Comparative analysis between ethinyl estradiol & cyperoterone acetate with or without metformin therapy in the treatment of polycyctic ovarian syndrome induced hirsutism

Abstract

Background Hirsutism is growth of terminal hair in male pattern distribution in females. The great majority of these women have polycystic ovarian syndrome (PCOS). Current evidence suggests that patients with PCOS, whether slim or obese, have elevated levels of insulin which stimulates androgen production from ovaries, leading to hirsutism. Metformin has been shown to be effective in reducing serum insulin levels and in turn its effects.Objectives To assess the effect of oral metoformin in hirsutism.Patients and method 160 patients of hirsutism were divided in two groups. Patients in group I were administered ethinyl estradiol 35μg with cyproterone acetate 2mg (Diane 35®) for 21 days and 100mg cyproterone acetate for first ten days of the menstrual cycle. While patients in group II were administered metformin 1000mg per day in addition to the above regime. Patients were followed up at 1, 3, 6 and then 9 months interval. The variables assessedincluded; degree of hirsutism, menstrual cyclicity, body mass index, luteinising hormone,follicle stimulating hormone levels and LH/FSH ratio.Results 137 patients were evaluable whereas 23 patients lost to follow up. Out of 68 patients in group I, 22/31 (70.9%) patients with severe hirsutism improved to moderate. While 16/26 (61.5%) patients with moderate hirsutism improved to mild. Among the 69 patients of group II, 24 (72.7%) with severe hirsutism and 14 (63%) with moderate hirsutism improved to moderate and mild, respectively. However, there was little statistical difference between tworegimes (p>0,05). Menstrual cyclicity improved in 41.1% of group I patients but in 79.7% of group II patients (p<0.05). Body mass index decreased in 23% of group I but in 44% of group II patients (p<0.05). Significant decrease in luteinising hormone and LH/FSH ratio with an increase in follicle stimulating hormone levels were seen.Conclusion Metformin was found to be only marginally effective in treating hirsutism, but was highly effective in regulating menstrual cycle and decreasing obesity. It may also have an effect on improving fertility.