Metformin or Antiandrogen in the Treatment of Hirsutism in Polycystic Ovary Syndrome
Lyndal Harborne,
Richard Fleming,
Helen Lyall,
Naveed Sattar and
Jane Norman
University Department of Obstetrics and Gynecology, Royal Infirmary, Glasgow, Scotland, United Kingdom G31 2ER
Address all correspondence and requests for reprints to: Dr. Richard Fleming, University Department of Obstetrics and Gynecology, Level 3 QEB, Royal Infirmary, Glasgow, Scotland, United Kingdom G31 2ER. E-mail: gqta13{at}udcf.gla.ac.uk.
Hirsutism is a common and distressing symptom frequently encounteredin women with polycystic ovary syndrome (PCOS), who also showrelative insulin resistance. The aim of this trial, in whichhirsutism was the primary end point, was to compare the efficacyof the oral antihyperglycemic medication metformin with thatof an established treatment, combined ethinyl estradiol andcyproterone acetate. Patients (n = 52) were randomized to receiveeither metformin (500 mg, three times daily) or Dianette (ethinylestradiol, 35 µg; cyproterone acetate, 2 mg) treatmentfor 12 months, with assessments before treatment, at 6 months,and at 12 months. Both objective and subjective methods of evaluatinghirsutism were used, and in addition, patient perceptions wereexamined. The results show that metformin is potentially aneffective treatment for moderate to severe hirsutism in womenwith PCOS. They also suggest that in some respects (Ferriman-Gallweyscore and patient self-assessment), it is more efficacious thanthe standard treatment (Dianette). The objective evaluationof hair diameter reduction showed that both treatments weremoderately effective at multiple anatomical sites. Dianettetreatment was responsible for profound suppression of androgenactivity, in contrast to metformin, which induced negligiblechange. However, metformin did reduce markers of insulin resistance.The data suggest that hirsutism may be effectively treated byreducing hyperinsulinemia.
Current address for L.H.: Division of Obstetrics and Gynecology,John Hunter Hospital, Lookout Road, New Lambton, 2305 New SouthWales, Australia.
Abbreviations: BMI, Body mass index; CL, confidence limits;CV, coefficient of variation; DHEAS, dehydroepiandrosteronesulfate; FG, Ferriman-Gallwey; HOMA-IR, homeostasis assessmentfor insulin resistance; IGFBP, IGF-binding protein; OAM, oralantihyperglycemic medication; PCOS, polycystic ovary syndrome.
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