DOI: https://doi.org/10.18370/2309-4117.2019.50.31-37

Androgen synthesis in menopause and diagnosis of causes of hyperandrogenism in menopause

О. А. Бурка, Т. М. Тутченко

Abstract


Increasing life expectancy makes the issue of medical management of hormonal, cardiometabolic and cosmetic changes caused by menopause increasingly relevant. The manifestations and consequences of hyperandrogenism (HA) in women of perimenopausal and menopausal age, both in context of cardiometabolic disorders and dermatopathies, often cause difficulties in diagnosis and uncertainty in management among medical specialists.

This literature review presents data from current studies on differences of synthesis, transport, and peripheral conversion of androgens in menopause in healthy women and in women with polycystic ovary syndrome, as well as on tumorous and non-tumorous causes of HA in menopause.

Most menopausal women have a relative HA due to increased ovarian synthesis caused by high luteinizing hormone levels and progressive estrogen decline, as well as increase of bioavailable testosterone fraction caused by a decrease in sex hormone binding globulin.

The causes of true (pathological) HA in menopause can be divided into non-neoplastic, represented by genetically determined syndromes (polycystic ovary syndrome, non-classical forms of congenital adrenal hyperplasia), ovarian hypertechosis, iatrogenic causes; and neoplastic causes – adrenal and ovarian tumors.

Diagnosis of the causes of HA in menopause can be a difficult task, successfully solved by a comprehensive approach with the use of next steps: careful analysis of anamnestic data, the details of which may indicate the presence of pre-existing polycystic ovary syndrome or non-classical congenital adrenal hyperplasia; history of the disease (gradual or sudden development of HA as signs of tumorous or non-tumorous origin) examination and physical examination (objective assessment of the degree of HA, signs of insulin resistance or endocrinopathy), use of laboratory diagnostics (confirmation of biochemical hyperandrogenism and use of oncologic markers in case of suspicion of certain types of tumors); additional methods of examination (ultrasound, MRI) and in some cases functional tests.


Keywords


hyperandrogenism; adrenal glands; ovaries; hyperthecosis; polycystic ovary syndrome; non-classical forms of congenital adrenal cortex; virilization; androgen-producing tumors; menopause; anti-Mullerian hormone; inhibin

References


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12.       Ali, I., Wojnarowska, F. «Physiological changes in scalp, facial and body hair after

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16.       Kurani, P.N., Goldberg, L.J., Safer, J.D. «Evaluation and Management of Hirsutism in Postmenopausal Women.» In: Essentials Menopause Manag. Springer International Publishing. Cham (2017): 209–19. doi: 10.1007/978-3-319-42451-4_12

17.       Barth, J.H. «How hairy are hirsute women?» Clin Endocrinol (Oxf) 47 (1997): 255–60. doi: 10.1046/j.1365-2265.1997.2481062.x

18.       Sam, S., Ehrmann, D.A. «Hormonal Evaluation of Hyperandrogenism in Women.» JAMA 314 (2015): 2557. doi: 10.1001/jama.2015.11612

19.       Enea, C., Boisseau, N., Fargeas-Gluck, M.A., et al. «Circulating Androgens in Women.» Sport Med 41 (2011): 1–15. doi: 10.2165/11536920-000000000-00000

20.       Botwood, N., Hamilton-Fairley, D., Kiddy, D., et al. «Sex hormone-binding globulin and female reproductive function.» J Steroid Biochem Mol Biol 53 (1995): 529–31. doi: 10.1016/0960-0760(95)00108-C

21.       Pasquali, R., Pignatelli, D., eds.Hyperandrogenism in women : beyond polycystic ovary syndrome. New-York. Karger (2019).

22.       Lasley, B.L., Crawford, S., McConnell, D.S. «Adrenal androgens and the menopausal transition.» Obstet Gynecol Clin North Am 38 (2011): 467–75. doi: 10.1016/j.ogc.2011.06.001

23.       Sarrel, P.M. «Androgen deficiency: menopause and estrogen-related factors.» Fertil Steril 77 (2002): 63–7. doi: 10.1016/S0015-0282(02)02967-9

24.       Davison, S.L., Bell, R., Donath, S., et al. «Androgen levels in adult females: changes with age, menopause, and oophorectomy.» J Clin Endocrinol Metab 90 (2005): 3847–53. doi: 10.1210/jc.2005-0212

25.       Spencer, J.B., Klein, M., Kumar, A., Azziz, R. «The Age-Associated Decline of Androgens in Reproductive Age and Menopausal Black and White Women.» J Clin Endocrinol Metab 92 (2007): 4730–33. doi: 10.1210/jc.2006-2365

26.       Lasley, B.L., Crawford, S.L., McConnell, D.S. «Ovarian adrenal interactions during the menopausal transition.» Minerva Ginecol 65 (2013): 641–51. Available from: [http://www. ncbi.nlm.nih.gov/pubmed/24346252], last accessed Dec 17, 2019.

27.       Couzinet, B., Meduri, G., Lecce, M.G., et al. «The Postmenopausal Ovary Is Not a Major Androgen-Producing Gland.» J Clin Endocrinol Metab 86 (2001): 5060–6. doi: 10.1210/jcem.86.10.7900

28.       Al-Azzawi, F. «Hormonal changes during menopause.» Maturitas. 63 (2009): 135–7. doi: 10.1016/J.MATURITAS.2009.03.009

29.       Burger, H.G., Dudley, E.C., Cui, J., et al. «A Prospective Longitudinal Study of Serum Testosterone, Dehydroepiandrosterone Sulfate, and Sex Hormone-Binding Globulin Levels through the Menopause Transition.» J Clin Endocrinol Metab 85 (2000): 2832–8. doi: 10.1210/jcem.85.8.6740

30.       Gambera, A., Scagliola, P., Falsetti, L., et al. «Androgens, insulin-like growth factor-I (IGF-I), and carrier proteins (SHBG, IGFBP-3) in postmenopause.» Menopause 11 (2004): 159–66. doi: 10.1097/01.GME.0000086700.47410.2A

31.       Gershagen, S., Doeberl, A., Jeppsson, S., Rannevik, G. «Decreasing serum levels of sex hormone-binding globulin around the menopause and temporary relation to changing levels of ovarian steroids, as demonstrated in a longitudinal study.» Fertil Steril 51 (1989): 616–21. doi: 10.1016/S0015-0282(16)60609-X

32.       Ofori, E.K., Conde Alonso, S., Correas-Gomez, L., et al. «Thigh and abdominal adipose tissue depot associations with testosterone levels in postmenopausal females.» Clin Endocrinol (Oxf) 90 (2019): 433–9. doi: 10.1111/cen.13921

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