Unlühizarci K, K., Everest, H., Bayram, F., & Keleştimur, F. (2002). Comparison of spironolactone and spironolactone plus finasteride in the treatment of hirsutism. Fertility and Sterility, 78(6), 1331-1333. https://doi.org/10.1016/s0015-0282(02)04294-2
Unlühizarci K K, Everest H, Bayram F, Keleştimur F. Comparison of spironolactone and spironolactone plus finasteride in the treatment of hirsutism. Fertil Steril. 2002;78(6):1331-1333. doi:10.1016/s0015-0282(02)04294-2
Unlühizarci K, Kürşad, et al. "Comparison of spironolactone and spironolactone plus finasteride in the treatment of hirsutism." Fertility and Sterility, vol. 78, no. 6, 2002, pp. 1331-1333.
For EndNote, Zotero or Mendeley:
License
No open license is recorded for this paper. Reuse terms are set by the publisher.
Spironolactone plus finasteride reduced hirsutism scores more
Adding finasteride to spironolactone reduced hirsutism scores by a larger percentage than spironolactone alone. The trial lasted six months and recruited 34 women. Among women whose periods were regular at the start, 5 out of 10 on spironolactone alone and 2 out of 10 on the combination bled between periods.
Key Findings
The mean Ferriman-Gallwey score fell from 23.9 to 17.7 with spironolactone alone (18 women) and from 26.4 to 15.6 with spironolactone plus finasteride (16 women); both declines were significant.
The percent reduction in hirsutism score at six months was significantly greater with the combination than with spironolactone alone.
Free testosterone declined slightly with spironolactone alone and slightly but significantly with the combination. DHEAS did not decline significantly in either group, and SHBG was unaffected.
No side effects required stopping therapy in either group.
Among women whose menses were formerly regular, intermenstrual bleeding (polymenorrhea) occurred in 6 of 12 (50%) on spironolactone alone and 2 of 10 (20%) on the combination.
Interpretation
The trial ran for six months at one university clinic in Turkey. Women were randomized to a drug group in alternating sequence. One observer, who did not know the treatments, scored hair growth. The women averaged about 20 years of age. Twenty-two had hirsutism of unknown cause. Twelve had irregular periods (oligomenorrhea) with polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS). The authors call the combination effective and safe. They note that the role of the free testosterone decline remains to be confirmed, and the findings support larger studies of this combination.
RRM Context
The authors link spironolactone's benefit mainly to a peripheral effect, since free testosterone fell only slightly. Hirsutism is a visible sign, and what drives it is a separate clinical question. Restorative reproductive medicine approaches that question by evaluation before treatment, including ovulation and bleeding patterns on a cycle chart. A chart would also record the bleeding changes this trial reported.
Our editorial summary of this paper, not the article's abstract.
Abstract
Hirsutism is a very common clinical problem encountered in daily practice, and, unfortunately, its treatment is far from satisfactory. In several studies, antiandrogens were given in combination with oral contraceptives (1–3), however, there are not enough data about the effects of combination therapy of antiandrogens in women with hirsutism. Thirty-four patients were recruited into the study from the Endocrinology Outpatient Clinic of Erciyes University Hospital. Each patient gave informed consent, and the study was approved by the ethics committee and Institutional Review Board of Erciyes University. Cushing’s syndrome, nonclassic adrenal hyperplasia, androgen-secreting tumors, and prolactinoma were excluded by appropriate tests and radiological investigations. Twelve patients were oligomenorrheic, and these patients had polycystic ovary syndrome. Twenty-two patients had idiopathic hirsutism.
047g8vk19 