Cyproterone Acetate and Ethinyl Estradiol Combination Improves Hyperandrogenism in Females

10 Nov, 21

Introduction

Polycystic ovary syndrome (PCOS), a common endocrine disorder, is characterised by menstrual irregularities, insulin resistance, chronic anovulation, associated infertility and hyperandrogenism. Hyperandrogenism manifests as acne, hirsutism, seborrhea, and alopecia. Combined oral contraceptives (COC) are generally preferred in women with PCOS who do not wish to become pregnant. Cyproterone acetate, a progestin, acts as an androgen receptor antagonist and effectively reduces acne and hirsutism.

Aim

This study evaluates the efficacy and safety associated with long-term use of combination of ethinyl estradiol and cyproterone acetate for the management of hyperandrogenism in women with PCOS.

Method

Study Design

Prospective study.

Treatment Strategy

The study population comprised 20 women with androgenic symptoms like acne, hirsutism and alopecia.
Acne was graded according to the number of comedones, papules or pistules present over face, neck or chest as mild (<10 score), moderate (10-25 score) and sever (>25 score).
Ferryman Gallway score was used to grade hirsutism as mild, moderate and severe with scores 7-9, 10-14 and >15 respectively.
All the patients took the cyproterone acetate 2 mg and ethinyl estradiol 0.35 µg from day 1 for 21 days in cyclic form.
Follow up was done at 6 months to 1 year.

Endpoints

Acne
Hirsutism
Menstrual irregularities
Side effects

Results

Out of the 20 women enrolled, 80% were married and 65% were aged between 21-30 years.
Distribution of patients according to symptoms at baseline is shown in Figure 1.

Figure 1. Distribution of patients according to symptoms

At cycle 3, papules disappeared in 40% and 71% of the cases with mild hirsutism showed improvement.
The proportion of cases showing improvement in the androgenic symptoms at cycle 3, cycle 6 and >6 cycles is seen in Figure 2.

Figure 2. % cases with improvement in androgenic symptoms

After 6 cycles, all cases had complete resolution of papules and hirsutism.
Severe headache and nausea were reported by 1 woman.

Conclusion

Combination of cyproterone acetate and ethinyl estradiol was effective in reducing the hyperandrogenic symptoms in women.
The menstrual cycles were normalised in 3 cycles.
Acne and hirsutism completely resolved after 6 cycles of treatment.
The treatment was well tolerated in all but one who had severe headache and nausea.

Int J Contemp Med Res 2016;3(4):989-992.