From the Guidelines
For middle-aged women with PCOS experiencing hyperandrogenism and hirsutism, the most effective treatment approach is a combination of hormonal therapy, anti-androgens, and lifestyle modifications, as recommended by the latest evidence-based guidelines 1. The primary goal of treatment is to reduce androgen levels, improve insulin sensitivity, and address the metabolic aspects of PCOS. First-line treatment often involves combined hormonal contraceptives (CHCs) containing ethinyl estradiol with a progestin like drospirenone or cyproterone acetate, which suppress ovarian androgen production and increase sex hormone binding globulin, reducing free testosterone 1. Spironolactone, an aldosterone antagonist with anti-androgenic properties, is commonly prescribed at 50-200 mg daily, often in combination with CHCs 1. For women not seeking contraception or with contraindications to CHCs, metformin (1500-2000 mg daily) can improve insulin sensitivity and reduce androgen levels 1. Lifestyle modifications, including regular exercise and a balanced diet, are important complementary approaches that help address the metabolic aspects of PCOS and may reduce androgen excess 1. Weight loss of 5-10% in overweight women can significantly improve hormonal profiles, and treatment response should be monitored over 6-12 months, as hair growth cycles mean visible improvement takes time. Some key points to consider when treating hyperandrogenism and hirsutism in middle-aged women with PCOS include:
- The importance of a comprehensive treatment approach that addresses both the hormonal and metabolic aspects of PCOS
- The need for regular monitoring and adjustment of treatment as needed to achieve optimal results
- The potential benefits of lifestyle modifications, including weight loss and exercise, in improving hormonal profiles and reducing androgen excess
- The importance of considering the individual patient's needs and preferences when selecting treatment options.
From the FDA Drug Label
In two multicenter, double-blind, randomized, placebo-controlled studies, 889 subjects, ages 14 to 45 years, with moderate acne received drospirenone and ethinyl estradiol tablets or placebo for six 28-day cycles The primary study was a parallel group design that included 384 evaluable reproductive-aged women with PMDD who were randomly assigned to receive drospirenone and ethinyl estradiol tablets or placebo treatment for 3 menstrual cycles.
The treatment options for hyperandrogenism and hirsutism in a middle-aged female with Polycystic Ovary Syndrome (PCOS) may include:
- Hormonal contraceptives, such as drospirenone and ethinyl estradiol tablets, which have been shown to be effective in treating acne and premenstrual dysphoric disorder (PMDD) symptoms in women with PCOS 2 2.
- These medications may help regulate hormonal imbalances and reduce androgen levels, which can contribute to hirsutism and hyperandrogenism.
- However, it is essential to consult a healthcare provider to determine the best course of treatment for individual cases of PCOS, as treatment plans may vary depending on the severity of symptoms and other factors.