HORMONE CENTER OF NEW YORK
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
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.
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
increased hair growth,
Question of the Month
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
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
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
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
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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