Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism.
OBJECTIVE
To compare second versus third generation combination oral contraceptives (OCs) in the treatment of hirsutism.


METHODS
Women with hirsutism, as defined by a minimum Ferriman-Gallwey score of 10, were randomized in a double-blind fashion to receive an OC containing either ethinyl estradiol/desogestrel or ethinyl estradiol/levonorgestrel for 9 months of treatment. Ferriman-Gallwey scores, androgen levels and sex hormone-binding globulin were measured at baseline and every 3 months for the duration of the study. Hormones were measured in duplicate by radioimmunoassay.


RESULTS
Of the 47 women enrolled, 24 were randomized to ethinyl estradiol/desogestrel and 23 were randomized to ethinyl estradiol/levonorgestrel. Mean sex hormone-binding globulin increased significantly in subjects using the desogestrel-containing contraceptive compared with the levonorgestrel-containing contraceptive. Ten subjects completed the 9 months of treatment in the levonorgestrel group and 11 completed the study in the desogestrel group. Mean free testosterone and 3alpha-androstanediol glucuronide decreased significantly in the group receiving ethinyl estradiol/desogestrel but not in the ethinyl estradiol/levonorgestrel group. Mean Ferriman-Gallwey scores decreased significantly in both treatment groups. Improvement in mean Ferriman-Gallwey score was 35.7 +/- 38.1% (p < 0.001) for the ethinyl estradiol/desogestrel arm and 33.4 +/- 27.3% (p < 0.001) for the ethinyl estradiol/levonorgestrel arm. There were no statistically significant differences found in the improvement of Ferriman-Gallwey scores between the two treatment arms, although the power to detect a difference was limited by the small sample size.


CONCLUSIONS
Treatment of hirsute women with third generation OCs containing desogestrel results in a significant increase in sex hormone-binding globulin and decrease in free testosterone and 3alpha-androstanediol glucuronide. Both second and third generation OCs were clinically effective in treating hirsutism.
Department of Obstetrics and Gynecology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0587, USA. dmbreitk@utmb.edu
Daniel M
DM
Breitkopf
Mitchell P
MP
Rosen
Steven L
SL
Young
Manubai
M
Nagamani
D000293:Adolescent; D000328:Adult; D000728:Androgens / Q000097:blood; D003277:Contraceptives, Oral, Combined / Q000627:therapeutic use*; D017135:Desogestrel / Q000008:administration & dosage; D004311:Double-Blind Method; D004997:Ethinyl Estradiol / Q000008:administration & dosage; D005260:Female; D006628:Hirsutism / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage; D008875:Middle Aged; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism; D016896:Treatment Outcome
D000728:Androgens; D003277:Contraceptives, Oral, Combined; D012738:Sex Hormone-Binding Globulin; D004997:Ethinyl Estradiol; D016912:Levonorgestrel; D017135:Desogestrel