MedifocusHealth

Obesity

It is very important for obese women with polycystic ovary syndrome (PCOS) to commence a supervised weight loss and exercise program as soon as possible. Research has shown that shedding as little as 7% of body weight can initiate the improvement of many symptoms of PCOS. A nutritionist can be very helpful in terms of information about healthy diet and nutrition and helping to set short and long-range goals for an effective weight reduction program. The evidence regarding the effect of treatment with metformin on weight loss is unclear.

Women with PCOS should also consult with the health care provider regarding development of a safe, individualized exercise program.

Hirsutism

The goal in treating hirsutism is to prevent the growth of new hair while controlling the growth of current hair. Hirsutism may be treated with medications or various types of hair removal.

Drug Therapy

• Oral contraceptives (e.g., Yasmin) - The FDA has not approved any oral contraceptives specifically for the treatment of hirsutism. However, they are widely used and their efficacy is well established.

• Antiandrogens

  • Spironolactone is highly effective for the treatment of hirsutism but does not have FDA approval for this indication. Some researchers report a 40-80% reduction in hair growth with this medication. It is the most widely used antiandrogen for treatment of hirsutism in the US.

  • Flutamide is effective but may carry the risk of liver toxicity. Its efficacy is very similar to spironolactone.

  • Cyproterone acetate - Cyproterone is a progestin which is effective in the treatment of hirsutism and is often combined with oral contraceptives to enhance its effect. Due to the possibility that it may be teratogenic (cause birth defects) it is not currently available in the US.

  • Ketoconazole - Ketoconazole is an antifungal agent that has some antiandrogenergic properties. It is considered as an alternative drug if a patient cannot tolerate other more effective medications.

• 5-alpha Reductase Inhibitors

  • Finasteride - This drug is an enzyme inhibitor and interferes with enzymes in the hair follicle. It is comparable with the antiandrogens and is reported to be as effective as spironolactone.

• Glucocorticoids

  • Dexamethasone is a glucocorticoid which may be used if there is adrenal androgen excess causing hirsutism. It is often given in combination with antiandrogens or oral contraceptives to enhance its effect.

• Insulin Sensitizing Agents

  • Metformin is a widely used insulin-sensitizing agent. Some research indicated that after 6 months on a regimen of metformin combined with dieting, some patients experienced a 10% reduction on their Ferriman-Gallwey scores. It also helps to prevent the metabolic syndrome.

  • Glitazones - Troglitazone was removed from the market due to hepatotoxicity (liver toxicity) and there is insufficient data at this time regarding the efficacy of rosiglitazone and pioglitazone on hirsutism.

• Biologic Modifiers of Hair Growth

  • Eflornithine HCL (Vaniqa) - This topical cream inhibits the enzyme in the hair follicle that stimulates hair growth. It is used only on the face and can cause burning and stinging. Improvement is gradual and if no change is noted within 6 months some doctors recommend discontinuing the cream. Reports of success vary with some studies indicating that one-third of women experience moderate or marked improvement but the effect is usually temporary. There have been no clinical studies demonstrating safety and efficacy of this cream for use in adolescents with hirsutism. It can be 6-12 months before benefit is actually seen. In some women, it can take up to 18 months before any improvement is observed.