CLINICAL AND HORMONAL EFFECTS OF GONADOTROPIN-RELEASING-HORMONE AGONIST PLUS AN ORAL-CONTRACEPTIVE IN SEVERELY HIRSUTE PATIENTS WITH POLYCYSTIC OVARY DISEASE

Objective: To evaluate the therapeutic effects of a GnRH agonist (GnRH -a), leuprolide acetate (LA) plus a pill containing ethinyl E(2) plus cyproterone acetate (CPA) in a group of women with severe hirsutism wh o were unresponsive to oral contraceptive (OC) therapy. Design: Twenty -four patients suffering from severe hirsutism secondary to polycystic ovary disease (PCOD) were treated for 12 months with 3.75 mg IM LA ev ery 28 days in association with 0.035 mg/d ethinyl E(2) plus 2 mg/d CP A (Diane; Schering, Berlin, Germany) for 21 d/mo. Setting: Patients we re recruited in the Institute of Obstetrics and Gynecology, St. Bambin o Hospital, University of Catania, Catania, Italy. Hormonal assays wer e performed in the Hormone Laboratories of St. Bambino Hospital, Unive rsity of Catania, Catania, Italy. Main Outcome Measure: Every 3 months the hirsutism score was evaluated. Mean serum concentrations of LH, F SH, E(2), total and free T, androstenedione (A), sex hormone-binding g lobulin (SHBG), and DHEAS were determined. Every 6 months a vaginal ul trasound examination was performed. Results: In all patients after 6 a nd 12 months of treatment with LA plus OC, the hirsutism score improve d significantly. Serum levels of LH, FSH, E(2), total and free T, A, a nd DHEAS decreased significantly, whereas SHBG showed a marked increas e. A significant reduction in the ovarian size was observed. Conclusio n: Gonadotropin-releasing hormone agonist, associated with a pill cont aining CPA, reduced the hirsutism in severely affected women with PCOD who are unresponsive to OC treatment alone.