Pittaway, D. E., Maxson, W. S., & Wentz, A. C. (1985). Spironolactone in combination drug therapy for unresponsive hirsutism. Fertility and Sterility, 43(6), 878-882. https://doi.org/10.1016/s0015-0282(16)48615-2
Pittaway DE, Maxson WS, Wentz AC. Spironolactone in combination drug therapy for unresponsive hirsutism. Fertil Steril. 1985;43(6):878-882. doi:10.1016/s0015-0282(16)48615-2
Pittaway, Donald E., et al. "Spironolactone in combination drug therapy for unresponsive hirsutism." Fertility and Sterility, vol. 43, no. 6, 1985, pp. 878-882.
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Spironolactone combinations helped 8 of 9 with unresponsive hirsutism
Eight out of nine women with unresponsive hirsutism responded to combination drug therapy in a 1985 case series of women who had each failed one drug. Hirsutism is excess hair growth in women. A response meant at least doubling the longer interval between shaving, bleaching or electrolysis, plus patient satisfaction after months of treatment.
Key Findings
With individualized single-drug therapy, 75% of 36 women had a clinical response: 80% on spironolactone, 73% on an oral contraceptive and 73% on dexamethasone.
Two of the nine had polycystic ovarian disease, four had it with raised DHEA sulfate, one had an adrenal source, and two had normal hormone levels and menses.
Eight of nine women met the criteria for a clinical response on combination therapy (P < 0.001 against their response to single-agent treatment). All nine noted a subjective improvement in hair growth.
Hormone measures taken 4 to 6 weeks after therapy began showed no statistically significant difference between the combination and single-drug treatment.
Transient diuresis (increased urination) during the first 2 weeks was the only side effect noted.
Interpretation
The paper is a 1985 case series from two university centers. Nine women whose hirsutism had resisted one drug received spironolactone with an oral contraceptive or dexamethasone. The authors compared the clinical response with the same women's earlier response to one drug, and compared hormone measures with groups given one drug. The paper describes no untreated control group. The second drug was chosen by whether the ovary or the adrenal gland was suspected as the main source of excess androgen. The authors caution that the response measure is subjective, note the small number of patients, and say the findings support more study.
RRM Context
Several women had polycystic ovarian disease, the paper's term for PCOS, which a 2026 Lancet consensus renamed PMOS (polyendocrine metabolic ovarian syndrome). The oral contraceptive in this study is a suppressive medication that lowers ovarian androgen. RRM looks for the cause of high androgen and treats it.
Our editorial summary of this paper, not the article's abstract.
Abstract
Clinical and laboratory evaluations of nine hirsute women were performed for determination the efficacy of combination drug therapy. Each patient had previously failed to respond to single drug therapy with oral contraceptives (OC), dexamethasone (DEX), or spironolactone (S) and received S (100 to 150 mg) and either an OC (mestranol, 0.05 to 0.08 mg, and norethindrone, 1 mg) or DEX (0.5 mg) daily. Total testosterone, dehydroepiandrosterone sulfate, free testosterone, and sex-hormone-binding globulin were measured before therapy and 4 to 6 weeks after initiation of therapy and were compared with the responses to OC (n = 7), DEX (n = 8), and S (n = 6). A satisfactory clinical response in the rate of hair growth was defined as at least a doubling of the time interval between adjunctive therapies (electrolysis, shaving, or bleaching) and patient satisfaction with treatment. The responses of the androgenic parameters were not statistically different between combination and single drug therapy. Although all patients noted a subjective improvement in hair growth, eight of nine fulfilled the criteria for a clinical response (P less than 0.001). Transient diuresis was the only side effect noted. The study suggests that combination drug therapy is an efficacious and well-tolerated approach to the management of unresponsive hirsutism.
