High estrogen in women (hyperestrogenism) is a condition characterized by an increased content of sex hormones, estrogens and their derivatives in a woman’s body. The main manifestations of hyperestrogenism are copious painful menstruation, premenstrual syndrome, breast tenderness. The basic diagnostic method is the assessment of hormonal status. To find out the causes of hormonal imbalance, an X-ray of the pituitary gland, gynecological ultrasound, and SCU are performed. Treatment is aimed at hormonal correction of the condition and depends on the cause of the deviation.
E28.0 Excess estrogen
Gynecological pathology, developing against the background of hyperestrogenism in women under 45 years of age, accounts for 6.6% of all diseases of the reproductive sphere. During perimenopause, this figure rises to 17-40%. The maximum amount of estrogens is synthesized in the first phase of the menstrual cycle, which lasts 7-14 days from the start of menstruation, then hormone production decreases until the beginning of the next menstrual cycle. High estrogen in women is normally characteristic of puberty and pregnancy.
The factors leading to an increase in the synthesis of estrogens can be divided into primary and secondary. As a result of the primary causes, an increased level of estrogens in the blood is determined compared to the norm (absolute hyperestrogenism). If the progesterone level is reduced, then the clinic of hyperestrogenism develops with normal estrogen levels. This is secondary (relative) hyperestrogenism. Common causes of increased estrogen are:
- Neoplasms of the pituitary gland or hypothalamus. The synthesis of steroid hormones in the ovaries is controlled by endocrine centers located in the brain. Tumors in this area can increase the level of regulatory hormones. In such conditions, the ovaries begin to work more actively, increasing the release of estrogens.
- Estrogen-producing tumors. With hormone-active tumors of the ovaries and adrenal glands, the synthesis of estrogens becomes uncontrolled, the symptoms increase very quickly. There is no dependence on the phases of the menstrual cycle, the level of hormones exceeds the norm by 5-7 times.
- Thyroid dysfunction. Regulatory hormones of the anterior pituitary gland are very similar in structure, in some cases they can act not only on the thyroid gland, but also on the ovaries. Both a decrease and an increase in the activity of the thyroid gland can lead to the development of hyperestrogenism.
- Chorionepithelioma. This malignant tumor, formed from germ cells, synthesizes chorionic gonadotropin. Under its influence, the production of estrogens in the ovaries increases.
- Fatness. Adipose tissue is regarded by scientists as an endocrine organ. With its excessive amount in the body, the accumulation of male androgen steroids increases, and their excess turns into estrogens. High estrogen in women develops.
- Hepatitis or cirrhosis of the liver. Inactivation of excess female sex hormones occurs by combining them with a protein — sex-binding globulin. It is produced by hepatocytes. When liver cells are destroyed and lose their function, there is an increase in the level of active estrogens in the serum.
Relative high estrogen in women in all women develops over the age of 35, when progesterone secretion decreases and the effect of pituitary hormones on the ovaries is disinhibited. The level of estrogens in the blood increases, the chance of multiple pregnancies increases. This process is the first indicator of aging of the body.
The effects of estrogens are manifested not only in the reproductive system. Estrogen receptors are located in the mammary glands, lungs, bones, liver, brain. They are divided into membrane (located on the cell wall) and nuclear (located in the cell nucleus). With high estrogen in women, excess hormones bind to receptors, triggering pathological reactions in the body.
A frequent negative membrane effect is an increase in the permeability of the cell wall. Fluid and electrolytes exit the vascular bed into the tissue, resulting in edema. Significant nuclear pathological effects are an increase in the rate of cell division, which leads to hyperplastic processes in the uterus, mammary glands. Excessive synthesis of proteins, for example, blood clotting factors, causes the formation of blood clots.
The most frequent complaint of patients is copious painful menstruation. The duration of the menstrual cycle may decrease, or vice versa, increase. In this case, the discharge becomes bright scarlet, abundant, with clots. Menstruation is painful, the pain is constant, aching, taking painkillers gives a short-term effect. They are accompanied by symptoms of blood loss: dizziness, weakness, tachycardia. This significantly reduces performance and mood.
High estrogen in women is characterized by weight gain, and fat is deposited according to the female type, mainly in the hip area. It can be difficult to get rid of extra pounds, despite the diet and physical activity. In the second half of the cycle, especially before menstruation, the sensitivity of the mammary glands increases, their tissue swells (breast swelling), painful sensations occur.
Manifestations of premenstrual syndrome are also expressed. In addition to physical discomfort, mood swings, tearfulness, irritability are added. Women cannot concentrate on work, they are absent-minded, sometimes their appetite increases sharply against this background, an uncontrolled craving for sweets appears. The retention of water and sodium in the tissues contributes to the development of edema, increased blood pressure.
