Crosby, P. D., & Rittmaster, R. S. (1991). Predictors of clinical response in hirsute women treated with spironolactone. Fertility and Sterility, 55(6), 1076-1081. https://doi.org/10.1016/s0015-0282(16)54355-6
Crosby PD, Rittmaster RS. Predictors of clinical response in hirsute women treated with spironolactone. Fertil Steril. 1991;55(6):1076-1081. doi:10.1016/s0015-0282(16)54355-6
Crosby, Peter D. A., and Roger S. Rittmaster. "Predictors of clinical response in hirsute women treated with spironolactone." Fertility and Sterility, vol. 55, no. 6, 1991, pp. 1076-1081.
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Spironolactone improved hirsutism in 72% of 109 women
Low-dose spironolactone improved hirsutism, which is excess body and facial hair, in 72 out of 100 women in a retrospective review of 109 women at an outpatient endocrinology clinic. Response was lowest with irregular periods and no birth control pill.
Key Findings
Hirsutism improved in 78 of 109 women (72%). Another 31 (28%) did not improve, and only 3 of them felt their hirsutism was worse.
Women with irregular menses who took no oral contraceptive improved least often: 55%, against 78% for the other three groups combined (P = 0.08).
Greater hirsutism severity (P = 0.04) and lower serum dehydroepiandrosterone sulfate (P = 0.05) went with improvement. Age, duration, testosterone and body mass index did not differ significantly.
Side effects affected 30% of women. Menorrhagia or spotting appeared in 20% of those on spironolactone alone and in 8% of those also on oral contraceptives.
Interpretation
This retrospective chart review covered consecutive women seen by one physician, with follow-up from 4 to 12 months. Improvement combined each woman's opinion, how often she removed hair, and a hirsutism score. The authors report that at least half of the women improved in every subgroup of age, duration or severity of hirsutism, obesity and serum hormone levels. They judge androgen dependency best by the pattern of hair growth. Across the whole group, menstrual status and pill use did not change response significantly. The authors note that unrecognized selection bias might have affected the results. Every woman had androgen-dependent hirsutism and no sign of a serious underlying disorder.
RRM Context
Hirsutism signals androgen activity. The women with irregular menses all had clinical features of PCOS, now also called PMOS (Polyendocrine Metabolic Ovarian Syndrome). RRM looks for the root cause of that androgen activity, with attention to ovulation and the cycle.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To examine the clinical efficacy of low dose spironolactone in hirsute women.
Design
Retrospective.
Setting
Outpatient endocrinology clinic.
Patients
One hundred nine consecutive women prescribed 75 to 100 mg/d spironolactone for at least 4 months in whom adequate follow-up data were available.
Results
Hirsutism improved in 72% of the women. Women with regular menses, whether or not they used oral contraceptives (OCs), had the highest response rate to spironolactone (78%), whereas women with irregular menses who did not use an OC had the lowest response rate (55%). Favorable responses were associated with increased severity of hirsutism (P = 0.04) and lower serum dehydroepiandrosterone sulfate levels (P = 0.05). Responders and nonresponders did not differ significantly in age (P = 0.10), duration of hirsutism (P = 0.14), pretreatment serum testosterone (T) (P = 0.48), or body mass index (P = 0.11). However, when each parameter was divided into subsets, trends toward decreasing response were observed with increasing age, duration of hirsutism over 15 years, and increasing serum T level.
Conclusion
Low-dose spironolactone improves hirsutism in a majority of hirsute women, irrespective of age, severity or duration of hirsutism, menstrual status, or serum hormone levels.
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