THE ROLE OF ORAL-CONTRACEPTIVES IN THE TREATMENT OF HYPERANDROGENIC DISORDERS

The clinical manifestations associated with hyperandrogenism, such as hirsutism and acne, are disturbing to most patients. In addition to co rrecting androgen-related problems, concerns such as contraception or other metabolic problems (for example, lipid/lipoprotein abnormalities , diabetes, hypertension) associated with these disorders and the effe cts of unopposed estrogen on the endometrium also need to be considere d. Oral contraceptives are a therapeutic modality that may address the se multiple problems. The potential mechanisms of action by which oral contraceptives correct excess androgen states include gonadotropin su ppression, reduction of circulating androgens, increased androgen bind ing, suppression of adrenal androgen secretion and inhibition of 5 alp ha-reductase, and androgen receptor binding. In normal women, there is good evidence that these actions occur with the use of oral contracep tives. Among women with anovulatory hyperandrogenic states, such as po lycystic ovary syndrome, the response to oral contraceptives in each o f these areas is somewhat more variable. However, oral contraceptive p reparations that are more estrogen dominant appear to produce many of the desired effects. From a clinical standpoint, 60-100% of women with hirsutism improve on oral contraceptives; acne shows improvement in a high percentage of women as well. The use of oral contraceptives also reduces the risk of endometrial hyperplasia that may be associated wi th anovulatory states. Finally, current low-dose preparations containi ng the newer progestins (for example, norgestimate and desogestrel) ap pear to be either neutral, or perhaps beneficial, with respect to thei r metabolic impact.