Long-term hyperestrogenism can contribute to endometrial hyperplasia, when the inner lining of the uterus grows pathologically and, when rejected, contributes to the development of massive bleeding. Due to the fact that estrogens increase the rate of cell division, there is a tendency to malignant processes, especially where tissues are most sensitive to female steroids — in the endometrium, the muscular lining of the uterus, mammary glands.
Areas of the overgrown endometrium with blood flow enter other organs and tissues. There they are able to attach with the formation of foci of growth. Ectopic endometrial foci affect healthy tissues and are the main cause of chronic pelvic pain in women. This is how endometriosis occurs. Under the influence of hyperestrogenism, the synthesis of coagulation factors increases, an increased tendency to vascular thrombosis develops.
During a gynecological examination, juicy, loose mucous membranes, their slight cyanosis, and abundant whiteness attract attention. It is not difficult to confirm hyperestrogenism: it is enough to detect an increase in the blood level of estradiol or a decrease in progesterone. A difficult task is to determine the cause of hyperestrogenism. Such patients are treated by a gynecologist-endocrinologist. Applied research methods:
- Hormonal screening. It is carried out on the 5-7 day of the menstrual cycle. The level of estradiol, testosterone, thyroid and pituitary hormones is determined in the blood. The progesterone test is performed 5 days before the expected menstruation.
- Radiography. According to the X-ray data, the anatomical structure of the pituitary gland is evaluated. Based on the study, a conclusion is made about its volume and form, the presence of additional formations.
- Electroencephalography. Based on the study, it is possible to analyze the electrical activity of subcortical brain centers. Their uncoordinated work indicates a disturbed regulation of the endocrine system.
- Sonography. Clinical manifestations of hyperestrogenism develop in target organs: genitals, mammary glands. According to the results of ultrasound in the uterus, fibroids, overgrowth (hyperplasia) of the endometrium can be detected. Cysts are more often detected in the mammary glands. During the ultrasound of the HSG, the structure of the uterus and appendages is visualized, pathological formations are detected.
- Biopsy. An aspiration biopsy of the contents of the uterine cavity is performed, with its help it is possible to track the appearance of atypical cells in the aspirate. Diagnostic curettage is used for a detailed examination of the endometrium, determining the type and degree of hyperplasia. As a therapeutic procedure, SCU is performed when uterine bleeding stops.
In women with uncomplicated hyperestrogenism, progestogens are very often used as a method of therapy. On the market, drugs of this group are represented by different forms of release: tablets, intrauterine systems, gels, injections. They make up for the deficiency of natural progesterone and reduce the severity of symptoms of high estrogen in women. Gel forms of progesterone are applied to the mammary glands, reducing their soreness and the risk of developing mastopathy.
If there are no contraindications to use, then microdosed combined oral contraceptives should be chosen as contraceptives for hyperestrogenism. Their intake reduces the stimulating effect of the pituitary gland on the ovaries, estrogens enter the body in minimal doses, blood loss and pain during menstruation decreases. If there are complications of hyperestrogenism (fibroids, endometrial hyperplasia), treatment involves the appointment of antiestrogens for a long time.
With small pituitary formations, preference is given to conservative methods of treatment using gonadotropin-releasing hormone agonists or antiandrogens. If there is a tendency of the pituitary tumor to grow, it is possible to use radiation therapy. Treatment of chorionepithelioma is almost always conservative, the tumor is sensitive to chemotherapy with antimetabolites, antitumor antibiotics.
In hormone-producing tumors, treatment begins with surgical removal of the source of estrogen. Surgical treatment of pituitary tumors is currently carried out by gentle endonasal access. In adolescents with rare genetic diseases (testicular feminization syndrome), with sex reversal with an underdeveloped non-functioning gonad, its mandatory removal is carried out at the first stage.
With timely treatment, the prognosis for life and reproductive function is favorable. You should not be afraid of prescribing hormonal drugs. In therapeutic doses, this is an effective and safe method of treating hyperestrogenism, which makes it possible to do without surgical intervention. For prevention, it is very important to reduce the excess production of estrogens in a natural way: normalize weight, give up bad habits, restore liver function.
The night sleep mode is of great importance. For the proper functioning of the pituitary gland, the evening bedtime should be no later than 23 hours, and the duration of sleep should be at least 8. At least once a month in the first half of the menstrual cycle, breast self—examination should be carried out. With any complaints about changes in the rhythm and nature of menstruation, other symptoms, you should immediately consult a gynecologist.