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Hormone therapy

If the hormone tests (and any repeat testing, if required) reveal a significant hormone disorder, this can be treated using a targeted approach. Of course, it is also possible for different hormone problems to be present at once, as a result of which multiple medications may occasionally need to be taken simultaneously.

Some additional information about the most important hormone disorders:

  • Hypothyroidism
  • Hyperprolactinaemia
  • PCO syndrome
  • Luteal phase defect
  • Thyroid disease

Decreased thyroid function (hypothyroidism)

Decreased thyroid function (hypothyroidism) is detected in some 10 – 20 % of female fertility patients (as well as in men!). It is not uncommon for hypothyroidism to be “latent”, meaning that while the condition does not cause any physical symptoms, it may already have a discernible effect on follicle (egg vesicle) maturation, thus contributing to what is known as a luteal phase defect.

Treatment: The administration of thyroid hormone even at very low doses may resolve the problem with your cycle, as a result of which ovulation will resume on cycle day 13/14.

Hyperprolactinaemia (excess prolactin)

If the pituitary gland produces too much prolactin (PRL), this will in most cases result in an excess level of prolactin in the blood (hyperprolactinaemia), which can certainly also be made worse by stress. So-called thyroid adenomas are less common. In this case, the PRL levels are usually extremely high. A thyroid adenoma is a benign tumour which, depending on the size, may even cause optic nerve damage. Such hyperprolactinaemias can generally be treated very effectively with drugs that reduce prolactin levels. Cycles and ovulation will become regular again.

In case of very high prolactin levels, computed tomography (CT) or magnetic resonance imaging (MRI) must be performed to rule out a pituitary tumour (which is most commonly a benign adenoma).

Treatment: Drugs to reduce prolactin levels

Hyperandrogenaemia (excess of male hormone levels)

The overproduction of male hormones (hyperandrogenaemia) may also effect the sensitive hormonal mechanism of the female cycle. If the hyperandrogenaemia originates in the adrenal glands it can be treated with cortisone. Excess weight is a vary common cause of hyperandrogenaemia, as well as for hyperandrogenism (increased peripheral effects with normal androgen levels, such as increased hair growth in places where such hair growth is uncommon in women or acne). In the fatty tissue, androgen (male hormone) is produced from oestrogen. This has negative effects on the cycle. It is therefore highly recommended that these patients lose weight (with diet and exercise). The symptoms are made worse by PCO syndrome(P olyC ystic O vary), which is frequently also present in these cases.

Treatment: Either targeted treatment to reduce androgen levels by administrating cortisone or stimulation with clomifene tablets will commonly permit ovulation. However, hormone injections may be added to the treatment.

PCO (polycystic ovary) syndrome

PCO syndrome is a disorder which results in abnormal cycles, missed ovulations, hyperandrogenaemia (excess male hormones) and hyperandrogenism (signs of elevated male hormones (androgens) without an elevated level of androgens in the blood). The detection of “classical PCO ovaries” by ultrasound is nowadays not absolutely essential for the diagnosis of PCO syndrome.

If PCO syndrome is accompanied by abnormal glucose tolerance (including insulin resistance), this will result in the pancreas pumping large quantities of insulin into the circulation. This can cause adverse effects in various places (brain, ovaries and liver).

Treatment: The cycle can be regulated by administering what is known as an insulin sensitizer (metformin) over a period of a few months. Often, women with PCO syndrome are somewhat heavier, which perpetuates the abnormal cycle. In the fatty tissue, androgen (male hormone) is produced from oestrogen. This, in conjunction with high insulin levels, has negative effects on the cycle. It is therefore highly recommended that these patients lose weight (with diet and exercise) in addition to the treatment metformin.

Luteal phase defect

After ovulation, the follicle (egg vesicle) undergoes vascularisation and fat deposition to produce what is known as the corpus luteum.

Various hormonal problems are frequently associated with what is known as a luteal phase defect (LPD), thus also requiring additional treatment. This treatment does not just involve the use of luteinising hormones. Rather, the root of the problem needs to be targeted. If the quality of the first half of the cycle is reduced, this will also have an effect on the time after ovulation, also known as the luteal phase.

Treatment: The standard approach in these cases is stimulation with clomifene. If this proves unsuccessful, follicle-stimulating hormone (FSH) can be given.