Preview

Title

Advanced search

Postmenopausal Hyperandrogenism: A Review of Etiology, Diagnosis, and Approaches to Menopausal Hormone Therapy

https://doi.org/10.31550/1727-2378-2025-24-5-79-85

Abstract

Aim. To systematize the data available in the literature on the etiology, diagnosis, and treatment of hyperandrogenism syndrome in postmenopausal women.

Key points. Hyperandrogenism in postmenopause represents a clinical problem that is often overlooked due to the misconception that hyperandrogenic conditions are rare after menopause. This review examines the etiology, diagnosis, and treatment of androgen excess in postmenopausal women, as well as diagnostic and therapeutic approaches.

Conclusion. Hyperandrogenism in postmenopause represents a complex clinical problem that requires careful differential diagnosis and an individualized approach to treatment to ensure optimal patient management and improve quality of their life.

About the Author

D. I. Burchakov
Privolzhsky Research Medical University
Russian Federation

Nizhny Novgorod



References

1. Soules M.R., Sherman S., Parrott E., Rebar R. et al. Executive summary: Stages of Reproductive Aging Workshop (STRAW). Climacteric. 2001;4(4):267–72.

2. Szmuilowicz E.D., Manson J.E., Rossouw J.E., Howard B.V. et al. Vasomotor symptoms and cardiovascular events in postmenopausal women. Menopause. 2011;18(6):603–10. DOI: 10.1097/gme.0b013e3182014849

3. Zaman A., Rothman M.S. Postmenopausal hyperandrogenism: evaluation and treatment strategies. Endocrinol. Metab. Clin. North Am. 2021;50(1):97–111. DOI: 10.1016/j.ecl.2020.12.002

4. Yoldemir T. Postmenopausal hyperandrogenism. Climacteric. 2022;25(2):109–17. DOI: 10.1080/13697137.2021.1915273

5. Tutzer M., Winnykamien I., Davila Guardia J., Castelo-Branco C. Hyperandrogenism in post-menopausal women: a diagnosis challenge. Gynecol. Endocrinol. 2014;30(1):23–5. DOI: 10.3109/09513590.2013.850661

6. Rothman M.S., Wierman M.E. How should postmenopausal androgen excess be evaluated? Clin. Endocrinol. (Oxf.). 2011;75(2):160–4. DOI: 10.1111/j.1365-2265.2011.04040.x

7. Fabbrocini G., Cantelli M., Masara` A., Annunziata M.C. et al. Female pattern hair loss: a clinical, pathophysiologic, and therapeutic review. Int. J. Womens Dermatol. 2018;4(4):203–11. DOI: 10.1016/j.ijwd.2018.05.001

8. Hirschberg A.L. Approach to investigation of hyperandrogenism in a postmenopausal woman. J. Clin. Endocrinol. Metab. 2023;108(5):1243–53. DOI: 10.1210/clinem/dgac673

9. Keevil B.G., Adaway J. Assessment of free testosterone concentration. J. Steroid Biochem. Mol. Biol. 2019;190:207–11. DOI: 10.1016/j.jsbmb.2019.04.008

10. Unluhizarci K., Hacioglu A., Taheri S., Karaca Z. et al. Idiopathic hirsutism: is it really idiopathic or is it misnomer? World J. Clin. Cases. 2023;11(2):292–8. DOI: 10.12998/wjcc.v11.i2.292

11. Krug E., Berga S.L. Postmenopausal hyperthecosis: functional dysregulation of androgenesis in climacteric ovary. Obstet. Gynecol. 2002;99(5 pt2):893–7. DOI: 10.1016/s0029-7844(01)01588-5

12. Alsamarai S., Adams J.M., Murphy M.K., Post M.D. et al. Criteria for polycystic ovarian morphology in polycystic ovary syndrome as a function of age. J. Clin. Endocrinol. Metab. 2009;94(12):4961–70. DOI: 10.1210/jc.2009-0839

13. Yance V.R.V., Marcondes J.A.M., Rocha M.P., Barcellos C.R.G. et al. Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies. Eur. J. Endocrinol. 2017;177(1):93–102. DOI: 10.1530/EJE17-0111

14. Melnichenko G.A., Dedov I.I., Belaya Zh.E., Rozhinskaya L.Ya. et al. Cushing’s disease: the clinical features, diagnostics, differential diagnostics, and methods of treatment. Problems of Endocrinology. 2015;61(2):55–77. (in Russian). DOI: 10.14341/probl201561255-77

15. Cordera F., Grant C., van Heerden J., Thompson G. et al. Androgensecreting adrenal tumors. Surgery. 2003;134(6):874–80; discussion 880. DOI: 10.1016/s0039-6060(03)00410-0

16. Ng L., Libertino J.M. Adrenocortical carcinoma: diagnosis, evaluation and treatment. J. Urol. 2003;169(1):5–11. DOI: 10.1016/S0022-5347(05)64023-2

