Hormonal and clinical effects of GnRH agonist alone, or in combination with a combined oral contraceptive or flutamide in women with severe hirsutism

The objective of this prospective randomized study was to evaluate and comp are the hormonal and clinical effects of long-acting gonadotropin-releasing hormone (GnRH) agonist and a combination of GnRH agonist with combined ova l contraceptive (COC) or flutamide in women with polycystic ovary syndrome (PCOS). Thirty-five hirsute women with PCOS, ranging in age from 19-27 years, were randomly divided into three groups: group A treated with GnRH agonist (n = 12), group B (n = 12) treated with GnRH agonist plus COC and group C (n = 1 1) treated with GnRH agonist plus flutamide for 6 months. Before, at the en d and 6 months after the end of treatment, blood samples were drawn from al l women (in early follicular phase in those with menstrual cycles) to measu re ovarian and adrenal androgens, gonadotropins luteinizing hormone (LH) an d follicle-stimulating hormone (FSH), estradiol and esr, one plasma levels. The results showed that all three protocols had good therapeutic efficacy. A significant reduction in hirsutism was observed in all patients after 6 m onths of therapy, the Ferriman-Gallwey scores dropping to 9 +/- 3 in group A, 10 +/- 4 in group B and 11 +/- 5 in group C. Six months after the end of therapy, the hirsutism score continued to be significantly reduced in all groups. After 6 months of therapy, a reduction in plasma levels of LH, FSH, estrone, estradiol, testosterone, free testosterone, androstenedione anti dehydroepiandrosterone sulfate (DHEAS) was observed in all groups although this was move pronounced in group B and group C. These therapies may be the basis of future treatments that quickly reduce h irsutism and remove its causes by reducing the secretion of ovarian and adr enal androgens and by blocking androgen receptors.