Spironolactone as a single agent for long‐term therapy of hirsute patients

OBJECTIVE To assess the androgen‐suppressing effect of spironolactone, and the use of this drug as a single agent in the long‐term therapy of hirsute patients with either polycystic ovary syndrome (PCOS) or idiopathic hirsutism (IH). Standard cyproterone acetate (CPA) treatment was used to evaluate the results obtained with spironolactone. DESIGN Prospective randomized study. PATIENTS Forty‐six hirsute women were separated randomly into two groups, stratified for polycystic ovary syndrome. For 12 months, Group 1 (21 patients, 10 PCOS) received spironolactone only (200 mg/day). Group 2 (23 patients, nine PCOS) received CPA (50 mg/day) with ethinyl oestradiol (35 μg/day). MEASUREMENTS Ferriman–Gallwey clinical score for hirsutism and serum testosterone, androstenedione, and LH levels. RESULTS In IH patients, hirsutism regressed equally with spironolactone (21 ± 2–14.5 ± 2) and CPA (23 ± 2–13 ± 2). In PCOS patients, the mean score for hirsutism after 12 months was significantly lower with CPA (12 ± 1) than with spironolactone (16 ± 1). Testosterone levels did not change with spironolactone; with CPA there was a decrease from baseline in PCOS (47% and 51%, 6 and 12 months) and IH patients (31% and 30%). Androstenedione levels also declined from baseline in CPA‐treated PCOS patients (38% and 39%, 6 and 12 months). Androgen levels were significantly different between the groups after 6 and 12 months. LH levels decreased with CPA (72%) but not with spironolactone. CONCLUSION Our results suggest that spironolactone used as a single agent is as effective as cyproterone acetate combined with oestradiol for long‐term treatment of patients with idiopathic hirsutism. In PCOS patients, spironolactone is still effective for reducing hirsutism; however, for treatment of the hormonal or metabolic manifestations associated with PCOS, it may be necessary to combine spironolactone with either an antigonadotrophic agent or a drug that improves peripheral insulin sensitivity.