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Trattamento di irsutismo e androgenizzazione in menopausa

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L’Endocrinologo Aims and scope

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La cessazione dell’attività ovarica che si verifica in menopausa comporta l’inversione del rapporto tra estrogeni e androgeni a favore di questi ultimi; ciò si traduce in una condizione di iperandrogenismo relativo e provoca delle ripercussioni sul profilo metabolico ed estetico, la cui espressione clinica è molto variabile ed è legata alla sensibilità individuale a tale squilibrio ormonale. La terapia estrogenica è in grado di ripristinare l’equilibrio endocrino mediante il supporto diretto degli estrogeni esogeni, ma anche attraverso una serie di effetti che riducono la biodisponibilità degli steroidi maschili. Tale risultato è più accentuato in seguito alla somministrazione di estrogeni per via orale. L’associazione del progestinico può contribuire ad antagonizzare gli effetti sfavorevoli dell’androgen izzazione quando si utilizzano preparati dotati di attività antiandrogenica. Soprattutto nelle fasi perimenopausali, quindi, la terapia ormonale sostitutiva, e in particolare l’impiego di progestinici dotati di attività antiandrogenica, ripristinando l’equilibrio endocrino, rappresenta un valido approccio alle forme di iperandrogenismo relativo. Durante la menopausa possono insorgere forme di iperandrogenismo assoluto di origine neoplastica o funzionale. Tra queste ultime, la più frequente è l’ipertecosi ovarica: nonostante l’approccio terapeutico classico e definitivo sia quello chirurgico, sono sempre più consistenti i dati sugli effetti della terapia medica basata sugli agonisti del GnRH, che rappresenta una valida alternativa soprattutto per quelle pazienti che non risultano delle candidate ottimali alla terapia chirurgica.

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  1. Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste, Via dell’Istria 65, 34137, Trieste, Italia

    Secondo Guaschino, Eva Grimaldi & Stefania Inglese

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Guaschino, S., Grimaldi, E. & Inglese, S. Trattamento di irsutismo e androgenizzazione in menopausa. L’Endocrinologo 4, 148–156 (2003). https://doi.org/10.1007/BF03344466

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