COMPARISON OF 4 DIFFERENT TREATMENT REGIMES IN HIRSUTISM RELATED TO POLYCYSTIC-OVARY-SYNDROME

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this synd rome. Pelvic ultrasonography was performed on all patients who were re ferred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 pat ients were included in the study. Patients were divided into four grou ps in regard to the drug chosen for treatment. Group 1 (n = 48) receiv ed low-dose combined oval contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-da y cycle with an oval contraceptive containing 2 mg cyproterone acetate , Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily. All patients were followed f requently with respect to side-effects, hirsutism scoring, and lipid a nd hormonal levels. All four drug regimens weve effective in the treat ment of hirsutism related to polycystic ovary syndrome, but the most e ffective seemed to be ketoconazole. The decrement level in hirsutism s coring was the largest in the ketoconazole group, followed by the cypr oterone, oval contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05 ). Although high-density lipoprotein-cholesterol levels increased in a ll groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0. 05), but not statistically different from that in Group 3 (22.3 +/- 5. 9%). The free testosterone levels decreased after treatment in all gro ups, but the decrement ratios did not differ significantly among group s, although the decrease in free testosterone levels with treatment se emed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respe ctively). In conclusion, ketoconazole seems to be an excellent alterna tive to more-recognized therapies, but its effect on lipoprotein profi le requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also b e treated.