COMBINATION GONADOTROPIN-RELEASING-HORMONE AGONIST AND ORAL-CONTRACEPTIVE THERAPY IMPROVES TREATMENT OF HIRSUTE WOMEN WITH OVARIAN HYPERANDROGENISM

Objective: To determine if combination GnRH agonist (GnRH-a) and oral contraceptive (OC) therapy was more effective than GnRH-a or OC alone in the treatment of hirsute women with ovarian hyperandrogenism. Design: Thirty-three hirsute women (ages 15 to 39 years) were randomized into three groups: 3.75 mg IM leuprolide acetate (LA) depot every 28 days for 6 months, combination monophasic oral contraceptive for 6 months (OC), or GnRH-a plus OC for 6 months (LA + OC). Main Outcome Measures: Comparative studies of changes in hormonal and hair parameters were performed at baseline, 3, and 6 months after starting therapy. Results: After 6 months, serum T and LH levels were decreased significantly in all groups although reduction was greater in GnRH-a groups than OC alone. The reduction of free T was significantly greater with LA + OC compared with LA or OC alone. This could be a consequence of the significant rise in sex hormone-binding globulin (SHBG) in LA. + OC and OC groups compared with LA in which there was no change in SHBG. Reduced facial hair density and decrease in hirsutism score was observed in both GnRH-a groups after 6 months. Conclusion: ''Add-back'' OC therapy used in combination with a GnRH-a increases SHBG and more effectively lowers free T levels in women with ovarian hyperandrogenism. Enhanced suppression of ''bioavailable'' androgens with combined GnRH-a and OC therapy failed to improve significantly the therapeutic effect of GnRH-a treatment alone on hirsutism.