Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism

To compare the efficacy of two antiandrogens, cyproterone acetate (CPA) and spironolactone, in the treatment of hirsutism. Prospective randomized single-blinded study. A tertiary hirsutism clinic. Forty-two premenopausal patients with hirsutism were selected. Subjects were randomized to receive either 100mg spironolactone and an oral contraceptive (OC) containing 150μg desogestrel and 30μg ethinyl E2 or 50mg CPA daily on days 1 to 10 of the menstrual cycle, which was administered with 35μg ethinyl E2 daily on days 1 to 21. Hirsutism scores were measured according to Ferriman-Gallwey scoring system and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. Hirsutism scores were decreased significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in CPA and spironolactone group were as follows: 19.23%±14.77% and 24.48%±14.27% at 3 months; 39.01%±19.77% and 37.46%±16.90% at 6 months; and 51.89%±20.87% and 46.39%±16.10% at 9 months, respectively. There was a trend toward a better response with CPA treatment, which did not achieve significance. None of the patients stopped treatment because of side effects. The present data suggest that both spironolactone and CPA were similarly effective in treatment of hirsutism.