Relapse of hirsutism following long-term successful treatment with oestrogen-progestogen combination

OBJECTIVE While several forms of treatment have been reported to be success ful in relieving hirsutism over periods of 6-12 months, there is little if any information on the long-term outcome of hirsutism following the withdra wal of successful treatment. The combination of ethinyl oestradiol, 35 mu g , and cyproterone acetate, 2 mg (EE-CA) for 21 days followed by 7 days with out treatment is widely used in a cyclical manner in the treatment of hirsu tism. The present study was undertaken to evaluate the outcome of withdrawa l of long-term successful treatment of hirsutism with EE-CA. DESIGN, PATIENTS AND MEASUREMENT In this retrospective study the clinical r ecords of 57 patients with idiopathic hirsutism or polycystic ovary syndrom e who had been treated with EE-CA were reviewed. The degree of hirsutism ha d been assessed by the Ferriman and Gallwey scoring system (FG). The testos terone/sex hormone binding globulin ratio (T/SHBG), was derived prior to an d following the introduction of treatment with EE-CA. RESULTS Fifty-two of the 57 patients achieved a satisfactory clinical respo nse. In the group of patients who were satisfied with the outcome of treatm ent, FG decreased from 12.9 +/- 3.6 to 5.5 +/- 2.5 and T/SHBG ratio decreas ed from 11.3 +/- 9.5 to 1 +/- 0.8 (reference range: 1-5.2). The duration of treatment prior to its withdrawal in this group was 28.2 +/- 13.7 months. The five patients who were not satisfied with the response abandoned treatm ent after 16 +/- 2.8 months; the pretreatment FG was 16.2 +/- 8.3, while th e T/SHBG decreased from 6.1 +/- 3.1 to 1.1 +/- 0.6 in these patients. Subse quent follow-up data, after withdrawal of treatment, were available on 34 o f these 52 patients. Twenty-eight of the 34 patients exhibited relapse of h irsutism after 6.15 +/- 2.8 months. Six patients did not relapse during a f ollow-up period of 18.8 +/- 7.8 months. The six patients who did not relaps e were treated for a significantly longer period than the group who relapse d, 40 +/- 6.9 and 26.1 +/- 8.3 months, respectively, P < 0.01. However, the groups did not differ significantly when examined for pretreatment FG, 11. 5 +/- 3.8 and 13.2 +/- 3.6 and pretreatment T/SHBG 8.9 +/- 5 and 13.4 +/- 1 1.9. CONCLUSION These data indicate that ethinyl oestradiol and cyproterone acet ate achieved a satisfactory clinical outcome in the treatment of hirsutism in 90% of patients. However, on withdrawal of treatment after a mean durati on of over 2 years, relapse occurred in 80% of these patients after a mean of 6 months. If it is assumed that the successfully treated patients lost t o follow-up all maintained long-term remission, the relapse rate is still a n unsatisfactory 65% at 6 months. These are disappointing results which ind icate for the first time that successful outcome requires that treatment be maintained for several years. Patients embarking upon treatment for hirsut ism should be advised that maintenance of reduced hair growth requires long -term treatment, probably for at least 3-4 years.