Cyproterone acetate or drospirenone containing combined oral contraceptives plus spironolactone or cyproterone acetate for hirsutism: Randomized comparison of three regimens

Objective: To compare the effectiveness of three different combinations of combined oral contraceptives (COCs) and anti-androgens in the treatment of hirsutism. Methods: A total of 134 women with moderate and severe hirsutism were randomly assigned to three treatment regimens: Group I received 30 mu g of ethinyl estradiol (EE)/3 mg of drospirenone (DRSP) plus 100 mg of cyproterone acetate (CPA) (n = 45); group II received 30 mu g of EE/3 mg of DRSP plus 100 mg of spironolactone (n = 44); and group III received 35 mu g of EE/2 mg of CPA plus 100 mg of CPA (n = 45), daily for 6 months. The decrease in the modified Ferriman-Gallwey hirsutism score (mFGS) was the main outcome measure. Results: The mean decrease in mFGS after 3 and 6 months of the treatment course was 26% and 49% in group I (both p < 0.01), 27% and 49% in group II (both p < 0.01), and 25% and 45% in group III (both p < 0.01), respectively, when compared with baseline. Although the mFGS was significantly decreased in all groups, there was no significant difference between groups. Conclusion: CPA or DRSP containing COCs in combination with CPA or spironolactone have similar effects for the treatment of hirsutism.