Congenital adrenal hyperplasia (CAH) is a genetic condition that affects both women and men. For women, adrenal hyperplasia can cause hormone imbalances that lead to too many male hormones being present in the body.
The Effect of Adrenal Hyperplasia on your Fertility
These excessive male hormones can cause problems with both the menstrual and ovulation cycles. Fertility problems are common in women who have been diagnosed with adrenal hyperplasia.
Many specialists overlook CAH as a factor in fertility because this disorder doesn’t have any obvious symptoms.
Unfortunately, many fertility specialists don’t even consider adrenal hyperplasia as a factor in why a woman isn’t getting pregnant until all other infertility causes have been examined and ruled out.
Linking Adrenal Hyperplasia to Your Infertility
Adrenal hyperplasia has a direct effect on the adrenal glands. These glands are located on either side of your lower back. These tiny glands play a big role in how your body functions.
Women who have CAH may not have enough of a particular enzyme that is necessary for the production of two important hormones in the adrenal glands: cortisol and aldosterone.
Not only are these two hormones needed to regulate your heart rate, blood pressure, and salt levels they are also needed to regulate the production of male hormones, also known as androgens.
When your body is missing the cortisol and aldosterone hormones, you may have more male hormones in your body than is normal. This may be the start of your fertility problems that may be preventing you from getting pregnant.
Problems with Menstruation Leading to Infertility
High levels of male hormones can lead to menstrual cycles that are very irregular. When you don’t have regular periods it can be hard for you to know if you’re fertile or not.
You may have a period and then you may not have another one for a few months. You may also experience anovulation, a condition where you don’t ovulate at all.
Symptoms of adrenal hyperplasia other than menstrual and ovulation abnormalities include:
- Mild to strong body odor.
- Mild to severe acne.
- Shortness in height.
- Too much body hair.
Mild cases of AH may show no symptoms at all, not even irregular periods. This is why infertility that is related to adrenal hyperplasia can be so hard to diagnose.
Types of Adrenal Hyperplasia
There are two different types of adrenal hyperplasia: classical and non-classical.
- Classical adrenal hyperplasia: In classical CAH your body will produce far more male hormones that it requires. This types of adrenal hyperplasia will occur in every one out of 15,000 births. Classical adrenal hyperplasia can be further broken into two categories: simple virilizing and salt wasting. Both of these types of classical adrenal hyperplasia can create what is known as an “adrenal crisis” when a woman is in a lot of stress such as dealing with infertility issues. Immediate medical attention will be needed. This is why it’s crucial to diagnose adrenal hyperplasia if you’re having difficulty getting pregnant.
- Non-classic adrenal hyperplasia: This type of adrenal hyperplasia is milder than the classic type. It is also known as late-onset adrenal hyperplasia since symptoms often don’t show until later in life, such as when a woman is trying to get pregnant.
For classical adrenal hyperplasia, you’ll need treatment to replace the cortisol and aldosterone hormones that your body is missing. You’ll work with an endocrinologist to determine what treatment is best for you.
If you’re having difficulty getting pregnant, your endocrinologist (a doctor who specializes in hormones) and infertility specialist may work together to make medical decisions that are crucial not only for you but for the health of your baby.
Adrenal Hyperplasia and How to Treat It
Blood tests are necessary to correctly diagnose congenital adrenal hyperplasia. If you have CAH and are trying to get pregnant your treatment will depend on your own medical circumstances.
The typical treatment is medication to increase levels of cortisol and aldosterone and to decrease levels of androgens. Steroid-type medications are usually used, such as hydrocortisone and dexamethasone which are able to work in the body much the way cortisol and aldosterone do.
Once cortisol and aldosterone hormone levels are up and male hormones have decreased, your menstrual cycle may become more regular allowing you to ovulate.
Many women who start taking medication are able to see significant improvements to the regularity of their cycle in just a few months. Steroid treatment can be used in combination with other infertility treatments in order to help you conceive.
It’s important to know that some women who have AH may have to be on steroid treatment for their entire lives.
Coping with Adrenal Hyperplasia
As with any lifelong medical condition, you’ll have to find ways to cope. When you add infertility problems to your medical problems there may be times when you find it hard to cope.
Talk to your doctor about finding counseling not only for CAH but also for your infertility issues. The less stress and anxiety that you feel at this time, the better your chances of conceiving.
The better your health is both mentally and physically, the easier it will be for you get pregnant.