Evaluation of biochemical hyperandrogenemia and body mass index in women presenting with amenorrhea.

INTRODUCTION

The aim of this study was to evaluate the correlation between biochemical hyperandrogenemia and body mass index in patients with amenorrhea as the main clinical presenting symptom.

METHODS

Among 136 patients presenting with secondary or primary amenorrhea, hyperandrogenemia was found to be the hormonal cause of this specific type of irregular menses in 21 patients. A retrospective study was carried out to investigate the patients' serum androgen findings and body mass index. The ultrasound features of the ovaries were also recorded.

RESULTS

Twenty-one of the 136 patients presenting with the most severe form of menstrual irregularity, amenorrhea - defined as an absence of menses for at least 6 months - were found to have elevated serum androgen levels. The androgen profile included elevated levels of total testosterone (TT), or dehydroepiandrosterone sulfate (DHEAS), or calculated free testosterone (cFT), or all three, with or without an elevated luteinizing hormone-follicle-stimulating hormone (LH : FSH) ratio. Six patients with a body mass index > 26 kg/m2 all had elevated cFT, while TT was only increased in three patients. All of the patients had low levels of sex hormone-binding globulin (SHBG). Two patients had abnormal TT, cFT, and DHEAS levels together with polycystic ovaries. Eleven patients with a body mass index (BMI) <or=26 kg/m2 were found to have all of the combinations of normal and abnormal androgens. In general, cFT was significantly increased in patients with a BMI > 26 kg/m2 ( P<0.001), while TT serum levels did not significantly differ between the two groups.

CONCLUSIONS

Amenorrhea is by definition the most severe form of menstrual disorder. Biochemical hyperandrogenemia can be found in a subgroup of amenorrheic patients. However, none of the biochemical findings of hyperandrogenemia correlated consistently with this specific type of menstrual disorder. In the women studied, there appears to be a correlation between elevated androgen levels and a BMI > 26 kg/m2. cFT appears to be a more appropriate criterion for identifying hyperandrogenemia than TT in patients presenting with amenorrhea. More information about this condition and studies including larger numbers of patients are needed.