Hirsutism and Virilizing Signs in Post Menopausal Woman

Q: Hello, my name is Dan. My wife, who is 60 years old, suffers from hirsutism with virilizing symptoms. Her testosterone levels are in the male range, and her LH is elevated. DHEA is normal. After a pelvic exam and transvaginal ultrasound, it was determined that she has two debris filled marble-sized cysts, one on each ovary. A CT scan was ordered, though we do not yet have the results. At this point, based on blood work and US, the gynecologist believes that the problem is ovarian hyperthecosis, and recommends bilateral oophorectomy. Any thoughts you have would be most appreciated.

Reply:

From her symptoms, the pictures does point towards ovarian hyperthecosis.

What is Ovarian Hyeprthecosis?

The condition is common in post menopausal women. In a normal female, ovarian stromal cells produce a little amount of testosterone and other male hormones required by the female body.

Due to some triggers, sometimes these stromal cells undergo hyperplasia, that is they multiply in number. The consequence is production of a lot of male hormones. The patient starts getting virilizing symptoms.

Management

Since she is post menopausal, bilateral oopherectomy is suggested. Both the ovaries need to be removed completely.

Though this stage is not cancerous, it is a type of hyperplasia. There are no medicines to stop it and it may be dangerous to let it stay unchecked.

Antagonizing the male hormones being produced is usually not successful in a long run.

If the CT scan confirms the diagnosis, you may have to go for the operation.

Take Care,

Buddy M.D.

Medical Advice (Q&As) on “Post Menopausal Women With Hirsutism and High Testosterone

  1. Dan

    Thank you for your helpful reply regarding ovarian hyperthecosis. The CT came back clear. My concern was/is that there may be a malignancy (Sertoli-Leydig?) inside the ovary too small to be detected by imaging.

    Reply
    1. Buddy M.D. Post author

      Malignancies, though very unlikely, are ruled out only by biopsy. You may discuss with your doctor to go for blood work screening tumor markers (beta-HCG, CA- 125).

      Reply
  2. khushboo

    Hello, My age 29. I’m suffering from hypo thyroid last 3.6 year. I take 25 mg tablet. I have a baby girl. Her age 2.4 year. From last 6 month, I had low bleeding on period time, 1 and 2 day no bleeding. But last two months very low bleeding only one pad. Thyroid is normal. Please advice me. Thank you.

    Reply
    1. Buddy M.D. Post author

      It is alright for menstrual bleeds to trim down with age. There is nothing to worry unless you have some discomfort.

      Do write to us if you have any pain, heaviness during menses or you note any irregularity with your menstrual periods.

      Reply
      1. khushboo

        Sir I have back pain in right side when bleeding start. Before periods some heaviness and pain in chest. Weight continues to increase.

        Reply