17. Moreno S., Montoya G., Armstrong J., Leteurtre E. et al. Profile and outcome of pure androgen-secreting adrenal tumors in women: experience of 21 cases. Surgery. 2004;136(6):1192–8. DOI: 10.1016/j.surg.2004.06.046

18. Walz M.K., Metz K.A., Theurer S., Myland C. et al. Differentiating benign from malignant adrenocortical tumors by a single morphological parameter-a clinicopathological study on 837 adrenocortical neoplasias. Indian J. Surg. Oncol. 2020;11(4):705–10. DOI: 10.1007/s13193-020-01205-4

19. Stojadinovic A., Brennan M.F., Hoos A., Omeroglu A. et al. Adrenocortical adenoma and carcinoma: histopathological and molecular comparative analysis. Mod. Pathol. 2003;16(8):742–51. DOI: 10.1097/01.MP.0000081730.72305.81

20. Wang C., Sun Y., Wu H., Zhao D. et al. Distinguishing adrenal cortical carcinomas and adenomas: a study of clinicopathological features and biomarkers. Histopathology. 2014;64(4):567–76. DOI: 10.1111/his.12283

21. Fleckenstein G., Sattler B., Hinney B., Wuttke W. et al. Androblastoma of the ovary: clinical, diagnostic and histopathologic features. Onkologie. 2001;24(3):286–91. DOI: 10.1159/000055094

22. Markopoulos M.C., Kassi E., Alexandraki K.I., Mastorakos G. et al. Hyperandrogenism after menopause. Eur. J. Endocrinol. 2015;172(2):R79–91. DOI: 10.1530/EJE-14-0468

23. Gui T., Cao D., Shen K., Yang J. et al. A clinicopathological analysis of 40 cases of ovarian Sertoli — Leydig cell tumors. Gynecol. Oncol. 2012;127(2):384–9. DOI: 10.1016/j.ygyno.2012.07.114

24. Muscat C., Calleja-Agius J. Review on Sertoli — Leydig cell tumours of the ovary. Discov. Med. 2024;36(181):234–47. DOI: 10.24976/Discov.Med.202436181.22

25. Healy D.L., Burger H.G., Mamers P., Jobling T. et al. Elevated serum inhibin concentrations in postmenopausal women with ovarian tumors. N. Engl. J. Med. 1993;329(21):1539–42. DOI: 10.1056/NEJM199311183292104

26. Rey R., Sabourin J.C., Venara M., Long W.Q. et al. Anti-Müllerian hormone is a specific marker of Sertoli- and granulosa-cell origin in gonadal tumors. Hum. Pathol. 2000;31(10):1202–8. DOI: 10.1053/hupa.2000.18498

27. Sekkate S., Kairouani M., Serji B., Tazi A. et al. Ovarian granulosa cell tumors: a retrospective study of 27 cases and a review of the literature. World J. Surg. Oncol. 2013;11:142. DOI: 10.1186/1477-7819-11-142

28. Carmina E., Guastella E., Longo R.A. Advances in the diagnosis and treatment of PCOS. Curr. Pharm. Des. 2016;22(36):5508–14. DOI: 10.2174/1381612822666160719105808

29. Adamyan L.V., Andreeva E.N., Absatarova Yu.S., Grigoryan O.R. et al. Clinical guidelines “Polycystic Ovary Syndrome”. Problems of Endocrinology. 2022;68(2):112–27. (in Russian). DOI: 10.14341/probl12874

30. Legro R.S., Arslanian S.A., Ehrmann D.A., Hoeger K.M. et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2013;98(12):4565–92. DOI: 10.1210/jc.2013-2350

31. Cheng V., Doshi K.B., Falcone T., Faiman C. Hyperandrogenism in a postmenopausal woman: diagnostic and therapeutic challenges. Endocr. Pract. 2011;17(2):e21–5. DOI: 10.4158/EP10138.CR

32. Forslund M., Schmidt J., Brännström M., Landin-Wilhelmsen K. et al. Reproductive hormones and anthropometry: a follow-up of PCOS and controls from perimenopause to older than 80 years. J. Clin. Endocrinol. Metab. 2021;106(2):421–30. DOI: 10.1210/clinem/dgaa840

33. Sharma A., Kapoor E., Singh R.J., Chang A.Y. et al. Diagnostic thresholds for androgen-producing tumors or pathologic hyperandrogenism in women by use of total testosterone concentrations measured by liquid chromatography-tandem mass spectrometry. Clin. Chem. 2018;64(11):1636–45. DOI: 10.1373/clinchem.2018.290825

34. Meun C., Franco O.H., Dhana K., Jaspers L. et al. High androgens in postmenopausal women and the risk for atherosclerosis and cardiovascular disease: the Rotterdam Study. J. Clin. Endocrinol. Metab. 2018;103(4):1622–30. DOI: 10.1210/jc.2017-02421

35. Hirschberg A.L. Polycystic ovary syndrome, obesity and reproductive implications. Womens Health. (Lond.). 2009;5(5):529–40; quiz 541– 2. DOI: 10.2217/whe.09.39

