Mithat Erenus

Comparison of finasteride versus spironolactone in the treatment of idiopathic hirsutism

Abstract Objective: To compare the efficacy of finasteride and spironolactone in the treatment of idiopathic hirsutism. Design: Prospective, randomized, single-blind study. Setting: A tertiary hirsutism clinic. Patient(s): Forty women with idiopathic hirsutism were selected. Intervention(s): Patients were assigned randomly to receive either 5 mg of finasteride or 100 mg of spironolactone for 9 months. Main Outcome Measure(s): Hirsutism scores were measured according to the Ferriman-Gallwey scoring system, and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. Result(s): Hirsutism scores were decreased significantly in both groups at the end of 9 months. The mean percent change (±SD) in hirsutism scores in the finasteride and spironolactone groups was as follows: 5.91% ± 7.18% and 20.60% ± 12.59% at 3 months, 10.61% ± 12.18% and 32.57% ± 15.68% at 6 months, and 15.15% ± 15.38% and 42.36% ± 12.31% at 9 months, respectively. There was a significantly better response with spironolactone treatment at the end of 9 months. Eleven (55%) of 20 patients in the spironolactone group experienced side effects. However, none of them stopped treatment because of side effects. Conclusion(s): The present data suggest that both finasteride and spironolactone are effective in the treatment of idiopathic hirsutism. However, it appears that the spironolactone group responded significantly better.

Comparison of the efficacy of spironolactone versus flutamide in the treatment of hirsutism

OBJECTIVE To compare the efficacy of two antiandrogens, spironolactone and flutamide, in the treatment of hirsutism. PATIENTS, PARTICIPANTS Twenty women with idiopathic hirsutism were randomized to receive either flutamide or spironolactone. DESIGN Twenty hirsute women were recruited from patients presenting to the hirsutism clinic in Marmara University, Istanbul. Each patient underwent a complete medical and gynecological examination as well as endocrine profile, hematologic, hepatic, and renal function analyses. Hirsutism scores were determined according to the Ferriman-Gallwey scoring system. These tests were then repeated at 3, 6, and 9 months of therapy. Ten patients received 250 mg of flutamide two times per day, and 10 patients received 100 mg of spironolactone for 9 months. RESULTS Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in flutamide and spironolactone group were as follows: 26.4% and 20.9% at 3 months; 39.5% and 32.9% at 6 months; and 46.4% and 39.6% at 9 months, respectively. There was a trend toward a better response with flutamide that did not achieve significance. None of the hormonal parameters changed significantly during this period of time. Irregular bleeding was observed in five patients (50%) of the spironolactone group, whereas none of the patients in the flutamide group experienced menstrual irregularity. Conversely, dry skin and increased appetite were experienced by two patients (20%) in the flutamide group but not in the spironolactone group. CONCLUSION These data suggest that both spironolactone and flutamide were similarly effective in treatment of hirsutism, and the pure antiandrogen flutamide is a safe and effective alternative in treatment.

Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism.

OBJECTIVE To compare the efficacy of two antiandrogens, cyproterone acetate (CPA) and spironolactone, in the treatment of hirsutism. DESIGN Prospective randomized single-blinded study. SETTING A tertiary hirsutism clinic. PATIENTS Forty-two premenopausal patients with hirsutism were selected. INTERVENTIONS Subjects were randomized to receive either 100 mg spironolactone and an oral contraceptive (OC) containing 150 microg desogestrel and 30 microg ethinyl E2 or 50 mg CPA daily on days 1 to 10 of the menstrual cycle, which was administered with 35 microg ethinyl E2 daily on days 1 to 21. MAIN OUTCOME MEASURES Hirsutism scores were measured according to Ferriman-Gallwey scoring system and side effects were monitored for 9 months of treatment. Blood samples were taken at each visit for assessment of endocrine, biochemical, and hematologic parameters. RESULTS Hirsutism scores were decreaded significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in CPA and spironolactone group were as follows: 19.23% +/- 14.77% and 24.48% +/- 14.27% at 3 months; 39.01% +/- 19.77% and 37.46% +/- 16.90% at 6 months; and 51.89% +/- 20.87% and 46.39% +/- 16.10% at 9 months, respectively. There was a trend toward a better response with CPA treatment, which did not achieve significance. None of the patients stopped treatment because of side effects. CONCLUSION The present data suggest that both spironolactone and CPA were similarly effective in treatment of hirsutism.

Compliance considerations with hormone replacement therapy.

