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J Womens Health (Larchmt). 2018 Jul;27(7):892-902. doi: 10.1089/jwh.2017.6833. Epub 2018 Jun 7.

Long-Term Response of Hirsutism and Other Hyperandrogenic Symptoms to Combination Therapy in Polycystic Ovary Syndrome.

Ezeh U1,2,3, Huang A4, Landay M4, Azziz R2,3,4,5,6.

Author information

1
1 Department of Obstetrics and Gynecology, Stanford Healthcare-ValleyCare Hospital, Pleasanton, California.
2
2 Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia .
3
3 Center for Androgen-Related Disorders, Cedars-Sinai Medical Center, Los Angeles, California.
4
4 Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
5
5 Department of Medicine, Medical College of Georgia, Augusta University , Augusta, Georgia .
6
6 State University of New York (SUNY) System Administration , Albany, New York.

Abstract

BACKGROUND:

Polycystic ovary syndrome (PCOS) affects 5%-15% of women and is the most common cause of hirsutism. Data on the time-course of improvement to suppressive therapy and predictors of that response in PCOS are lacking. The objectives of our study are to determine the long-term response and identify predictors of response in PCOS women treated with suppressive therapy, including spironolactone (SPL) + oral contraceptives (OCs).

MATERIALS AND METHODS:

Retrospective cross-sectional analysis of 200 women with PCOS (1990 NIH criteria) treated with suppressive therapy in general, and a subgroup of 138 subjects treated with OCP+SPL who had been prospectively included in a biorepository. Main outcome measure included improvement rate per 100 person-month of follow-up for hirsutism, menstrual irregularity and acne measured qualitatively as "feeling better", and changes in the severity of hirsutism quantified by modified Ferriman-Gallwey [mF-G] score.

RESULTS:

During a mean follow-up of 34.2 months, 85.1%, 82.7%, and 79.3% of patients reported improvement in hirsutism, menstrual dysfunction, and acne, respectively. The modified Ferriman-Gallwey (mF-G) hirsutism score improved by 59.9%. The net reduction in mF-G score and the percent of patients reporting improvement in hirsutism were greater for OC+SPL than for either drug alone, with no difference in the percent of patients free of adverse effects. Among those treated with OC+SPL (nā€‰=ā€‰138), the initial mF-G and sex hormone-binding globulin (SHBG) independently predicted successful therapy for hirsutism.

CONCLUSION:

There is a high rate of patient satisfaction with suppressive therapy in PCOS. The efficacy of suppressive therapy for hirsutism was greater with OC+SPL than with either drug alone. Successful treatment of hirsutism with combination OC+SPL requires at least 6 months of therapy, with the proportion of satisfied patients continuing to increase with treatment duration. The probability of patient satisfaction with OC+SPL treatment for hirsutism can be predicted by her initial mF-G score or SHBG level.

KEYWORDS:

PCOS; combination oral contraceptive; predictors; spironolactone; treatment success

PMID:
29878857
PMCID:
PMC6065519
[Available on 2019-07-01]
DOI:
10.1089/jwh.2017.6833
[Indexed for MEDLINE]

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