Endocrine Abstracts

Hirsutism and hair loss are common and distressing problems for patients with PCOS. Both are associated with significant psychological impact, including symptoms of depression and reduced quality of life. Treatment options for hirsutism include non-pharmacological approaches (lifestyle change, cosmetic treatments, direct hair removal methods) and pharmacotherapy. Lifestyle change resulting in weight loss can result in modest improvements in Ferriman-Gallwey scores in addition to benefiting other components of the syndrome. Laser therapy and photoepilation are well-tolerated and effective, especially when repeated treatments are given, but benefits have not yet been documented in the long-term. Topical eflornithine, an inhibitor of ornithine decarboxylase, may be effective but only generally in mild cases and treatment may be discontinued if no improvements are seen after 2–4 months of use. Pharmacological treatments include combined oral contraceptives (OCs), anti-androgens and insulin sensitisers, all of which were shown to be superior to placebo in a recent systematic review of randomised controlled trials. Insulin sensitiser monotherapy is less effective than anti-androgens, used alone or in combination with OCs. Evidence suggests that spironolactone, finasteride and flutamide are equally effective as anti-androgen monotherapy, whereas OCs containing cyproterone acetate or drosperinone are no more effective than OCs without anti-androgenic progestins. Topical minoxidil may be considered as an addition to anti-androgen therapy in the presence of androgenic alopecia. Treatment choice needs to be individualised, recognising that prolonged therapy (at least 12 months) is needed for optimal results. The potential for teratogenicity (feminisation of a male foetus) should also be considered when treating a young woman with an anti-androgen, hence strict contraception is mandatory during treatment and for a month after discontinuation.