The clinical picture in hyperandrogenism

Few women with hyperandrogenism is aware of the presence of this syndrome in their body until they encounter some problems (eg, menstrual irregularities, until amenorrhea The absence of menstruation (amenorrhea) - ambiguous symptom Inability to conceive or carry a child). Most hyperandrogenism flows erased with mild symptoms.

In humans, produced by both male and female hormones. Only the difference between their ratio. Men have more forms of male sex (androgen) hormones, and women, respectively, female sex (estrogens) hormones. The male sex hormone secreted by the adrenal glands and ovaries. Hyperandrogenism - a pathological condition in which the female body there is increased production of androgens. Increased production of male sex hormones affects the organs and tissue-"target". These include skin, ovaries, sebaceous and sweat glands and hair. Hyperandrogenism be ovarian, adrenal and central (pituitary and hypothalamus) genesis.

Causes

• congenital adrenal hyperplasia;
• functional changes in the ovaries and adrenal glands;
• tumors of the ovaries or adrenal glands;
• disease hypothalamic-pituitary system;
• hypothyroidism;
• hyperprolactinemia (increased formation of prolactin, which stimulates the synthesis of milk);
• medication with androgenic properties (doping agents, progestins, anabolic steroids);
• stress (they affect the adrenal gland and increase the allocation of male sex hormones).

The clinical picture

• hirsutism - the appearance of a woman's body hair of male type (single core hair above the upper lip, cheeks, chin, on peripapillary fields, marked hairiness white line of the abdomen, crotch, thighs, legs);
• the occurrence of seborrhea, alopecia (hair loss);
• irregular menstruation (irregular periods, with delays up to amenorrhea). In congenital hyperandrogenism later menarche (first menstruation);
• the appearance of female: male figure closer to developed shoulder girdle, pelvis narrowed, muscled, altered fat deposits on the thighs, atrophic breasts; also reduced tone of voice;
• the presence of acne Acne: facial trouble   (acne), oily and porous skin of the face, the back;
• if the cause of hyperandrogenism lies in malfunction of the pituitary gland - is accompanied by obesity;
• when hyperandrogenism is a violation of the sensitivity of tissues to insulin, which leads to increased insulin levels and the possible emergence of diabetes;
• androgen excess violates cyclic processes in the ovaries, which is manifested anovulation (egg just can not break through the dense tunica albuginea of ​​the ovary, which is formed as a result of the increased content of androgens to get into the uterus) and infertility;
• If pregnancy does occur, then it proceeds with the threat of interruption, and more and does is interrupted;
• hyperandrogenism and affects fetal development, causing placental insufficiency and fetal growth retardation. In childbirth complications arise in the form of weakness of labor or late rupture of membranes.

Diagnostics

Diagnosis of hyperandrogenism is known difficulties, especially in the so-called "soft" forms. The physician should collect the correct history, to evaluate symptoms (arose suddenly in the reproductive age or have started to emerge gradually from the beginning of puberty), assign tools and hormonal methods of examination. These methods include:

• blood tests (to determine the level 17 defense industry, LH, FSH, male sex hormones and their decay products;
• Analysis of urine (also to determine the 17-DIC, testosterone);
• ultrasound of the uterus, ovaries and adrenal glands;
• to exclude pituitary pathology - X-rays of the skull bones (Turkish saddle);
• tomography.

Treatment

Treatment options depend on the form of hyperandrogenism and objectives (elimination of external manifestations, restore reproductive function in infertility or maintaining pregnancy). If an omuzhestvlyayuschaya tumor of the ovary or adrenal gland, then, of course, surgery is required. And with increased formation of androgens as a result of disruption of the pituitary and hypothalamus is the treatment, depending on both the cause and the purpose for which the patient wants to achieve. Very good effect render hormonal contraceptives with antiandrogenic action ("Diane-35", "Janine", "Yasmin"). They normalize the sebaceous glands, struggling with acne. If obesity is assigned to a low-fat diet and exercise. Hyperandrogenism adrenal origin treated with drugs glucocorticoids (dexamethasone), he is also appointed and pregnancy maintenance dose. For the treatment of infertility Infertility Treatment - What principles are priority Induced ovarian hyperandrogenism, appointed by clomiphene (stimulant of ovulation). If medication to stimulate ovulation Ovulation - How to determine as accurately as possible?   ineffective, surgical treatment (laparoscopy to inflict cuts on thick capsule of the ovaries).

