Women with Polycystic Ovarian syndrome are commonly prescribed oral contraceptives for the reducing effect of anti-androgens on symptoms such as acne and hirsutism. I don't have great medical knowledge, but I'm just curious as to whether a separate form of hormonal therapy exist specifically for PCOS that would reduce the side effects many experience from birth control?
1 Answer
This is a reasonably recent review of old and new treatments for polycystic ovary syndrome (PCOS).
Bednarska S, Siejka A. The pathogenesis and treatment of polycystic ovary syndrome: What's new? Adv Clin Exp Med. 2017 Mar-Apr;26(2):359-367. doi: 10.17219/acem/59380. PMID: 28791858.
https://pubmed.ncbi.nlm.nih.gov/28791858/
As indicated in this review, combined estrogen/progestin oral contraceptives that have anti-androgenic effects are the “first line” recommendation for women with PCOS not seeking to become pregnant because they:
“restore regular periods, reduce symptoms of hyperandrogenism (hirsutism, acne, alopecia) and reduce risk of endometrial hyperplasia”
The review identifies the following non-OC anti-androgenic medications that are used to treat women with PCOS:
GnRH (gonatrophen releasing hormone) analogs, ketoconazole, steroids, spironolactone, and flutamide. (an androgen receptor antagonist). Finasteride (a 5-alpha reductase inhibitor) is mentioned as a medication that can be used specifically to manage alopecia in women with PCOS.
All of these non-OC antiandrogenic treatments used to treat PCOS are also associated with side effects, described in Table 2 of the review.
A second reasonably recent review of PCOS recommends against flutamide in women with PCOS because of it is hepatotoxic and expensive.
McCartney CR, Marshall JC. CLINICAL PRACTICE. Polycystic Ovary Syndrome. N Engl J Med. 2016 Jul 7;375(1):54-64. doi: 10.1056/NEJMcp1514916. PMID: 27406348; PMCID: PMC5301909.
https://pubmed.ncbi.nlm.nih.gov/27406348/
This review mentions that:
“Antiandrogens may disrupt androgen-dependent processes (e.g., formation of external genitalia) in a male fetus; this mandates concomitant use of reliable contraception.”
Thus, while there are non-OC anti-androgens that can be used to manage hirsutism and acne (and alopecia) in women with PCOS, these medications are not without side effects that might be worse than OCs and a woman taking these non-OC anti-androgens would still need to use contraception if fertile.
