The authors examined the effect of three months' treatment with spironolactone in 34 women with polycystic ovary syndrome. In all patients a significant decrease in hirsutism was noted as well as restoration of a regular although anovulatory menstrual pattern. Plasma luteinizing hormone and follicle-stimulating hormone levels remained unchanged after spironolactone treatment; however, prolactin levels were lowered in both women with normal and those with elevated basal levels. Plasma testosterone, androstenedione, and dehydroepiandrosterone sulfate levels were decreased after three months of therapy. No side effects were observed. Plasma electrolytes and liver function tests were normal during the entire time of treatment. This therapy is recommended as initial nontoxic but effective treatment for women with polycystic ovary syndrome who are hirsute and have menstrual disturbances.
Milewicz, A., Silber, D., & Kirschner, M. A. (1983). Therapeutic effects of spironolactone in polycystic ovary syndrome. Obstetrics and gynecology, 61(4), 429-432.
Milewicz A, Silber D, Kirschner MA. Therapeutic effects of spironolactone in polycystic ovary syndrome. Obstet Gynecol. 1983;61(4):429-432.
Milewicz, A., et al. "Therapeutic effects of spironolactone in polycystic ovary syndrome." Obstetrics and gynecology, vol. 61, no. 4, 1983, pp. 429-432.
Androgenic Polycystic Ovary Syndrome (PCOS) creates physical/emotional burdens in 4-20% of premenopausal women living with PCOS (WLWP) few menstruations per year, subfertility, hirsutism/acne and low quality of life by validated PCOS Questionnaire (PCOSQ). Combined hormonal contraceptives (CHC), the current standard-of-care, improve PCOSQ only 16%; with stopping CHC, benefits disappear within 6-months. We hypothesize too-fast brain/luteinizing hormone (LH) pulses cause PCOS. Progesterone (P4) slows LH when testosterone (FreeT) is normal. Combining two approved medications, Cyclic P4 with anti-androgen, Spironolactone (Sp), will likely provide effective, durable benefits. WLWP lit-review suggested significant P4 7-14-day benefits. A 6-month prospective feasibility study of CyclicP4/Sp is necessary. Perform a pilot study in 40 WLWP on Cyclic P4 (300 mg/bedtime, 14 days/month) plus Spironolactone (Sp, 200 mg/d). Assess longitudinal within-WLWP 6-month 1) PCOSQ; 2) FreeT, HbA1c, and LH; plus 3) WLWP's acceptance of CyclicP4/Sp. Single-centre, prospective, longitudinal single cohort study. Recruit \~7-8 WLWP/month over 4-6 months; 85% retention. Eligible WLWP have physician-diagnosed PCOS, are 1-month off CHC/metformin, ages 19-35 (avoiding adolescence/perimenopause), HbA1c <6.4% (no diabetes) and commit to non-hormonal contraception, if needed. Recruitment uses online, internet, strategic ads and tear-tab posters. Measures at 0 and 6 as above plus K+ (safety assessment). Menstrual Cycle Diary monitoring (flow, adherence), 2 visits, monthly telephone/emails for support and assessment of any adverse effects. changes by paired T-test.
A feasibility 6-month study of CyclicP4/Sp will facilitate a CIHR-funded RCT of CHC versus this innovative and likely beneficial treatment for WLWP.
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.
The treatment of hirsute women is controversial and often presents a therapeutic dilemma. Mechanical methods (such as shaving or using depilatories) are safe but often unacceptable to the patient, whereas suppression of adrenal or ovarian function may not be effective and may have undesirable side effects. An alternative approach is the use of a drug that blocks androgen action at the hair follicle. Such blocking should be successful whether the source of the excess androgen is ovarian or adrenal. Because cimetidine has recently been found to have antiandrogenic activity, 1 2 3 we used it to treat severely hirsute women and assessed its . . .