36. Diamanti-Kandarakis E., Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr. Rev. 2012;33(6):981–1030. DOI: 10.1210/er.2011-1034

37. Xing C., Zhang J., Zhao H., He B. Effect of sex hormone-binding globulin on polycystic ovary syndrome: mechanisms, manifestations, genetics, and treatment. Int. J. Womens Health. 2022;14:91–105. DOI: 10.2147/IJWH.S344542

38. Speiser P.W., Arlt W., Auchus R.J., Baskin L.S. et al. Congenital adrenal hyperplasia due to steroid 21-hydroxylase deficiency: an Endocrine Society Clinical practice guideline. J. Clin. Endocrinol. Metab. 2018;103(11):4043–88. DOI: 10.1210/jc.2018-01865

39. Ishii T., Kashimada K., Amano N., Takasawa K. et al. Clinical guidelines for the diagnosis and treatment of 21-hydroxylase deficiency (2021 revision). Clin. Pediatr. Endocrinol. 2022;31(3):116–43. DOI: 10.1297/cpe.2022-0009

40. Carmina E., Dewailly D., Escobar-Morreale H.F., Kelestimur F. et al. Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women. Hum. Reprod. Update. 2017;23(5):580–99. DOI: 10.1093/humupd/dmx014

41. Azziz R., Sanchez L.A., Knochenhauer E.S., Moran C. et al. Androgen excess in women: experience with over 1000 consecutive patients. J. Clin. Endocrinol. Metab. 2004;89(2):453–62. DOI: 10.1210/jc.2003-031122

42. Meczekalski B., Szeliga A., Maciejewska-Jeske M., Podfigurna A. et al. Hyperthecosis: an underestimated nontumorous cause of hyperandrogenism. Gynecol. Endocrinol. 2021;37(8):677–82. DOI: 10.1080/09513590.2021.1903419

43. Elhassan Y.S., Idkowiak J., Smith K., Asia M. et al. Causes, patterns, and severity of androgen excess in 1205 consecutively recruited women. J. Clin. Endocrinol. Metab. 2018;103(3):1214–23. DOI: 10.1210/jc.2017-02426

44. Cussen L., McDonnell T., Bennett G., Thompson C.J. et al. Approach to androgen excess in women: clinical and biochemical insights. Clin. Endocrinol. (Oxf.). 2022;97(2):174–86. DOI: 10.1111/cen.14710

45. Nieman L.K., Biller B.M.K., Findling J.W., Newell-Price J. et al. The diagnosis of Cushing’s syndrome: an Endocrine Society clinical practice guideline. J. Clin. Endocrinol. Metab. 2008;93(5):1526–40. DOI: 10.1210/jc.2008-0125

46. Fleseriu M., Auchus R., Bancos I., Ben-Shlomo A. et al. Consensus on diagnosis and management of Cushing’s disease: a guideline update. Lancet Diabetes Endocrinol. 2021;9(12):847–75. DOI: 10.1016/S2213-8587(21)00235-7

47. Zaĭdieva Ia.Z. Hyperandrogenism in postmenopausal women: clinical forms and differential diagnosis. Russian Bulletin of Obstetrician-Gynecologist. 2013;13(4):89–94. (in Russian)

48. Zotter Z., Veszeli N., Csuka D., Varga L. et al. Frequency of the virilising effects of attenuated androgens reported by women with hereditary angioedema. Orphanet. J. Rare Dis. 2014;9:205. DOI: 10.1186/s13023-014-0205-6

49. Vorona E., Nieschlag E. Adverse effects of doping with anabolic androgenic steroids in competitive athletics, recreational sports and bodybuilding. Minerva Endocrinol. 2018;43(4):476–88. DOI: 10.23736/S0391-1977.18.02810-9

50. Azziz R., ed. Androgen excess disorders in women. Humana Press; 2006. 488 p.

51. Shlyakhto E.V., Sukhikh G.T., Serov V.N., Dedov I.I. et al. Russian eligibility criteria prescribing menopausal hormonal hormones therapy for patients with cardiovascular and metabolic diseases. Consensus document of the Russian Cardiological Society, Russian Society of Obstetricians and Gynecologists, Russian Association of Endocrinologists, Eurasian Association of Therapists, Association of Phlebologists of Russia. Problems of Endocrinology. 2023;69(5):115– 36. (in Russian). DOI: 10.14341/probl13394

52. Kuhl H. Pharmacology of estrogens and progestogens: influence of different routes of administration. Climacteric. 2005;8(suppl.1):3–63. DOI: 10.1080/13697130500148875


Review

For citations:


Burchakov D.I. Postmenopausal Hyperandrogenism: A Review of Etiology, Diagnosis, and Approaches to Menopausal Hormone Therapy. Title. 2025;24(5):79-85. (In Russ.) https://doi.org/10.31550/1727-2378-2025-24-5-79-85

Views: 14


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1727-2378 (Print)
ISSN 2713-2994 (Online)