Will Slynd (drospirenone) treat hirsutism in Polycystic Ovary Syndrome (PCOS)?

Slynd (Drospirenone) for Hirsutism Treatment in PCOS

Slynd (drospirenone) can be effective for treating hirsutism in PCOS patients due to its anti-androgenic properties, though it may be less effective than combined oral contraceptives containing cyproterone acetate. 1

Mechanism and Efficacy

Drospirenone is a progestin with anti-androgenic properties that can help address hirsutism in PCOS patients through several mechanisms:

• It blocks androgen receptors, reducing the effect of testosterone on hair follicles
• It increases sex hormone binding globulin (SHBG), which reduces free testosterone levels
• It provides endometrial protection while helping regulate menstrual cycles

Studies comparing drospirenone with other anti-androgens have shown:

• Combined oral contraceptives containing drospirenone can significantly improve hirsutism scores in PCOS patients 2
• However, cyproterone acetate-containing contraceptives appear to be more effective for clinical hirsutism treatment after 12 months (-35% reduction in Ferriman-Gallwey score with cyproterone acetate vs -18% with drospirenone) 3

Treatment Algorithm for Hirsutism in PCOS

1. First-line options:

   • Combined oral contraceptives containing anti-androgenic progestins (drospirenone or cyproterone acetate)
   • Spironolactone 100mg daily (visible improvement typically takes 6 months) 1

2. For moderate to severe hirsutism:

   • Consider combination therapy with both an anti-androgenic oral contraceptive and spironolactone
   • Metformin may be added if insulin resistance is present 4

3. For patients with contraindications to hormonal therapy:

   • Spironolactone as monotherapy (200mg/day) can be effective, particularly for idiopathic hirsutism 5
   • Metformin alone may provide some benefit through reducing insulin resistance 4

Important Clinical Considerations

• Treatment response for hirsutism is slow, typically requiring at least 6 months before visible improvement

• Drospirenone has additional benefits for PCOS patients including:

  • Menstrual cycle regulation
  • Endometrial protection
  • Potential improvement in acne

• Caution: While drospirenone has anti-androgenic properties, it may have less potent effects on hirsutism compared to cyproterone acetate 3

Monitoring and Expectations

• Assess hirsutism using the Ferriman-Gallwey scoring system at baseline and after 6-12 months of treatment
• Monitor for potential side effects of drospirenone including:
  • Hyperkalemia (due to its anti-mineralocorticoid effects)
  • Venous thromboembolism risk (though this is primarily with combined hormonal contraceptives)
• Regular follow-up every 6 months is recommended to monitor treatment efficacy and metabolic parameters 1

Remember that hirsutism treatment requires patience, as hair growth cycles mean that visible improvement typically takes at least 6 months, with maximal effects seen after 12 months of consistent therapy.