To diagnose hyperandrogenism and prescribed treatment will help preserve not only reproduction, but also to achieve positive results in infertility.

Anna Sozinova

The procedure for taking a smear on the flora

Before taking a smear on the flora of the woman should not urinate for about two hours, as the urine can drain needed to study the cells and bacteria. In addition, during the days preceding the survey, you must avoid sexual intercourse, do not douche, do not use vaginal suppositories Vaginal suppositories - for contraception and treatment of inflammation   and creams.

Smear on the flora takes on a gynecological chair Gynaecological chair: Take a closer look . With the help of mirrors gynecologist opens access to places for swabbing. Smear taken with a special sterile disposable chopsticks (spatula) from the vagina, cervix and urethra. For a healthy woman is a painless procedure, but if there is inflammation, the pain may occur when taking a smear from the urethra. Taken spatula biological material is deposited on a glass slide and spread evenly over its surface, wherein each stroke has its own label. After taking all three smears are dried and sent to the laboratory.

What makes a stroke in laboratory

In the laboratory, a smear stained Gram special dyes, this allows a better look at the cells as they are colored differently. This is especially true of bacteria, which are divided into two groups: gram-positive and gram-negative. Gram-positive bacteria have a thick shell that allows them to keep the paint after washing smear, this group of bacteria include, for example, Staphylococcus and Streptococcus.

Gram negative bacteria have a less dense skin, and after washing the paint stroke disappears (gonococcus, Escherichia coli, and so forth). After painting held smears under a microscope.

How are the results of smear on the flora

Smear on the flora - is, above all, the identification of inflammation and infection. A large number of white blood cells indicates that there is an inflammatory process and advocates-leukocytes (they are the main cells of the immune system) rushed to the site of infection to fight the pathogen. The number of leukocytes is considered to be the field of view of the microscope, they are seen in multiple fields of view, and then takes an average number (rate - 15 leucocytes in the field of view).

The next indicator - are the cells of the surface layer of the epithelium (squamous epithelium) lining the internal female sex organs. The normal squamous epithelium should be mandatory if it is not, it may indicate hormonal disturbances woman. A large number of desquamated squamous epithelium is a sign of inflammation.

Bacteria are always present in the genital tract of women. Healthy woman in the genital tract can be seen only sticks (usually lactobacilli create an acidic environment in the vagina, which prevents the development of pathogenic microflora). Other micro-organisms that normally live in the vagina (fungi, gardnerelly, Staphylococcus aureus), are present in small amounts that do not allow them to see the smear. The emergence of these microorganisms in large quantities, as well as microorganisms that cause diseases, sexually transmitted diseases, said the presence of infection. Sometimes a smear on the flora can be found so-called key cells - squamous cells, which are attached to the stick gardnerelly, which gives them a distinctive grainy look, it indicates the presence of vaginal dysbiosis Dysbacteriosis vagina - how to fight?   (presence of a large number of pathogenic microflora, which at the first opportunity in the form of reduced immunity cause disease).

Upon detection of pathogenic microflora, or simply in the presence of a large number of white blood cells (the infectious agent is not always to be found in a smear) is necessarily carried out sowing of bodily fluid taken from the genitals to the nutrient medium, where the cultivation of pathogen, its identification and its sensitivity to antibiotics .

Furthermore, there is so called latent infections that can not be determined in a smear. This virus, chlamydia Chlamydia: insidious and widespread disease , Ureaplasma, mycoplasma, which have very small dimensions, which is why they can not be seen under the light microscope. To detect such an infection, blood is taken for the PCR (polymerase chain reaction). Using PCR detected DNA of an infectious agent.

Smear on the flora - is only a preliminary study to detect inflammatory disease and in some cases - of infectious agents.

  Galina Romanenko