Treatment of Ovarian Hyperthecosis in Premenopausal Women Without a Defined Unilateral Lesion on Imaging

When ovarian hyperthecosis presents in a premenopausal woman without a radiologically defined unilateral ovarian lesion, localising the source of androgen excess requires a targeted diagnostic and surgical strategy distinct from the straightforward postmenopausal case.

Clinical scenario

Premenopausal woman with ovarian hyperthecosis, bilateral increased ovarian stroma and volume on ultrasound, and elevated serum testosterone of ovarian origin — but without a discrete unilateral lesion identifiable on imaging. Bilateral ovarian stromal enlargement on ultrasound is characteristic of this condition. Because no dominant lesion guides lateralisation, the diagnostic approach must go beyond routine imaging.

Treatment approach

The protocol involves specialised venous sampling to localise the source of androgen excess before any surgical decision is made — the results of this step determine whether and how a targeted surgical approach, with fertility preservation, is appropriate.

Full protocol details — including the complete sampling procedure, surgical criteria, and decision pathway — are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/cen.15265

However, in premenopausal women lacking a radiologically defined unilateral lesion, simultaneous adrenal and ovarian vein sampling should be considered rather more seriously.
Bilateral increased ovarian stroma on ultrasound is characteristic of OHT.
Ovarian vein sampling in such cases may lateralise and, therefore, indicate targeted unilateral surgical oophorectomy whilst preserving fertility.
Premenopausal: consider simultaneous adrenal and ovarian vein sampling.

View source ↗