Hirsutism - Causes, Symptoms and Treatment .MF .
treatment of hirsutism
Treatment girsutizmayavlyaetsya most difficult task, not only due to hypersecretion of androgens, but also their peripheral metabolism.
At the level of the target tissue, particularly hair follicle, are transformed into the active T dihydrotestosterone influenced by the enzyme 5α-reductase.Equally important is the increasing fractions of free androgens, which exacerbates the clinical manifestations of hyperandrogenism.
hirsutism treatment involves blocking the action of androgens in different ways:
- inhibition of synthesis of endocrine glands,
- increase in the concentration PSSG, ie a decrease of bioactive androgens,
- inhibition of the synthesis of dihydrotestosterone in the target tissue by inhibiting the activity of the enzyme 5α..reductase,
- androgen receptor blockade to the level of the hair follicle.
Given the role of adipose tissue in the synthesis of androgens, a prerequisite for the treatment of hirsutism in women with obesity is to normalize body weight.It show
Combined oral kontratseptivyshiroko used to treat hirsutism, particularly when expressed mild forms.The mechanism of action of COCs is based on the inhibition of the synthesis of LH, as well as raising the level of PSSG, which reduces the concentration of free androgens.The most effective, based on clinical studies, COCs containing desogestrel, gestodene, norgestimate.
One of the first anti-androgen cyproterone acetate was (androkur), the mechanism of action is based on the blockade of androgen receptors in the target tissue and suppressing gonadotropic secretion.Antiandrogens is also Diane-35, a combination of 2 mg.cyproterone acetate with 35 micrograms.ethinyl estradiol, has also contraceptive effect.Gain Diana antiandrogenic effect can be achieved supplementation androkura - 25-50 mg.5-to 15-day cycle.The duration of treatment ranged from 6 months to 2 years or more.The drug was well tolerated, the side effects are sometimes observed at the beginning of the reception lethargy, pasty, mastalgia, weight gain, and decreased libido.
spironolactone (veroshpiron) also has anti-androgenic effect.Blocks peripheral receptors and androgen synthesis in the adrenal glands and the ovaries, contributes to the reduction in body weight.Chronic administration of 100 mg.a day marked reduction in hirsutism.Side effects: a weak diuretic effect (in the first 5 days of treatment), lethargy, drowsiness.Duration of treatment - from 6 months to 2 years or more.
flutamide - a non-steroidal anti-androgen used in the treatment of prostate cancer.The mechanism of action is based primarily on the inhibition of hair growth by receptor blockade and a slight suppression of the synthesis of T. No side effects were observed.Appoint 250-500 mg.per day for 6 months or more.Already after 3 months showed apparent clinical effect without changing the androgen levels in blood.
rilizingovyh agonists gonadotropin hormone (Zoladex, Diferelin depot buserelin, Dekapeptil) for the treatment of hirsutism are rarely used.They can be administered at a high level of LH.The mechanism of action is based on the blockade of gonadotropic pituitary function and, therefore, LH-dependent synthesis of androgens in ovarian theca cells.The disadvantage is the appearance characteristic of the climacteric syndrome complaints due to a sharp decline in ovarian function.These drugs are used to treat hirsutism rare.
Drug treatment of hirsutism is not always effective, so widely used various kinds epillyatsii (electric, laser, chemical and mechanical).
Hyperandrogenism and chronic anovulation observed with endocrine disorders such as congenital adrenal hyperplasia, an endocrine-neyroobmenno syndrome, Cushing's disease and hyperprolactinemia.In this case, the ovaries develop morphological changes similar to polycystic ovary syndrome, and there is hyperandrogenism.In such cases, we are talking about so-called secondary polycystic ovaries and basic principle of treatment is the treatment of the above diseases.