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WEBSITE NEWSLETTER
HORMONE CENTER OF NEW YORK
Geoffrey Redmond, MD
 

 Issue # 2

 

This newsletter is published several times a year to provide women
with up to the minute information about common hormone conditions.

 

Important: In this issue, I discuss several new treatments for PCOS (polycystic ovary syndrome). Please keep in mind that the purpose of the Hormone Center of New York
and this newsletter is to provide general information. Anyone with a medical condition should be under the care of a physician and any changes in treatment must be discussed with him or her.

 

New Treatments for PCOS
 (polycystic ovary syndrome)

 

I devoted the first of these newsletters to the WHI study on risks of hormone replacement therapy (HRT) because this issue is so important to women in or approaching menopause. This second newsletter discuss several matters of interest to women with PCOS, hirsutism (increased unwanted hair) and alopecia (scalp hair loss). There is a brief comment at the end on WHI and HRT for menopause; the next issue will discuss this is more detail. More information on the conditions discussed in the newsletter is available in the website articles (acne, increased hair growth, alopecia and menopause) and Question of the Month
archives.


Video on PCOS
A video which tells eloquently what it is like to be a woman with PCOS has been made by Randi Cecchine, a talented young filmmaker who herself has PCOS. More information is available at www.scrambledthewebsite.com


Metformin for PCOS during pregnancy
Many readers know that metformin, originally developed for diabetes, but now used for the insulin resistance of PCOS, can help some women with PCOS become pregnant. (It may help with weight loss too!) At first, women were told to discontinue it the moment their pregnancy test was positive. A recent study suggests that it can be continued during pregnancy and even reduces the miscarriage rate. The babies born were healthy. This is good news for women with PCOS. However, any medication use when pregnant or trying to get pregnant should be discussed in advance with your doctor.

The forgotten insulin sensitizers
Metformin (Glucophage®, Glucophage XR®) has been a great advance in the treatment of PCOS. Recently it has become available as a generic in the U.S., which will be a big help to women without prescription drug coverage. Met helps with weight loss, though it is not a diet pill, may restore ovulation and normal menstrual cycles, and probably benefits long term health.

Unfortunately, some women simply cannot take metformin. The majority feel fine on it but a few get upset stomach and diarrhea. Does this mean that these women cannot get treatment for their insulin resistance (IR)? Fortunately, it does not. Two other medications, of the so-called glitazone family, may help the IR in women with PCOS. They are similar to troglitazone (Rezulin®) which was withdrawn because of liver problems. The new ones, pioglitazone (Actos®) and rosiglitazone (Avandia ®) are much safer but monitoring blood tests for liver function is recommended. For women with PCOS and marked IR who cannot take metformin, or do not get a complete response to it, these new agents should be considered. At this time, these medications are not labeled for treatment of IR but they are effective in lowering insulin levels and probably in restoring ovulation.

Insulin sensitizers are a great advance in treatment of PCOS. However, their main benefit is on metabolism and ovulation. They help only a little with hirsutism and alopecia. So for women who have these problems and are not trying for pregnancy, use of a testosterone blocker at the same time may give a better result.

Dutasteride (Avodart®)
The long-awaited new 5-alpha-reductase inhibitor, dutasteride, received FDA approval late last year for treatment of prostate enlargement in men and became available in the U. S. in December, 2002. The enzyme it inhibits is the one which activates testosterone by converting it to DHT (dihydrotestosterone). DHT is the active form of testosterone in the hair follicle and so blocking its formation is a potential treatment for hirsutism (increased facial and body hair) and androgenic alopecia (scalp hair loss due to testosterone). It is possible that dutasteride can help acne also but it is too soon to tell. Finasteride (Proscar® and Propecia®) also inhibits this enzyme but dutasteride is much more effective.

The FDA approved labeling for dutasteride includes warnings that women should not even touch the tablets, let alone take them. However there are similar warnings for finasteride which has been used by women. The concern is that these medications, like any which block testosterone, could interfere with the development of an unborn male child. What this means is that these medications should not be taken by any woman who might become pregnant. An additional problem with dutasteride is that it may take as long as 6 months after a person stops taking it before it is completely out of her system. So avoidance of pregnancy is critical.

The studies on men’s hair loss suggest that dutasteride may work better than finasteride and, given how it works in the body, this should be the case. This means that in all probability it will work for female alopecia as well. For the reasons I’ve already discussed, dutasteride is not for most women with alopecia or hirsutism. However, it may be appropriate in special situations. No woman should take dutasteride without careful personal consideration. Any use should be in consultation with a physician knowledgeable about treatment of women with testosterone blockers. I have discussed dutasteride because it is important news for women with hirsutism and alopecia and many have been asking about it. However it is not for casual use.

Spironolactone (Aldactone®) will still be the first choice for many women with alopecia and hirsutism. However for those few women who do not get a good response to spiro and who will not become pregnant, dutasteride is another possibility.


Well-being and Estrogen
I’ll have more to say about this important subject in the next issue. It you have not seen the previous newsletter which discusses the recent findings on HRT in detail, you might want to take a look.

Now, I just want to alert readers to a study to be published in New England Journal of Medicine in May, 2003 and which has already received some media coverage. The conclusion of the study was that HRT did not improve quality of life. However, there was a basic problem in how the study was done: most of the women in the study did not have symptoms related to menopause. No medication will help symptoms you are fortunate not to have. The experience of myself and countless other clinicians is that those women who have significant discomfort with menopause do feel better on HRT. The study does not contradict this. And when HRT fails to relieve symptoms it is often because the dose or preparation is not the optimal one for the individual woman. So this report does not really tell us anything that was not obvious before. I’ll have more to say about it in the next issue. Since HRT is a very individual choice, women need to have complete and objective information which we will continue to provide.

The next issue will also include an update on oral contraceptives and acne.

 

Here are some links to articles on The Hormone Center Website which discuss related subjects:

Alopecia -- Female Hair Loss

Making Sense of HRT

PCOS (Polycystic Ovary Syndrome)

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