The purpose of this study was to determine womens own reasons for postmenopausal hormone replacement therapy (HRT) utilization and discontinuation in a Turkish population and to investigate the variables that have influenced the compliance to treatment. Design The study was comprised of 613 postmenopausal women who presented to the Menopause Unit in the Marmara University Hospital. Results A total of 437 women (71.2%) reported that they continued using postmenopausal HRT and 176 women (28.7%) discontinued treatment with an average 4.5 months duration of use (range 1–60 months). Hot flashes was the most common reason for initiating therapy (258 women, 42.0%). Prevention of osteoporosis was mentioned by 149 (24.3%) women as a reason to begin HRT. Bleeding episodes (44.8%) was the most common factor in the patients decision to discontinue HRT. Continuation of HRT was significantly more common among women who started HRT either because of physician recommendation or osteoporosis concern (p < 0.05). Additionally, a greater percentage of surgically menopausal women began and continued HRT(p < 0.0001) than naturally menopausal women. The educational status of the patients was directly related to incidence of beginning HRT but was not related to the discontinuation of HRT. Conclusions Education of menopausal women about the long-term benefits of HRT is critical in improving compliance. (Menopause 1998;5:102–106 ® 1998, The North American Menopause Society.)

Endometrial disease diagnosed by transvaginal ultrasound and dilatation and curettage

BACKGROUND This study is designed to compare endometrial thickness measured by transvaginal ultrasound with endometrial pathology by dilatation and curettage. METHODS Fifty-four women with postmenopausal bleeding were evaluated. Endometrial thickness, including both layers of the endometrium, was measured by transvaginal ultrasound after which fractional curettage was performed and samples taken were then dispatched for histologic examination. RESULTS Median endometrial thicknesses of 5 mm, 8.5 mm and 6 mm were found for benign, hyperplastic and carcinomatous endometrium, respectively. Of the eight hyperplastic samples, two cases had 4 mm, and one case had 3mm endometrial thickness. Similarly, of the nine malignant samples, three cases had an endometrial thickness of 3 mm. Three mm has been found to be the best cut off point for endometrial abnormalities in postmenopausal bleeding with 100% sensitivity but low specificity (13%). CONCLUSION Fractional curettage seems to be the best method for detecting endometrial abnormalities in women with postmenopausal bleeding.

A randomised, double‐blind trial comparing raloxifene HCl and continuous combined hormone replacement therapy in postmenopausal women: effects on compliance and quality of life

Objective To compare continuous combined hormone replacement therapy (ccHRT) and raloxifene with respect to compliance and quality of life, which were predefined secondary endpoints of a large, prospective study designed to investigate the uterine effects of both treatments.

Effects of a single dose of oral estrogen on left ventricular diastolic function in hypertensive postmenopausal women with diastolic dysfunction

Abstract Objective: To evaluate the acute effects of a single dose of oral estrogen on left ventricular diastolic function in hypertensive postmenopausal women with diastolic dysfunction. Design: Prospective, double-blind, placebo-controlled, clinical study. Setting: Cardiology and postmenopausal outpatient clinics of a university hospital. Patient(s): Thirty postmenopausal women with hypertension (diastolic blood pressure of >90 mm Hg) and left ventricular diastolic dysfunction (mitral E/A ratio [the ratio of peak velocity of early mitral diastolic filling to late diastolic filling] of 100 ms) were included in the study. Thirty normotensive postmenopausal women with normal left ventricular diastolic function served as the control group. Intervention(s): Conjugated equine estrogen (0.625 mg) was given orally. Left ventricular diastolic function was assessed by Doppler echocardiography at baseline and 3 hours after the administration of estrogen. Main Outcome Measure(s): Left ventricular diastolic filling as assessed by Doppler echocardiography. Result(s): Estrogen had no effect on heart rate or blood pressure in either study group. The baseline E/A ratios were 0.72 ± 0.26 and 1.22 ± 0.30, and the isovolumic relaxation times were 122 ± 18 ms and 89 ± 14 ms in the hypertensive and normotensive groups, respectively. Estrogen had no significant effect on any of the Doppler parameters in the normotensive group. In the hypertensive group, there was a trend toward normalization of the E/A ratio (from 0.73 ± 0.11 to 0.84 ± 20) and a significant improvement in the isovolumic relaxation time (from 124 ± 20 ms to 105 ± 13 ms) in response to the administration of estrogen compared with placebo. Conclusion(s): A single dose of oral estrogen caused a significant improvement in left ventricular diastolic filling in hypertensive postmenopausal women with diastolic dysfunction.

