Combination gonadotropin-releasing hormone agonist and oral contraceptive therapy improves treatment of hirsute women with ovarian hyperandrogenism.
OBJECTIVE
To determine if combination GnRH agonist (GnRH-a) and oral contraceptive (OC) therapy was more effective than GnRH-a or OC alone in the treatment of hirsute women with ovarian hyperandrogenism.


METHODS
Thirty-three hirsute women (ages 15 to 39 years) were randomized into three groups: 3.75 mg IM leuprolide acetate (LA) depot every 28 days for 6 months, combination monophasic oral contraceptive for 6 months (OC), or GnRH-a plus OC for 6 months (LA + OC).


METHODS
Comparative studies of changes in hormonal and hair parameters were performed at baseline, 3, and 6 months after starting therapy.


RESULTS
After 6 months, serum T and LH levels were decreased significantly in all groups although reduction was greater in GnRH-a groups than OC alone. The reduction of free T was significantly greater with LA + OC compared with LA or OC alone. This could be a consequence of the significant rise in sex hormone-binding globulin (SHBG) in LA + OC and OC groups compared with LA in which there was no change in SHBG. Reduced facila hair density and decrease in hirsutism score was observed in both GnRH-a groups after 6 months.


CONCLUSIONS
"Add-back" OC therapy used in combination with a GnRH-a increases SHBG and more effectively lowers free T levels in women with ovarian hyperandrogenism. Enhanced suppression of "bioavailable" androgens with combined GnRH-a and OC therapy failed to improve significantly the therapeutic effect of GnRH-a treatment alone on hirsutism.
Elkind-Hirsch
K E
KE
Baylor College of Medicine, Houston, Texas, USA.
Anania
C
C
Mack
M
M
Malinak
R
R
D000293:Adolescent; D000328:Adult; D003276:Contraceptives, Oral / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004717:Endometrium / Q000473:pathology; D004997:Ethinyl Estradiol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006628:Hirsutism / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications* / Q000473:pathology; D016729:Leuprolide / Q000008:administration & dosage / Q000627:therapeutic use*; D007986:Luteinizing Hormone / Q000097:blood; D009640:Norethindrone / Q000008:administration & dosage / Q000627:therapeutic use; D010049:Ovarian Diseases / Q000150:complications* / Q000473:pathology; D013739:Testosterone / Q000097:blood
D003276:Contraceptives, Oral; D013739:Testosterone; D004997:Ethinyl Estradiol; D007986:Luteinizing Hormone; D016729:Leuprolide; D009640:Norethindrone