Relapse of hirsutism following long-term successful treatment with oestrogen-progestogen combination

While several forms of treatment have been reported to be successful in relieving hirsutism over periods of 6-12 months, there is little if any information on the long-term outcome of hirsutism following the withdrawal of successful treatment. The combination of ethinyl oestradiol, 35 micrograms, and cyproterone acetate, 2 mg (EE-CA) for 21 days followed by 7 days without treatment is widely used in a cyclical manner in the treatment of hirsutism. The present study was undertaken to evaluate the outcome of withdrawal of long-term successful treatment of hirsutism with EE-CA. DESIGN, PATIENTS AND MEASUREMENT: In this retrospective study the clinical records of 57 patients with idiopathic hirsutism or polycystic ovary syndrome who had been treated with EE-CA were reviewed. The degree of hirsutism had been assessed by the Ferriman and Gallwey scoring system (FG). The testosterone/sex hormone binding globulin ratio (T/SHBG), was derived prior to and following the introduction of treatment with EE-CA.

Fifty-two of the 57 patients achieved a satisfactory clinical response. In the group of patients who were satisfied with the outcome of treatment, FG decreased from 12.9 +/- 3.6 to 5.5 +/- 2.5 and T/SHBG ratio decreased from 11.3 +/- 9.5 to 1 +/- 0.8 (reference range: 1-5.2). The duration of treatment prior to its withdrawal in this group was 28.2 +/- 13.7 months. The five patients who were not satisfied with the response abandoned treatment after 16 +/- 2.8 months; the pretreatment FG was 16.2 +/- 8.3, while the T/SHBG decreased from 6.1 +/- 3.1 to 1.1 +/- 0.6 in these patients. Subsequent follow-up data, after withdrawal of treatment, were available on 34 of these 52 patients. Twenty-eight of the 34 patients exhibited relapse of hirsutism after 6.15 +/- 2.8 months. Six patients did not relapse during a follow-up period of 18.8 +/- 7. 8 months. The six patients who did not relapse were treated for a significantly longer period than the group who relapsed, 40 +/- 6.9 and 26.1 +/- 8.3 months, respectively, P < 0.01. However, the groups did not differ significantly when examined for pretreatment FG, 11.5 +/- 3.8 and 13.2 +/- 3.6 and pretreatment T/SHBG 8.9 +/- 5 and 13.4 +/- 11.9.

These data indicate that ethinyl oestradiol and cyproterone acetate achieved a satisfactory clinical outcome in the treatment of hirsutism in 90% of patients. However, on withdrawal of treatment after a mean duration of over 2 years, relapse occurred in 80% of these patients after a mean of 6 months. If it is assumed that the successfully treated patients lost to follow-up all maintained long-term remission, the relapse rate is still an unsatisfactory 65% at 6 months. These are disappointing results which indicate for the first time that successful outcome requires that treatment be maintained for several years. Patients embarking upon treatment for hirsutism should be advised that maintenance of reduced hair growth requires long-term treatment, probably for at least 3-4 years.