Adding Combined Oral Contraceptives or Metformin to Laser Treatment in Polycystic Ovarian Syndrome Hirsute Patients

March 2021 | Volume 20 | Issue 3 | Original Article | 302 | Copyright © March 2021


Published online February 5, 2021

Nevine Dorgham MDa, Amin Sharobim MDb, Hisham Haggag MDc, Mona El-Kalioby MDa, Dina Dorgham MDa

aDepartment of Dermatology, Faculty of Medicine, Cairo University, Cairo, Egypt
bDepartment of Dermatology, National Research Center (NRC), Cairo University, Cairo, Egypt
cDepartment of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, Cairo, Egypt

Abstract
Background: Hirsutism is estimated to affect 10% to 20% of females, provoking significant psychological damage and social embarrassment. Polycystic ovary syndrome is a major cause of hirsutism.
Aim: Assessing the impact of adding combined oral contraceptives (COCs) or metformin to laser hair removal on the quality of life of polycystic ovarian syndrome (PCOS) patients with hirsutism.
Methodology: One-hundred-fifty PCO patients diagnosed with hirsutism were included in this study. Patients were randomized into three groups: group 1 received laser hair removal alone, group 2 received metformin and laser hair removal, and group 3 received COCs and laser hair removal. A diode laser with a wavelength of 810 nm was used for hair removal in all patients according to a protocol of 6 monthly sessions followed by another two sessions after three and six months. Patients were assessed using a visual analog scale (VAS) and Dermatology Life Quality Index (DLQI) and a customized questionnaire (Hirsutism Life Quality Index; HLQI).
Results: All patients showed a significant improvement in both quality indices (DLQI and HLQI) after treatment relative to pretreatment. Group 3 showed significantly better improvements when compared with group 2 and group 1. At three and six months, group 3 showed non-significantly better DLQI and HLQI as compared with at zero months. On the other hand, group 2 patients displayed significant worsening of both DLQI and HLQI scores at three months, with subsequent improvements again at six. Finally, group 1 patients showed nonsignificant worsening at three months, and significant worsening at 6 months.
Conclusion: Combining hormonal treatment with laser hair removal can achieve greater hair reduction, significant improvements in patients' QOL, and better maintenance as compared with when combining metformin with laser hair removal or conducting alone.

J Drugs Dermatol. 20(3):302-306. doi:10.36849/JDD.2021.5652

INTRODUCTION

Hirsutism is defined as the growth of excessive terminal hair in androgen-dependent sites in females.1 Hirsutism affects 10% to 20% of women,2 having a major impact on their quality of life.3

Hirsutism can be idiopathic or secondary to ovarian etiology (eg, polycystic ovarian syndrome (PCOS) and ovarian tumors), adrenal etiology (eg, congenital adrenal hyperplasia, Cushing syndrome, and adrenal virilizing tumors), or pituitary etiology (eg, Cushing disease or hyperprolactinemia), or can be drug-induced.4 PCOS is the most common cause of hirsutism in affected patients.5 Affected patients present with hyperandrogenism, menstrual irregularities, infertility, and dysmetabolic syndrome.4

Treatment options for hirsutism include pharmacological therapies, such as oral contraceptive pills, antiandrogens, insulin sensitizers, and topical eflornithine, and cosmetic maneuvers including laser hair removal, shaving, waxing, plucking, bleaching, chemical treatment, and electrolysis.2 Laser-assisted hair removal is supported as a viable therapy for the treatment of hirsutism.6,7 Metformin is a well-known insulin sensitizer that works in the context of hirsutism by reducing the circulating insulin levels, which subsequently decreases the concentration of free circulating androgens.8 Hormonal treatments include oral contraceptive pills and antiandrogens in the form of spironolactone, cyproterone acetate, finasteride, and nonsteroidal antiandrogens such as flutamide.9

PATIENTS AND METHODS

This was a single-center, prospective, balanced randomization (allocation ratio 1:1:1), controlled study.

One hundred fifty women were enrolled in the present study after providing informed written consent. The inclusion criteria were an age of 18 to 40 years with a confirmed diagnosis of PCOS according to the Rotterdam criteria10 and facial hirsutism as assessed by the Ferriman–Gallwey score. Hirsute patients with