Efficacy and Safety of Anti-Androgens in the Management of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

August 2023 in “ EClinicalMedicine ”

Simon Alesi, Maria Forslund, Johanna Melin, Daniela Romualdi, Alexia S Peña, Chau Thien Tay, Selma F. Witchel, Helena Teede, Aya Mousa

anti-androgens polycystic ovary syndrome PCOS finasteride flutamide spironolactone bicalutamide hirsutism COCP hyperandrogenism Propecia Aldactone combined oral contraceptive pill

From the encyclopedia

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Bicalutamide →

a nonsteroidal anti-androgen, most commonly used orally for women

Studysummary This study reported that anti-androgens combined with lifestyle modifications were more effective than metformin and lifestyle in reducing hirsutism and certain hormonal measures in women with PCOS, but they were not more effective than a placebo combined with lifestyle changes. Our plain-language summary of this paper — not a Tressless recommendation.

This systematic review and meta-analysis examined the efficacy and safety of anti-androgens in managing polycystic ovary syndrome (PCOS), pooling data from 13 studies involving 961 participants. The anti-androgens used were finasteride, flutamide, spironolactone, and bicalutamide. The results showed that anti-androgens combined with lifestyle changes were superior to metformin combined with lifestyle changes for treating hirsutism and other symptoms. However, they were not superior to a placebo combined with lifestyle changes. Daily use of anti-androgens was more effective for hirsutism than use every three days. Combining anti-androgens with COCP resulted in poorer lipid profiles compared with COCP ± placebo. The study concluded that current evidence does not support the use of anti-androgens preferentially to COCPs to treat hyperandrogenism in PCOS. Anti-androgens could be considered to treat hirsutism in PCOS, where COCPs are contraindicated, poorly tolerated, or present a sub-optimal response after a minimum 6-month period. The study also highlighted the need for more research on adolescents with PCOS, as only two studies in this review included this demographic.

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Research cited in this study

16 / 16 results

research Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis

67 citations , March 2018 in “The Journal of Clinical Endocrinology & Metabolism”

This study reported that estrogen-progestin oral contraceptives, antiandrogens, and insulin sensitizers are more effective than placebo in treating hirsutism in women, with combination therapies generally proving superior to monotherapy.

Combined Oral Contraception and Bicalutamide in Polycystic Ovary Syndrome and Severe Hirsutism: A Double-Blind Randomized Controlled Trial

research Combined Oral Contraception and Bicalutamide in Polycystic Ovary Syndrome and Severe Hirsutism: A Double-Blind Randomized Controlled Trial

25 citations , December 2017 in “The Journal of Clinical Endocrinology & Metabolism”

This study found that using an oral contraceptive with bicalutamide significantly reduced hirsutism in women with PCOS compared to an oral contraceptive alone, although it increased total cholesterol and LDL levels.

research Comparison of Finasteride, Metformin, and Finasteride Plus Metformin in PCOS

4 citations , January 2017 in “Acta Endocrinologica”

This study found that both finasteride and metformin effectively reduced androgen levels and insulin resistance parameters in women with PCOS, without clear evidence of one treatment being superior.

research The Prevalence and Phenotypic Features of Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

767 citations , September 2016 in “Human Reproduction”

This review analyzes the reported prevalence of polycystic ovary syndrome (PCOS) based on different diagnostic criteria but does not provide new clinical results.

research Comprehensive Overview of Polycystic Ovary Syndrome

883 citations , August 2016 in “Nature Reviews Disease Primers”

This review discusses the current understanding of polycystic ovary syndrome, focusing on its epidemiology, pathophysiology, diagnosis, management, and future research directions, but reports no new clinical results.

research Androgen Excess: Investigations and Management

82 citations , May 2016 in “Best Practice & Research in Clinical Obstetrics & Gynaecology”

This article outlines the clinical features, evaluation, and treatment strategies for androgen excess in polycystic ovary syndrome, highlighting important diagnostic and management approaches but reporting no new research results.

research Intermittent Low-Dose Finasteride Administration Is Effective for Treatment of Hirsutism in Adolescent Girls: A Pilot Study

23 citations , February 2014 in “Journal of Pediatric and Adolescent Gynecology”

This study found that a low-dose intermittent finasteride regimen significantly reduced hirsutism scores in adolescent girls with PCOS or idiopathic hirsutism, with similar efficacy but potentially safer and less expensive than continuous administration.

Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome: A Six-Month, Open-Label Randomized Study

research Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome: A Six-Month, Open-Label Randomized Study

75 citations , July 2013 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that combining low-dose spironolactone with metformin provided greater clinical benefits and improved treatment compliance in women with PCOS compared to either drug alone.

research Treatment Options for Polycystic Ovary Syndrome

514 citations , February 2011 in “International journal of women's health”

This review discusses treatments for various symptoms of polycystic ovary syndrome, including lifestyle changes, medical, and surgical interventions, but does not present new clinical results.

research The Androgen Excess and PCOS Society Criteria for the Polycystic Ovary Syndrome: The Complete Task Force Report

1540 citations , October 2008 in “Fertility and Sterility”

This review discusses the definition of polycystic ovary syndrome proposed by the AE-PCOS Society Task Force, emphasizing hyperandrogenism, ovarian dysfunction, and excluding related disorders, while noting potential variations needing more research.

research A Systematic Review of Commonly Used Medical Treatments for Hirsutism in Women

75 citations , November 2007 in “Clinical endocrinology”

This study found that several drugs, including flutamide and spironolactone, significantly reduced hirsutism in women, with reduced effectiveness in those with higher BMI.

research Intermittent Low-Dose Finasteride Is as Effective as Daily Administration for the Treatment of Hirsute Women

29 citations , September 2004 in “Fertility and Sterility”

This study found that an intermittent low-dose regimen of finasteride (2.5 mg every 3 days) effectively reduced hirsutism scores in women with idiopathic hirsutism or polycystic ovary syndrome, with fewer side effects than continuous daily administration.

research Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS)

4025 citations , December 2003 in “Human Reproduction”

This review discusses the evolution of diagnostic criteria for polycystic ovary syndrome and emphasizes its association with various metabolic and cardiovascular risks, but it provides no new research findings.

research Australian Medicines Handbook 2003

2 citations , October 2003 in “Australian Prescriber”

This article describes the Australian Medicines Handbook as a compact, readable, and comprehensive drug reference guide for Australian practitioners, but it does not present new research findings.

research Comparison of Diane 35 and Diane 35 Plus Finasteride in the Treatment of Hirsutism

50 citations , April 2000 in “Fertility and Sterility”

This study found that a combination therapy of Diane 35 with finasteride was more effective at reducing hirsutism scores in women with idiopathic hirsutism or polycystic ovary syndrome after 3 months compared to Diane 35 alone.

research Comparison of Finasteride Versus Flutamide in the Treatment of Hirsutism

75 citations , October 1999 in “European journal of endocrinology”

This study found that both finasteride and flutamide effectively reduce hirsutism in women with polycystic ovary syndrome or idiopathic hirsutism, but flutamide was more effective.