Excessive ovarian androgen production developing in post-menopausal women can be associated with severe hirsutism and virilisation. In the absence of an identifiable androgen-secreting tumour, medical therapy rather than surgical removal is a potential treatment option. Despite this, the role and outcomes of medical therapy are not well characterised in this context. We present the long-term outcomes of 2 women with postmenopausal ovarian hyperandrogenism, both of whom were treated successfully with GnRH agonists. Case 1: A 56 year old postmenopausal female was referred with a 2 yr history of severe hirsutism (Ferriman-Gallwey (FG) score of 22) (normal <7) and progressive male-pattern baldness. She was not otherwise virilised. Serum testosterone was 7.2 nmol/L. Case 2: A 66 year old postmenopausal female with central adiposity, insulin-treated type 2 diabetes, insulin resistance (insulin dose>100 units/day, C-peptide 3674 pmol/L) and coronary heart disease developed marked hirsutism (FG score 22). She was not otherwise virilised. Serum testosterone was 6.2 nmol/L. In both cases, biochemical and imaging investigations were suggestive of an ovarian source of androgen excess without evidence of an ovarian tumour. Both received 9 months of GnRH agonist therapy (triptorelin 3.75 mg IM monthly) which resulted in suppression of biochemical hyperandrogenism and obvious clinical improvement (FG score 14 and 13 after 6 months for cases 1 and 2 respectively). There was no recurrence of hyperandrogenism more than 2 yrs after cessation of triptorelin in either patient. GnRH agonist treatment using triptorelin appears to be an effective non-surgical option in the management of postmenopausal ovarian hyperandrogenism of non-tumourous origin. These cases illustrate the possibility of long-term remission following cessation of GnRH agonists although the optimal duration of therapy remains unclear.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.