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Hair Loss Study Abstract: Sequential estrogen-progestin addition to gonadotropin-releasing hormone agonist suppression for the chronic treatment of ovarian hyperandrogenism
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Title
Sequential estrogen-progestin addition to gonadotropin-releasing hormone agonist
suppression for the chronic treatment of ovarian hyperandrogenism: a pilot study.
Author
Lemay A; Faure N
Address
Endocrinologie de la Reproduction, Hôpital St-François d'Assise, Québec, Canada.
Source
J Clin Endocrinol Metab, 79: 6, 1994 Dec, 1716-22
Abstract
The purpose of the study was to evaluate the efficacy and safety of a sequential regimen
of estrogen-progestin addition to GnRH agonist suppression in ovarian hyperandrogenism.
Eight patients presenting with a polycystic ovary syndrome were treated with an sc implant
of GnRH agonist every 4 weeks for 48 weeks. Starting at week 9, patients were replaced
with 100 micrograms transdermal estradiol patches continuously and sequentially combined
with 10 mg oral medroxyprogesterone acetate the last 2 weeks of each 4-week period. The
rapid down-regulation of the pituitary-ovarian axis led to significant reduction of
testosterone and androstenedione to 48.9% and 67.4% of baseline, respectively. During
steroid replacement, testosterone and androstenedione continued to decrease gradually. The
baseline hirsutism score (18.7 +/- 1.3) progressively fell to 9.7 +/- 2.0 at the end of
treatment. The mean hair diameter was significantly reduced (0.097 +/- 0.004 vs. 0.081 +/-
0.005 mm). A withdrawal bleeding was obtained in 63.6% of the artificial cycles, but
breakthrough bleeding occurred during 48% of the sequential replacements. The incidence of
menopausal symptoms was low. There was a nonsignificant decrease in bone mineral content
of the lumbar spine and the femoral neck but no trend in Ca2+/creatinine and OH-proline
(OH-P)/creatinine ratios or in serum triglycerides and cholesterol fractions. There was a
nonsignificant increase in hirsutism score in five patients followed up for 24 weeks after
cessation of treatment, although there was a rapid return of hormones toward baseline and
recurrence of irregular bleeding. Transdermal estradiol addition periodically combined
with medroxyprogesterone acetate is effective in reducing hirsutism and is safe in
minimizing side effects and bone loss. A regimen allowing a better bleeding control would
make this approach a valuable alternative for prolonged or repeated palliative treatment
of excessive hair growth and irregular bleeding in polycystic ovary syndrome.
Language of Publication
English
Unique Identifier
95081286
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