growth cycles and a reduction in the size of the hair follicles. From these, only very thin, sometimes even barely visible downy hairs grow. Gradually, more and more hair is thus lost and those affected suffer from bald patches on the head.
Diagnosis and course of the disease
In order to make the diagnosis of hyperthecosis ovarii, tissue of the ovary must be examined. Here, histologic findings typical of the disease are seen. The ovaries are enlarged and surrounded by a thick capsule. The connective tissue supporting the ovary, the so-called stromal tissue, is very pronounced and contains certain vesicles. These are called atretic follicles. In the theca interna, a part of the connective tissue cortex of the ovary, numerous luteinizing cells are found. These produce increased amounts of luteinizing hormone (LH), which in a healthy body promotes ovulation and corpus luteum formation. Unlike polycystic ovarian syndrome, no polycystic degenerations are found. The diagnosis is supported by a laboratory examination of the blood. Dramatically elevated levels of testosterone and androstenion are found in the blood. Androstenion is a steroid hormone that is chemically very similar to testosterone. Similar high testosterone and androsterion levels are otherwise only found in androgen-producing tumors. Despite the luteinizing cells, the luteinizing hormone value is within the normal range. Likewise, 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 definite blood count and histologic findings allow a diagnosis of hyperthecosis ovarii to be made with confidence.
Complications
Hyperthecosis ovarii causes irregularities of the menstrual cycle in women in most cases.This irregularity can have a negative impact on everyday life and not infrequently leads to mood swings and pain. Additional bleeding occurs and male hormones are produced. In most cases, therefore, there is a masculinization of the woman, which is associated with severe psychological discomfort or depression. Hyperthecosis ovarii also affects the skin, causing it to be oily and pimples to form on the skin. This results in aesthetic discomfort, which not infrequently leads to lowered self-esteem or inferiority complexes. Furthermore, there is hair loss and in some cases severe acne. Patients often avoid social contacts due to the symptoms and suffer from severe fatigue. Hyperthecosis ovarii can be treated with the help of medication. In most cases, testosterone levels rise briefly after treatment, but then fall again, so that the symptoms also disappear. As a rule, however, those affected are no longer able to have children. Therefore, in many cases, psychological treatment is equally necessary.
When should one go to the doctor?
Disorders or severe irregularities of the menstrual cycle should be checked by a doctor. If menstruation stops, the cycle lengthens, or there are changes in the amount of blood excreted, there are discrepancies that need to be investigated and treated. If discomfort or pain occurs in the lower abdomen, a visit to the doctor is advisable. In case of sexual dysfunctions or abnormalities during the sexual act, a clarification of the symptoms is necessary. A feeling of pressure in the lower abdomen as well as problems with a bent posture should be examined by a doctor. If discomfort occurs in sitting positions or if the affected person notices a feeling of tightness in the area of the internal female genital organs, a visit to the doctor is recommended. If an increase in body hair is noticed, mood swings occur or there are changes in voice pitch, the signs should be checked by a doctor. In case of hair loss, bald patches of scalp hair or beard growth on a woman’s face, medical examinations are recommended. A blood test in a laboratory is needed to clarify the cause. Consultation of a doctor is recommended in case of severe skin blemishes, increased or repeated pimple formation or other abnormalities of the skin appearance. If there are visual changes in the female reproductive organs, a visit to the doctor is necessary as soon as possible.
Treatment and therapy
Treatment of hyperthecosis ovarii is rather difficult. Therapy is usually by administration of GnRH analogues. GnRH analogs are substances that have a similar structure to gonadotropin-releasing hormone (GnRH). GnRH is normally produced in the hypothalamus and causes so-called gonadotropins to be released. Gonadotropins are produced in the anterior pituitary. Gonadotropins include, for example, LH, FSH or prolactin. Like the endogenous gonadotropin-releasing hormone, the GnRH analogs bind to the receptors of the pituitary gland. This results in increased release of gonadotropins. Initially, 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, the ovaries do not necessarily become functional again as a result. A desire to have children cannot usually be fulfilled despite therapy with GnRH analogues in hyperthecosis ovarii. If drug therapy does not work, both ovaries must be removed. After this drastic procedure, affected women must take synthetic estrogens and progestins for life.
Prevention
Because the cause of hyperthecosis ovarii is still unclear, the condition cannot be prevented. In order to detect hyperthecosis ovarii in time, gynecological screening examinations should be performed annually. If the gynecologist diagnoses hyperthecosis ovarii, therapy should be initiated as soon as possible. In this way, the course of the disease can possibly be positively influenced. Physical damage caused by the androgen excess can thus ideally be prevented in good time.
Aftercare
The therapy of hyperthecosis ovarii passes directly into the aftercare phase. The appropriate measures can positively influence the course so that the disease does not trigger any harmful consequences. In order to prevent the androgen excess, regular check-ups with a gynecologist are necessary. Affected women often suffer from the hormonal changes and the complexes that accompany them. 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 dietary habits helps to combat the skin blemishes that often appear. This improves the appearance of the skin. 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 patients are no longer able to have children as a result of the disease, the psychological burden increases. To avoid depression, targeted psychotherapy is often necessary. Confident communication with family members, friends and a self-help group also provides more self-confidence and zest for life.
What you can do yourself
Women affected by hyperthecosis ovarii suffer from various complaints due to the hormonal changes, which also appear externally and are therefore often accompanied by inferiority complexes. The masculinization of the affected patients as well as the altered body hair, voice pitch and hair loss not infrequently lead to psychological problems that need to be attended to by a psychologist. In addition, it is possible for the affected women to contain the externally visible changes of the disease by cosmetic measures. Severe skin blemishes are also treated by a doctor, with patients participating in the therapy by adopting an adapted diet and lifestyle. In addition, some of the women suffering from hyperthecosis ovarii are no longer able to have children of their own. This represents a strong psychological burden for the patients, which is to be worked off if possible with a psychotherapy. The women with the disease are at increased risk of developing depression as a result of the symptoms and limitations of the disease. For this reason, accompanying psychological care is appropriate even if the symptoms are only mild in individual cases. It is helpful for those affected to inform their social environment about the disease and, if necessary, to seek support in self-help groups.
