ORAL-CONTRACEPTIVE PILLS, GONADOTROPIN-RELEASING-HORMONE AGONISTS, ORUSE IN COMBINATION FOR TREATMENT OF HIRSUTISM - A CLINICAL RESEARCH-CENTER STUDY

The effectiveness of oral contraceptive pills (OCPs), GnRH agonist (Gn RH-a), and a combination of OCPs and GnRH-a in the treatment of hirsut e women was compared and the impact of these treatments on hormonal an d Ca metabolism was investigated. Thirty-three women were prospectivel y enrolled and randomized into three treatment groups (11 in each grou p). The serum levels of LH, estradiol, testosterone, free testosterone , androstenedione, and 17-hydroxyprogesterone declined in all 3 treatm ent groups, whereas the inclusion of GnRH-a treatment tended to promot e a more rapid decrease in these hormone levels. Total cholesterol, lo w density lipoprotein, and high density lipoprotein levels remained un changed. The assessment of hirsutism by the Ferriman-Gallwey score rev ealed a similar 25% reduction in score by all three treatment groups b y 6 months. In addition, no difference was detected between groups wit h respect to hair diameters and the vellus index. Clinical assessment of hirsutism at 3 months by the patients revealed that the GnRH-a and the OCPs-plus-GnRH-a groups had better responses than the group on OCP s alone, but by 6 months all three groups were similar. The symptoms o f hot flashes and vaginal dryness were greatest in subjects treated wi th GnRH-a alone. Serum Ca, phosphorus, alkaline phosphatase, osteocalc in, and 2-h fasting and 24-h urinary Ca excretion levels all increased significantly in subjects treated with the GnRH-a alone, whereas a de crement or no changes occurred for these measurement in the other two groups. The estimated Ca balance was unchanged in the OCPs and the OCP s-plus-GnRH-a groups but declined by 90 mg/day from baseline in the Gn RH-a-treated women (p less than or equal to 0.001). Bone density signi ficantly decreased in the lumber spine in women treated with GnRH-a al one, with a less marked decline in the femoral neck. In contrast, wome n receiving OCPs plus GnRH had increased bone density in the lumbar sp ine. It is concluded that: 1) clinical measures of hirsutism are not d ifferent after 6 months of treatment with OCPs alone, GnRH-a alone, or a combination of the two; 2) the decline in gonadotropins and steroid hormones and improvement in clinical response were more rapid and pro nounced when GnRH-a treatment was added to OCP administration; and 3) the negative impact of GnRH-a alone on Ca balance and bone loss Limits its usefulness as a single agent for long-term therapy of hirsutism.