Clinical Scenario

This protocol applies to a postmenopausal woman with confirmed ovarian hyperthecosis, bilateral increased ovarian stroma and volume on ultrasound, and elevated serum testosterone identified as being of ovarian origin — demonstrated by greater than 50% suppression on GnRH analogue testing.

This condition is characteristically seen after menopause, when high concentrations of LH are present and the ovary has few or no remaining follicles able to aromatise androgens to oestrogen. Bilateral increased ovarian stroma on ultrasound is a hallmark finding of ovarian hyperthecosis (OHT).

Management Approach

Management in this postmenopausal setting centres on surgical intervention. For women in whom surgery is not an option, a long-term hormonal suppression approach may be employed. The complete treatment algorithm — including the criteria for choosing between available modalities — is set out in the full structured protocol.

Treatment goal: Suppression of serum testosterone by at least 50%, assessed 28 days after initiation of therapy.

References

DOI: 10.1111/cen.15265

This condition is usually seen after menopause, where there are high concentrations of LH, after the ovary has few, if any, remaining follicles able to aromatise androgens to oestrogen.
Bilateral increased ovarian stroma on ultrasound is characteristic of OHT.
In practice, postmenopausal women with suppressed androgens after GnRH analogue should undergo bilateral oophorectomy unless there is a clear unilateral lesion; in this scenario, a discussion with the patient around unilateral or bilateral oophorectomy should be undertaken.
Postmenopausal: consider bilateral oophorectomy or long term GnRH therapy if unfit for surgery.
A positive response to GnRH analogue testing signposts a potential long-term treatment modality in women for whom surgery may not be an option.

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Treatment of Ovarian Hyperthecosis in a Postmenopausal Woman with Bilateral Increased Ovarian Stroma

References