Recurrence rate of hirsutism after 3 different antiandrogen therapies

BACKGROUND Although antiandrogens are frequently and successfully used to treat hirsutism, little attention has been paid to optimal duration of treatment and recurrence rate after cessation of therapy. OBJECTIVE Our purpose was to determine the recurrence rate of hirsutism after 3 different antiandrogen therapies. METHODS Eighty-one hirsute women referred to a tertiary hirsutism clinic were assigned to one of three regimens: spironolactone 100 mg/day with an oral contraceptive, cyproterone acetate 50 mg/day on days 1 to 10 with an oral contraceptive, or flutamide 250 mg twice a day. Hirsutism scores according to the Ferriman-Gallwey scoring system and endocrine parameters were evaluated before, during, and 1 year after withdrawal of treatment regimens. RESULTS Hirsutism scores decreased significantly and similarly in spironolactone, flutamide, and cyproterone acetate treatment groups. However, 1 year after withdrawal of treatment in all antiandrogen therapy groups, hirsutism returned. CONCLUSION Antiandrogens are effective in the treatment of hirsutism. However, cessation of antiandrogen therapy is followed by recurrence.

Effect of tibolone treatment on intima- media thickness and the resistive indices of the carotid arteries

OBJECTIVE To assess the effect of tibolone treatment on the intima-media thickness (IMT) of the common carotid artery (CCA) and the resistive indices (RIs) of the CCA and internal (ICA) and external (ECA) carotid and the vertebral arteries (VAs) in postmenopausal women as sonographic markers of atherosclerosis. DESIGN A prospective study. SETTING University hospital. PATIENT(S) Twenty postmenopausal women who had no cardiovascular disease. INTERVENTION(S) Noninvasive measurements of the IMT of the CCA and the RI of the CCA, ICA, ECA, and VA were made with ultrasound at baseline and after 12 weeks of tibolone treatment. MAIN OUTCOME MEASURE(S) IMT of the CCA and RI of the CCA, ICA, ECA, and VA. RESULT(S) Three months of tibolone treatment decreased the IMT of the CCA (mean +/- SD) from 0.70 +/- 0.22 mm (95% confidence interval [CI], 0.60-0.80) to 0.47 +/- 0.17 mm (95% CI, 0.39-0.55) by 28%. Resistive indices of the CCA, ICA, and VA also decreased significantly. CONCLUSION(S) The present study showed that tibolone treatment decreases both the IMT of the CCA and RI of the CCA, ICA, and VA, which appears to be related to its anti-atherosclerotic effect. Nevertheless, the clinical implications of these findings are yet to be investigated.

Comparison of effects of continuous combined transdermal with oral estrogen and oral progestogen replacement therapies on serum lipoproteins and compliance

Objective To compare the effects of transdermal and oral hormone replacement therapy on compliance and serum lipoproteins. Design A total of 159 naturally menopausal women who received either 0.05 mg transdermal estradiol twice weekly or 0.625 mg oral conjugated estrogen daily, with 2.5 mg oral medroxyprogesterone acetate daily, were retrospectively studied. Continuation with or drop-out from treatment regimens, side-effects and bleeding patterns were recorded during a 2-year follow-up period. Baseline, first-year and second-year serum lipoprotein levels were compared between the two groups. Results Of the 100 women taking oral estrogen, 28 (28%) had dropped out whereas of the 59 women receiving transdermal estrogen, 17 (28.8%) had dropped out at the end of 2 years. The occurrence of bleeding episodes was the most common reason given for discontinuation in both treatment groups (52.9% in the transdermal group and 35.7% in the oral treatment group). The mean increase in high-density lipoprotein (HDL) level for the first year and second year was 10.2 ± 3.2% and 31.4 ± 2.8%, and 13.5 ± 3.2% and 33.6 ± 3.6% with oral treatment and transdermal therapy, respectively. The mean decrease in total cholesterol for the first year and second year was 2.9 ± 1.9% and 14.7 ± 1.6%, and 5.6 ± 1.7% and 5.7 ± 1.6% with oral and transdermal treatment, respectively. Likewise, the mean decrease in low-density lipoprotein (LDL) cholesterol for the first year and second year was 6.2 ± 2.5% and 18 ± 2.9%, and 7.9 ± 3.0% and 15.9 ± 5.2% with oral and transdermal treatment, respectively. There was no significant difference between groups in any of the lipid parameters. Transdermal treatment decreased triglyceride levels by 33.7 ± 3.9%, whereas oral estrogen treatment increased triglycerides by 18.6 ± 4.3% at the end of 2 years. This difference between the two groups was statistically significant (p < 0.0001). Conclusion Continuation of treatment was similarly high at the end of 2 years with both transdermal and oral estrogen treatment. Both treatments changed serum lipids favorably. Nevertheless, triglycerides were increased by oral estrogen but decreased by transdermal treatment at 2 years; this difference between the groups was significant.