Oral contracpetives may be effective for treating hirsutism

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Oral contraceptives
Spironolactone
Flutamide
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Oral Contraceptives for Hirsutism

Oral contraceptives are one of the most popular medications in the therapy of females with hormonal disorders. The associated conditions of hirsutism and other androgen overproduction related ailments (most commonly polycystic ovary syndrome) are clinically treated by the use of oral contraceptive pills (OCPs).

The treatment procedure is the blocking of ovarian steroid production with the use of estrogen and progestins contained in oral contraceptive pills.

OCPs are also combined with androgen blocking (at hair follicles) drugs like spironolactone, flutamide and finasteride. These combinations work well to reduce side effects and to increase cosmetic results.

Treatment of hirsutism with OCPs

OCPs block ovarian androgen production and hence treat hyperandrogenism. The combined action of estrogen and progesterone in OCPs help curb gonadotropin secretion and the ‘mid-cycle’ gonadotropin stimulus. The outcome is a curb on ovarian steroidogenesis. Moreover, the estrogen and progestin work independently to treat hirsutism as well.

Estrogen raises circulating levels of SHBG and hence lessens the free testosterone count in the serum. Progestins on the other hand plug 5a-reductase action. Hence, it works against androgen receptors and at the same time boosts the metabolic clearance rate (MCR) of both testosterone and DHT.

Ethinyl estradiol and a synthetic progestin is an essential component of all OCPs. The dose of ethinyl estradiol fluctuates from as low as 20 mg in the newer pills to 50 mg in older drugs. Many types of progestins are included in OCPs, some with greater androgenic potency than others.

The low androgenic potency progestins are norgestimate, desogestrel and gestodene. While the high androgenic activity, progestins are levonorgestrel and norgestrel. However, there have been no clinical conclusions that lower androgenic progestins are successful in hirsutism therapy.

Treatment with OCPs is generally adviced for 1 to 2 years. Research has also reported that serum androgen levels can be effectively controlled for up to 2 years after stopping the OCPs. This ensures long-term benefits even after therapy is stopped.

Cyproterone acetate and drospirenone are the two OCPs that have proved highly effective in treating hirsutism. Cyproterone acetate, an androgen blocker, can be administered singly or combined with ethinyl estradiol as a contraceptive (Dianette) for effective treatment of PCOS triggered hirsutism. Another oral contraceptive Yasmin, contains Drospirenone, which also works well on women with PCOS-related hirsutism. Drospirenone is an anti-androgenic progestin derived from 17a-spironolactone and similar in activity to spironolactone. Drospirenone has a three-pronged action:

  1. Blocking androgen receptors
  2. Suppressing ovarian androgen synthesis
  3. As it works against aldosterone it also has diuretic results that helps lessen premenstrual symptomatology, such as abdominal bloating and breast tenderness.

In a survey conducted on 82 women, use of Yasmin reported considerable decrease of facial hair production and in some patients a total cure of hirsutism.

Treatment of acne vulgaris with OCPs

Since OCPs suppress serum androgen concentration, it has also proved beneficial in treating acne vulgaris. In fact, it is the most popular therapy in young females with acne and seeking contraception.

Research demonstrating the effectiveness of OCPs in acne treatment was reported since the 1980s, but the first randomized placebo-controlled survey results was published much later in 1997.

A clinical evaluation of an OCP with norgestimate content vis-à-vis a placebo administered for six phases in females with average acne vulgaris came up with positive results. In both methods, there was a decrease in degree of scars (comedones, papules, pustules and nodules).

It has been suggested that such acne therapy have a considerable placebo effect since the patients are also asked to follow a healthy skin-care routine simultaneously. However, the OCP using patients reported better results than the placebo ones.

Disadvantages of OCPs

There are two major contentions so far, as OCPs are concerned. Here is an overview:

1. There is a controversy that the effectiveness of OCPs on hirsutism cases might be reduced on obese patients, since around 50 percent of women with PCOS suffer from obesity. One group of researchers reported that obese PCOS females did not show any improvement in hirsutism after 6 months of OCP usage, while there was marked change in F–G scores in lean PCOS patients. Lean PCOS patients registered a striking fall in serum testosterone and androstenedione levels, while the serum testosterone fall in obese cases was negligible and there was no change in androstenedione levels at all.

2. The side effect of OCPs on carbohydrate metabolism is the other area of concern among PCOS patients. This happens because many of them suffer from insulin resistant, glucose intolerant or are frankly diabetic. There have been various theories regarding this, probably depending on the kind of OCP formulations used in the survey.


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